Legislature(2017 - 2018)CAPITOL 106

05/09/2017 03:00 PM HEALTH & SOCIAL SERVICES

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Audio Topic
03:02:53 PM Start
03:03:29 PM HB215
03:48:53 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= HB 215 DHSS: PUBLIC HEALTH FEES TELECONFERENCED
Moved CSHB 215(HSS) Out of Committee
-- Public Testimony --
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                          May 9, 2017                                                                                           
                           3:02 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Ivy Spohnholz, Chair                                                                                             
Representative Bryce Edgmon, Vice Chair                                                                                         
Representative Sam Kito                                                                                                         
Representative David Eastman                                                                                                    
Representative Jennifer Johnston                                                                                                
Representative Colleen Sullivan-Leonard                                                                                         
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Geran Tarr                                                                                                       
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 215                                                                                                              
"An Act relating to program receipts; and relating to fees for                                                                  
services provided by the Department of Health and Social                                                                        
Services."                                                                                                                      
                                                                                                                                
     - MOVED CSHB 215(HSS) OUT OF COMMITTEE                                                                                     
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 215                                                                                                                  
SHORT TITLE: DHSS: PUBLIC HEALTH FEES                                                                                           
SPONSOR(s): FINANCE                                                                                                             
                                                                                                                                
04/07/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
04/07/17       (H)       HSS, FIN                                                                                               
04/18/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/18/17       (H)       Heard & Held                                                                                           
04/18/17       (H)       MINUTE(HSS)                                                                                            
04/20/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/20/17       (H)       -- MEETING CANCELED --                                                                                 
04/25/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/25/17       (H)       -- MEETING CANCELED --                                                                                 
05/09/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
JENNY MARTIN, Staff                                                                                                             
Representative Paul Seaton                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   During  the  hearing  of HB  215,  offered                                                             
testimony and answered questions.                                                                                               
                                                                                                                                
JILL LEWIS, Deputy Director                                                                                                     
Division of Public Health                                                                                                       
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   During  the  hearing  of HB  215,  offered                                                             
testimony and answered questions.                                                                                               
                                                                                                                                
JEANNIE MONK, Vice President                                                                                                    
Policy and Programs                                                                                                             
Alaska State Hospital and Nursing Home Association (ASHNHA)                                                                     
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 215.                                                                       
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:02:53 PM                                                                                                                    
                                                                                                                                
CHAIR IVY SPOHNHOLZ  called the House Health  and Social Services                                                             
Standing   Committee    meeting   to    order   at    3:02   p.m.                                                               
Representatives   Spohnholz,  Eastman,   Kito,  Sullivan-Leonard,                                                               
Edgmon, and Johnston were present at the call to order.                                                                         
                                                                                                                                
                HB 215-DHSS: PUBLIC HEALTH FEES                                                                             
                                                                                                                                
3:03:29 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced  that the only order  of business would                                                               
be HOUSE BILL NO. 215, "An  Act relating to program receipts; and                                                               
relating  to fees  for  services provided  by  the Department  of                                                               
Health and Social Services."                                                                                                    
                                                                                                                                
3:04:09 PM                                                                                                                    
                                                                                                                                
JENNY  MARTIN, Staff,  Representative Paul  Seaton, Alaska  State                                                               
Legislature, explained  that the  proposed bill  came out  of the                                                               
subcommittee  process,  when  indirect expenditure  reports  were                                                               
reviewed,  as  ways for  the  departments  to become  more  self-                                                               
sufficient.  One  of these suggestions had been  to consider that                                                               
public health  centers charge fees  not previously allowed.   She                                                               
shared that  further discussions with  the Department of  Law and                                                               
the Division of Public Health [Department of Health and Social                                                                  
Services] had recognized that the proposed bill was somewhat                                                                    
limiting, and she asked to explain the proposed amendment.                                                                      
                                                                                                                                
3:05:22 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ moved to adopt Amendment 1, labeled 30-                                                                         
LS0673\D.3, Glover, 5/4/17, which read:                                                                                         
                                                                                                                                
