Legislature(2017 - 2018)CAPITOL 106

03/08/2018 03:00 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HB 358 INSURANCE COVERAGE FOR TELEHEALTH TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
+= HB 351 JUVENILES: JUSTICE,FACILITES,TREATMENT TELECONFERENCED
Moved CSHB 351(HSS) Out of Committee
-- Public Testimony --
*+ HB 193 HEALTH CARE; BALANCE BILLING TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
+= HB 336 SUPPORTIVE DECISION-MAKING AGREEMENTS TELECONFERENCED
Moved CSHB 336(HSS) Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         March 8, 2018                                                                                          
                           3:19 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Bryce Edgmon, Vice Chair                                                                                         
Representative Sam Kito                                                                                                         
Representative Geran Tarr                                                                                                       
Representative David Eastman (via teleconference)                                                                               
Representative Jennifer Johnston                                                                                                
Representative Colleen Sullivan-Leonard                                                                                         
Representative Matt Claman (alternate)                                                                                          
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Ivy Spohnholz, Chair                                                                                             
Representative Dan Saddler (alternate)                                                                                          
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 358                                                                                                              
"An  Act relating  to insurance  coverage  for benefits  provided                                                               
through telehealth; and providing for an effective date."                                                                       
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 351                                                                                                              
"An Act  relating to care  of juveniles and to  juvenile justice;                                                               
relating  to employment  of juvenile  probation  officers by  the                                                               
Department of Health and Social  Services; relating to terms used                                                               
in  juvenile justice;  relating to  mandatory reporters  of child                                                               
abuse or  neglect; relating to adjudication  of minor delinquency                                                               
and   the  deoxyribonucleic   acid  identification   registration                                                               
system; relating to sexual assault  in the third degree; relating                                                               
to sexual assault  in the fourth degree;  repealing a requirement                                                               
for  administrative revocation  of  a  minor's driver's  license,                                                               
permit, privilege to drive, or  privilege to obtain a license for                                                               
consumption or possession of alcohol  or drugs; and providing for                                                               
an effective date."                                                                                                             
                                                                                                                                
     - MOVED CSHB 351(HSS) OUT OF COMMITTEE                                                                                     
                                                                                                                                
HOUSE BILL NO. 193                                                                                                              
"An Act  relating to  insurance trade  practices and  frauds; and                                                               
relating to emergency services and balance billing."                                                                            
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 336                                                                                                              
"An Act relating to supported decision-making agreements to                                                                     
provide for decision- making assistance; and amending Rule 402,                                                                 
Alaska Rules of Evidence."                                                                                                      
                                                                                                                                
     - MOVED CSHB 336(HSS) OUT OF COMMITTEE                                                                                     
                                                                                                                                
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 358                                                                                                                  
SHORT TITLE: INSURANCE COVERAGE FOR TELEHEALTH                                                                                  
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ                                                                                         
                                                                                                                                
02/19/18       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/19/18       (H)       HSS, L&C                                                                                               
03/08/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 351                                                                                                                  
SHORT TITLE: JUVENILES: JUSTICE,FACILITES,TREATMENT                                                                             
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ                                                                                         
                                                                                                                                
02/16/18       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/16/18       (H)       HSS, JUD                                                                                               
03/06/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/06/18       (H)       Heard & Held                                                                                           
03/06/18       (H)       MINUTE(HSS)                                                                                            
03/08/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 193                                                                                                                  
SHORT TITLE: HEALTH CARE; BALANCE BILLING                                                                                       
SPONSOR(s): REPRESENTATIVE(s) GRENN                                                                                             
                                                                                                                                
03/24/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/24/17       (H)       HSS, L&C                                                                                               
03/08/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 336                                                                                                                  
SHORT TITLE: SUPPORTIVE DECISION-MAKING AGREEMENTS                                                                              
SPONSOR(s): REPRESENTATIVE(s) MILLETT                                                                                           
                                                                                                                                
02/07/18       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/07/18       (H)       HSS, JUD                                                                                               
03/01/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/01/18       (H)       Heard & Held                                                                                           
03/01/18       (H)       MINUTE(HSS)                                                                                            
03/08/18       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
BERNICE NISBETT, Staff                                                                                                          
Representative Ivy Spohnholz                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 358 on behalf of the bill                                                                   
sponsor, Representative Spohnholz.                                                                                              
                                                                                                                                
ANNA LATHAM, Deputy Director                                                                                                    
Juneau Division                                                                                                                 
Division of Insurance                                                                                                           
Department of Commerce, Community & Economic Development                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during discussions of HB                                                              
358 and HB 193.                                                                                                                 
                                                                                                                                
MATT DAVIDSON, Social Services Program Officer                                                                                  
Division of Juvenile Justice                                                                                                    
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during discussion of HB                                                               
351.                                                                                                                            
                                                                                                                                
REPRESENTATIVE JASON GRENN                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 193 as the sponsor of the                                                                   
bill.                                                                                                                           
                                                                                                                                
RYAN JOHNSTON, Staff                                                                                                            
Representative Jason Grenn                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented the Sectional Analysis on behalf                                                               
of the bill sponsor, Representative Grenn.                                                                                      
                                                                                                                                
MEGAN WALLACE, Attorney                                                                                                         
Legislative Legal Counsel                                                                                                       
Legislative Legal Services                                                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during discussion of HB                                                               
193.                                                                                                                            
                                                                                                                                
NATHAN PAIMANN, MD                                                                                                              
Bartlett Regional Hospital                                                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during discussion of HB 193.                                                                   
                                                                                                                                
HANS RODVIK, Staff                                                                                                              
Representative Charisse Millett                                                                                                 
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Presented HB  336  on behalf  of the  bill                                                             
sponsor, Representative Millett.                                                                                                
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:19:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  called the House Health  and Social Services                                                             
Standing   Committee    meeting   to    order   at    3:19   p.m.                                                               
Representatives Tarr,  Kito, Johnston, and  Sullivan-Leonard were                                                               
present  at  the  call  to order.    Representatives  Edgmon  and                                                               
Eastman  (via  teleconference)  arrived  as the  meeting  was  in                                                               
progress.                                                                                                                       
                                                                                                                                
            HB 358-INSURANCE COVERAGE FOR TELEHEALTH                                                                        
                                                                                                                                
3:21:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  announced that  the first order  of business                                                               
would  be HOUSE  BILL  NO.  358, "An  Act  relating to  insurance                                                               
coverage for benefits provided  through telehealth; and providing                                                               
for an effective date."                                                                                                         
                                                                                                                                
3:21:34 PM                                                                                                                    
                                                                                                                                
BERNICE  NISBETT,  Staff,  Representative Ivy  Spohnholz,  Alaska                                                               
State  Legislature,   paraphrased  from  the   Sponsor  Statement                                                               
[Included in  members' packets] [original  punctuation provided],                                                               
which read:                                                                                                                     
                                                                                                                                
