Legislature(2017 - 2018)CAPITOL 106

03/30/2017 03:00 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HB 100 POSTTRAUMATIC STRESS INJURY AWARENESS DAY TELECONFERENCED
Moved HB 100 Out of Committee
-- Testimony <Invitation Only> --
+= HB 159 OPIOIDS;PRESCRIPTIONS;DATABASE;LICENSES TELECONFERENCED
Heard & Held
-- Public Testimony --
*+ HB 164 PROTECT: VULNERABLE ADULTS/LONG TERM CARE TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
*+ HB 186 FOOD DONATIONS TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         March 30, 2017                                                                                         
                           3:06 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Ivy Spohnholz, Chair                                                                                             
Representative Bryce Edgmon, Vice Chair                                                                                         
Representative Sam Kito                                                                                                         
Representative Geran Tarr                                                                                                       
Representative David Eastman                                                                                                    
Representative Jennifer Johnston                                                                                                
Representative Colleen Sullivan-Leonard                                                                                         
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Matt Claman (alternate)                                                                                          
Representative Dan Saddler (alternate)                                                                                          
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 164                                                                                                              
"An  Act relating  to  the  protection  of vulnerable  adults  and                                                              
residents of long term care facilities."                                                                                        
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 100                                                                                                              
"An  Act establishing  June  27  of  each year  as  Post-Traumatic                                                              
Stress Injury Awareness Day."                                                                                                   
                                                                                                                                
     - MOVED HB 100 OUT OF COMMITTEE                                                                                            
                                                                                                                                
HOUSE BILL NO. 186                                                                                                              
"An Act  relating to the  donation of food;  and relating  to food                                                              
banks."                                                                                                                         
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 159                                                                                                              
"An  Act relating  to the  prescription  of opioids;  establishing                                                              
the   Voluntary  Nonopioid   Directive   Act;   relating  to   the                                                              
controlled  substance  prescription   database;  relating  to  the                                                              
practice  of dentistry;  relating  to  the practice  of  medicine;                                                              
relating to  the practice  of podiatry;  relating to the  practice                                                              
of osteopathy;  relating to the  practice of nursing;  relating to                                                              
the practice of optometry; relating to the practice of                                                                          
veterinary medicine; related to the duties of the Board of                                                                      
Pharmacy; and providing for an effective date."                                                                                 
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 164                                                                                                                  
SHORT TITLE: PROTECT: VULNERABLE ADULTS/LONG TERM CARE                                                                          
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
                                                                                                                                
03/08/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/08/17       (H)       HSS, FIN                                                                                               
03/30/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 100                                                                                                                  
SHORT TITLE: POSTTRAUMATIC STRESS INJURY AWARENESS DAY                                                                          
SPONSOR(s): TUCK                                                                                                                
                                                                                                                                
02/01/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/01/17       (H)       HSS                                                                                                    
03/30/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 186                                                                                                                  
SHORT TITLE: FOOD DONATIONS                                                                                                     
SPONSOR(s): TALERICO                                                                                                            
                                                                                                                                
03/17/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/17/17       (H)       HSS                                                                                                    
03/30/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 159                                                                                                                  
SHORT TITLE: OPIOIDS;PRESCRIPTIONS;DATABASE;LICENSES                                                                            
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
                                                                                                                                
03/06/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/06/17       (H)       HSS, FIN                                                                                               
03/18/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/18/17       (H)       Heard & Held                                                                                           
03/18/17       (H)       MINUTE(HSS)                                                                                            
03/25/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/25/17       (H)       -- MEETING CANCELED --                                                                                 
03/30/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
TERESA HOLT, Long Term Care Ombudsman                                                                                           
Office of the Long Term Care Ombudsman                                                                                          
Alaska Mental Health Trust Authority                                                                                            
Department of Revenue                                                                                                           
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Presented HB 164 on behalf of the Governor.                                                              
                                                                                                                                
REPRESENTATIVE CHRIS TUCK                                                                                                       
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 100 as prime sponsor of the                                                                 
bill.                                                                                                                           
                                                                                                                                
KENDRA KLOSTER, Staff                                                                                                           
Representative Chris Tuck                                                                                                       
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Explained HB 100 on behalf of the prime                                                                  
sponsor of the bill, Representative Tuck.                                                                                       
                                                                                                                                
KENT HALL, Vice President                                                                                                       
Honor For All                                                                                                                   
Lansing, Michigan                                                                                                               
POSITION STATEMENT:  Testified in support of HB 100.                                                                          
                                                                                                                                
VERDIE BOWEN, Director of Veterans Affairs                                                                                      
Office of Veterans Affairs                                                                                                      
Department of Military & Veterans' Affairs                                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 100.                                                                          
                                                                                                                                
ROBERT DOEHL, Deputy Commissioner                                                                                               
Office of the Commissioner/Adjutant General                                                                                     
Department of Military & Veterans Affairs                                                                                       
JBER, Alaska                                                                                                                    
POSITION STATEMENT:  Testified in support of HB 100.                                                                          
                                                                                                                                
REPRESENTATIVE DAVE TALERICO                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 186 as prime sponsor of the                                                                 
bill.                                                                                                                           
                                                                                                                                
ELIJAH VERHAGEN, Staff                                                                                                          
Representative Dave Talerico, Alaska State Legislature                                                                          
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 186 on behalf of the prime                                                                  
sponsor, Representative Dave Talerico.                                                                                          
                                                                                                                                
TERRY BANNISTER, Attorney                                                                                                       
Legislative Legal Counsel                                                                                                       
Legislative Legal Services                                                                                                      
Legislative Affairs Agency                                                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during discussion of HB                                                               
186.                                                                                                                            
                                                                                                                                
HOLLIS HALL, Secretary of the Board                                                                                             
Fairbanks Community Food Bank                                                                                                   
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 186.                                                                          
                                                                                                                                
SAMANTHA KIRSTEIN, Director of Community Development                                                                            
Fairbanks Community Food Bank                                                                                                   
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 186.                                                                          
                                                                                                                                
CARA DURR, Director of Public Engagement                                                                                        
Food Bank of Alaska                                                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 186.                                                                          
                                                                                                                                
EDDIE EZELLE                                                                                                                    
Matanuska-Susitna Food Bank                                                                                                     
Matanuska-Susitna Valley, Alaska                                                                                                
POSITION STATEMENT:  Testified during discussion of HB 186.                                                                   
                                                                                                                                
JAY C. BUTLER, M.D., Chief Medical Officer/Director                                                                             
Central Office                                                                                                                  
Division of Public Health (DPH)                                                                                                 
Department of Health and Social Services (DHSS)                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Answered questions during the discussion of                                                              
HB 159.                                                                                                                         
                                                                                                                                
STACIE KRALY, Chief Assistant Attorney General/Statewide Section                                                                
Supervisor                                                                                                                      
Human Services Section                                                                                                          
Civil Division (Juneau)                                                                                                         
Department of Law                                                                                                               
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified and answered questions during the                                                              
discussion of HB 159.                                                                                                           
                                                                                                                                
JOSHUA STREAM, M.D.                                                                                                             
Providence Alaska Medical Center (PAMC)                                                                                         
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 159.                                                                          
                                                                                                                                
MICHAEL CARSON, Chair                                                                                                           
Mat-Su Opioid Task Force                                                                                                        
Matanuska-Susitna (Mat-Su) Valley, Alaska                                                                                       
POSITION STATEMENT:  Testified in support of HB 159.                                                                          
                                                                                                                                
CHRISTINA LOVE                                                                                                                  
Community Resources Coordinator                                                                                                 
Aiding Women in Abuse and Rape Emergencies (AWARE Inc.)                                                                         
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 159.                                                                          
                                                                                                                                
KARA NELSON, Director                                                                                                           
Haven House                                                                                                                     
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 159.                                                                          
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:06:38 PM                                                                                                                    
                                                                                                                                
CHAIR IVY  SPOHNHOLZ called the  House Health and  Social Services                                                            
Standing    Committee   meeting    to   order    at   3:06    p.m.                                                              
Representatives  Spohnholz,  Sullivan-Leonard,   Eastman,  Edgmon,                                                              
Tarr,  and   Johnston  were   present  at   the  call   to  order.                                                              
Representative Kito arrived as the meeting was in progress.                                                                     
                                                                                                                                
        HB 164-PROTECT: VULNERABLE ADULTS/LONG TERM CARE                                                                    
                                                                                                                                
3:08:08 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced  that the first order  of business would                                                              
be  HOUSE BILL  NO. 164,  "An Act  relating to  the protection  of                                                              
vulnerable adults and residents of long term care facilities."                                                                  
                                                                                                                                
3:08:28 PM                                                                                                                    
                                                                                                                                
TERESA HOLT,  Long Term  Care Ombudsman, Office  of the  Long Term                                                              
Care Ombudsman,  Alaska Mental Health Trust  Authority, Department                                                              
of  Revenue,  introduced HB  164  on  behalf  of the  House  Rules                                                              
Committee  on request  of the Governor.   She  explained that  the                                                              
proposed bill  would amend provisions  of AS 47.62, Office  of the                                                              
Long Term Care  Ombudsman, and AS 47.24, protection  of vulnerable                                                              
adults, to ensure  alignment with the Older Americans  Act of 1965                                                              
and its  implementing regulations.   She  reported that  the Older                                                              
Americans Act  was reauthorized  in 2016  and new regulations  for                                                              
Long  Term  Care  Ombudsman  were  created.    As  a  result,  the                                                              
Administration  for  Community   Living  reviewed  all  states  to                                                              
ensure compliance  with these changes, and this  review identified                                                              
two  Alaska   statutes  as  being   out  of  alignment   with  the                                                              
reauthorization  and the  Long  Term Care  Ombudsman  regulations.                                                              
She lauded  these as good  changes which  would be helpful  to her                                                              
office.  She stated  that the proposed bill would  align state and                                                              
federal  statutes and  regulations to  ensure that  the Office  of                                                              
the  Long Term  Care Ombudsman  only  shared resident  information                                                              
with informed  consent, and to ensure  that the office  can obtain                                                              
records  to investigate  and make  referrals when  a resident  was                                                              
unable to provide  informed consent.  The proposed  bill added new                                                              
terms for  residents and  resident representatives  and, due  to a                                                              
conflict  of  interest,  it  removed   the  option  for  mandatory                                                              
reporters  to meet  reporting requirements  by submitting  reports                                                              
to the  office.   The proposed  bill clarified  the separation  of                                                              
the role  of the  Long Term Care  Ombudsman from  the role  of the                                                              
Department of Health  and Social Services, and  clarified that the                                                              
Office  of the Long  Term Care  Ombudsman may  serve residents  in                                                              
long term care facilities under the age of 60.                                                                                  
                                                                                                                                
3:10:30 PM                                                                                                                    
                                                                                                                                
MS.  HOLT   paraphrased  the   Sectional  Analysis   [Included  in                                                              
members' packets], which read:                                                                                                  
                                                                                                                                
     Section 1  is a technical  amendment to AS  47.24.010(a)                                                                 
     to  update  the  name  of  the  entity  responsible  for                                                                   
     receiving  reports to the  department "vulnerable  adult                                                                   
     centralized intake office".                                                                                                
                                                                                                                                
     Section 2  is a technical  amendment to AS  47.24.010(e)                                                                 
     to  update  the  name  of  the  entity  responsible  for                                                                   
     receiving  reports to the  department "vulnerable  adult                                                                   
     centralized intake office".                                                                                                
                                                                                                                                