     Page 1, lines 5 - 6:                                                                                                       
          Delete all material and insert:                                                                                       
               "(90)  the  following fees, receipts, income,                                                                    
     and monetary recoveries collected  by the Department of                                                                    
     Health and Social Services:                                                                                                
               (A)   receipts  of the  Department of  Health                                                                    
     and Social Services, Bureau of Vital Statistics;                                                                           
               (B)      monetary  recoveries   of   Medicaid                                                                    
     expenditures  from   recipients,  third   parties,  and                                                                    
     providers under AS 47;                                                                                                     
               (C)    the   state's  share  of  overpayments                                                                    
     collected under AS 47.05.080;                                                                                              
               (D) income  received from a state  or federal                                                                    
     agency for children in foster care under AS 47.14.100;                                                                     
               (E)     fees  received  or   collected  under                                                                    
     AS 44.29.022   for   nursing  and   planning   services                                                                    
     provided at  health centers, genetic  screening clinics                                                                    
     and  specialty  clinics,  the  certification  of  x-ray                                                                    
     machines, the Alcohol Safety  Action Program, and other                                                                    
     public health programs and services;                                                                                       
               (F)   fees  received  under AS 18.08.080  for                                                                    
     the  certification  of emergency  medical  technicians,                                                                    
     emergency  medical dispatchers,  and emergency  medical                                                                    
     technician instructors;                                                                                                    
               (G)  fees received under AS 47.32;                                                                               
               (H)    the  state's share  of  child  support                                                                    
     collections  for  reimbursement  of  the  cost  of  the                                                                    
     Alaska temporary  assistance program as  provided under                                                                    
     AS 25.27.120, 25.27.130, and AS 47.27.040; and                                                                             
               (I)    monetary   recoveries  under  AS 09.58                                                                    
     (Alaska  Medical Assistance  False Claim  and Reporting                                                                    
     Act)."                                                                                                                     
                                                                                                                                
     Page 1, line 10:                                                                                                           
          Delete "AS 44.29.020(a)(1) - (8)"                                                                                     
          Insert "AS 44.29.020(a)(1) - (8) and (14)                                                                         
     [AS 44.29.020(a)(1) - (8)]"                                                                                                
                                                                                                                                
     Page 1, line 12:                                                                                                           
          Delete "AS 18.05.010"                                                                                             
          Insert "AS 18"                                                                                                    
                                                                                                                                
     Page 2, following line 3:                                                                                                  
     Insert a new bill section to read:                                                                                         
        "*  Sec.  3. AS 37.05.146(c)(42),  37.05.146(c)(59),                                                                
     37.05.146(c)(60),  37.05.146(c)(61),  37.05.146(c)(62),                                                                    
     37.05.146(c)(63),  37.05.146(c)(64),  37.05.146(c)(65),                                                                    
     37.05.146(c)(66),  37.05.146(c)(67),  37.05.146(c)(71),                                                                    
     and 37.05.146(c)(88) are repealed."                                                                                        
                                                                                                                                
REPRESENTATIVE EDGMON objected for discussion.                                                                                  
                                                                                                                                
3:05:41 PM                                                                                                                    
                                                                                                                                
MS. MARTIN paraphrased from the Amendment D.3 statement                                                                         
[included in members' packets], which read as follows [original                                                                 
punctuation provided]:                                                                                                          
                                                                                                                                
     After clarification  with the Dept. of  Health & Social                                                                    
     Services  (DHSS)  and  the Department  of  Law  it  was                                                                    
     determined  that  only  listing AS  18.05.010  (as  the                                                                    
     services  for   which  DHSS  could  create   fees)  was                                                                    
     limiting for public health. AS  18.05.010 is limited to                                                                    
     DHSS duties under  AS 18.05, 18.09, and  AS 18.15.355                                                                      
     18.15.395,  but   public  health   provides  additional                                                                    
     services under  other areas of  AS 18. For  example, if                                                                    
     public health  were to  get a  request to  provide data                                                                    
     collection services  under AS 18.08  (Emergency Medical                                                                    
     Services), they  would not be  able to charge  fees for                                                                    
     that service. This amendment corrects this issue.                                                                          
                                                                                                                                