     HB  358 will  enhance access  to health  care services,                                                                    
     primarily mental health and  primary care, for Alaskans                                                                    
     who  have  insurance  plans  with  Moda,  Premera  Blue                                                                    
     Cross, United Healthcare, and  Aetna Life Insurance, to                                                                    
     name a few. HB 358  does this by requiring the insurers                                                                    
     previously  listed to  provide  insurance coverage  for                                                                    
     health  care  services   provided  through  telehealth.                                                                    
     Increasing  access to  health care  services throughout                                                                    
     Alaska is  crucial. Because of our  unique geographical                                                                    
     landscape and  our rural  and aging  communities spread                                                                    
     out across the state,  telehealth can enhance access to                                                                    
     health care and improve clinical outcomes.                                                                                 
                                                                                                                                
     Here are some of the advantages of telehealth:                                                                             
          ? Better access and  privacy in rural, remote, and                                                                    
     urban areas of Alaska                                                                                                      
          ? Early intervention which can lead to savings                                                                        
          ? Greater  access for  referrals to  providers who                                                                    
     specialize in treating specific health issues                                                                              
          ? Better, and potentially  quicker, access means a                                                                    
     potential reduction in  suicides, domestic violence and                                                                    
     other serious events                                                                                                       
          ? Zero impact on state budget                                                                                         
                                                                                                                                
     Under  HB  358,  telehealth benefits  for  all  covered                                                                    
     health   care   services,   including   mental   health                                                                    
     benefits,   will  be   reimbursable  for   health  care                                                                    
     providers licensed  in the state without  an initial in                                                                    
     person appointment.  Depending on the  patient's needs,                                                                    
     a   telehealth  appointment   can  provide   education,                                                                    
     reviewing of  prescriptions and checking  symptoms, all                                                                    
     at a distance on a secure system.                                                                                          
                                                                                                                                
     Health  care  services   delivered  via  telehealth  is                                                                    
     happening all  over the country,  and Alaska is  at the                                                                    
     forefront of  providing telehealth services  for urban,                                                                    
     rural,  aging, and  the underserved  communities across                                                                    
     the state.                                                                                                                 
                                                                                                                                
MS. NISBETT presented the definition of tele-health as it was                                                                   
written in AS 47.05.27(e), and read:                                                                                            
                                                                                                                                
     the  practice  of  health  care  delivery,  evaluation,                                                                    
     diagnosis,   consultation,  or   treatment  using   the                                                                    
     transfer of health care data  through audio, visual, or                                                                    
     data   communications  performed   over  two   or  more                                                                    
     locations   between   providers  who   are   physically                                                                    
     separated  from the  recipient or  from  each other  or                                                                    
     between a  provider and a recipient  who are physically                                                                    
     separated from each other.                                                                                                 
                                                                                                                                
MS. NISBETT reported that prominent  health care organizations in                                                               
Alaska had stated that tele-health  can increase access, an issue                                                               
recommended by the  Alaska Health Care Commission  for the Alaska                                                               
State Legislature  to address.   She  noted that  the legislature                                                               
had  passed  Senate  Bill  74  in 2016,  which  was  primarily  a                                                               
Medicaid  reform bill  with  significant tele-health  components.                                                               
She  pointed  out  that  the  proposed  bill  would  only  impact                                                               
insurance plans regulated by the Division of Insurance.                                                                         
                                                                                                                                
3:24:49 PM                                                                                                                    
                                                                                                                                
MS. NISBETT paraphrased from the  Sectional Analysis [included in                                                               
members' packets], which read:                                                                                                  
                                                                                                                                
     Section 1.                                                                                                               
     AS  21.42.422 has  been  amended  to require  insurance                                                                    
     coverage for benefits provided via telehealth.                                                                             
                                                                                                                                
     Section 2.                                                                                                               
     AS 21.42.422  is a new  subsection that  defines health                                                                    
     care insurer  as a person  transacting the  business of                                                                    
     health   care  insurance   except   for  a   nonfederal                                                                    
     governmental  plan.  It  also adds  the  definition  of                                                                    
     telehealth  under  47.05.270(e)   as  the  practice  of                                                                    
     health    care    delivery,   evaluation,    diagnosis,                                                                    
     consultation,  or  treatment,  using  the  transfer  of                                                                    
     health  care  data  through   audio,  visual,  or  data                                                                    
     communications,  performed over  two or  more locations                                                                    
     between  providers who  are  physically separated  from                                                                    
     the recipient or from each  other or between a provider                                                                    
     and a recipient who  are physically separated from each                                                                    
     other.                                                                                                                     
                                                                                                                                
     Section 3                                                                                                                
     The  changes  to Section  1  of  this bill  applies  to                                                                    
     health care  insurance plans that are  offered, issued,                                                                    
     delivered, or renewed on or after the effective date.                                                                      
                                                                                                                                
     Section 4                                                                                                                
     The effective date is July 1, 2019.                                                                                        
                                                                                                                                
3:26:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD asked  if a  patient in  a rural                                                               
area would  need to see a  primary physician prior to  the use of                                                               
tele-health.                                                                                                                    
                                                                                                                                
3:27:20 PM                                                                                                                    
                                                                                                                                
ANNA  LATHAM,  Deputy  Director,  Juneau  Division,  Division  of                                                               
Insurance,   Department  of   Commerce,   Community  &   Economic                                                               
Development, offered her belief that,  although this had not been                                                               
addressed in  the proposed  bill, as  the bill  read, it  was not                                                               
necessary for an in-person appointment  prior to the use of tele-                                                               
health.                                                                                                                         
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  opined   that  it  was  "really                                                               
important that  we do have  coverage for our  tele-health process                                                               
and network for  patients that don't have  access to physicians."                                                               
She wanted to ensure there was  not a gap in the process allowing                                                               
that  someone  did  not  receive  the  proper  oversight  from  a                                                               
physician while in a rural area.                                                                                                
                                                                                                                                
REPRESENTATIVE TARR  noted that this had  previously been limited                                                               
to  mental  health  services,  but,  was  now  expanded  for  all                                                               
telehealth.                                                                                                                     
                                                                                                                                
MS. LATHAM said that was correct.                                                                                               
                                                                                                                                
3:29:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  asked to  hear from  a physician                                                               
or  nurse practitioner  for the  effect of  the proposed  bill on                                                               
their practice.                                                                                                                 
                                                                                                                                
MS.  NISBETT,  in  response to  Representative  Sullivan-Leonard,                                                               
explained that providers primarily  used telehealth for follow up                                                               
appointments,    consultation,   education,    and   review    of                                                               
prescriptions.   However,  if a  patient  in rural  Alaska had  a                                                               
serious condition, it was suggested  they travel to an urban area                                                               
to  see a  doctor.   She  declared that  telehealth  was not  the                                                               
initial or primary service of care.                                                                                             
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  asked to ensure  that everything                                                               
was covered by the providers.                                                                                                   
                                                                                                                                