     Section   3  amends  AS   47.24.013(a)  to  remove   the                                                                 
     requirement  to forward reports  of maltreatment  to the                                                                   
     Long   Term  Care  Ombudsman's   office.  Adds   passive                                                                   
     language  to  allow the  DHSS  to transfer  reports  for                                                                   
     Long  Term  Care Ombudsman's  investigation  as  defined                                                                   
     under AS.62.015.                                                                                                           
                                                                                                                                
     Section  4 amends  AS 47.24.013(b)  to delete  reference                                                                 
     to  DHSS's   obligation  to   investigate  reports   for                                                                   
     vulnerable  adult's age  60 or less.  The Department  of                                                                   
     Health and  Social Services  is responsible for  reports                                                                   
     involving vulnerable adults ages 18 and older.                                                                             
                                                                                                                                
     Section  5 amends  AS 47.24.013(d)  to  remove the  Long                                                                 
     Term   Care  Ombudsman's   obligation   to   mandatorily                                                                   
     provide  a report  to the  DHSS  Central Intake.  Aligns                                                                   
     state  law with  federal  law  requiring the  Long  Term                                                                   
     Care Ombudsman's  office to only forward  information of                                                                   
     a complainant  or resident  with appropriate consent  or                                                                   
     court   order.  (45  CFR   1327.11(e)(3)).  Amended   to                                                                   
     reflect   current  Department   of   Human  and   Social                                                                   
     Services    responsibility    for    vulnerable    adult                                                                   
     centralized intake.                                                                                                        
                                                                                                                                
     Section  6 amends  AS 47.24.015(a)  to remove  reference                                                                 
     to reports transferred  to the Office of Long  Term Care                                                                   
     Ombudsman    under   47.24.013.   Updates    legislative                                                                   
     language   to   appropriately  reference   subjects   of                                                                   
     reports are  vulnerable adults. Removes  requirement for                                                                   
     face to face interview.                                                                                                    
                                                                                                                                
     Section  7 amends  AS 47.62.015(a)  to  add language  to                                                                 
     align state  law with federal law by providing  the Long                                                                   
     Term  Care Ombudsman  the authority  to investigate  and                                                                   
     resolve  a complaint  for a  person residing  in a  long                                                                   
     term  care  facility who  is  not  defined as  an  older                                                                   
     Alaska.                                                                                                                    
                                                                                                                                
     Section  8   amends  AS  47.62.015(c)  to   include  all                                                                 
     residents of a long term care facility.                                                                                    
                                                                                                                                
     Section 9  repeals and reenacts  AS 47.62.025  to define                                                                 
     access  to long  term  care facilities,  older  Alaskan,                                                                   
     and  records.  Title  amended  to include  all  ages  of                                                                   
     residents  of long  term  care facilities.  Section  (a)                                                                   
     amended to  include all ages  of residents of  long term                                                                   
     care  facilities. Section  (b)  amended  to include  all                                                                   
     ages  of residents  of  long  term care  facilities  and                                                                   
     amended  to allow  for  consent to  be  provided by  the                                                                   
     resident   or  the  resident's   representative   or  by                                                                   
     subpoena.                                                                                                                  
                                                                                                                                
     Section  10  repeals  and reenacts  AS  47.62.030(b)  to                                                                 
     include  all ages  of residents.  Amended  to allow  for                                                                   
     disclosures  with consent.  Adds authority for  resident                                                                   
     representative to  give consent. Amended to  align state                                                                   
     law with  federal law  to clarify limited  circumstances                                                                   
     when  the  Office  of  Long   Term  Care  Ombudsman  has                                                                   
     authority  to  report  resident-identifying  information                                                                   
     without  obtaining resident  or resident  representative                                                                   
     consent.                                                                                                                   
                                                                                                                                
     Section 11  amends AS 47.62.060  to include all  ages of                                                                 
     residents of long term care facilities.                                                                                    
                                                                                                                                
     Section   12  amends   AS   47.62.090   to  revise   the                                                                 
     definition  of  "older  Alaskan" as  an  individual  who                                                                   
     lives  in  Alaska  since definition  of  "resident"  was                                                                   
     added  to mean  individual living  in a  long term  care                                                                   
     facility.  Adds new  sections to define  resident as  an                                                                   
     individual  who resides  in  a long  term care  facility                                                                   
     and  to  align state  law  with  federal law  to  define                                                                   
     resident  representative  and   authority  the  resident                                                                   
     representative has to act on behalf of the resident.                                                                       
                                                                                                                                
     Section     13    repeals     AS    47.24.010(f),     AS                                                                 
     47.24.013(c)(3),  and AS  47.24.013(e). AS  47.24.010(f)                                                                   
     is   repealed  as   Federal   statute  and   regulations                                                                   
     prohibit  representatives of the  Office Long Term  Care                                                                   
     Ombudsman  from abuse reporting  requirements when  such                                                                   
     reporting  would disclose identifying  information  of a                                                                   
     complainant or  resident without appropriate  consent or                                                                   
     court   order.   (45   CFR    1327.11(e)(3)).   Therefor                                                                   
     mandatory  reporting to  the  Office of  Long Term  Care                                                                   
     Ombudsman  does  not  fulfill   a  mandatory  reporter's                                                                   
     obligation  under  law  to  make  mandatory  reports  of                                                                   
     maltreatment.    AS    47.24.013(c)(3)    repeals    the                                                                   
     requirement  for  the  Office  of  the  Long  Term  Care                                                                   
     Ombudsman  to provide  results of  investigation to  the                                                                   
     DHSS.  OAA   Section  712(d)(2)(B)  establishes   strict                                                                   
     disclosure  limitations. The  Long  Term Care  Ombudsman                                                                   
     program  is  intended  to  be  a  safe,  person-centered                                                                   
     place for  residents to bring their concerns.  Residents                                                                   
     can  be  assured  that their  information  will  not  be                                                                   
     disclosed  without  their consent,  the  consent of  the                                                                   
     resident    representative,   or    court   order.    AS                                                                   
     47.24.013(e)  is  repealed as  the  Office of  the  Long                                                                   
     Term  Care Ombudsman  is not the  appropriate agency  to                                                                   
     officially substantiate  abuse or neglect  complaints on                                                                   
     behalf  of  DHSS.  The  Office of  the  Long  Term  Care                                                                   
     Ombudsman   represents  the   interests  of   residents,                                                                   
     rather  than  the  interests   of  the  DHSS.  (See  OAA                                                                   
     Section    712(a)(3)(E),     (a)(5)(B)(iv);    45    CFR                                                                   
     1327.13(a)(5), 1327.19(a)(4)).                                                                                             
                                                                                                                                
3:13:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  asked  about the  rationale  for                                                              
the amendment in Section 3.                                                                                                     
                                                                                                                                
MS. HOLT  explained that often there  were residents of  long term                                                              
care  facilities  who were  55  years  of  age, and  the  previous                                                              
legislation  only allowed that  her office  work with  people over                                                              
60 years  of age.  This  would allow the  Office of the  Long Term                                                              
Care Ombudsman to serve people under the age of 60.                                                                             
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD   asked  about  removal   of  the                                                              
requirement to  forward reports of  maltreatment to the  Office of                                                              
the Long Term Care Ombudsman.                                                                                                   
                                                                                                                                
CHAIR  SPOHNHOLZ clarified  that Ms.  Holt had  been referring  to                                                              
Section   4,   and  that   Representative   Sullivan-Leonard   had                                                              
questions regarding Section 3.                                                                                                  
                                                                                                                                
MS.  HOLT  directed  attention  to  the  original  statute,  which                                                              
stated  that  Department  of Health  and  Social  Services  (DHSS)                                                              
would forward  all reports  on people  over the age  of 60  to the                                                              
Office of  the Long  Term Care Ombudsman  for investigation.   She                                                              
explained  that the  Office of the  Long Term  Care Ombudsman  had                                                              
different investigation  priorities, and would  investigate issues                                                              
for residents  of long term care  facilities.  She  explained that                                                              
Adult   Protective   Services  and   Licensing   investigated   to                                                              
substantiate  a report  of harm.    This would  clarify that  DHSS                                                              
would  conduct  the  verifications,  and those  reports  would  be                                                              
forwarded to the Office of the Long Term Care Ombudsman.                                                                        
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  suggested that the  Office of the                                                              
Long Term Care  Ombudsman would want that information  in order to                                                              
assist in the process for helping.                                                                                              
                                                                                                                                
MS. HOLT  replied that two years  prior, there had been  a meeting                                                              
of  people  who worked  with  seniors  living  in long  term  care                                                              
facilities,  which resulted in  a system  of initial response  for                                                              
investigation.   She  relayed that  this  memorandum of  agreement                                                              
dictated   that  "if   adult  protective   services,   residential                                                              
licensing,  and quality assurance  feels like  it's a  report that                                                              
we should  have a  copy of, that  they will  forward that  to us."                                                              
She stated  that the majority  of the reports  of harm  were about                                                              
residents  who had  fallen  to the  floor,  but  were checked  and                                                              
found  to be  fine.   She pointed  out that  a review  of each  of                                                              
these  was very  time consuming,  and  was not  necessary for  her                                                              
office to review.                                                                                                               
                                                                                                                                
3:17:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  asked if the Office of the  Long Term Care                                                              
Ombudsman wanted to  know about an incident for  maltreatment of a                                                              
person in long term care.                                                                                                       
                                                                                                                                
MS. HOLT  replied that her  office did  want to know,  adding that                                                              
the office  received between  15-20 reports  daily.  She  reported                                                              
that  central intake  received  about 50  reports  daily, and,  as                                                              
many of these had  already been resolved, her office  did not need                                                              
to receive those  reports.  She added that people  could also call                                                              
her office  directly.  She offered  her belief that  this proposed                                                              
process would work.                                                                                                             
                                                                                                                                
3:18:35 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ  summarized  that   the  proposed  process  would                                                              
narrow the  requirement for data  reporting or reports of  harm to                                                              
only   be  those   which  were   substantiated   or  needed   more                                                              
investigation.                                                                                                                  
                                                                                                                                
MS. HOLT expressed  her agreement, and stated that  the mandate of                                                              
the Office of the  Long Term Care Ombudsman was  to resolve issues                                                              
of residents that required assistance.                                                                                          
                                                                                                                                
CHAIR  SPOHNHOLZ  suggested that  there  could be  language  which                                                              
would more specifically address the concern.                                                                                    
                                                                                                                                
3:20:39 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that HB 164 would be held over.                                                                       
                                                                                                                                
        HB 100-POSTTRAUMATIC STRESS INJURY AWARENESS DAY                                                                    
                                                                                                                                
3:20:55 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  announced that the  next order of  business would                                                              
be HOUSE BILL NO.  100, "An Act establishing June  27 of each year                                                              
as Post-Traumatic Stress Injury Awareness Day."                                                                                 
                                                                                                                                
3:21:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CHRIS TUCK,  Alaska  State Legislature,  explained                                                              
that the  term "Post-Traumatic Stress  Disorder" had  been changed                                                              
to  "Post-Traumatic  Stress  Injury."   He  paraphrased  from  the                                                              
Sponsor Statement [Included in members' packets], which read:                                                                   
                                                                                                                                
