Legislature(2019 - 2020)CAPITOL 106

03/28/2019 03:00 PM HEALTH & SOCIAL SERVICES

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Audio Topic
03:02:25 PM Start
03:03:00 PM Presentation: Alaska Children's Justice Act Task Force
03:55:39 PM HB22
04:00:53 PM HB29
04:03:52 PM HB97
04:16:17 PM HB86
04:38:19 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Presentation: Children's Justice Act Task Force TELECONFERENCED
+= HB 22 EXTEND SUICIDE PREVENTION COUNCIL TELECONFERENCED
Moved HB 22 Out of Committee
+= HB 29 INSURANCE COVERAGE FOR TELEHEALTH TELECONFERENCED
Moved HB 29 Out of Committee
+= HB 97 TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS TELECONFERENCED
Moved CSHB 97(HSS) Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
*+ HB 86 MENTAL HEALTH HOSPITAL: CONTRACTS/BIDS TELECONFERENCED
Heard & Held
<Bill Hearing Rescheduled from 3/26/19>
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         March 28, 2019                                                                                         
                           3:02 p.m.                                                                                            
                                                                                                                                
                             DRAFT                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Ivy Spohnholz, Co-Chair                                                                                          
Representative Matt Claman                                                                                                      
Representative Harriet Drummond                                                                                                 
Representative Geran Tarr                                                                                                       
Representative Lance Pruitt                                                                                                     
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Tiffany Zulkosky, Co-Chair                                                                                       
Representative Sharon Jackson                                                                                                   
                                                                                                                                
OTHER LEGISLATORS PRESENT                                                                                                     
                                                                                                                                
Representative Andy Josephson                                                                                                   
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
PRESENTATION: ALASKA CHILDREN'S JUSTICE ACT TASK FORCE                                                                          
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
HOUSE BILL NO. 22                                                                                                               
"An Act extending the termination date of the Statewide Suicide                                                                 
Prevention Council; and providing for an effective date."                                                                       
                                                                                                                                
     - MOVED HB 22 OUT OF COMMITTEE                                                                                             
                                                                                                                                
HOUSE BILL NO. 29                                                                                                               
"An Act relating to insurance coverage for benefits provided                                                                    
through telehealth; and providing for an effective date."                                                                       
                                                                                                                                
     - MOVED HB 29 OUT OF COMMITTEE                                                                                             
                                                                                                                                
HOUSE BILL NO. 97                                                                                                               
"An Act relating to the prescription of drugs by a physician                                                                    
assistant without physical examination."                                                                                        
                                                                                                                                
     - MOVED CSHB 97(HSS) OUT OF COMMITTEE                                                                                      
                                                                                                                                
HOUSE BILL NO. 86                                                                                                               
"An Act relating to a state-owned inpatient mental health                                                                       
treatment hospital; and providing for an effective date."                                                                       
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 22                                                                                                                   
SHORT TITLE: EXTEND SUICIDE PREVENTION COUNCIL                                                                                  
SPONSOR(s): REPRESENTATIVE(s) TARR                                                                                              
                                                                                                                                
02/20/19       (H)       PREFILE RELEASED 1/7/19                                                                                
02/20/19       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/20/19       (H)       HSS, FIN                                                                                               
03/26/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/26/19       (H)       Heard & Held                                                                                           
03/26/19       (H)       MINUTE(HSS)                                                                                            
03/28/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 29                                                                                                                   
SHORT TITLE: INSURANCE COVERAGE FOR TELEHEALTH                                                                                  
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ                                                                                         
                                                                                                                                
02/20/19       (H)       PREFILE RELEASED 1/11/19                                                                               
02/20/19       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/20/19       (H)       HSS, L&C                                                                                               
03/26/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/26/19       (H)       Heard & Held                                                                                           
03/26/19       (H)       MINUTE(HSS)                                                                                            
03/28/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 97                                                                                                                   
SHORT TITLE: TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS                                                                            
SPONSOR(s): REPRESENTATIVE(s) KREISS-TOMKINS                                                                                    
                                                                                                                                
03/15/19       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/15/19       (H)       HSS, L&C                                                                                               
03/26/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/26/19       (H)       Heard & Held                                                                                           
03/26/19       (H)       MINUTE(HSS)                                                                                            
03/28/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 86                                                                                                                   
SHORT TITLE: MENTAL HEALTH HOSPITAL: CONTRACTS/BIDS                                                                             
SPONSOR(s): REPRESENTATIVE(s) FIELDS                                                                                            
                                                                                                                                