3:31:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CLAMAN asked,  as  the  proposed bill  restricted                                                               
telehealth to providers  licensed in Alaska, if it  would be more                                                               
difficult  to  receive  telehealth services  from  mental  health                                                               
providers from out of state.                                                                                                    
                                                                                                                                
MS. NISBETT asked for clarification.                                                                                            
                                                                                                                                
REPRESENTATIVE  CLAMAN explained  that  there  were instances  in                                                               
which  mental  health providers  worked  with  social workers  in                                                               
Alaska  to provide  person to  person  counseling services,  even                                                               
though the  medication was  managed by an  out of  state provider                                                               
who only  communicated with the patient  from afar.  He  asked if                                                               
the out of state provider  would not receive an insurance payment                                                               
because they were not licensed in Alaska.                                                                                       
                                                                                                                                
MS. NISBETT said that she would research this.                                                                                  
                                                                                                                                
3:33:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHNSTON  asked for  clarification that  there was                                                               
telemedicine  through  the  Indian   Health  Service  (IHS),  and                                                               
whether  this proposed  bill would  expand  service to  community                                                               
members  in  rural villages  not  covered  by the  Indian  Health                                                               
Service.                                                                                                                        
                                                                                                                                
MS. NISBETT replied that this was correct.                                                                                      
                                                                                                                                
3:34:13 PM                                                                                                                    
                                                                                                                                
MS. LATHAM stated that the  proposed bill expanded telehealth and                                                               
removed  it   from  solely  mental   health  benefits,   for  the                                                               
individual  and  small  group   market,  as  those  markets  were                                                               
regulated by the Division of Insurance.                                                                                         
                                                                                                                                
REPRESENTATIVE JOHNSTON asked  if this was covered  as a Medicaid                                                               
reimbursement, rather than the IHS.                                                                                             
                                                                                                                                
MS. LATHAM offered  her belief that, as the IHS  was the payer of                                                               
last  resort,  a  plan  in  the  individual  market  would  cover                                                               
telehealth benefits.   She stated that she was  not familiar with                                                               
the benefits  covered under IHS,  although her  understanding was                                                               
that it would be covered under both scenarios.                                                                                  
                                                                                                                                
3:35:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  asked if the  proposed changes  would impact                                                               
the benefits covered by Medicaid,  noting that this proposed bill                                                               
was for private and group plans.                                                                                                
                                                                                                                                
MS. LATHAM  explained that the  proposed bill only  covered plans                                                               
regulated  by the  Division of  Insurance,  which included  large                                                               
groups, small groups, and the individual market.                                                                                
                                                                                                                                
REPRESENTATIVE TARR referenced  House Bill 234 in  2016 which did                                                               
not include a section regarding licensure by the state.                                                                         
                                                                                                                                
3:36:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR said that HB 358 would be held over.                                                                        
                                                                                                                                
         HB 351-JUVENILES: JUSTICE,FACILITES,TREATMENT                                                                      
                                                                                                                                
3:36:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR announced  that the  next order  of business                                                               
would  be  HOUSE BILL  NO.  351,  "An  Act  relating to  care  of                                                               
juveniles  and to  juvenile justice;  relating  to employment  of                                                               
juvenile  probation  officers by  the  Department  of Health  and                                                               
Social  Services; relating  to terms  used  in juvenile  justice;                                                               
relating  to  mandatory  reporters  of child  abuse  or  neglect;                                                               
relating   to  adjudication   of   minor   delinquency  and   the                                                               
deoxyribonucleic   acid   identification   registration   system;                                                               
relating  to sexual  assault  in the  third  degree; relating  to                                                               
sexual assault in the fourth  degree; repealing a requirement for                                                               
administrative revocation of a  minor's driver's license, permit,                                                               
privilege  to  drive,  or  privilege  to  obtain  a  license  for                                                               
consumption or possession of alcohol  or drugs; and providing for                                                               
an effective date."                                                                                                             
                                                                                                                                
3:37:39 PM                                                                                                                    
                                                                                                                                
MATT  DAVIDSON,  Social  Services Program  Officer,  Division  of                                                               
Juvenile  Justice,  Department  of Health  and  Social  Services,                                                               
stated that  the proposed bill was  an update for the  terms used                                                               
in the  juvenile justice statute  to describe the  facilities and                                                               
staff.    Most   of  the  bill  applied   to  conforming  changes                                                               
throughout the statutes,  and not for actual  changes to meaning,                                                               
or changes  to the powers or  duties of the Division  of Justice.                                                               
He  listed some  of the  outdated  terms used  in statute,  which                                                               
included  juvenile work  camps and  detention homes,  noting that                                                               
these  were  being updated  with  modern  terms to  describe  the                                                               
facilities.     He  stated  that  the   definition  for  juvenile                                                               
probation  officer was  being  updated, as  well  as providing  a                                                               
delineation  between adult  and  juvenile  probation officers  in                                                               
statute.   He pointed out  that the proposed bill  added juvenile                                                               
justice staff  and probation officers  as mandatory  reporters of                                                               
child  abuse and  neglect  in  AS 47.17.    He  stated that  this                                                               
reflected a role of the staff  in working with kids, as they were                                                               
often disclosing this  type of activity, which  would be reported                                                               
to the Office of Children's Services.                                                                                           
                                                                                                                                
REPRESENTATIVE TARR  clarified that  this was current  policy and                                                               
was now being written into statute.                                                                                             
                                                                                                                                
3:39:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   TARR   opened   public   testimony   and   after                                                               
ascertaining no  one wished to  testify, closed  public testimony                                                               
on HB 351.                                                                                                                      
                                                                                                                                
3:40:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR moved to adopt  proposed Amendment 1, labeled                                                               
30-LS0416\R.1, Glover, 2/28/18, which read:                                                                                     
                                                                                                                                
     Page 13, lines 6 - 7:                                                                                                      
         Delete "the minor is not in sight or sound of                                                                        
     adult prisoners, and"                                                                                                    
                                                                                                                                
REPRESENTATIVE CLAMAN objected for discussion.                                                                                  
                                                                                                                                
REPRESENTATIVE   TARR  explained   that   proposed  Amendment   1                                                               
addressed page  13, lines 6  - 7, of  the proposed bill  in which                                                               
youth could be detained in a  temporary secure holding area.  She                                                               
stated that  removal of  this language  could be  problematic for                                                               
these temporary secure holding areas.                                                                                           
                                                                                                                                
3:41:40 PM                                                                                                                    
                                                                                                                                
MR. DAVIDSON clarified  that this section of the bill  was in the                                                               
delinquency  statute and,  while drafting  it, the  separation of                                                               
sight and sound had been added  to the wrong place.  He explained                                                               
that  currently this  applied  to  youth in  the  custody of  the                                                               
Department of Corrections,  as explained in lines 18 and  21.  He                                                               
stated that the intent of the  bill was not for the Department of                                                               
Corrections  to  have  sight  and   sound  separation  for  those                                                               
individuals and that it was not required by law.                                                                                
                                                                                                                                