     Post-traumatic   stress   injury  (PTSI)   can   develop                                                                   
     following  any  event  that  makes  you  fear  for  your                                                                   
     safety,  especially  if the  event  feels  unpredictable                                                                   
     and   uncontrollable.  PTSI   can   affect  people   who                                                                   
     personally experience  the threatening event,  those who                                                                   
     witness  the event,  or  those who  pick  up the  pieces                                                                   
     afterwards,  such  as emergency  workers.  Symptoms  may                                                                   
     include flashbacks,  nightmares, and severe  anxiety, as                                                                   
     well as uncontrollable  thoughts about the event.  It is                                                                   
     estimated  that  almost  260  million  people  worldwide                                                                   
     suffer  from PTSI.  In the  U.S., about  3.5% of  adults                                                                   
     are  diagnosed   with  PTSI  annually.  The   impact  of                                                                   
     traumatic   events  on  children   is  often  more   far                                                                   
     reaching  than trauma  on adults, not  only because  the                                                                   
     child  has fewer  emotional  and intellectual  resources                                                                   
     to cope,  but also  because the  child's development  is                                                                   
     adversely  affected. According to  one study, more  than                                                                   
     60% of  children ages 0-17  experienced or witnesses  at                                                                   
     least  one  traumatic  event.  Between  2000  and  2014,                                                                   
     approximately  139,000 active-duty service  members were                                                                   
     diagnosed  with  new  onset   of  post-traumatic  stress                                                                   
     within  the  Military  Health System  (MHS).  Of  these,                                                                   
     roughly   112,000   service   members   were   diagnosed                                                                   
     following  a  deployment  of  30  days  or  more  to  an                                                                   
     overseas  contingency operation.  The numbers  presented                                                                   
     reflect  only those  service members  identified by  the                                                                   
     MHS. As such,  they may underestimate the  true scope of                                                                   
     the  problem since  they do  not  reflect those  service                                                                   
     members  who choose  not to seek  assistance because  of                                                                   
     concerns  around  stigma  and other  barriers  that  may                                                                   
     discourage  them  from  seeking  help.  Referring  to  a                                                                   
     post-traumatic stress  injury as a disorder  perpetuates                                                                   
     the  stigma which  in  turn discourages  people  seeking                                                                   
     proper  medical  treatment.  Raising  awareness  of  the                                                                   
     condition  and  eliminating  the  stigma  may  encourage                                                                   
     people affected  to seek help voluntarily and  allow for                                                                   
     timely treatment  that may  alleviate PTSI symptoms  and                                                                   
     even prevent  suicide. The United States  Senate, United                                                                   
     State  House  of  Representatives  and  27  states  have                                                                   
     united  by bringing  national  awareness to  individuals                                                                   
     who  are  suffering  with  PTSI.  House  Bill  100  will                                                                   
     establish  June  27  as  Post-Traumatic   Stress  Injury                                                                   
     Awareness Day  in Alaska, providing an  opportunity each                                                                   
     year to raise awareness and conduct outreach.                                                                              
                                                                                                                                
3:24:54 PM                                                                                                                    
                                                                                                                                
KENDRA  KLOSTER, Staff,  Representative Chris  Tuck, Alaska  State                                                              
Legislature, explained  the proposed bill, which  established June                                                              
27 of each  year as Post-Traumatic Stress Injury  (PTSI) Awareness                                                              
Day.  She  reiterated that a  resolution had been passed  in 2016,                                                              
during the  previous legislative  session,  to designate  June 27,                                                              
2016, as  a day  of awareness.   She relayed  that the  date, June                                                              
27, had  been inspired  by the  birthday of  National Guard  Staff                                                              
Sergeant Joe Beale,  who suffered from PTSI and took  his own life                                                              
on April 26, 2007.                                                                                                              
                                                                                                                                
3:26:49 PM                                                                                                                    
                                                                                                                                
KENT HALL, Vice President, Honor For All, spoke about post-                                                                     
traumatic stress  injury, and offered his personal  story of PTSI.                                                              
He   reported   that   although   he   left   Vietnam   in   1969,                                                              
"unfortunately, Vietnam  never left me."  He shared  that he still                                                              
had issues,  and attended group  therapy with other veterans.   He                                                              
reported  that Lansing,  Michigan had  four such  groups of  10 or                                                              
more veterans.   He credited  the founders  of "Honor For  All" as                                                              
working hard  to create awareness  for this by creating  the first                                                              
PTSD   (post-traumatic   stress   disorder)   Awareness   Day   in                                                              
Washington, DC in  2011, and that Michigan became  the first state                                                              
to  pass a  resolution  for  June 27  to  be recognized  as  Post-                                                              
Traumatic  Stress Injury  (PTSI) Awareness  Day.   He shared  that                                                              
the subtle  change of  term allowed him  to understand  the reason                                                              
for his  problems, as  he was  not diagnosed  until 2011,  and had                                                              
dealt with his personal  issues for four decades.   He stated that                                                              
Honor For Allow  showed him that his problems were  a wound, not a                                                              
weakness,  and  with  this  understanding,   he  became  a  public                                                              
spokesman.   He  noted  that  there were  still  20  - 22  veteran                                                              
suicides  daily,  declaring  "that's  just not  acceptable."    He                                                              
stated  that his  organization would  fight  for any  help to  end                                                              
this.     He   shared   that  30   states   were  "on-board   with                                                              
resolutions."   He  lauded Alaska's  reputation  for "looking  out                                                              
for veterans."                                                                                                                  
                                                                                                                                
3:31:17 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  expressed  appreciation for  his service  and his                                                              
passion  for this program,  and  offered hope  for his success  in                                                              
healing.                                                                                                                        
                                                                                                                                
3:32:01 PM                                                                                                                    
                                                                                                                                
VERDIE BOWEN,  Director of  Veterans Affairs,  Office of  Veterans                                                              
Affairs,  Department of Military  & Veterans  Affairs, stated  his                                                              
support for  the proposed bill.   He shared that the help  was out                                                              
there, but  that the  awareness of  injuries caused through  post-                                                              
traumatic  stress needed  to be  promoted.   He  noted that  often                                                              
veterans did  not seek  assistance, reporting  that 30  percent of                                                              
veterans  from   combat  zones   were  experiencing   this  injury                                                              
according to the  Veterans' Administration.  He  stated that there                                                              
were  now 1600  new  mental  health professionals  throughout  the                                                              
U.S. working  with the Veterans'  Administration.  He  offered his                                                              
belief that signifying  PTSI instead of PTSD would  help eliminate                                                              
the stigma to the injury.                                                                                                       
                                                                                                                                
3:35:24 PM                                                                                                                    
                                                                                                                                
ROBERT    DOEHL,    Deputy    Commissioner,    Office    of    the                                                              
Commissioner/Adjutant  General, Department of Military  & Veterans                                                              
Affairs,  stated support  for  the proposed  bill.   He  clarified                                                              
that PTSI was not  limited to veterans and there  was no intent to                                                              
demean  any of  the struggles  faced  in dealing  with  this.   He                                                              
reported  that police  officers  had  also expressed  support  for                                                              
this as a tool when working with veterans "having a bad day."                                                                   
                                                                                                                                
3:37:03 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  reiterated that post-traumatic stress  injury was                                                              
an injury not  only experienced by veterans, and  pointed out that                                                              
many  survivors of  adverse  childhood experiences  also  suffered                                                              
from  PTSI.    She  offered  a  personal  story  from  her  family                                                              
regarding PTSI.   She  pointed out that  anyone could  suffer from                                                              
this if put in the wrong circumstances.                                                                                         
                                                                                                                                
3:38:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EDGMON moved  to report  HB 100  out of  committee                                                              
with  individual  recommendations   and  the  accompanying  fiscal                                                              
notes.   There  being  no objection,  HB 100  was  moved from  the                                                              
House Health and Social Services Standing Committee.                                                                            
                                                                                                                                
3:39:10 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:39 p.m. to 3:44 p.m.                                                                       
                                                                                                                                
                     HB 186-FOOD DONATIONS                                                                                  
                                                                                                                                
3:44:52 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that the next order of business would                                                                 
be HOUSE BILL NO. 186, "An Act relating to the donation of food;                                                                
and relating to food banks."                                                                                                    
                                                                                                                                
3:45:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  DAVE TALERICO,  Alaska State  Legislature, as  the                                                              
sponsor  of  the  proposed  bill,  paraphrased  from  the  Sponsor                                                              
Statement [included  in members'  packets], which read  as follows                                                              
[original punctuation provided]:                                                                                                
                                                                                                                                
     HB  186 seeks  to reduce the  amount of  wasted food  in                                                                   
     the state  while increasing  the amount of food  donated                                                                   
     to  food  banks  and  other   charitable  organizations.                                                                   
     Nearly 15%  of Alaskans fall  into the category  of food                                                                   
     insecure  individuals.  Many  businesses  are  currently                                                                   
     donating excess  food however many  desire to do  so but                                                                   
     are   not   because  of   liability.   Many   charitable                                                                   
     organizations do  not receive sufficient  food donations                                                                   
     to  feed  the  homeless and  hungry  that  without  such                                                                   
     charities  have  no  way to  eat.  These  charities  and                                                                   
     people may  greatly benefit  from more donated  food. HB                                                                   
     186  will allow  hotels, restaurants,  stores and  other                                                                   
     food  donors who choose  to donate  their excess  unsold                                                                   
     food  or out  dated  food to  donate  to  food banks  or                                                                   
     charitable  organizations   free  from  liability.  This                                                                   
     will open  up the doors for  thousands of pounds  of new                                                                   
     donated  food  to  charities  and  thus  help  feed  the                                                                   
     nearly  15% hungry Alaskans.  HB will  require that  all                                                                   
     food donors  that choose  to donate  hot excess food  to                                                                   
     simply  label the donated  hot food  that can be  frozen                                                                   
     and re-served.  HB 186  will also  reduce the amount  of                                                                   
     food  put  into our  landfills  which  smells,  attracts                                                                   
     animals,  birds  and  unnecessarily  takes up  space.  I                                                                   
     urge  your support  for  this bill  to  help reduce  the                                                                   
     amount  of  wasted  food  and  increase  the  amount  of                                                                   
     donated food to decrease hunger in Alaska. Thank you!                                                                      
                                                                                                                                
3:48:06 PM                                                                                                                    
                                                                                                                                
ELIJAH VERHAGEN, Staff, Representative Dave Talerico, Alaska                                                                    
State Legislature,  explained the  bill, and paraphrased  from the                                                              
Sectional Analysis [Included in  members' packets], which read:                                                                 
                                                                                                                                
     Sec.  1  -  AS 17.20.345  Amends  AS  17.20.345  (a)  by                                                                 
     adding  charitable  organizations  in  statute  next  to                                                                   
     food  banks to  be  able to  receive  donated food  from                                                                   
     donors who  may donate their  food free from  liability.                                                                   
     Amends  AS   17.20.345  (b)(l)  by  adding   a  sentence                                                                   
     clarifying  that the labels  referenced in this  statute                                                                   
     do not include  the new label referenced in  section two                                                                   
     of this bill;  which requires heated donated  food to be                                                                   
     labeled.  Amends  AS 17.20.345  (b)  by adding  a  third                                                                   
     bullet  point allowing  donors  of food  to donate  food                                                                   
     with an  expired date  on it.  Amends AS .17.20.345  (c)                                                                   
     by  adding  charitable organizations  in  statute  along                                                                   
     with food  banks to  be able  to receive donated  salmon                                                                   
     from hatcheries.                                                                                                           
                                                                                                                                