03/06/19       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/06/19       (H)       HSS, L&C                                                                                               
03/26/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/26/19       (H)       <Bill Hearing Rescheduled to 3/28/19>                                                                  
03/28/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
CATHY BALDWIN-JOHNSON, MD                                                                                                       
Medical Director                                                                                                                
Alaska CARES                                                                                                                    
The Children's Hospital at Providence                                                                                           
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Presented a PowerPoint titled "Child Abuse                                                               
in Alaska: 2019 Update."                                                                                                        
                                                                                                                                
JARED PARRISH, PhD                                                                                                              
Senior Epidemiologist, MCH-Epi                                                                                                  
Division of Public Health                                                                                                       
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Presented a PowerPoint titled "Child Abuse                                                               
in Alaska: 2019 Update."                                                                                                        
                                                                                                                                
MIKE HOPPER, PhD                                                                                                                
Child & Adolescent Psychologist                                                                                                 
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified during the presentation by Alaska                                                              
Children's Justice Act Task Force.                                                                                              
                                                                                                                                
BERNICE NESBIT, Staff                                                                                                           
Representative Ivy Spohnholz                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Reviewed HB 29 on behalf of the bill                                                                     
sponsor, Representative Spohnholz.                                                                                              
                                                                                                                                
REID HARRIS, Staff                                                                                                              
Representative Jonathan Kreiss-Tomkins                                                                                          
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Reviewed HB 97 on behalf of the bill                                                                     
sponsor, Representative Kreiss-Tomkins.                                                                                         
                                                                                                                                
DEBORAH STOVERN, Executive Administrator                                                                                        
State Medical Board                                                                                                             
Division of Corporations, Business, and Professional Licensing                                                                  
Department of Commerce, Community & Economic Development                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:   Answered questions during  discussion of HB                                                             
97.                                                                                                                             
                                                                                                                                
REPRESENTATIVE ZACH FIELDS                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Introduced HB  86  as the  sponsor of  the                                                             
bill.                                                                                                                           
                                                                                                                                
TRISTAN WALSH, Staff                                                                                                            
Representative Zach Fields                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Presented the  sectional analysis  and the                                                             
committee substitute for HB 86.                                                                                                 
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:02:25 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  IVY  SPOHNHOLZ  called  the  House  Health  and  Social                                                             
Services  Standing  Committee  meeting  to  order  at  3:02  p.m.                                                               
Representatives  Spohnholz,  Drummond,   Tarr,  and  Claman  were                                                               
present at the  call to order.  Representative  Pruitt arrived as                                                               
the  meeting   was  in   progress.     Also  in   attendance  was                                                               
Representative Josephson.                                                                                                       
                                                                                                                                
^Presentation: Alaska Children's Justice Act Task Force                                                                       
     Presentation: Alaska Children's Justice Act Task Force                                                                 
                                                                                                                                
3:03:00 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ announced  that the  first order  of business                                                               
would  be a  presentation by  the Alaska  Children's Justice  Act                                                               
Task Force.                                                                                                                     
                                                                                                                                
3:03:54 PM                                                                                                                    
                                                                                                                                
CATHY BALDWIN-JOHNSON,  MD, Medical  Director, Alaska  CARES, The                                                               
Children's Hospital  at Providence,  acknowledged the  Task Force                                                               
members  in the  audience.   She  presented  a PowerPoint  titled                                                               
"Child Abuse  in Alaska: 2019  Update," and paraphrased  slide 1,                                                               
"Introduction to the Alaska CIATF," which read:                                                                                 
                                                                                                                                
     Federally mandated and funded                                                                                              
                                                                                                                                
     Mission: Identify areas where  improvement is needed in                                                                    
     the   statewide   response   to   child   maltreatment,                                                                    
     particularly child  sexual abuse,  make recommendations                                                                    
     and take action to improve the system.                                                                                     
                                                                                                                                
     Statewide, multidisciplinary membership                                                                                    
                                                                                                                                
     Legislation  to   improve  protection  &   justice  for                                                                    
     children (starvation, serious physical abuse, privacy)                                                                     
                                                                                                                                
     Focus on  education: child  abuse in  Alaska, mandatory                                                                    
     reporting, &  best practices for  the multidisciplinary                                                                    
     response to child abuse                                                                                                    
                                                                                                                                
DR.  BALDWIN-JOHNSON  moved  on   to  paraphrase  slide  2,  "Key                                                               
Points," which read:                                                                                                            
                                                                                                                                
     What's  happening  with  child  abuse  and  neglect  in                                                                    
     Alaska?                                                                                                                    
                                                                                                                                
     It's COMMON                                                                                                                
                                                                                                                                
     What is the impact?                                                                                                        
                                                                                                                                