3:42:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CLAMAN removed  his  objection.   There being  no                                                               
further objection, Amendment 1 was adopted.                                                                                     
                                                                                                                                
3:42:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN moved to adopt proposed Amendment 2,                                                                     
labeled 30-LS-0416\R.2, Laffen, 3/8/18, which read:                                                                             
                                                                                                                                
     Page 18, line 21, through page 19, line 13:                                                                                
          Delete all material and insert:                                                                                       
        "* Sec. 38. AS 47.17.020(a) is amended to read:                                                                     
          (a)  The following persons who, in the                                                                                
     performance of their occupational  duties  or [,] their                                                                
     appointed  duties under  (8)  of  this subsection,  [OR                                                                    
     THEIR VOLUNTEER  DUTIES UNDER (9) OF  THIS SUBSECTION,]                                                                    
     have  reasonable  cause to  suspect  that  a child  has                                                                    
     suffered harm  as a  result of  child abuse  or neglect                                                                    
     shall  immediately  report  the  harm  to  the  nearest                                                                    
     office of the department:                                                                                                  
               (1)  practitioners of the healing arts;                                                                          
               (2)        school   teachers    and    school                                                                    
     administrative   staff   members,  including   athletic                                                                    
     coaches, of public and private schools;                                                                                    
               (3)    peace  officers and  officers  of  the                                                                    
     Department of Corrections;                                                                                                 
               (4)         administrative     officers    of                                                                    
     institutions;                                                                                                              
               (5)  child care providers;                                                                                       
               (6)  paid employees  of domestic violence and                                                                    
     sexual  assault programs,  and crisis  intervention and                                                                    
     prevention programs as defined in AS 18.66.990;                                                                            
               (7)   paid employees of an  organization that                                                                    
     provides   counseling  or   treatment  to   individuals                                                                    
     seeking to control their use of drugs or alcohol;                                                                          
               (8)  members of  a child fatality review team                                                                    
     established under  AS 12.65.015(e) or 12.65.120  or the                                                                    
     multidisciplinary child  protection team  created under                                                                    
     AS 47.14.300;                                                                                                              
               (9)   juvenile  probation officers,  juvenile                                                                
     probation   office  staff,   and   staff  of   juvenile                                                                
     detention    facilities    and    juvenile    treatment                                                                
     facilities, as those terms  are defined in AS 47.12.990                                                                
     [VOLUNTEERS WHO  INTERACT WITH CHILDREN IN  A PUBLIC OR                                                                    
     PRIVATE SCHOOL FOR MORE THAN FOUR HOURS A WEEK]."                                                                          
                                                                                                                                
     Page 19, following line 13:                                                                                                
     Insert a new bill section to read:                                                                                         
        "* Sec. 39. AS 47.17.022(e) is amended to read:                                                                     
          (e)  Each school district that provides training                                                                      
     under this  section shall provide notice  to public and                                                                    
     private schools  located in the school  district of the                                                                    
     availability  of the  training  [AND INVITE  VOLUNTEERS                                                                    
         WHO ARE REQUIRED TO REPORT ABUSE OR NEGLECT OF                                                                         
       CHILDREN UNDER AS 47.17.020 TO PARTICIPATE IN THE                                                                        
     TRAINING AT NO COST TO THE VOLUNTEER]."                                                                                    
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 19, line 15:                                                                                                          
          Delete "and 47.14.990(9)"                                                                                             
          Insert ", 47.14.990(9); and AS 47.17.020(j)"                                                                          
                                                                                                                                
     Page 19, line 31:                                                                                                          
          Delete "Section 41"                                                                                                   
          Insert "Section 42"                                                                                                   
                                                                                                                                
REPRESENTATIVE TARR objected.                                                                                                   
                                                                                                                                
REPRESENTATIVE EASTMAN explained that  proposed Amendment 2 would                                                               
protect the  treatment of  volunteers and  recognize them  as not                                                               
paid and  not receiving  direct benefits for  their service.   He                                                               
stated  that the  current proposal  would  allow that  volunteers                                                               
were  criminally liable  for not  reporting  under the  mandatory                                                               
reporter requirement.  He said  that the proposed amendment would                                                               
not limit  a volunteer's  ability to  make a  report.   He stated                                                               
that  making  a  volunteer  criminally   liable  just  for  their                                                               
volunteer work would result in fewer volunteers.                                                                                
                                                                                                                                
3:44:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  shared a provision  from House Bill  44 that                                                               
had been  added to  statute in  2015.  She  noted that  there had                                                               
been  a  lot of  discussion  for  this  provision, and  that  the                                                               
provision  had  been  added because  of  some  very  high-profile                                                               
incidences  for individuals  abusing children.   She  stated that                                                               
this  was an  attempt  to create  a better  system,  and it  only                                                               
applied to  those who volunteered  for more than four  hours each                                                               
week.   She pointed out that  it was important for  these longer-                                                               
term volunteers to have the  training as their behavior and their                                                               
recognition  of other  behavior would  be enhanced.   She  shared                                                               
that,  although she  frequently received  communication regarding                                                               
this bill, she  had not heard of any issues  with this provision.                                                               
She  declared  that  she  was  not  supportive  of  the  proposed                                                               
amendment.   She pointed out  that the proposed bill  was focused                                                               
on  updates to  the Division  of Juvenile  Justice statutes,  and                                                               
that the mandatory reporter provisions  were specific to juvenile                                                               
probation.                                                                                                                      
                                                                                                                                
3:47:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  asked whether  volunteers  were                                                               
already covered for liability.                                                                                                  
                                                                                                                                
MR.  DAVIDSON explained  that the  volunteers  referenced in  the                                                               
proposed  amendment   were  not  specific  to   Juvenile  Justice                                                               
volunteers.   He  noted  that the  proposed  bill added  juvenile                                                               
justice officers  and juvenile probation  staff to  the mandatory                                                               
reporting requirement.  He deferred  to Representative Tarr for a                                                               
better  understanding  of the  mandatory  reporter  statute.   He                                                               
pointed out  that the Office of  Children's Services administered                                                               
the mandatory reporter training.                                                                                                
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  stated her  understanding  that                                                               
there  was liability  coverage  for volunteers  and  asked for  a                                                               
comparison of  the description beginning  on page 18, line  22 of                                                               
the proposed bill with the proposed Amendment 2.                                                                                
                                                                                                                                
MR.  DAVIDSON  said  that  he was  not  familiar  with  liability                                                               
coverage for volunteers.                                                                                                        
                                                                                                                                
3:49:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  opined that volunteers were  covered through                                                               
the school district and elsewhere.                                                                                              
                                                                                                                                