     Sec. 2  - AS  17.20.345 Amends  AS 17.20.345 is  amended                                                                 
     by adding a  new section which allows donors  of food to                                                                   
     donate excess  hot food to  food banks and  charities as                                                                   
     long as they label it as previously heated food.                                                                           
                                                                                                                                
     Sec.  3  -  AS 17.20.346  Amends  AS  17.20.346  (a)  by                                                                 
     adding  charitable  organizations  in  statute  next  to                                                                   
     food  banks   to  be  free  from  liability   to  donate                                                                   
     received  food to  hungry individuals  as  long as  they                                                                   
     first   inspect   it  and   deem   it  fit   for   human                                                                   
     consumption.   Amends  AS   17.20.346   (b)  by   adding                                                                   
     charitable organizations  in statute next to  food banks                                                                   
     to  be free  to  receive donated  food  with an  expired                                                                   
     date on it.                                                                                                                
                                                                                                                                
     Sec.  4  - AS  17.20.347  Amends  AS? 17.20.347  (1)  by                                                                 
     adding delicatessen,  restaurant, hotel and  store under                                                                   
     the  definition of  donor.  Amends AS  17.20.347 (2)  by                                                                   
     deleting  part of the  definition of a  food bank  so as                                                                   
     to separately  define a nonprofit organization  in a new                                                                   
     section.                                                                                                                   
                                                                                                                                
     Sec. 5  - AS 17 .20.34  7 Amends AS 17.20.347  by adding                                                                 
     three    new   definitions    namely   1.    "charitable                                                                   
     organization"   means  a  nonprofit  organization   that                                                                   
     provides food  without charge to individuals  who do not                                                                   
     have  money to  pay  for the  food or  who  do not  have                                                                   
     homes;   2.  "food"   includes  unsold   hot  food;   3.                                                                   
     "nonprofit    organization"   means   an    organization                                                                   
     recognized  by  the state  or  federal government  as  a                                                                   
     nonprofit organization.                                                                                                    
                                                                                                                                
3:55:44 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EDGMON  asked if there  was a need for  language in                                                              
the proposed  bill to  tie in donor  to charitable  organizations,                                                              
possibly  for tax  purposes or  benefits  in statutes,  to make  a                                                              
donor involved  in commercial activities  more willing  to provide                                                              
an act of charity.                                                                                                              
                                                                                                                                
3:56:59 PM                                                                                                                    
                                                                                                                                
MR. VERHAGEN  directed attention  to page 1,  line 5,  which read:                                                              
"a  donor  of  food  for free  distribution  by  a  food  bank  or                                                              
charitable  organization  is  not  subject to  civil  or  criminal                                                              
liability arising."   He stated  that a  donor of food  could give                                                              
to a  food bank or  charitable organization.   He pointed  to page                                                              
3, which  defined donor.   He  referred to  the Legislative  Legal                                                              
Services to discuss any tax benefits.                                                                                           
                                                                                                                                
3:57:44 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ said  that the financial incentive  for donors was                                                              
well  detailed in  federal  tax  law, and  that  the donor  simply                                                              
needed  to  identify and  attribute  a  value  to the  items  when                                                              
adding it  to their  individual taxes.   She said  this was  up to                                                              
the individual donor.                                                                                                           
                                                                                                                                
REPRESENTATIVE JOHNSON asked about caterers.                                                                                    
                                                                                                                                
MR.  VERHAGEN  directed   attention  to  page  3,   line  15,  and                                                              
acknowledged  that although  the specific  mention of caterer  was                                                              
not included, he offered his belief that it could be added.                                                                     
                                                                                                                                
3:59:04 PM                                                                                                                    
                                                                                                                                
TERRY    BANNISTER,   Attorney,    Legislative   Legal    Counsel,                                                              
Legislative  Legal Services, Legislative  Affairs Agency,  offered                                                              
her  belief that  the definition  of  donor had  many terms  which                                                              
would include  caterer, but that  the specific term  caterer could                                                              
be added.                                                                                                                       
                                                                                                                                
3:59:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  reported  that the  federal  government  had                                                              
recently  made specific  tax incentives  for food  donation.   She                                                              
asked  that the  presentation include  the  information that  each                                                              
year in the U.S.  enough food was thrown away to  feed the country                                                              
for six months.                                                                                                                 
                                                                                                                                
MR. VERHAGEN said that other testifiers would expand on this.                                                                   
                                                                                                                                
4:01:12 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ expressed  her desire to reduce food  waste to its                                                              
absolute minimum,  especially to  address hunger  in Alaska.   She                                                              
declared that there  was a challenge for food  safety and handling                                                              
of hot foods.  She asked if this had been addressed.                                                                            
                                                                                                                                
4:02:21 PM                                                                                                                    
                                                                                                                                
MR.  VERHAGEN said  that  this had  been  discussed  and that  the                                                              
charitable  organizations had  these  handling procedures  already                                                              
in place.                                                                                                                       
                                                                                                                                
CHAIR SPOHNHOLZ  pointed to  page 3, line  31, and added  that she                                                              
had  worked  for   many  nonprofit  organizations   which  had  no                                                              
expertise in food  safety and handling.  She said  that this still                                                              
created a concern for her.                                                                                                      
                                                                                                                                
4:04:28 PM                                                                                                                    
                                                                                                                                
HOLLIS  HALL, Secretary  of the  Board,  Fairbanks Community  Food                                                              
Bank, said  that he grew  up during the  depression and  World War                                                              
II,  and that  he remembered  food ration  books and  stamps.   He                                                              
stated that  "food waste  was not  an option when  I grew  up, but                                                              
now,  it seems  to be."   He  said that  on any  given day,  there                                                              
could be "a couple  of times or more of food  that would otherwise                                                              
be waste  if it were  not brought  to the foodbank.   It  would be                                                              
discarded, but we  find a use for it."  He  acknowledged that some                                                              
days  there was  a shortage  of  fresh food,  and  that there  was                                                              
always room for  more.  He declared that an objective  of the food                                                              
bank was to see  that no one would go hungry,  and that this could                                                              
best be accomplished with donations of food.                                                                                    
                                                                                                                                
4:06:31 PM                                                                                                                    
                                                                                                                                
SAMANTHA KIRSTEIN,  Director of  Community Development,  Fairbanks                                                              
Community  Food  Bank,  expressed  her support  for  the  proposed                                                              
bill.   She reported  that there  was similar federal  legislation                                                              
which was "the  backbone of national food banking  for many years,                                                              
and  does  reduce  the liability  for  those  generous  commercial                                                              
donors."  She said  that there was still concern  from some Alaska                                                              
donors.  She offered  a history of the food bank  in the Fairbanks                                                              
community and  its current work,  which included  daily collection                                                              
and distribution of  two to five tons of local surplus  food.  She                                                              
reported  that every  food  box  included 20  pounds  of food  per                                                              
person,  which was  expected to  last for nine  meals per  person.                                                              
She  explained,  as the  food  bank  was  an emergency  supply  of                                                              
locally donated  and salvaged  food, that  any family  could order                                                              
10 food boxes each  calendar year.  She stated that  the food bank                                                              
worked  at the  Department of  Environmental Conservation  highest                                                              
standards  for  collection,  storage, and  distribution  of  food,                                                              
serving 30,000  people each  year.  She  reported that  each year,                                                              
the  food bank  collected  and  distributed  more than  2  million                                                              
pounds of  food in food  boxes.  She  added that they  worked with                                                              
more  than 100  food  donors, distributing  the  food through  100                                                              
agencies, and  that they worked  hard to  adhere to all  the rules                                                              
for food  handling.   She declared  that the food  bank was  not a                                                              
political  organization.   She  asked that  the  proposed bill  be                                                              
moved from the committee immediately.                                                                                           
                                                                                                                                
4:12:02 PM                                                                                                                    
                                                                                                                                
CARA DURR,  Director of  Public Engagement,  Food Bank  of Alaska,                                                              
said  that  the  proposed  bill   enhanced  and  complemented  the                                                              
provisions in the  federal legislation and was  very successful in                                                              
its support  for retail  groceries and  other businesses  in their                                                              
efforts  to donate  food  that would  otherwise  be  wasted.   She                                                              
expressed  her  hope  that  the proposed  bill  would  give  extra                                                              
assurance to  any small business  owners who might be  hesitant to                                                              
donate because of  any perceived liability.  She  pointed out that                                                              
as 106,000  Alaskans faced  food insecurity,  it was important  to                                                              
reduce food waste and encourage donations.                                                                                      
                                                                                                                                
4:13:26 PM                                                                                                                    
                                                                                                                                
EDDIE  EZELLE,  Matanuska-Susitna  Food Bank,  encouraged  support                                                              
for  the  proposed  bill,  pointing  out that  there  had  been  a                                                              
reduction  in giving.   He  added  that the  proposed bill  helped                                                              
protect  food distributors  from  unnecessary lawsuits  concerning                                                              
the donated food products, and it helped people in need.                                                                        
                                                                                                                                
4:15:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   SULLIVAN-LEONARD    offered   her   whole-hearted                                                              
support for the proposed legislation.                                                                                           
                                                                                                                                
CHAIR SPOHNHOLZ announced that HB 186 would be held over.                                                                       
                                                                                                                                
         HB 159-OPIOIDS;PRESCRIPTIONS;DATABASE;LICENSES                                                                     
                                                                                                                                
4:15:36 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced  that the final order  of business would                                                              
be HOUSE  BILL NO. 159,  "An Act relating  to the prescription  of                                                              
opioids;  establishing  the  Voluntary  Nonopioid  Directive  Act;                                                              
relating  to  the  controlled  substance   prescription  database;                                                              
relating to  the practice of  dentistry; relating to  the practice                                                              
of medicine;  relating to  the practice  of podiatry;  relating to                                                              
the practice of  osteopathy; relating to the  practice of nursing;                                                              
relating to  the practice of  optometry; relating to  the practice                                                              
of veterinary  medicine;  related to  the duties  of the Board  of                                                              
Pharmacy; and providing for an effective date."                                                                                 
                                                                                                                                
4:16:02 PM                                                                                                                    
                                                                                                                                
JAY  C.  BUTLER, M.D.,  Chief  Medical  Officer/Director,  Central                                                              
Office,  Division of  Public Health  (DPH),  Department of  Health                                                              
and Social  Services  (DHSS), stated  that HB  159 is an  approach                                                              
aimed to  improve the  care of persons  living with  addiction and                                                              
to  address  some  of the  primary  prevention  possibilities,  as                                                              
related  to legal  prescription of  opioids in  the community,  by                                                              
supporting  more  rational pain  management  practices  throughout                                                              
the state.   He said the division  would like to  address concerns                                                              
expressed by  various stakeholders  by suggesting an  amendment to                                                              
the proposed bill.                                                                                                              
                                                                                                                                
DR. BUTLER  said one concern relates  to a section in  HB 159 that                                                              
would authorize  pharmacists to  partially fill prescriptions  for                                                              
opioids; part  of the desired  amendment would align  the language                                                              
more with  the federal  Comprehensive Addiction  and Recovery  Act                                                              
(CARA),  by deleting  language  that  would immediately  void  any                                                              
unfilled portion  of the prescription,  which would, as  a result,                                                              
require the  pharmacist to notify  the prescriber.  A  second part                                                              
of the  amendment would  clarify the roles  of the prescriber  and                                                              
the  dispenser.    Regarding  the   prescription  drug  monitoring                                                              
program (PDMP),  he said the  intent of  Senate Bill 74  last year                                                              
and the proposed  HB 159 before the committee was  and is that the                                                              
prescribers  check the  PDMP prior  to  issuing prescriptions  for                                                              
schedule II  or schedule III  controlled substances, and  the role                                                              
of the pharmacist  is to populate the PDMP when  the dispensing is                                                              
done.                                                                                                                           
                                                                                                                                