     Amendment  page  1, line  1-23  to  page 2,  line  1-2:                                                                
     changes how public health is  listed under AS 37.05.146                                                                  
     (c)  AS  37.05.146  (c)  is   the  definition  list  of                                                                  
     designated  general  fund  program  receipts  and  non-                                                                    
     general fund  program receipts  that are  accounted for                                                                    
     separately,  and  appropriations   from  these  program                                                                    
     receipts  are not  made from  the unrestricted  general                                                                    
     fund. In HB215  ver D, public health  programs under AS                                                                    
     18.05.010 were  added to the  list as number  (90). For                                                                    
     reasons noted  above, this  amendment broadens  (90) by                                                                    
     replacing  AS  18.05.010   with  the  language:  "other                                                                    
     public  health programs  and services"  (Amendment-line                                                                    
     16).  Note: the  specific  public  health programs  and                                                                    
     services  for   which  DHSS  may  establish   fees  are                                                                    
     specified under AS 44.29.022 (a).                                                                                          
                                                                                                                                
     In  addition,  because  the  list  under  (c)  includes                                                                    
     programs and  services from many  different departments                                                                    
     it  was  determined  that the  statute  could  be  made                                                                    
     clearer  by  consolidating   other  DHSS  programs  and                                                                    
     services along with public health  under (90). From the                                                                    
     current  list  of  89 program  receipts  the  following                                                                    
     would move under (90):                                                                                                     
                                                                                                                                
     ? current #42 would become (90) (A)                                                                                        
     ? #59 becomes (B)                                                                                                          
     ? #60 becomes (C)                                                                                                          
     ? #61 becomes (D)                                                                                                          
     ? #62, 63,65, 66 becomes (E)                                                                                               
     ? #64 becomes (F)                                                                                                          
     ? #67 is now (G)                                                                                                           
     ? #71 is now (H)                                                                                                           
     ? #88 is now (I)                                                                                                           
                                                                                                                                
     Amendment page  2, line 4-6: adds  AS 44.29.020 (a)(14)                                                                
     to AS  44.29.022 (a) Fees for  department services This                                                                  
     will allow  public health the option  to establish fees                                                                    
     for  services  and  programs it  provides  through  its                                                                    
     tobacco control programs under AS44.29.020(a)(14).                                                                         
                                                                                                                                
     Amendment  page 2,  line  8-10:  replaces AS  18.05.010                                                                
     with   AS  18   under  AS   44.29.022  (a)   As  stated                                                                  
     previously,   only  listing   AS  18.05.010   under  AS                                                                    
     44.29.022 (a)  was limiting and  did not  encompass all                                                                    
     the public  health services that DHSS  provides and for                                                                    
     which they  could develop fees.  While there  are other                                                                    
     departments also  listed within  AS 18,  language under                                                                    
     AS 44.29.022  (a) states that the  commissioner of DHSS                                                                    
     may only establish fees for  services listed under this                                                                    
     statute that are provided by DHSS.                                                                                         
                                                                                                                                
     Amendment page 2, line 12-16:  repeals statues moved to                                                                
     new subsection  AS 37.05.146 (c)  (90) As  noted above,                                                                  
     these   statues  were   moved   under   (90)  to   help                                                                    
     consolidate DHSS programs under one subsection.                                                                            
                                                                                                                                
3:11:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN asked how the fees would be worked out                                                                   
for the tobacco control programs.                                                                                               
                                                                                                                                
3:11:33 PM                                                                                                                    
                                                                                                                                
JILL  LEWIS,   Deputy  Director,   Division  of   Public  Health,                                                               
Department of  Health and  Social Services,  stated that  much of                                                               
what had been done in the  way of prevention activities would not                                                               
have charged fees.  She  suggested that services through Alaska's                                                               
Tobacco  Quit Line,  including  nicotine  patches and  counseling                                                               
services which were currently not  charging fees, could have fees                                                               
for the  services, which  would allow  for additional  funding to                                                               
increase the services.                                                                                                          
                                                                                                                                
3:12:42 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ asked if the  department could bill insurance, or                                                               
would an individual have to bill  their own insurance.  She noted                                                               
that many insurance plans covered tobacco cessation.                                                                            
                                                                                                                                