3:50:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN reported that,  as a mandatory reporter in                                                               
his  role as  a  firefighter for  the Matanuska-Susitna  Borough,                                                               
they regularly received  this training.  He  stated that proposed                                                               
Amendment  2   recognized  that  volunteers  should   be  treated                                                               
separately than those who were paid.   He offered his belief that                                                               
"telling someone who's  abusing a child that they  need to report                                                               
the abuse of  that child is not  going to have much  of an effect                                                               
on stopping  that abuse.   I think  if someone  already violating                                                               
the law ...  probably isn't going to change much."   He said that                                                               
it  would impact  those who  were recruiting  volunteers to  work                                                               
with  children, as  many volunteers  would  not sign  up under  a                                                               
condition of liability.  He  pointed out that liability insurance                                                               
would  protect against  a civil  suit, but  proposed Amendment  2                                                               
would protect  against criminal sanctions.   He stated  that this                                                               
amendment was  not limiting the  ability to report  anything that                                                               
was of concern or limiting the training offered.                                                                                
                                                                                                                                
3:52:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR maintained her objection.                                                                                   
                                                                                                                                
3:52:29 PM                                                                                                                    
                                                                                                                                
A  roll  call  vote  was  taken.    Representative  Eastman  (via                                                               
teleconference)  voted   in  favor   of  proposed   Amendment  2.                                                               
Representatives   Sullivan-Leonard,  Claman   (alternate),  Kito,                                                               
Edgmon,  Johnston,  and  Tarr  voted   against  it.    Therefore,                                                               
Amendment 2 failed by a vote of 1 yea - 6 nays.                                                                                 
                                                                                                                                
3:53:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EDGMON  moved  to  report  HB  351,  Version  30-                                                               
LS0416\R,   as  amended,   out  of   committee  with   individual                                                               
recommendations and  the accompanying fiscal notes.   There being                                                               
no objection, CSHB  351(HSS) was moved from the  House Health and                                                               
Social Services Standing Committee.                                                                                             
                                                                                                                                
3:54:09 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:54 p.m. to 3:56 p.m.                                                                       
                                                                                                                                
              HB 193-HEALTH CARE; BALANCE BILLING                                                                           
                                                                                                                                
3:56:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR announced  that the  next order  of business                                                               
would be HOUSE BILL NO. 193,  "An Act relating to insurance trade                                                               
practices  and frauds;  and relating  to  emergency services  and                                                               
balance billing."                                                                                                               
                                                                                                                                
3:56:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   JASON    GRENN,   Alaska    State   Legislature,                                                               
paraphrased  from the  Sponsor  Statement  [included in  members'                                                               
packets], which read:                                                                                                           
                                                                                                                                
     House  Bill 193  is focused  on protecting  Alaskans in                                                                    
     emergency   situations   from  being   surprised   with                                                                    
     unexpected  medical bills.  The most  common occurrence                                                                    
     for  balance  billing  is during  emergency  situations                                                                    
     where  patients   are  left   without  the   option  or                                                                    
     wherewithal  to  ensure  they are  treated  by  an  in-                                                                    
     network provider. As a result,  they find themselves on                                                                    
     the  hook  for  hefty  medical  bills,  despite  having                                                                    
     proper  health insurance.  HB 193  would help  Alaskans                                                                    
     already  dealing   with  the   turmoil  of   a  medical                                                                    
     emergency  by removing  them from  the billing  side of                                                                    
     the  equation. When  a  patient is  already  in a  dire                                                                    
     situation,  they   should  not  be  punished   for  the                                                                    
     inability  of  an  in-network provider  to  respond  to                                                                    
     their crisis.                                                                                                              
                                                                                                                                
     HB  193 bans  the  practice of  medical providers  from                                                                    
     balance  billing in  emergency situations  and requires                                                                    
     insurance  providers to  hold  harmless their  clients.                                                                    
     This covers emergency situations  inside and outside of                                                                    
     hospitals. If a patient  was transported to a hospital,                                                                    
     or  an  emergency  arose  during  a  medical  procedure                                                                    
     requiring an out-of-network  provider, this legislation                                                                    
     mandates  the   insurance  and  medical   providers  to                                                                    
     develop  a   fair  and  equitable   payment  agreement.                                                                    
     Instead  of  being  left to  handle  the  labyrinth  of                                                                    
     medical billing on their own,  the patient will be held                                                                    
     harmless in these situations.                                                                                              
                                                                                                                                
     Medical costs are a major  concern in Alaska. HB 193 is                                                                    
     a  part of  a national  movement  to protect  consumers                                                                    
     from   unexpected  costs   in   an  already   difficult                                                                    
     situation. Twenty-one  states have  a ban of  some kind                                                                    
     on  balance billing  and more  states  are looking  are                                                                    
     into the issue. Unexpected  and excessive medical bills                                                                    
     from   out-of-network  providers   contribute  to   the                                                                    
     growing  problem   of  consumer  medical   debt,  which                                                                    
     continues  to  be  a   significant  cause  of  personal                                                                    
     bankruptcy. The goal  of this legislation is  to hold a                                                                    
     patient  harmless  while   the  medical  and  insurance                                                                    
     providers  come  to  an   agreement  for  the  services                                                                    
     rendered.                                                                                                                  
                                                                                                                                
3:58:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EDGMON moved to adopt the proposed committee                                                                     
substitute (CS) for HB 193, labeled 30-LS0466\T, Wallace,                                                                       
3/6/18, as the working draft.                                                                                                   
                                                                                                                                
3:59:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR objected for discussion.                                                                                    
                                                                                                                                
3:59:08 PM                                                                                                                    
                                                                                                                                
RYAN JOHNSTON, Staff, Representative Jason Grenn, Alaska State                                                                  
Legislature, paraphrased from the Sectional Analysis, which                                                                     
read:                                                                                                                           
                                                                                                                                
     Section 1:  Establishes a "Hold Harmless"  standard for                                                                  
     insurance providers  in the  situation where  a covered                                                                    
     person  receives medical  care  from an  out-of-network                                                                    
     medical   provider  in   an  emergency.   An  insurance                                                                    
     provider will hold a covered  person harmless to ensure                                                                    
     that the covered  person only pay what  would have been                                                                    
     paid  if   the  medical  provider  was   an  in-network                                                                    
     provider.                                                                                                                  
                                                                                                                                
     Outlines  the  standards  to establish  the  situations                                                                    
     where a medical provider  cannot balance bill a covered                                                                    
     person. An  insurance provider shall pay  a non-network                                                                    
     health  care  provider  if  the  health  care  provider                                                                    
     renders to a covered person;                                                                                               
                                                                                                                                
          emergency services or  treats an emergency medical                                                                    
     condition                                                                                                                  
          services at an in-network facility                                                                                    
          services for which a referral was made by an in-                                                                      
     network  health  care  provider to  an  out  of-network                                                                    
     health  care  provider  without  the  explicit  written                                                                    
     consent of the covered person.                                                                                             
                                                                                                                                
     The covered  person is  still required  to pay  the in-                                                                    
     network  rates  for  the  deductible,  coinsurance  and                                                                    
     copayment.  The amount  paid by  the covered  person is                                                                    
     required  to be  counted  towards  the covered  persons                                                                    
     deductible.                                                                                                                
                                                                                                                                