DR. BUTLER  said the  third part  of the  desired amendment  would                                                              
address  concerns  related  to  the daily  updates  of  the  PDMP,                                                              
recognizing  that even  the weekly  update  required under  Senate                                                              
Bill 74  has not been  implemented.   The amendment  would specify                                                              
that  the implementation  to daily  update would  not occur  until                                                              
2018.    He said  the  fourth  component  of the  amendment  would                                                              
address  the  waiver   of  liability  under  the   opioid  advance                                                              
directive.   He stated,  "In the  bill that I  presented to  you a                                                              
couple  of  weeks ago,  it  specified  waiving liability  for  not                                                              
administering  an opioid  when a  directive  was in  place.   This                                                              
broadens  the  waiver of  liability  to  include in  the  instance                                                              
where perhaps  ... [an]  opioid is  inadvertently administered  to                                                              
someone, with an advance directive."                                                                                            
                                                                                                                                
DR. BUTLER  said the  key points of  the requested amendment  were                                                              
based  on   feedback  of   a  number   of  stakeholders,   but  he                                                              
specifically  acknowledged   the  Pharmacy  Association   for  its                                                              
helpful guidance and  "a number of providers" for  their input, as                                                              
well.                                                                                                                           
                                                                                                                                
4:19:54 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ moved  to adopt  Amendment 1,  [which is  a typed                                                              
amendment   not  drafted   by  Legislative   Legal  and   Research                                                              
Services, dated at  top-right] "AM 3/28/2017" and  read as follows                                                              
[original punctuation provided]:                                                                                                
                                                                                                                                
     Page 1, line 3, following "dentistry;":                                                                                    
          Insert "relating to the practice of pharmacy;"                                                                        
                                                                                                                                
     Page 2, lines 2 - 3:                                                                                                       
          Delete all material and insert:                                                                                       
        "(b) The commissioner shall adopt regulations to                                                                        
       implement this chapter. The regulations under this                                                                       
     chapter shall"                                                                                                             
                                                                                                                                
      Page 2, line 25, following "opioid":                                                                                      
       Insert ", or for inadvertent administration of an                                                                        
     opioid,"                                                                                                                   
                                                                                                                                
     Page 15, line 14:                                                                                                          
          Delete "a"                                                                                                            
          Insert "[A]"                                                                                                          
          Delete "diagnosis"                                                                                                    
          Insert "[DIAGNOSIS]"                                                                                                  
                                                                                                                                
     Page 15, line 16:                                                                                                          
          Delete "a"                                                                                                            
          Insert "[A]"                                                                                                          
                                                                                                                                
      Page 15, line 17:                                                                                                         
          Delete "diagnosis"                                                                                                    
          Insert "[DIAGNOSIS]"                                                                                                  
                                                                                                                                
     Page 16, following line 24:                                                                                                
          Insert a new bill section to read:                                                                                    
     "*  Sec. 19.  AS 08.68.100(a),  as amended  by sec.  10,                                                                   
     ch. 25, SLA    2016, is amended to read:                                                                                   
          (a) The board shall                                                                                                   
      (1)  adopt  regulations  necessary  to  implement  this                                                                   
     chapter, including  regulations                                                                                            
           (A)   pertaining  to   practice  as  an   advanced                                                                   
     practice  registered     nurse   [PRACTITIONER]  and   a                                                                   
     certified  registered  nurse   anesthetist;  regulations                                                                   
     for an  advanced practice registered  nurse who  holds a                                                                   
     valid    federal   Drug    Enforcement    Administration                                                                   
     registration  number  must  address  training in    pain                                                                   
     management and opioid use and addiction;                                                                                   
          (B)   necessary  to   implement   AS  08.68.331   -                                                                   
     08.68.336  relating to  certified nurse  aides in  order                                                                   
     to protect  the health, safety,  and welfare  of clients                                                                   
     served by nurse aides;                                                                                                     
          (C) pertaining to retired nurse status; and                                                                           
          (D)   establishing   criteria   for   approval   of                                                                   
     practical   nurse  education   programs  that  are   not                                                                   
     accredited by a national nursing accrediting body;                                                                         
      (2)  approve curricula  and adopt  standards for  basic                                                                   
     education  programs that prepare  persons for  licensing                                                                   
     under AS  08.68.190;                                                                                                       
      (3)   provide  for   surveys  of   the  basic   nursing                                                                   
     education  programs  in  the   state  at  the  times  it                                                                   
     considers necessary;                                                                                                       
      (4)   approve   education   programs  that   meet   the                                                                   
     requirements  of  this chapter  and  of the  board,  and                                                                   
     deny,   revoke,  or   suspend   approval  of   education                                                                   
     programs for failure to meet the requirements;                                                                             
      (5)  examine,  license,  and   renew  the  licenses  of                                                                   
     qualified applicants;                                                                                                      
      (6)  prescribe  requirements  for competence  before  a                                                                   
     former nurse  may resume the  practice of nursing  under                                                                   
     this chapter;                                                                                                              
      (7)  define   by  regulation  the  qualifications   and                                                                   
     duties  of  the  executive  administrator  and  delegate                                                                   
     authority  to   the  executive  administrator   that  is                                                                   
     necessary to conduct board business;                                                                                       
      (8)  develop  reasonable   and  uniform  standards  for                                                                   
     nursing practice;                                                                                                          
      (9)   publish  advisory   opinions  regarding   whether                                                                   
     nursing  practice  procedures  or policies  comply  with                                                                   
     acceptable  standards  of nursing  practice  as  defined                                                                   
     under this chapter;                                                                                                        
      (10) require  applicants under  this chapter to  submit                                                                   
     fingerprints  and the  fees required  by the  Department                                                                   
     of  Public  Safety  under   AS  12.62.160  for  criminal                                                                   
     justice  information  and a  national  criminal  history                                                                   
     record   check;   the  department   shall   submit   the                                                                   
     fingerprints  and  fees  to  the  Department  of  Public                                                                   
     Safety  for a  report  of criminal  justice  information                                                                   
     under AS  12.62 and a  national criminal history  record                                                                   
     check under AS 12.62.400;                                                                                                  
      (11)   require  that  a   licensed  advanced   practice                                                                   
     registered nurse  [PRACTITIONER] who has a  federal Drug                                                                   
     Enforcement    Administration     registration    number                                                                   
     register  with  the  controlled  substance  prescription                                                                   
     database under AS 17.30.200(o)."                                                                                           
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 18, line 15:                                                                                                          
          Delete "a"                                                                                                            
          Insert "[A]"                                                                                                          
          Delete "diagnosis"                                                                                                    
          Insert "[DIAGNOSIS]"                                                                                                  
                                                                                                                                
     Page 18, line 18:                                                                                                          
          Delete "a"                                                                                                            
          Insert "[A]"                                                                                                          
          Delete "diagnosis"                                                                                                    
          Insert "[DIAGNOSIS]"                                                                                                  
                                                                                                                                
     Page 19, following line 15:                                                                                                
          Insert a new bill section to read:                                                                                    
      "* Sec. 24. AS 08.72.140 is amended to read:                                                                              
          Sec.  08.72.140. Qualifications  for licensure.  An                                                                   
     applicant for licensure as an  optometrist                                                                                 
      (1)  shall be  a graduate  of  a school  or college  of                                                                   
     optometry recognized by  the board;                                                                                        
      (2) may not  have committed an act in  any jurisdiction                                                                   
     that  would   have  constituted  a  violation   of  this                                                                   
     chapter  or regulations  adopted under  this chapter  at                                                                   
     the time the act was committed;                                                                                            
      (3)  may not  have  been  disciplined by  an  optometry                                                                   
     licensing  entity in  another jurisdiction  and may  not                                                                   
     be  the subject  of  a pending  disciplinary  proceeding                                                                   
     conducted  by an optometry  licensing entity in  another                                                                   
     jurisdiction;  however,  the   board  may  consider  the                                                                   
     disciplinary  action  and,  in the  board's  discretion,                                                                   
     determine if the person is qualified for licensure;                                                                        
      (4) shall have successfully completed                                                                                     
          (A)  the  written  and  practical  portions  of  an                                                                   
     examination  on  ocular  pharmacology  approved  by  the                                                                   
     board   that  tests   the   licensee's  or   applicant's                                                                   
     knowledge   of  the   characteristics,   pharmacological                                                                   
     effects, indications,  contraindications, and  emergency                                                                   
     care  associated  with  the   prescription  and  use  of                                                                   
     pharmaceutical agents;                                                                                                     
          (B) a  nontopical therapeutic pharmaceutical  agent                                                                   
     course of  at least  23 hours approved  by the  board or                                                                   
     an examination  approved by  the board on the  treatment                                                                   
     and management of ocular disease; and                                                                                      
          (C)   an  optometry   and  nontopical   therapeutic                                                                   
     pharmaceutical  agent  injection   course  of  at  least                                                                   
     seven  hours   approved  by  the  board   or  equivalent                                                                   
     training acceptable to the board; and                                                                                      
      (5) shall  meet other  qualifications for licensure  as                                                                   
     established under  this chapter and regulations  adopted                                                                   
     by  the   board  under  AS  08.72.050   regulations  for                                                                   
     qualifications  for licensees who  hold a valid  federal                                                                   
     Drug  Enforcement  Administration  number  must  address                                                                   
     training   in  pain  management   and  opioid   use  and                                                                   
     addiction."                                                                                                                
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 23, line  9, following "prescribed.",  through line                                                                   
     16:                                                                                                                        
          Delete all material.                                                                                                  
                                                                                                                                
     Page 23, line 17:                                                                                                          
          Delete "(c)"                                                                                                          
          Insert "(b)"                                                                                                          
                                                                                                                                
     Page 24, lines 20 - 29:                                                                                                    
          Delete all material and insert:                                                                                       
          "*  Sec. 31. AS  17.30.200(a),  as amended by  sec.                                                                   
     21, ch. 25, SLA 2016, is amended to read:                                                                                  
               (a)  The  controlled   substance  prescription                                                                   
     database is  established in  the Board of Pharmacy.  The                                                                   
     purpose  of   the  database   is  to  contain   data  as                                                                   
     described in  this section regarding every  prescription                                                                   
     for  a schedule  II,  III,  or IV  controlled  substance                                                                   
     under  federal law dispensed  in the  state to a  person                                                                   
     other than those  administered to a patient  at a health                                                                   
     care facility  or a  correctional facility, except  when                                                                   
     prescribing  opioids to  an inmate  at the  time of  the                                                                   
     inmate's release."                                                                                                         
                                                                                                                                
     Page 25, line 8:                                                                                                           
          Delete "daily [WEEKLY]"                                                                                               
          Insert "weekly"                                                                                                       
                                                                                                                                