     Adverse Childhood Experiences (ACE) Studies                                                                                
                                                                                                                                
     Alaska ACEs and their costs                                                                                                
                                                                                                                                
     What can we  do to change the trajectory  for our kids?                                                                    
     HOPE!                                                                                                                      
                                                                                                                                
     A real-life look at trauma                                                                                                 
                                                                                                                                
3:06:45 PM                                                                                                                    
                                                                                                                                
DR.   BALDWIN-JOHNSON   shared   slide  4,   "Adverse   Childhood                                                               
Experiences  (ACE),"   and  explained   that  this  was   a  huge                                                               
collaborative study  between the Centers for  Disease Control and                                                               
Prevention  (CDC) researchers  and  Kaiser  Permanente, a  health                                                               
maintenance organization in California.   She reported that there                                                               
were more than 17,000  participants, mostly middle-aged Caucasian                                                               
with at  least some  college education.   She reported  that they                                                               
were asked about events which may  have happened to them prior to                                                               
18 years of  age, which included physical,  sexual, and emotional                                                               
abuse,  as well  as physical  and emotional  neglect.   She added                                                               
that  there were  also five  questions about  family dysfunction,                                                               
whether a  parent or caregiver  suffered from mental  illness, if                                                               
someone in  the family had gone  to jail or prison,  did they see                                                               
their mother  being treated violently, was  there substance abuse                                                               
in  the  home,   or  was  there  divorce  or   separation.    The                                                               
researchers were surprised at how  common it was for this history                                                               
of  child maltreatment,  with a  significant correlation  between                                                               
this  history and  the most  common causes  of disease  and early                                                               
death.  She directed attention to  slide 5, "34%," and noted that                                                               
more  than one-third  of  Alaskan adults  reported  a history  of                                                               
physical or sexual abuse, or physical or emotional neglect.                                                                     
                                                                                                                                
3:08:55 PM                                                                                                                    
                                                                                                                                
DR. BALDWIN-JOHNSON moved on to  slide 6, "Alaska ACEs snapshot,"                                                               
which listed  issues as reported  by Alaskan adults.   She stated                                                               
that people  who had  sustained at  least four  or more  of these                                                               
categories  of abuse,  neglect, or  family dysfunction  were much                                                               
more likely to  be unemployed, unable to work, or  to report poor                                                               
health.                                                                                                                         
                                                                                                                                
3:09:24 PM                                                                                                                    
                                                                                                                                
DR.  BALDWIN-JOHNSON indicated  slide  7, a  graph  of abuse  and                                                               
dysfunction with  the relative  percentage of  co-occurrence with                                                               
other exposures.  She pointed  out that these exposures tended to                                                               
occur in clusters in families.                                                                                                  
                                                                                                                                
3:10:06 PM                                                                                                                    
                                                                                                                                
DR.  BALDWIN-JOHNSON   presented  slide  8,   "Adverse  Childhood                                                               
Experiences   (ACE),"  and   emphasized   that   the  more   ACEs                                                               
documented, the higher the risk  for developing health and social                                                               
problems.     She   reported  that   childhood  trauma   modified                                                               
development  and impacted  genetics.   She moved  on to  slide 9,                                                               
"Impacts Start Prior to Birth,"  and paraphrased the slide, which                                                               
read:                                                                                                                           
                                                                                                                                
     Prenatal exposures and experiences can have an impact                                                                      
     on both vulnerability as well as resiliency                                                                                
                                                                                                                                
     Impacts on brain development and genetics                                                                                  
                                                                                                                                
     Examples:  FASD ? Asthma hospitalization risk                                                                              
                                                                                                                                
3:11:42 PM                                                                                                                    
                                                                                                                                
DR.  BALDWIN-JOHNSON  shared  slide 10,  "The  Developing  Brain:                                                               
Macro  View,"  comparing  photos which  revealed  the  difference                                                               
between infant  and adult brains.   She said that the  baby brain                                                               
was  meant  to  grow  and  develop  in  response  to  the  things                                                               
experienced  after birth.    She  moved on  to  slide 11,  "Rapid                                                               
Growth of  Neuron Development," declaring  that this was  a micro                                                               
view of the  brain.  She noted  that, at birth, there  were not a                                                               
lot of  nerve cells and connections,  but that after 6  years the                                                               
brain was  filling with information.   She reported that,  in the                                                               
teen years,  the brain went "through  a time of pruning;"  when a                                                               
skill  was not  used, it  was  pruned, and  new connections  were                                                               
developed.                                                                                                                      
                                                                                                                                