MS. LEWIS, in response, said that  as the department did not have                                                               
the volume  to set up a  third-party billing system, it  would be                                                               
cost  prohibitive.   She explained  that the  patient was  billed                                                               
with first party  billing, and then patient would  send the claim                                                               
to  the insurance  company  for reimbursement.    She noted  that                                                               
although the  Tobacco Quit Line  was an administrative  cost, any                                                               
extra service  would free up funding  because it could then  be a                                                               
first party billing.                                                                                                            
                                                                                                                                
3:14:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EDGMON removed  his  objection.   There being  no                                                               
further objection, Amendment 1 was adopted.                                                                                     
                                                                                                                                
3:14:37 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened public testimony on HB 215.                                                                              
                                                                                                                                
3:14:52 PM                                                                                                                    
                                                                                                                                
JEANNIE MONK,  Vice President, Policy and  Programs, Alaska State                                                               
Hospital  and  Nursing  Home  Association  (ASHNHA),  shared  the                                                               
ASHNHA  concerns for  the  proposed bill.    They recognized  the                                                               
serious budget  situation facing Alaska  and the need to  look to                                                               
all sides  for revenue to  support state services.   They believe                                                               
it is  appropriate for the  Division of Public Health  to explore                                                               
when it is  possible to charges fees for services  provided.  She                                                               
expressed  her support  for the  proposed amendment  to put  fees                                                               
into designated  funds which  then go  back into  those programs.                                                               
She expressed  concern about  the broad  latitude being  given to                                                               
the  Division  around regulatory  compliance  as  it allowed  the                                                               
Division  of  Public Health  authority  to  impose fees  for  the                                                               
administration of public  health programs.  She  stated that this                                                               
was a very broad statute which  allowed the charging of fees in a                                                               
very broad way, and the  proposed Amendment 1 broadened this even                                                               
further.   She noted that currently  there was a list  in statute                                                               
for services  to which fees could  be charged, all of  which have                                                               
gone  through  a  public  process allowing  for  comment.    They                                                               
support  allowing  public health  more  latitude  to charge  user                                                               
fees,  when   appropriate  and   reasonable,  and   believe  that                                                               
stakeholder involvement  is important to  the process.   In their                                                               
experience, the regulatory and budget  processes alone were often                                                               
insufficient to  provide appropriate  oversight to what  fees the                                                               
division  could impose  and what  compliance programs  they could                                                               
build  up with  this new  revenue  source.   Once the  regulation                                                               
process  is  underway  there is  no  opportunity  for  meaningful                                                               
dialogue to impact  what is being proposed.   They realize public                                                               
comment is  always an option  during the regulation  process, but                                                               
it is often too late in the  process.  She declared the desire to                                                               
protect  health care  providers and  the public  from unnecessary                                                               
and  growing  regulatory and  cost  burdens.   She  offered  some                                                               
examples, which  included radiological  device fees to  support a                                                               
second   radiological   health    physicist   for   registration,                                                               
certification,  and  inspection  of   radiology  devices.    They                                                               
supported requiring  a stakeholder process on  the reasonableness                                                               
of  fees prior  to  the  regulation process  and  feel this  will                                                               
strengthen  the effort  to charge  appropriate user  fees.   They                                                               
believe that  public health services  are a critical part  of our                                                               
health system  and will never  be sustainable based on  user fees                                                               
alone.   They advocate  for continued  funding for  public health                                                               
functions to  protect vulnerable  populations and  ensure healthy                                                               
communities.    They  want  to be  sure  public  health  services                                                               
continue even when no user fees are available to support them.                                                                  
                                                                                                                                
3:21:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOHNSTON asked,  regarding radiological  fees, if                                                               
there was federal oversight onsite.                                                                                             
                                                                                                                                
MS. MONK replied that although she  did not know all the details,                                                               
it was how the device was  licensed and accredited.  She reported                                                               
that the  facility had to  go through  a process outlined  at the                                                               
federal  level  to  ensure  the  safety  and  protection  of  the                                                               
equipment.    She  said  that  there  were  people  on  site  who                                                               
inspected and  operated the  equipment, and  their qualifications                                                               
were part of the review process.                                                                                                
                                                                                                                                
REPRESENTATIVE   SULLIVAN-LEONARD  asked   if   this  created   a                                                               
duplicate oversite from both the state and the federal agencies.                                                                
                                                                                                                                