     Page 25, following line 23:                                                                                                
          Insert a new bill section to read:                                                                                    
          "*  Sec. 33. AS  17.30.200(b),  as amended by  sec.                                                                   
     32, of this Act, is amended to read:                                                                                       
               (b)    The   pharmacist-in-charge    of   each                                                                   
     licensed   or   registered  pharmacy,   regarding   each                                                                   
     schedule  II,  III,  or IV  controlled  substance  under                                                                   
     federal  law   dispensed  by  a  pharmacist   under  the                                                                   
     supervision  of   the  pharmacist-in-charge,   and  each                                                                   
     practitioner  who  directly  dispenses  a  schedule  II,                                                                   
     III,  or  IV  controlled  substance  under  federal  law                                                                   
     other than those  administered to a patient  at a health                                                                   
     care facility  or a  correctional facility, except  when                                                                   
     prescribing  opioids to  an inmate  at the  time of  the                                                                   
     inmate's  release,  shall  submit  to the  board,  by  a                                                                   
     procedure  and in  a format  established  by the  board,                                                                   
     the   following  information   for   inclusion  in   the                                                                   
     database on at least a daily [WEEKLY] basis:                                                                               
          (1)  the name of  the prescribing practitioner  and                                                                   
     the    practitioner's    federal     Drug    Enforcement                                                                   
     Administration    registration     number    or    other                                                                   
     appropriate identifier;                                                                                                    
          (2) the date of the prescription;                                                                                     
          (3) the  date the prescription  was filled  and the                                                                   
     method  of payment;  this paragraph  does not  authorize                                                                   
     the  board to include  individual credit  card or  other                                                                   
     account numbers in the database;                                                                                           
     (4) the name,  address, and date of birth  of the person                                                                   
     for whom the prescription was written;                                                                                     
     (5) the  name and national  drug code of the  controlled                                                                   
     substance;                                                                                                                 
     (6)  the   quantity  and  strength  of   the  controlled                                                                   
     substance dispensed;                                                                                                       
     (7)  the  name   of  the  drug  outlet   dispensing  the                                                                   
     controlled substance; and                                                                                                  
     (8)  the   name  of   the  pharmacist  or   practitioner                                                                   
     dispensing   the   controlled    substance   and   other                                                                   
     appropriate identifying information."                                                                                      
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 27, lines 21 - 25:                                                                                                    
          Delete all material and insert:                                                                                       
               "(e)  The  failure of  a  pharmacist-in-charge                                                                   
     or a [,]  pharmacist [, OR PRACTITIONER] to  register or                                                                   
     submit  information to  the database  as required  under                                                                   
     this  section   is  grounds   for  the  board   to  take                                                                   
     disciplinary    action    against   the    license    or                                                                   
     registration   of  the  pharmacy   or  pharmacist.   The                                                                   
     failure  of a  practitioner  to register  or review  the                                                                   
     database  as required  by this  section  is grounds  for                                                                   
     the practitioner's  [OR FOR ANOTHER] licensing  board to                                                                   
     take    disciplinary    action     against    the    [A]                                                                   
     practitioner."                                                                                                             
                                                                                                                                
     Page 29, line 23:                                                                                                          
          Delete all material and insert:                                                                                       
          "* Sec.  40. Sections 22,  24, 26, 28, 30,  32, 52,                                                                   
     and 73,  ch. 25, SLA 2016, are repealed."                                                                                  
                                                                                                                                
     Page 29, line 27:                                                                                                          
          Delete    "and   the   Department    of   Commerce,                                                                   
     Community, and      Economic Development"                                                                                  
     Page 29, following line 30:                                                                                                
          Insert a new subsection to read:                                                                                      
          "(b)  The Department  of  Commerce, Community,  and                                                                   
     Economic  Development  may adopt  regulations  necessary                                                                   
     to  implement   the  changes  made  by  this   Act.  The                                                                   
     regulations take  effect under AS 44.62  (Administrative                                                                   
     Procedure  Act), but  not before the  effective date  of                                                                   
     the relevant  provision of  this Act implemented  by the                                                                   
     regulation."                                                                                                               
                                                                                                                                
     Page 29, line 31:                                                                                                          
          Delete "(b)"                                                                                                          
          Insert "(c)"                                                                                                          
                                                                                                                                
     Page 30, line 3:                                                                                                           
          Delete "28"                                                                                                           
          Insert "30"                                                                                                           
                                                                                                                                
     Page 30, line 5:                                                                                                           
          Delete "28"                                                                                                           
          Insert "30"                                                                                                           
                                                                                                                                
     Page 30, line 6:                                                                                                           
          Delete all material and insert:                                                                                       
     "* Sec. 43.  Section 28 of this Act takes  effect on the                                                                   
     effective date of sec. 12, ch. 25, SLA 2016.                                                                               
     * Sec.  44. Section 31 of  this Act takes effect  on the                                                                   
     effective date of sec. 21, ch. 25, SLA 2016.                                                                               
                                                                                                                                
     * Sec.  45. Section 32 of  this Act takes effect  on the                                                                   
     effective date of sec. 23, ch. 25, SLA 2016.                                                                               
     * Sec.  46. Section 34 of  this Act takes effect  on the                                                                   
     effective date of sec. 25, ch. 25, SLA 2016.                                                                               
     * Sec.  47. Section 35 of  this Act takes effect  on the                                                                   
     effective date of sec. 27, ch. 25, SLA 2016.                                                                               
     * Sec.  48. Sections 36 and  37 of this Act  take effect                                                                   
     on the effective date of sec. 34, ch. 25, SLA 2016.                                                                        
     * Sec. 49. Sections  2, 3, 7 - 14, 19, 21,  24 - 26, 33,                                                                   
     and 38 of this Act take effect July 1, 2018.                                                                               
     * Sec.  50. Sections 1  and 40 of  this Act take  effect                                                                   
     July 1, 2019.                                                                                                              
     * Sec. 51.  Except as provided in secs. 43 -  50 of this                                                                   
     Act,  this   Act  takes  effect  immediately   under  AS                                                                   
     01.10.070(c)."                                                                                                             
                                                                                                                                
4:20:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD objected  to the motion  to adopt                                                              
Amendment 1, for the purpose of discussion.                                                                                     
                                                                                                                                
4:20:31 PM                                                                                                                    
                                                                                                                                
STACIE KRALY,  Chief Assistant Attorney General/Statewide  Section                                                              
Supervisor,  Human  Services  Section,  Civil  Division  (Juneau),                                                              
Department  of Law, offered  details related  to proposed  changes                                                              
to HB 159  under Amendment 1.   As shown in Amendment  1, she said                                                              
the first change  would be to the bill title  to include "relating                                                              
to the  practice of  pharmacy".   She explained  that many  of the                                                              
changes that  would be made under  the proposed Amendment  1 would                                                              
be technical  changes to add  something that  was not meant  to be                                                              
omitted.   Ms. Kraly  stated that  the second  change, on  page 2,                                                              
lines  2-3,  of  HB  159,  would  address  the  advance  directive                                                              
language  and  provide  that  the  commissioner  would  adopt  the                                                              
regulations.   She said another  change would  be on page  2, line                                                              
25,  and  provide   additional  immunity  for  a   prescriber  who                                                              
inadvertently administers  an opioid when a person  has an advance                                                              
directive "that's  been adopted  by this statute."   She  said the                                                              
next two changes,  on page 15, line 14 and [17],  were recommended                                                              
by the American  Cancer Association because it felt  that a person                                                              
may  need  opioid  pain  management  after  a  diagnosis,  so  the                                                              
language should not limit that to diagnosis.                                                                                    
                                                                                                                                
MS.  KRALY,  regarding  the  change   that  would  be  made  under                                                              
Amendment 1, on  page 16, following line 24, of  HB 159, explained                                                              
that  two  practitioners   had  been  omitted   inadvertently  for                                                              
purposes  of participation  in the  PDMP  and the  changes to  the                                                              
continuing  medical education  provisions.    The proposed  change                                                              
would correct  one of  those omissions,  address the inclusion  of                                                              
advanced  practice nurses,  and  make conforming  edits to  change                                                              
the  nomenclature as  was  changed in  legislation  last year  "to                                                              
make  sure that  we're talking  about advanced  practice nurses  -                                                              
registered nurses."   Ms.  Kraly pointed to  the changes  on pages                                                              
18,  lines  15  and  18, of  HB  159,  which  again  would  delete                                                              
"diagnosis"  to  broaden  the construct  for  the  exceptions  for                                                              
administering  opioids   to  include,  for   example,  post-cancer                                                              
treatment,  when a  diagnosis  has already  been  addressed.   She                                                              
next said that  the new section  proposed to be added  on page 19,                                                              
following  line 15,  addresses one  of  the omissions  advertently                                                              
made.     The   new  language   would   include  optometrists   in                                                              
participation  of PDMPs,  as  well as  in  the continuing  medical                                                              
education (CME) requirements.                                                                                                   
                                                                                                                                
MS.  KRALY said  the change  proposed to  page 23,  line 9,  would                                                              
mean that  a request  for a  prescription to  be partially  filled                                                              
would not void the prescription.                                                                                                
                                                                                                                                
4:26:45 PM                                                                                                                    
                                                                                                                                
DR.  BUTLER  added  that  this is  the  portion  of  the  proposed                                                              
amendment  about which  he  had previously  said  would align  the                                                              
language with CARA.                                                                                                             
                                                                                                                                
4:26:54 PM                                                                                                                    
                                                                                                                                
MS. KRALY moved  on to the change  that would be made  on page 24,                                                              
lines 20-29.   She explained that  this part of Amendment  1 would                                                              
relate to  when an opioid is  being prescribed, so the  PDMP would                                                              
apply to a prescription  issued to an inmate upon  release from [a                                                              
correctional facility].                                                                                                         
                                                                                                                                
4:27:58 PM                                                                                                                    
                                                                                                                                
DR. BUTLER noted  that this part of Amendment 1  also would update                                                              
language  to specify  this pertains  to schedule  II, III,  and IV                                                              
drugs.   He offered  his understanding that  the old  language had                                                              
included federal schedule I drugs, which are illegal substances.                                                                
                                                                                                                                
MS. KRALY  added that the language  [that would be Section  31] is                                                              
replacing Section 29.                                                                                                           
                                                                                                                                
MS. KRALY moved on  to the proposed change to page  25, line 8, to                                                              
reinstate a  requirement for certain  information to  be submitted                                                              
weekly  to "the  board."   She said  the plan  is to  stay with  a                                                              
weekly requirement for  one year, then go to daily.   She said the                                                              
change proposed for  language on page 25, line  23, also addresses                                                              
the  change from  daily  to  weekly.   She  admitted  it may  seem                                                              
confusing, but the  reason for the repetition is  for drafting and                                                              
effective date purposes.                                                                                                        
                                                                                                                                
MS. KRALY  directed attention to  the proposed change to  page 27,                                                              
lines 21-25.   She  explained the change  was requested  on behalf                                                              
of both  pharmacists and  prescribers, and  it would clarify  that                                                              
pharmacists  must register  with the PDMP  and submit  information                                                              
on  the PDMP,  whereas  a  prescriber  registers and  reviews  the                                                              
PDMP.                                                                                                                           
                                                                                                                                
4:30:58 PM                                                                                                                    
                                                                                                                                
MS.  KRALY said  Amendment 1  proposes technical  changes on  page                                                              
29, line  23, regarding  a delayed effective  date and  the timing                                                              
of  repeals.    She  stated  that  the  purpose  of  the  deletion                                                              
proposed on  page 29, line 27  and the insertion proposed  on page                                                              
29,  following  line  30  is to  ensure  that  the  Department  of                                                              
Commerce,   Community   &   Economic   Development   (DCCED)   has                                                              
sufficient time  to draft regulations  that will  become effective                                                              
"upon adoption of  future effective dates."  In  other words, this                                                              
transitional  language would  allow DCCED  to continue working  on                                                              
regulations, even  though certain provisions  of the bill  are not                                                              
effective.     In  response  to   Chair  Spohnholz,   she  offered                                                              
clarification as to  the numbering in this portion  of the bill as                                                              
it would be amended  by Amendment 1.  She said,  "When you have it                                                              
all in there, it'll make sense."                                                                                                
                                                                                                                                