     The final  payment determined for the  medical provider                                                                    
     will subtract any amount paid by the covered person.                                                                       
                                                                                                                                
     The insurance provider  is to pay the  greater of three                                                                    
     possible amounts;                                                                                                          
                                                                                                                                
          the  median  negotiated  contract  rate  generated                                                                    
     using  the in-network  health  care  providers for  the                                                                    
     service provided;                                                                                                          
                                                                                                                                
          That is  equal to  the 80th percentile  of charges                                                                    
     for  the  services  calculated   using  a  method  that                                                                    
     establishes  a  statistically   credible  profile  that                                                                    
     reflects  the  general  cost  differences  between  the                                                                    
     geographical area  where the service was  preformed and                                                                    
     the  other  geographical  areas  when  performed  by  a                                                                    
     health care provider in the  same or similar specialty;                                                                    
     or                                                                                                                         
          That would be paid  under Medicare for the service                                                                    
     provided.                                                                                                                  
                                                                                                                                
     Medical  providers are  required to  send all  bills to                                                                    
     the  insurance  provider,  except for  the  deductible,                                                                    
     coinsurance and copayment.                                                                                                 
                                                                                                                                
     Contains a  clause that if  a covered  person knowingly                                                                    
     elects to  use an out-of-network medical  provider then                                                                    
     they can be balanced billed for the services.                                                                              
                                                                                                                                
4:01:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KITO   asked  for  clarification   regarding  the                                                               
determination of the calculations.                                                                                              
                                                                                                                                
MR.  JOHNSTON  explained  that  the  greater  of  three  possible                                                               
amounts model was  taken from an [PP]ACA  [Patient Protection and                                                               
Affordable Care Act]  regulation that was adopted at  the time of                                                               
its federal  adoption.  He  stated that the 80th  percentile, the                                                               
usual and  customary rate, had been  used as the standard  by the                                                               
State of Alaska, a precedent had already been set for its use.                                                                  
                                                                                                                                
4:02:41 PM                                                                                                                    
                                                                                                                                
MR.  JOHNSTON   continued  to   paraphrase  from   the  Sectional                                                               
Analysis, which read:                                                                                                           
                                                                                                                                
     Section 2:  Health care insurance plans  obtained under                                                                  
     AS  39.30.090 or  provided under  AS 39.30.091  will be                                                                    
     subject  to the  requirements  of  secs. 21.36.512  and                                                                    
     21.36.513.                                                                                                                 
                                                                                                                                
     Section 3: Bans the practice  of "Balance Billing" by a                                                                  
     medical  provider under  the criteria  of section  1 of                                                                    
     the  bill. Stipulates  that  the  medical provider  can                                                                    
     still   bill  for   the  deductible,   coinsurance  and                                                                    
     copayment.                                                                                                                 
                                                                                                                                
     States that  a medical provider will  be paid according                                                                    
     to section 1 of the bill.                                                                                                  
                                                                                                                                
       Section 4: Establishes the punishment for medical                                                                      
         providers under the Unfair Trade Practices and                                                                         
     Consumer Protection.                                                                                                       
                                                                                                                                
4:03:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  mused that  Version T  of the  proposed bill                                                               
did not have an effective date.                                                                                                 
                                                                                                                                
REPRESENTATIVE KITO  asked whether  the consumer  was responsible                                                               
for the balance billing.                                                                                                        
                                                                                                                                
MR. JOHNSTON  replied that the  patient would not  be responsible                                                               
for balance billing, and that  the patient would only be required                                                               
to  pay the  co-insurance co-payment  and deductible  at the  in-                                                               
network  rates.   The  insurance  provider,  after providing  the                                                               
three possible amounts, would choose  the greater, which would be                                                               
the reimbursement amount for the medical provider.                                                                              
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  offered  her  belief  that  the                                                               
insurance through  the State of  Alaska already  covered patients                                                               
for emergency  room treatment.   She asked  if the care  for many                                                               
patients was not being covered in the emergency room.                                                                           
                                                                                                                                
4:05:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GRENN  explained   that  initially  the  proposed                                                               
legislation  had been  suggested by  a constituent  who had  this                                                               
experience with  another insurance provider  in Alaska.   He said                                                               
that  insurance for  State of  Alaska employees  was still  under                                                               
investigation,  although   statements  from  the   Department  of                                                               
Administration indicated that  the state did not  balance bill in                                                               
emergency situations as those focused on by the proposed bill.                                                                  
                                                                                                                                
4:06:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD asked  for additional information                                                               
to those  statistics for non-coverage of  emergency situations by                                                               
insurance companies in Alaska as well as other states.                                                                          
                                                                                                                                
4:06:27 PM                                                                                                                    
                                                                                                                                
MR. JOHNSTON said that he would provide that information.                                                                       
                                                                                                                                
4:06:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHNSTON asked, as  there were insurance companies                                                               
which did  cover balance billing,  whether this would  "level the                                                               
field for everybody."                                                                                                           
                                                                                                                                
4:07:10 PM                                                                                                                    
                                                                                                                                
MR. JOHNSTON replied that the  proposed bill only covered private                                                               
insurers  and would  "not catch  all the  plans like  self-funded                                                               
plans."   He stated that  this would be  the standard for  out of                                                               
network plans with billings for emergency situations.                                                                           
                                                                                                                                
REPRESENTATIVE JOHNSTON  suggested to  expand the breadth  of the                                                               
proposed  bill.   She mused  that,  as 21  states were  currently                                                               
offering this,  it would  be good to  have those  benchmarks, how                                                               
long they had  been offering this program, and if  there had been                                                               
any  cause  and  effect.    She asked  about  the  proposed  80th                                                               
percentile,  which  she  deemed  was  "very  different  than  the                                                               
current  80th   percentile,  cause  you're  using   a  geographic                                                               
region."    She offered  her  belief  that  this was  a  business                                                               
geographic region, and asked how  this would change if there were                                                               
certain  fees.   She shared  that  past problems  with this  80th                                                               
percentile had  arisen as,  although the  policy and  the purpose                                                               
was  very   good,  it  had  caused   a  "hockey  stick"     in  a                                                               
representative chart  of medical  costs.   She suggested  to take                                                               
some emergency fees and see what would happen.                                                                                  
                                                                                                                                
4:09:49 PM                                                                                                                    
                                                                                                                                
MR.  JOHNSTON   replied  that  he  had   been  reviewing  various                                                               
databases  and  that  his experimentation  for  the  geographical                                                               
area,  using  FAIR Health,  had  revealed  a  similar rate.    He                                                               
acknowledged that "the geographical  area has been an interesting                                                               
part of this conversation."                                                                                                     
                                                                                                                                
4:10:44 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOHNSTON acknowledged  that the  database he  had                                                               
used, FAIR  Health, was an  excellent source, except that  it was                                                               
voluntary.   She  stated that  an  advantage for  only using  the                                                               
Municipality  of Anchorage  was  that a  local ordinance  allowed                                                               
someone  to ask  a medical  facility about  a procedure  and then                                                               
"get the rack rate."                                                                                                            
                                                                                                                                