MS. MONK explained  that this could be a result  should the state                                                               
decide to charge a fee to  license and inspect these devices that                                                               
were  already  being  accredited  by   a  federal  agency.    She                                                               
clarified  that currently  there was  not any  duplication.   She                                                               
suggested that  as it  was very complicated,  there may  not have                                                               
been awareness of the existing regulations.                                                                                     
                                                                                                                                
3:23:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN   asked  if   there  were   any  specific                                                               
proposals to change the current bill to address these concerns.                                                                 
                                                                                                                                
MS. MONK replied that  she did not have any at  this moment.  She                                                               
suggested that there  could be a pre-regulation  process, as once                                                               
the regulation process began there was not any dialogue allowed.                                                                
                                                                                                                                
CHAIR SPOHNHOLZ  asked about state institutions  which were being                                                               
nationally accredited  to receive compensation from  Medicaid and                                                               
whether this was covering all the radiologic equipment.                                                                         
                                                                                                                                
MS. MONK  said that she  did not know  all the details  but noted                                                               
that   there   were   a  variety   of   different   accreditation                                                               
requirements depending on the provided services.                                                                                
                                                                                                                                
CHAIR  SPOHNHOLZ reflected  on earlier  testimony that  authority                                                               
had been given some time ago  for x-ray equipment.  She expressed                                                               
concern  that  there  was  imaging  equipment  that  was  not  in                                                               
accredited facilities.   She acknowledged that  members of ASHNHA                                                               
were  adhering  to standards  which  were  much higher  to  allow                                                               
billing to Medicaid  and Medicare.  She  suggested that exclusion                                                               
of the authority to the department  to do these inspections for a                                                               
more targeted population may not be wise.                                                                                       
                                                                                                                                
3:26:33 PM                                                                                                                    
                                                                                                                                
MS.  MONK  clarified  that  she  was not  advocating  to  not  do                                                               
everything possible to  ensure safe patient care.   She suggested                                                               
that the ability  to charge fees should not  drive this decision,                                                               
it should  be evidence-based practices.   If there  was equipment                                                               
which was  not being  inspected adequately,  then this  should be                                                               
addressed.   She  stated that  the bigger  concern was  for these                                                               
important  conversations   to  occur  prior  to   the  regulation                                                               
process, or there could be double regulations.                                                                                  
                                                                                                                                
CHAIR SPOHNHOLZ expressed  her concern that only  those who could                                                               
afford to  pay for  data analysis would  be able  to participate,                                                               
and  that  Ms.  Monk  had indicated  that  there  was  difficulty                                                               
getting data back from the department.                                                                                          
                                                                                                                                
MS.  MONK  said  that  she  had  been  referring  to  the  Health                                                               
Facilities  Data  Reporting  Program,  which  mandates  that  all                                                               
hospitals  and nursing  homes,  ambulatory  surgery centers,  and                                                               
imaging centers  submit data on  all their discharges.   She said                                                               
that this  data was assembled into  a large data set.   She added                                                               
that currently  facilities could  request the  data set  but that                                                               
the cost  was $2,000, which  was more than many  small facilities                                                               
could afford  to pay.   She  noted that  as the  small facilities                                                               
would not have the analytical  capabilities, ASHNHA had suggested                                                               
a standard  set of reports be  available for access to  the data,                                                               
outside of  paying for it.   The smaller facilities needed  a way                                                               
to turn this large data set into some useful information.                                                                       
                                                                                                                                
3:30:23 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ asked about earlier  comments that as an external                                                               
stakeholder, there  was not enough opportunity  to participate in                                                               
the  regulatory process  and to  provide feedback  during a  time                                                               
that it was really valuable.                                                                                                    
                                                                                                                                
MS. MONK  reported that once  the regulations were  drafted, they                                                               
were released with  a 30-day public comment period.   After that,                                                               
the department could decide what to  do with those comments.  She                                                               
pointed  out  that  this  was   not  a  dialogue  process.    She                                                               
reiterated that  it was necessary  to have dialogue prior  to the                                                               
regulations  being drafted  to  help ensure  they  best meet  the                                                               
needs of all  those impacted.  She stated that  it could be done,                                                               
and  she  offered  her belief  that  the  current  administration                                                               
generally did this.  She  expressed her concern, however, that as                                                               
general  practices  change,  if  this   was  not  outlined  as  a                                                               
requirement in  legislation, it was  not known what  could happen                                                               
in the future.                                                                                                                  
                                                                                                                                