MS. KRALY  next talked  about the effective  date sections  of the                                                              
bill, Sections 43-48,  all of which she said  relate to conforming                                                              
edits  and changes  that need  to be made  as a  result of  Senate                                                              
Bill 74  "and the  rolling effective  dates of  how the  PDMP will                                                              
operate."   She said it is  important to coordinate  the effective                                                              
dates so  that "everybody's going  into effect at the  same time."                                                              
She said  Section 49 would  provide an  effective date of  July 1,                                                              
2018, and  this would  deal with the  changes to the  occupational                                                              
licensing  boards,  as to  the CMEs  and  the  obligations of  the                                                              
boards to  implement changes  for participation  in the  PDMP, "so                                                              
that they all apply  at the same time."  Section  50 would provide                                                              
an effective  date of  July 1, 2019,  to Sections  1 and 40  of HB                                                              
159, which  deal with  the opioid advance  directive.   Section 51                                                              
addresses everything  else in the  bill and gives it  an immediate                                                              
effective date.                                                                                                                 
                                                                                                                                
4:36:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN asked  about  the aforementioned  proposed                                                              
exemption  that  would  result  in  not  collecting  date  from  a                                                              
correctional facility, except at the end of the inmate's term.                                                                  
                                                                                                                                
MS. KRALY  explained that  the purpose  of having  the PDMP  is to                                                              
ensure  that  people are  not  "doctor  shopping" or  being  over-                                                              
prescribed,  and  since  a correctional  facility  is  a  confined                                                              
environment,  the  purpose  of  the  PDMP  is  lost,  because  the                                                              
facility  is   a  controlled  environment.     When   inmates  are                                                              
released, they are  no longer in that controlled  environment, and                                                              
when they  are given  a prescription, that  information is  in the                                                              
PDMP,  so   that  when  they   visit  a   doctor  or  pick   up  a                                                              
prescription,  the provider  or pharmacist  knows how recently  an                                                              
opioid prescription has been given.                                                                                             
                                                                                                                                
REPRESENTATIVE   EASTMAN  suggested  the   need  to   compare  the                                                              
prescribing  habits of a  provider in  a correctional  facility to                                                              
that of his/her peers.                                                                                                          
                                                                                                                                
4:40:04 PM                                                                                                                    
                                                                                                                                
DR.  BUTLER replied,  "A lot  of the  focus is  on the  outpatient                                                              
use."   He said  that looking back  at the  history of  the opioid                                                              
epidemic, one  of the  original reviews of  the risk  of addiction                                                              
and  substance misuse  was based  on an  analysis of  hospitalized                                                              
patients and  showed that  the risk of  "problem use"  after being                                                              
administered an  opioid after  hospitalization was extremely  low.                                                              
Unfortunately, he  said, those data were misapplied  to outpatient                                                              
settings.   He said  he thinks it  is still fair  to say  that the                                                              
risk   is   low   in   the  setting   of   a   patient   that   is                                                              
institutionalized,  which is  one reason  why, when  a patient  is                                                              
being prepared  for release,  "if there's going  to be ...  a drug                                                              
taken with  them when they leave  the institution, as  a discharge                                                              
medication, we would definitely want visibility on that."                                                                       
                                                                                                                                
4:41:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOHNSTON referred  to advance practice  registered                                                              
nurses,  and  she  said  that  made   her  think  about  physician                                                              
assistants.  She  surmised that may be part of the  title with the                                                              
practice  of medicine,  but said  she wondered  how that might  be                                                              
addressed.                                                                                                                      
                                                                                                                                
DR. BUTLER  responded that physician  assistants are  included and                                                              
are  regulated  under  the  [Alaska  State]  Medical  Board.    In                                                              
response to a  follow-up question, he confirmed  that is different                                                              
from the [Alaska Board of] Nursing.                                                                                             
                                                                                                                                
4:42:41 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
4:43:29 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ  asked  Representative  Sullivan-Leonard  if  she                                                              
maintained her objection to the motion to adopt Amendment 1.                                                                    
                                                                                                                                
4:43:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  removed  her objection.    There                                                              
being no further objection, Amendment 1 was adopted.                                                                            
                                                                                                                                
4:43:50 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ [opened public testimony on HB 159].                                                                            
                                                                                                                                
4:43:53 PM                                                                                                                    
                                                                                                                                
JOSHUA  STREAM, M.D.,  Providence  Alaska  Medical Center  (PAMC),                                                              
stated that he  is an anesthesiologist, who is  fellowship trained                                                              
in acute pain management  and is the chair of the  Pain Management                                                              
Council   at  PAMC.     He  related   that  the   council   is  an                                                              
interdisciplinary  group  comprising medical  providers,  clinical                                                              
leaders,  and  administrators  all  dedicated  to  improving  pain                                                              
management  for the  benefit of  PAMC's patients.   He  emphasized                                                              
his  support  of  HB  159,  especially   its  proposal  of  opioid                                                              
dispensing limits and provider education.                                                                                       
                                                                                                                                
DR. STREAM  said during his  experience working with  patients and                                                              
providers  of  every  specialty  he has  seen  inappropriate  pain                                                              
management daily, which  results in patients being hurt.   He said                                                              
the  mismanagement almost  always involves  the over  prescription                                                              
of and  overreliance on  opioids, which is  a huge patient  safety                                                              
issue.    He  explained  that  beyond  addiction  and  dependence,                                                              
opioids  have many  acute  side effects  that  result in  hospital                                                              
readmission,  poor   pain  control,  "and  everything   else  that                                                              
entails."   Dr.  Stream  said this  mismanagement  occurs both  in                                                              
hospitals and in the community.                                                                                                 
                                                                                                                                
DR. STREAM  said he  has spent  years committing  his practice  to                                                              
provider education  regarding safe and effective  pain management,                                                              
because "a lot of  providers seem to be stuck in  a different sort                                                              
of  practice  from  decades  past," which  he  explained  was  the                                                              
reason  the council  was  created  in 2015.    Over  the past  two                                                              
years,  he  related, the  council  has  spearheaded  comprehensive                                                              
efforts in provider  education that have had a  dramatic impact on                                                              
prescribing  practices.  One  result has  been the improvement  of                                                              
pain management  in PAMC  over the  past year  or so, with  people                                                              
less  dependent  on  opioids  across  all  specialties,  including                                                              
pediatrics,  surgery,   internal  medicine,   emergency  medicine,                                                              
urology, obstetrics and gynecology, and orthopedics.                                                                            
                                                                                                                                
DR.  STREAM  stated  that  ensuring   consistent  and  appropriate                                                              
education for providers  outside PAMC has been a  struggle, and HB                                                              
159  would open  the door  to achieving  that  goal.   He said  he                                                              
thinks  it is  appropriate to  address  the patient's  perspective                                                              
with  support and  treatment for  opioid  addiction and  recovery,                                                              
but he opined that  would only be a Band-Aid over  what he sees as                                                              
the  real issue:   the  lack of  provider education.   Dr.  Stream                                                              
stated,  "We  need  to stem  the  tide  of  inappropriate  opioids                                                              
flooding  through our pharmacies  and into  the patients'  bodies,                                                              
and  the only  way  to  do this  is  by mandating  and  overseeing                                                              
provider education  to ensure  the best,  safest outcomes  for all                                                              
patients  in Alaska,  not  just those  that  happen to  be at  our                                                              
hospital."   He posited that as  it is medical  professionals that                                                              
helped  to  create   the  current  opioid  crisis,   it  is  their                                                              
responsibility  to help "turn  it around," and  HB 159 is  "a step                                                              
in the right direction."                                                                                                        
                                                                                                                                
4:46:41 PM                                                                                                                    
                                                                                                                                
MICHAEL  CARSON, Chair,  Mat-Su  Opioid Task  Force, testified  in                                                              
support of  HB 159.  He reported  that 80 percent of  heroin users                                                              
started  with opioid  use;  75 percent  of  those individuals  got                                                              
those  pills  from  grandparents,  parents, or  friends  or  stole                                                              
them.   He suggested  the state  look at  a program, called  "Mind                                                              
Your  Meds,"  which he  said  would  "cut  the  spigot off."    He                                                              
informed  the  committee  that  heroin is  now  being  mixed  with                                                              
fentanyl, the latter  of which is 50-100 times  more powerful than                                                              
morphine.    He said  the  newest  data,  as  of March  18,  2017,                                                              
published from  the Medical Science  Department of  the University                                                              
of  Arkansas, concludes  that an  initial  10-day prescription  of                                                              
pain medication  can translate  to one  in five patients  becoming                                                              
long-term  users.   He  said, "Dr.  Martin's  last statement  with                                                              
that conclusion  was we ... didn't  really expect that."   He said                                                              
addiction  is powerful  and deadly:   90 people  die of  overdoses                                                              
every day,  nationally.   He said consumers  of medicine,  as well                                                              
as  all people  in the  medical  field, need  to be  aware of  the                                                              
addiction  potential of  pain  medication.   He  related that  the                                                              
Mat-Su Opioid  Task Force  is in  full support of  HB 159  and all                                                              
the amendments that have been addressed.                                                                                        
                                                                                                                                
4:49:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  asked  how  there  could  be  a  partnership                                                              
between task forces such as Mr. Carson chairs and legislators.                                                                  
                                                                                                                                
MR. CARSON responded  that the Mat-Su Opioid Task  Force meets the                                                              
first Tuesday  of each  month, and Dr.  Butler will  be presenting                                                              
at the  next meeting.   He  mentioned that  his task force,  along                                                              
with  another, and  Dr. Butler  had a  conversation with  Governor                                                              
Bill Walker.   He said the  information [related to HB  159] would                                                              
be  presented at  the next  task force  meeting.   He stated,  "We                                                              
will  do whatever  it takes  to get  this information  out and  be                                                              
able to provide  the information for our community."   He said the                                                              
task force  has identified  five top priorities,  and one  of them                                                              
is  prevention.    He  said  the  task  force  is  hoping  to  get                                                              
information out  to schools and  to engage civic groups,  in order                                                              
to have "all  the stakeholders at the  table to be able  to find a                                                              
solution to this plague."                                                                                                       
                                                                                                                                
REPRESENTATIVE  TARR  said she  would  welcome hearing  any  ideas                                                              
that come out of  the next task force meeting.   She said the bill                                                              
focuses  heavily   on  "the  prescription  side   of  things"  and                                                              
"removing  the supply,"  but she  said she thinks  groups  such as                                                              
the Mat-Su Opioid  Task Force are more in touch  with the families                                                              
and people affected [by opioid addiction].                                                                                      
                                                                                                                                
MR.  CARSON said  the task  force just  launched a  new web  site,                                                              
matsuopiatetaskforce.com,  which provides  a resource list  of all                                                              
Southcentral  Alaska providers.   A  future plan  is to develop  a                                                              
page on  the web  site that  would list  all nonclinical  support.                                                              
He  announced  that Anchorage  would  have  its first  task  force                                                              
meeting on  4/11/17.   He indicated the  Mat-Su Opioid  Task Force                                                              
has reached out  to Bristol Bay, and Copper River  Valley has been                                                              
in contact  with Mr.  Carson's task force.   He invited  committee                                                              
members  to reach  out through  the  web site,  including to  give                                                              
feedback or ask questions.                                                                                                      
                                                                                                                                