4:11:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CLAMAN  asked about the  lack of a  definition for                                                               
balance billing in  the proposed bill, as it  was not necessarily                                                               
a term that was easily understood.                                                                                              
                                                                                                                                
MR.  JOHNSTON  offered his  belief  that,  as the  proposed  bill                                                               
focused  on the  emergency situations,  balance billing  was what                                                               
was stipulated in the bill, and  the bill itself was "kind of the                                                               
definition."   He acknowledged  that balance  billing was  a much                                                               
broader term.                                                                                                                   
                                                                                                                                
4:12:16 PM                                                                                                                    
                                                                                                                                
MEGAN WALLACE,  Attorney, Legislative Legal  Counsel, Legislative                                                               
Legal Services,  reiterated that the bill  described the instance                                                               
of balance billing, and she opined:                                                                                             
                                                                                                                                
     because the explanation  in Section 3 of  the bill that                                                                    
     talks, that  uses the  term balance  bill, specifically                                                                    
     states that  the balance bill cannot  result in charges                                                                    
     that are  more than those  out of pocket  expenses that                                                                    
     the  covered  person  would   incur  in  an  in-network                                                                    
     facility or being treated by  an in-network health care                                                                    
     provider.    That the  bill  is  sufficiently clear  to                                                                    
     articulate what the balance bill would be for.                                                                             
                                                                                                                                
4:13:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR   mused  that,  as  some   insurers  covered                                                               
Providence  [Alaska  Medical  Center]  and  some  covered  Alaska                                                               
Regional  [Hospital], a  person  would be  taken  to the  closest                                                               
hospital in an emergency.   The proposed bill would eliminate the                                                               
possibility that  a person  would pay  extra charges  even though                                                               
they  had  not  been  taken  to the  hospital  covered  by  their                                                               
insurance.                                                                                                                      
                                                                                                                                
4:14:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   GRENN   expressed   his   agreement   with   her                                                               
explanation for  the intent  of the  proposed bill,  pointing out                                                               
that this was only for emergency  situations as it was not always                                                               
possible to indicate which hospital.                                                                                            
                                                                                                                                
4:14:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  removed  her  objection.   There  being  no                                                               
further objection, Version T was adopted.                                                                                       
                                                                                                                                
4:16:34 PM                                                                                                                    
                                                                                                                                
NATHAN PAIMANN,  MD, Bartlett Regional  Hospital, in  response to                                                               
Representative Tarr,  explained that some physicians  staffing at                                                               
hospitals  were independent,  and had  to independently  contract                                                               
with  the  network to  be  in-network  providers.   Although  the                                                               
hospital could  be in-network,  the providers may  not be  an in-                                                               
network  provider.   He  stated  that  the proposed  bill  "would                                                               
change  this  so  you  had no  surprise  insurance  gap  billing,                                                               
outside of what your usual and customary charges would be."                                                                     
                                                                                                                                
4:18:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KITO shared some  anecdotes of hospital situations                                                               
for  physicians   not  in-network  which  resulted   in  surprise                                                               
billings for the patients.                                                                                                      
                                                                                                                                
4:19:04 PM                                                                                                                    
                                                                                                                                
MS.  LATHAM,  in  response  to  Representative  Sullivan-Leonard,                                                               
stated that  there was an  80th percentile regulation  already in                                                               
effect,  which  had been  adopted  to  include the  treatment  of                                                               
emergency  services and  services  at an  in-network hospital  or                                                               
ambulatory surgical center,  as explained on page 2, lines  4 - 6                                                               
of the  proposed bill.   She added  that the proposed  bill "does                                                               
broaden the  scope of coverage  services to services for  which a                                                               
referral was  made by an  in-network health care provider  to the                                                               
non-network health care providers  without written consent of the                                                               
covered  person."     She  declared  that   this  did  strengthen                                                               
provisions  for consumers.   She  directed attention  to page  4,                                                               
line 27, which  created a violation of the  [Alaska] Unfair Trade                                                               
Practices  and Consumer  Protection Act.   She  expressed concern                                                               
that,  as the  Division of  Insurance had  never regulated  state                                                               
health plans,  Section 2 of  the proposed  bill [page 4,  line 5]                                                               
moved AS 39 under AS 21, which she deemed to be "unusual."                                                                      
                                                                                                                                
4:21:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  expressed that she  had concerns                                                               
with the  application and possible  outcome because of  Section 4                                                               
[page 4, lines 27 - 29].                                                                                                        
                                                                                                                                
MS. LATHAM replied  that, as this was enforced  by the Department                                                               
of Law, it offered "very, very strong consumer protections."                                                                    
                                                                                                                                
4:22:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  asked if the bill  sponsor could                                                               
review that section.                                                                                                            
                                                                                                                                
REPRESENTATIVE JOHNSTON asked if the  concern for Section 2 [page                                                               
4,   lines  6   -  11]   was   because  it   was  an   additional                                                               
responsibility,  and  whether  it  was  for  the  possibility  of                                                               
"opening up a door that might go beyond this."                                                                                  
                                                                                                                                
MS.  LATHAM said  that  this  was similar  to  House  Bill 25,  a                                                               
contraceptive  coverage bill,  as  this proposed  bill also  just                                                               
included the state self-insured,  non-federal health plans, which                                                               
had  never  been  under  the   jurisdiction  of  AS  21  and  was                                                               
unprecedented.                                                                                                                  
                                                                                                                                
4:23:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KITO  asked  if  she was  referencing  the  state                                                               
employee plans.                                                                                                                 
                                                                                                                                
MS. LATHAM said, "that's exactly what I'm referencing."                                                                         
                                                                                                                                
4:23:36 PM                                                                                                                    
                                                                                                                                
                                                                                                                                
REPRESENTATIVE TARR said that HB 193 would be held over.                                                                        
                                                                                                                                
                                                                                                                                
          HB 336-SUPPORTIVE DECISION-MAKING AGREEMENTS                                                                      
                                                                                                                                
4:23:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  announced that  the final order  of business                                                               
would  be HOUSE  BILL  NO.  336, "An  Act  relating to  supported                                                               
decision-making  agreements  to   provide  for  decision-  making                                                               
assistance; and amending Rule 402, Alaska Rules of Evidence."                                                                   
                                                                                                                                
4:24:21 PM                                                                                                                    
                                                                                                                                
HANS  RODVIK,  Staff,  Representative  Charisse  Millett,  Alaska                                                               
State  Legislature,   paraphrased  from  the   Sponsor  Statement                                                               
[Included in members' packets], which read:                                                                                     
                                                                                                                                
     With over 100 wards per  public guardian Alaska has one                                                                    
     of  the  highest  rates of  full  guardianship  in  the                                                                    
     nation.  Studies  concerning   individuals  under  full                                                                    
     guardianship  have  found  that such  individuals  were                                                                    
     significantly  less likely  to  have any  kind of  paid                                                                    
     employment and  are less likely  to be  integrated into                                                                    
     their community, than  people provided less restrictive                                                                    
     options to full guardianship.                                                                                              
                                                                                                                                