3:32:46 PM                                                                                                                    
                                                                                                                                
MS. LEWIS clarified that the  division was not looking to broaden                                                               
its regulatory authority, offering her  belief that the intent of                                                               
the  proposed bill  was to  work within  the existing  authority.                                                               
She noted that this included  oversight of the radiologic devices                                                               
as the division  already had the statutory authority  but had not                                                               
implemented  the  regulations  as  they  did  not  yet  have  the                                                               
commensurate fee  authority.   She stated  that the  division was                                                               
not anxious  to charge  fees, even as  they recognized  that with                                                               
the current  budget situation public  health was not  free health                                                               
care.  She declared that when there  was an ability to pay and it                                                               
did not  undermine the  public health  mission, it  was incumbent                                                               
upon the division to be  more self-sufficient.  She reported that                                                               
inspections  were  typically fee  based  in  other states.    She                                                               
stated  that   they  would  review   the  overlap   with  federal                                                               
accreditation,  noting  that  they  did not  currently  have  the                                                               
regulations  for  MRI and  CT  devices,  and this  process  would                                                               
include  wrapping  in  the accreditation  requirements  from  the                                                               
Centers  for Medicaid  and Medicare  Services.   She pointed  out                                                               
that accreditation was periodic and  tended to review whether the                                                               
proper policies  and procedures were  in place and was  not there                                                               
to  validate the  compliance or  do interim  checks.   She stated                                                               
that it would not serve  any purpose to duplicate those elements,                                                               
but instead, to  focus on the elements not being  done.  She said                                                               
that the division  was open for discussion to  better improve the                                                               
process and  to discuss the cost  benefit and the burden  of fees                                                               
on the  various stakeholders.   She pointed  out that  the fiscal                                                               
note  projected an  extra year  to  allow time  for meetings  and                                                               
discussion  as to  the best  approach  and reasonable  fee.   She                                                               
spoke  about   the  health  facility  discharge   reporting,  and                                                               
explained that  as they had  moved into the Health  Analytics and                                                               
Vital  Records Section,  that  branch of  Public  Health had  the                                                               
authority  to  institute a  fee  system  and  charge fees.    She                                                               
offered her belief that the division  was not charging a fee to a                                                               
facility to receive back its own  data.  She pointed out that any                                                               
additional  analysis and  custom  reporting was  different.   She                                                               
expressed her  agreement that mandatory reporters  should have an                                                               
expectation for something  to be given back,  including access to                                                               
their own data and a set of baseline reports.                                                                                   
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD asked if  there was currently any                                                               
federal oversight for the equipment in public facilities.                                                                       
                                                                                                                                
3:39:32 PM                                                                                                                    
                                                                                                                                
MS. LEWIS  offered her understanding  that although this  was not                                                               
her  area  of  expertise,  accreditation   was  to  accredit  the                                                               
facility  and not  the individual  machines.   She reported  that                                                               
there  were safety  elements in  the  accreditation process,  and                                                               
there were  more general,  set standards  to comply  with federal                                                               
and state law.  She explained  that the state would do the actual                                                               
inspection of the individual machines.                                                                                          
                                                                                                                                
3:40:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  asked to  clarify that  the fees                                                               
would  be  to  get  a  health  care  specialist  to  oversee  the                                                               
radiological devices for compliance.                                                                                            
                                                                                                                                
MS. LEWIS offered  her belief that the specialist  would check to                                                               
ensure that policies and procedures  were in place, but they were                                                               
not going to test or calibrate the machines.                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  asked what the  driving desire was  to do                                                               
this, specifically  for the radiological  devices, as it  was not                                                               
currently being done.                                                                                                           
                                                                                                                                
MS.  LEWIS reported  that as  there had  been a  proliferation of                                                               
these devices,  in the Department  of Health and  Social Services                                                               
effort  to  register,  inspect, and  certify  these  devices  the                                                               
department had  discovered its  lack of  capacity for  follow up.                                                               
She said there  would be a cursory, unofficial  inspection of the                                                               
CT  machines, even  though  it  was not  part  of the  regulatory                                                               
process.                                                                                                                        
                                                                                                                                