3:12:52 PM                                                                                                                    
                                                                                                                                
DR. BALDWIN-JOHNSON  paraphrased slide  12 "Key  Concepts," which                                                               
read:                                                                                                                           
                                                                                                                                
     Neurons are designed to change  in response to external                                                                    
     signals                                                                                                                    
                                                                                                                                
     The  undifferentiated  developing brain  is  critically                                                                    
     dependent on environmental cues                                                                                            
                                                                                                                                
     Disruption,  or lack  of critical  cues, can  result in                                                                    
     compromised brain function                                                                                                 
                                                                                                                                
     Development of  brain areas occur  in a  certain order:                                                                    
     "Building Blocks"                                                                                                          
                                                                                                                                
DR. BALDWIN-JOHNSON  shared slide 13, "Key  Concepts, Continued,"                                                               
which read:                                                                                                                     
                                                                                                                                
     Children  learn to  form relationships  and respond  to                                                                    
     stress - just as they learn to see, hear, walk, talk                                                                       
                                                                                                                                
     Relationships  children   have  with   caregivers  play                                                                    
     critical roles in  regulating stress hormone production                                                                    
     during early years of life                                                                                                 
                                                                                                                                
     Toxic stressors in  childhood create measurable changes                                                                    
     to the brain                                                                                                               
                                                                                                                                
3:14:12 PM                                                                                                                    
                                                                                                                                
DR. BALDWIN-JOHNSON paraphrased slide  14, "The Brain: Targets of                                                               
Stress," which read:                                                                                                            
                                                                                                                                
     Cerebral cortex EEG changes smaller callosum                                                                               
                                                                                                                                
     Limbic system neuronal changes decreased size                                                                              
                                                                                                                                
     Brainstem/ Cerebellum altered transmitters                                                                                 
                                                                                                                                
                                                                                                                                
DR. BALDWIN-JOHNSON moved on to  slide 15, "Two Roads to Travel,"                                                               
and stated  that there  were two  roads for  kids to  travel when                                                               
they were born.  She paraphrased from the slide, which read:                                                                    
                                                                                                                                
     Safe and Nurturing                                                                                                       
                                                                                                                                
      Have a stable foundation from which to explore their                                                                      
     world                                                                                                                      
                                                                                                                                
     Spend more time in the upper blocks (bonding, talking,                                                                     
     interpersonal relationships)                                                                                               
                                                                                                                                
      Child feels calm and safe and can focus their energy                                                                      
     on learning                                                                                                                
                                                                                                                                
     Trauma and Chaos                                                                                                         
                                                                                                                                
       When a child is unsafe/threatened, they spend more                                                                       
     time in the lower blocks, focusing only on survival                                                                        
                                                                                                                                
         Fight, Flight or Freeze neural pathways become                                                                         
     "hardwired"                                                                                                                
                                                                                                                                
3:15:23 PM                                                                                                                    
                                                                                                                                
DR.  BALDWIN-JOHNSON  concluded  with   slide  16,  "Life  course                                                               
perspective," and stated  that there were things  that could push                                                               
a child's trajectory, noting that  well-educated parents who were                                                               
able  to meet  their kids  emotional needs,  read to  their kids,                                                               
provide appropriate  discipline, get  the necessary  health care,                                                               
and have an  adequate education which starts early  will push the                                                               
life trajectory upward for a better start.                                                                                      
                                                                                                                                
3:16:11 PM                                                                                                                    
                                                                                                                                
JARED PARRISH,  PhD, Senior Epidemiologist, MCH-Epi,  Division of                                                               
Public  Health,   Department  of  Health  and   Social  Services,                                                               
presented slide 17 "New emerging  data resources" and stated that                                                               
the "Alaska Longitudinal Child Abuse  and Neglect Linkage Project                                                               
(ALCANLink)"  was a  novel data  source that  no other  state had                                                               
currently.    He explained  that  they  had taken  their  limited                                                               
resources  and maximized  them to  turn a  cross sectional  study                                                               
into a  longitudinal study  to allow them  to follow  people over                                                               
time, and  accurately estimate  risk.  He  pointed to  the Alaska                                                               
Pregnancy  Risk Assessment  Monitoring System  (Alaska PRAMS),  a                                                               
survey conducted  in nearly all  50 states, which was  offered to                                                               
new mothers  shortly after  birth with  questions related  to the                                                               
pre-birth,  birth,   and  after   delivery  experiences.     That                                                               
information was  integrated with administrative data  sources and                                                               
child  welfare records  to  track the  population  in Alaska  and                                                               
estimate the  risk.  He added  that a goal was  to integrate with                                                               
as many administrative  data sources as possible.   He noted that                                                               
PRAMS was  weighted for  population, so every  birth need  not be                                                               
linked, but instead the data from the survey response was used.                                                                 
                                                                                                                                