4:53:26 PM                                                                                                                    
                                                                                                                                
CHRISTINA LOVE,  Community Resources Coordinator, Aiding  Women in                                                              
Abuse  and Rape Emergencies  (AWARE  Inc.), stated  that she  is a                                                              
person in long-term  recovery from use of intravenous  (IV) heroin                                                              
and  other mind  altering substances.    She related  that in  her                                                              
capacity  as  resources  coordinator,  she works  with  women  and                                                              
children that  have been  physically and  sexually harmed;  she is                                                              
the disability response  team coordinator for Juneau;  and she was                                                              
on the opioid  task force.   She stated strong agreement  with the                                                              
nonopioid  directive,  rational  pain  management  practices,  and                                                              
continuing  care education  for  prescribers.   She  said she  has                                                              
been thinking  of her own experience  and that of the  people with                                                              
whom she  works, all  the various prescribers  in Alaska,  and the                                                              
powerful idea that  "right now, someone is being  overprescribed -                                                              
right this very  moment."  She said this includes  not being given                                                              
the necessary information by a prescriber.                                                                                      
                                                                                                                                
MS.  LOVE  named  several  medical   institutions  in  Alaska  and                                                              
indicated that  each has a  file on her  that highlights  that she                                                              
is allergic  to opioids  and, if  she were to  be given  them, she                                                              
would die.   She clarified  that she has  painted a  clear picture                                                              
for every  doctor and nurse  with whom  she has come  into contact                                                              
describing  what  her  life  looked  like  prior  to  coming  into                                                              
recovery.   She said when she was  using, she could not  even lift                                                              
her arms,  because of the  many track marks;  she was  on multiple                                                              
drugs; she  was living  on the  street; her  life had  no meaning;                                                              
she  tried to  end her  life several  times with  overdoses.   She                                                              
continued as follows:                                                                                                           
                                                                                                                                
     And coming into  recovery, even with that  picture, when                                                                   
     I had  my daughter in 2003,  I had to over and  over and                                                                   
     over tell  them that I could  not have opioids.   When I                                                                   
     sprained  my ankle,  they tried  to  give me  a shot  of                                                                   
     Dilaudid,  and I  had to  tell  them over  and over  and                                                                   
     over.   When  I had  my wisdom  teeth pulled,  I had  to                                                                   
     tell  them over  and over  and over  that "I  may be  in                                                                   
     discomfort, I  may be in pain,  but I will not  die, you                                                                   
     know?"   And  so,  they would  tell  me something  like,                                                                   
     "Well,  I'm going  to leave  it up to  pharmacy for  you                                                                   
     anyway, in case  you want it."  And I had  to explain to                                                                   
     them again,  "I am  strong enough today  to say  no, but                                                                   
     ... maybe  tomorrow looks  totally different,"  but say,                                                                   
     "this  is a lifelong  illness  for me, and  it does  not                                                                   
     always  mean that I  will be  as strong  as I am  today;                                                                   
     and if I were  to relapse, that is exactly  what my life                                                                   
     would look like."                                                                                                          
                                                                                                                                
MS. LOVE  said she  has seen  this happen  a hundred times,  where                                                              
people  she works  with  or loved  ones  that  have had,  perhaps,                                                              
three years  of recovery, "went  in for the same  dental procedure                                                              
that I  have, and  they have not  made it  back."  She  emphasized                                                              
that the  importance of  HB 159  is one  of life  and death.   She                                                              
described  the  beginning  of  her   addiction  as  when  she  was                                                              
prescribed oxycodone  following knee surgery.  She  said, "It lead                                                              
to a  place of  unspeakable horrors  ..., and I  never want  to be                                                              
back there  again."   She said she  wants the  right to  have that                                                              
information in  her file so that  she does not have  to repeatedly                                                              
have that conversation.                                                                                                         
                                                                                                                                
MS. LOVE  said there are many  wonderful providers.  She  said she                                                              
spent  the  last four  years  of  her recovery  educating  herself                                                              
about  addiction  and recovery,  and  she  still  has so  much  to                                                              
learn.  She  stated that she  cannot even imagine giving  a health                                                              
care provider  all the information  he/she would need in  just two                                                              
hours.   She  thanked  the committee  for  considering the  issue,                                                              
giving her the opportunity to testify, and for HB 159.                                                                          
                                                                                                                                
4:57:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  remarked that after  listening to                                                              
Ms. Love's  testimony, it  seems as if  health care  providers are                                                              
focused solely  on opioids  for pain relief.   She asked  Ms. Love                                                              
if  she was  ever offered  anything else  for the  relief of  pain                                                              
besides opioids.                                                                                                                
                                                                                                                                
MS. LOVE  answered no.   She  said, "We  had thought about  making                                                              
... a  safety plan."   She  explained that  when her daughter  was                                                              
born, there were  many complications, and she had  to have someone                                                              
come  stay with  her to  dole out  her medications  as needed  and                                                              
then discard the  rest.  Now that she has read  more on the issue,                                                              
she is aware  of alternative options,  but she had not  been aware                                                              
of them when her  daughter was born, and she had  been in recovery                                                              
for one year.   She indicated that [the alternatives]  she knows a                                                              
lot more about now would have been wonderful options then.                                                                      
                                                                                                                                
4:58:43 PM                                                                                                                    
                                                                                                                                
KARA  NELSON, Director,  Haven  House, testified  that  she is  in                                                              
long-term  recovery  and has  not  taken a  drink  or drugs  since                                                              
2011, on  the day she was  released from Lemon  Creek Correctional                                                              
Center.    She  said  Haven  House   is  a  faith-based,  peer-led                                                              
recovery house  for women  coming home  after incarceration.   She                                                              
said she  works often with  Ms. Love, as  well as with  many other                                                              
women and men  in the community.   She stated that she  is in full                                                              
support   of  HB   159,  particularly   the  voluntary   nonopioid                                                              
directive.   She related  having had  a difficult time  expressing                                                              
an  opposing view  to  a doctor  treating  her  daughter, who  she                                                              
described as having  some issues related to recovery.   Ms. Nelson                                                              
talked about a woman  from Haven House that had  been in recovery,                                                              
went to  the dentist, was prescribed  opioids by her  dentist, who                                                              
wanted  her to  have  them  just in  case  she needed  them,  even                                                              
though she had explained  her addiction and need to  not have them                                                              
prescribed.   The woman ended up  taking the opioids and  within a                                                              
couple days  was shooting heroin,  but luckily came to  Ms. Nelson                                                              
for help.   Ms. Nelson said  those just beginning  recovery cannot                                                              
face making a decision  [about opioid use for pain],  and she said                                                              
in  the  woman's case,  "that  could  have  been avoided  in  that                                                              
moment."   Ms.  Nelson indicated  that although  her doctors  know                                                              
that she  is in  recovery, she  has been  offered medication  that                                                              
would not  be in support  of her  recovery.  She  said she  has to                                                              
repeatedly  remind her  doctors.   She  indicated  that while  she                                                              
supports the  education piece  proposed under  HB 159,  she thinks                                                              
two hours  of training  within two  years of  a renewal  is "super                                                              
minimal" when considering [the enormity of the issue].                                                                          
                                                                                                                                
MS. NELSON echoed  Ms. Love's remark that there  are many educated                                                              
providers that  have the  best intention.   She said  the recovery                                                              
environment  is changing  at a rapid  pace, in  terms of  recovery                                                              
communities, addiction,  and available information.   She said she                                                              
has  to  keep up  [with  the  information]  daily, so  she  cannot                                                              
imagine going  to school to be  a doctor, coming back  years later                                                              
to  get updates  on best  practices.   Ms.  Nelson concluded,  "We                                                              
have  249 million  prescriptions  that  were prescribed  in  2013;                                                              
that's  every single  ... adult  in the United  States of  America                                                              
with a  bottle of  prescribed opioids."   She  asserted that  that                                                              
statistic is  crazy, and she  said HB 159  is one tool  that could                                                              
"bring health and wellness to our people."                                                                                      
                                                                                                                                
5:03:53 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ  expressed appreciation  to  Ms.  Nelson and  Ms.                                                              
Love for sharing  their personal experiences in  recovery to shine                                                              
light on a subject that is "complicated, challenging, often                                                                     
intractable for many, and yet completely preventable."                                                                          
                                                                                                                                
5:04:17 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that public testimony would be left                                                                   
open and HB 159 is held over.                                                                                                   
                                                                                                                                
5:04:39 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health and Social Services Standing Committee meeting was                                                                       
adjourned at 5:05 p.m.                                                                                                          

Document Name Date/Time Subjects
HB 159 Sectional Analysis ver A 3.6.17.pdf HHSS 3/18/2017 3:00:00 PM
HHSS 3/25/2017 3:00:00 PM
HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 159
HB0159 ver A 3.6.17.pdf HHSS 3/18/2017 3:00:00 PM
HHSS 3/25/2017 3:00:00 PM
HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 159
HB159 Fiscal Note DHSS-PHAS 3.6.17.pdf HHSS 3/18/2017 3:00:00 PM
HHSS 3/25/2017 3:00:00 PM
HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 159
HB159 Sponsor Statement 3.6.17.pdf HHSS 3/18/2017 3:00:00 PM
HHSS 3/25/2017 3:00:00 PM
HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 159
HB159 Supporting Document - Letter from Alaska Dental Society.pdf HHSS 3/25/2017 3:00:00 PM
HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 159
HB159 Supporting Document - PDMP side by side comparison 3.23.17.pdf HHSS 3/25/2017 3:00:00 PM
HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 159
HB159 Supporting Document - Opioid Bill FAQ 3.23.17.pdf HHSS 3/25/2017 3:00:00 PM
HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 159
HB 159 Governor's Amendment.pdf HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 159
HB 186 Fiscal Note DEC--EH 3.24.17.pdf HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HB 186
HB 186 Sponsor Statement 3.20.17.pdf HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HB 186
HB 186 Support Letter - Fairbanks Community Food Bank 3.20.17.pdf HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HB 186
HB 186 Sectional Analysis ver J 3.20.17.pdf HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HB 186
HB 186 Supporting Documents - Feeding America Alaska Stats 3.20.17.pdf HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HB 186
HB 186 Ver J 3.20.17.pdf HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HB 186
HB100 Supporting Document-Support Letter Honor for All 2.6.17.pdf HHSS 3/30/2017 3:00:00 PM
HB 100
House Bill 100 ver A.pdf HHSS 3/30/2017 3:00:00 PM
HB 100
HB100 Supporting Document-PTSD Factsheet 2.23.17.pdf HHSS 3/30/2017 3:00:00 PM
HB 100
HB100 Fiscal Note DOA--SSA 3.24.17.pdf HHSS 3/30/2017 3:00:00 PM
HB 100
HB100 Sponsor Statement 2.23.17.pdf HHSS 3/30/2017 3:00:00 PM
HB 100
HB164 Sponsor Statement - Governor's Transmittal Letter.pdf HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HB 164
HB164 Sectional Analysis.pdf HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HB 164
HB164 ver A.PDF HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HB 164
HB164 Fiscal Note-DHSS-SDSA-1-20-17.PDF HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HB 164
HB164 Fiscal Note-DOR-OLTCO-1-20-17.PDF HHSS 3/30/2017 3:00:00 PM
HHSS 4/4/2017 3:00:00 PM
HB 164