REPRESENTATIVE EASTMAN  opined that  most, if  not all,  of these                                                               
devices  had associated  service contracts  for calibration  on a                                                               
periodic basis.   He asked  what about the  federal certification                                                               
process was not achieving the goal.                                                                                             
                                                                                                                                
MS.  LEWIS  explained  that the  manufacturer  could  adjust  the                                                               
machine but  would not  be testing  for compliance  or validating                                                               
the compliance.  She suggested that  there could be a conflict of                                                               
interest for  this work.   She  acknowledged that  the department                                                               
could review and address this for any future use.                                                                               
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  shared  that  the  manufacturer                                                               
would  do  any  repairs,  whereas   a  specialist  would  do  the                                                               
calibrations.                                                                                                                   
                                                                                                                                
3:44:26 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ closed public testimony on HB 215.                                                                              
                                                                                                                                
3:44:47 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ reported that all  the state departments had been                                                               
asked to  come up  with creative new  ways to  diversify funding,                                                               
while   working  within   the   regulatory   limitations.     She                                                               
acknowledged that although this  was a practical and constructive                                                               
way, there  were some clear  sideboards regarding  its authority.                                                               
She noted that  the department can't charge more than  it cost to                                                               
provide a service  and that safety was a concern.   She expressed                                                               
her concern that  MRIs and other imaging equipment  was not being                                                               
tested in Alaska.   She said that she was glad  to see a proposal                                                               
to advance  this, although she  acknowledged a concern  by ASHNHA                                                               
for enough  collaboration in  the process.   She  reiterated that                                                               
the fee development process would not be a quick rush.                                                                          
                                                                                                                                
3:47:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN suggested that  the proposed bill could be                                                               
evaluated at the beginning of the next session.                                                                                 
                                                                                                                                
3:48:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EDGMON moved to report  HB 215, as amended, out of                                                               
committee  with individual  recommendations and  the accompanying                                                               
fiscal  notes.   There being  no objection,  CSHB 215(HSS)  moved                                                               
from the House Health and Social Services Standing Committee.                                                                   
                                                                                                                                
3:48:53 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 3:49 p.m.                                                                                                          

Document Name Date/Time Subjects
HB0215 ver D 4.7.17.pdf HHSS 4/18/2017 3:00:00 PM
HHSS 4/25/2017 3:00:00 PM
HHSS 5/9/2017 3:00:00 PM
HB 215
HB215 Fiscal Note DHSS--PHAS 4.17.17.pdf HHSS 4/18/2017 3:00:00 PM
HHSS 4/25/2017 3:00:00 PM
HHSS 5/9/2017 3:00:00 PM
HB 215
HB215 Sectional Analysis ver D 4.7.2017.pdf HHSS 4/18/2017 3:00:00 PM
HHSS 4/25/2017 3:00:00 PM
HHSS 5/9/2017 3:00:00 PM
HB 215
HB215 Sponsor Statement ver D 4.7.2017.pdf HHSS 4/18/2017 3:00:00 PM
HHSS 4/25/2017 3:00:00 PM
HHSS 5/9/2017 3:00:00 PM
HB 215
HB215 Supporting Document - Division of Public Health Fee Summary 4.7.17.pdf HHSS 4/18/2017 3:00:00 PM
HHSS 4/25/2017 3:00:00 PM
HHSS 5/9/2017 3:00:00 PM
HB 215
HB215 Supporting Document - Division of Public Health Funding Sources 4.7.17.pdf HHSS 4/18/2017 3:00:00 PM
HHSS 4/25/2017 3:00:00 PM
HHSS 5/9/2017 3:00:00 PM
HB 215
HB215 Supporting Document - Draft Amendment D.3 explanation 5.5.17.pdf HHSS 5/9/2017 3:00:00 PM
HB 215
HB215 Draft proposed Amendment D.3 5.5.17.pdf HHSS 5/9/2017 3:00:00 PM
HB 215
HB215 Supporting Document - Fees statutes 5.5.17.pdf HHSS 5/9/2017 3:00:00 PM
HB 215