     Policy  makers  should  engage in  efforts  to  provide                                                                    
     adults    with     intellectual    and    developmental                                                                    
     disabilities  (IDD)  the  needed  tools  to  experience                                                                    
     lives with the most  autonomy, freedom and independence                                                                    
     as possible.  The Supported  Decision-Making Agreements                                                                    
     Act does just that.                                                                                                        
                                                                                                                                
     Designed as  a mechanism to  enable adults with  IDD to                                                                    
     enter  into  newly   created  legal  structures  called                                                                    
     supported  decision-making   agreements  (SDMA),  House                                                                    
     Bill 336  will provide  a less  restrictive alternative                                                                    
     to  full guardianship  for adults  with IDD.  Guided by                                                                    
     the  experience of  other states,  HB  336 will  enable                                                                    
     adults with  disabilities to  maintain their  rights to                                                                    
     make decisions currently being taken  away from them by                                                                    
     guardianship orders.                                                                                                       
                                                                                                                                
     The  philosophy  underpinning   HB  336  contends  that                                                                    
     adults  with  IDD  do  have  and  should  retain  their                                                                    
     constitutional and  civil rights to live  as freely and                                                                    
     autonomously as  possible. HB 336 will  help change the                                                                    
     current system  in which one  person tends  makes every                                                                    
     decision for adults with IDD,  even though those adults                                                                    
     have capacity to  make many decisions on  their own; to                                                                    
     a system where adults who  can make life decisions with                                                                    
     support from  others no longer  have the right  to make                                                                    
     those   decisions  taken   away   from   them  by   the                                                                    
     government.                                                                                                                
                                                                                                                                
     HB 336 will  enable OPA to focus its  efforts on adults                                                                    
     who  truly  need  full  guardianship,  while  providing                                                                    
     Alaskans experiencing  varying levels of IDD  an avenue                                                                    
     to live happier and healthier lives.                                                                                       
                                                                                                                                
MR. RODVIK  pointed out that  the proposed bill had  been written                                                               
in conjunction  with the Governor's  Council on  Disabilities and                                                               
Special Education  to address  these issues  and allow  people to                                                               
live more self-guided lives.                                                                                                    
                                                                                                                                
4:25:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  reminded that public testimony  had remained                                                               
open.                                                                                                                           
                                                                                                                                
4:26:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR closed public testimony on HB 336.                                                                          
                                                                                                                                
4:26:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHNSTON  stated her support of  the proposed bill                                                               
and pointed to a cost savings.                                                                                                  
                                                                                                                                
4:26:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CLAMAN stated his support of the proposed bill.                                                                  
                                                                                                                                
4:27:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KITO stated that the  proposed bill was a key tool                                                               
to enable support of family members.                                                                                            
                                                                                                                                
4:27:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   SULLIVAN-LEONARD  expressed   her  support   and                                                               
offered a personal anecdote.                                                                                                    
                                                                                                                                
4:28:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR stated her support of the proposed bill.                                                                    
                                                                                                                                
4:28:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EDGMON  moved to  report  CSHB  336, Version  30-                                                               
LS1239\J, Bannister,  2/26/18, out  of committee  with individual                                                               
recommendations and  the accompanying fiscal notes.   There being                                                               
no objection, CSHB  336(HSS) was moved from the  House Health and                                                               
Social Services Standing Committee.                                                                                             
                                                                                                                                
4:30:56 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 4:30 p.m.                                                                                                          
                                                                                                                                
                                                                                                                                

Document Name Date/Time Subjects
HB 193 Draft Proposed Blank CS ver T 03.08.2018.pdf HHSS 3/8/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Definitions 03.08.2018.pdf HHSS 3/8/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Sectional Analysis 03.08.2018.pdf HHSS 3/8/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HB 193
HB 193 Sponsor Statement 03.08.2018.pdf HHSS 3/8/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HB 193
HB193 Fiscal Note CED--IO 3.7.2018.pdf HHSS 3/8/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HB 193
HB358 Fiscal Note CED--IO 3.7.2018.pdf HHSS 3/8/2018 3:00:00 PM
HB 358
HB358 Sponsor Statement 03.07.18.pdf HHSS 3/8/2018 3:00:00 PM
HB 358
HB358 Sectional Analysis ver J 03.07.18.pdf HHSS 3/8/2018 3:00:00 PM
HHSS 3/29/2018 3:00:00 PM
HB 358
HB351 Additional Document -- DJJ responses to questions.pdf HHSS 3/8/2018 3:00:00 PM
HB 351
HB 351 Draft Proposed Amendment R.1 3.5.2018.pdf HHSS 3/6/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 351
HB351 Sectional Analysis 3.5.2018.pdf HHSS 3/6/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 351
HB351 Fiscal Note DHS--DJJ 3.5.2018.pdf HHSS 3/6/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 351
HB351 Sponsor Statement 3.5.2018.pdf HHSS 3/6/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 351
HB351 Supporting Document -- Letter from DJJ.pdf HHSS 3/6/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 351
HB 336 Fiscal Note DHS--SDS 2.28.2018.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336
Draft CS for HB 336 Version J Explanation of Changes.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336
Draft CS for House Bill 336 Version J Sectional Analysis.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336
House Bill 336 Additional Documents Rule 402 2.9.2018.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336
House Bill 336 Draft CS Version J.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336
House Bill 336 Sponsor Statement 2.9.2018.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336
House Bill 336 Supporting Documents - Govs Council on Disabilities 2.9.2018.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336
House Bill 336 Supporting Documents - OPA & Guardianship 2.9.2018.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336
House Bill 336 Supporting Documents - Paper on Guardianship Concerning NCI Adult Consumer Survey 2.9.2018.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336
House Bill 336 Supporting Documents - SDMA Example from Autistic Self Advocary Network 2.9.2018.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336
House Bill 336 Supporting Documents - SDMA Example from Texas 2.9.2018.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336
House Bill 336 Supporting Documents - SDMA Law from Delaware 2.9.2018.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336
House Bill 336 Supporting Documents - SDMA Texas 2.9.2018.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336
House Bill 336 Supporting Documents Massachusetts SDMA Example 2.9.2018.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336
House Bill 336 Supporting Documents National Core Indicators 2016 Survey 2.9.2018.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336
House Bill 336 Supporting Documents SDMA - Agenda for Action 2.9.2018.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336
House Bill 336 Supporting Documents SDMA Bill from Rhode Island 2.9.2018.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336
House Bill 336 Supporting Documents SMDA Paper by Council on Quality and Leadership 2.9.2018.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336
HB 336 Letter of Support AARP Alaska.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336
HB 336 Letter of Support Delaune.pdf HHSS 3/1/2018 3:00:00 PM
HHSS 3/8/2018 3:00:00 PM
HB 336