3:18:30 PM                                                                                                                    
                                                                                                                                
DR. PARRISH addressed slide 18  "Risk (incidence) among children"                                                               
and noted that  each year they were including  an additional year                                                               
in age.   He reported that 37 percent of  children born in Alaska                                                               
would be reported to child welfare  before the age of nine years.                                                               
He declared  that this was  a large  proportion and was  an issue                                                               
for the Division of Public Health  to address.  He continued with                                                               
slide  19,   "Maltreatment  burden,"   and  explained   that  the                                                               
prevalence estimate  for maltreatment was  for 10 percent  of the                                                               
child population, ages 0 to 17  years, to have contact with child                                                               
welfare  in  an  annual  year.     He  reported  that  the  adult                                                               
prevalence  indicated   that  34   percent  of   adults  reported                                                               
experiencing  some   form  of  abuse  or   neglect  during  their                                                               
childhood,  which he  called a  proxy  for the  risk or  lifetime                                                               
burden  for  a  child.    He  said  that  as  they  measured  the                                                               
cumulative  incidents,  it  was  expected  for  the  estimate  to                                                               
closely  match  or   exceed  that  34  percent  as   it  was  the                                                               
measurement of actual events as they occurred.                                                                                  
                                                                                                                                
3:20:12 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  asked whether  a report  of contact  with the                                                               
Office of  Children's Services (OCS)  was a  report of harm  or a                                                               
substantiated report.                                                                                                           
                                                                                                                                
DR. PARRISH replied that this was  a report of harm.  In response                                                               
to  Representative  Drummond, he  explained  that  BRFSS was  the                                                               
behavioral risk factor surveillance system.                                                                                     
                                                                                                                                
3:20:38 PM                                                                                                                    
                                                                                                                                
DR.  PARRISH shared  slide  20, "Among  children  born in  Alaska                                                               
during 2009-2011," and  reported that each was an  estimate for a                                                               
child under  nine years  of age:  one out of  three would  have a                                                               
report of  harm to child  welfare; one out  of four would  have a                                                               
report of harm  screened in with child welfare; one  out of eight                                                               
would have  a report  of harm  substantiated with  child welfare;                                                               
and one out of sixteen would  be removed from their home by child                                                               
welfare.  He moved on to  slide 21, "First report by maltreatment                                                               
type,"  which  shared  the reports  for  physical  abuse,  sexual                                                               
abuse, mental  injury, and  neglect.  He  pointed out  that these                                                               
were the  four classifications used by  OCS.  He noted  that each                                                               
of  the  estimates  could  be  calculated  because  they  were  a                                                               
cumulative  measure during  the  developmental  periods for  kids                                                               
over their life course trajectory.                                                                                              
                                                                                                                                
3:22:13 PM                                                                                                                    
                                                                                                                                
DR. PARRISH said that the data  "have a ton of information that I                                                               
could be providing to you,  but usually with information and data                                                               
I  found that  I  can  give data  overload  very  quickly, as  he                                                               
presented  slide  22,  "Pre-birth  household  dysfunction."    He                                                               
clarified that this  was not ACEs research but was  an attempt to                                                               
better understand  ACEs.  He  pointed out that abuse  and neglect                                                               
were suffered directly  by a child and  the household dysfunction                                                               
was the environment  in which a child developed.   He stated that                                                               
household  dysfunction could  be  measured prior  to birth  which                                                               
allowed for the  ACE score of a  child at birth.   He pointed out                                                               
that the  more household dysfunctions  the more likely  the child                                                               
would have  contact with  child welfare before  the age  of nine.                                                               
He declared that  an accumulation of bad things  in life impacted                                                               
the ability  to appropriately make  a safe  place for a  child to                                                               
develop.   He  moved on  to slide  24, "PRAMS  Questions used  to                                                               
quantify  pre-birth   household  dysfunction  beyond   ACEs  only                                                               
questions."  He listed financial  stress, arguments with partner,                                                               
homelessness,   partner  didn't   want  pregnancy,   and  partner                                                               
threatens   or   limits   activities  as   additional   household                                                               
dysfunctions that  also were strongly related,  independently for                                                               
contact  with  child  welfare.   He  acknowledged  that  although                                                               
dysfunction could occur  in every household, if  there were three                                                               
of these,  it was  140 percent  more likely for  a report  to OCS                                                               
before the  age of  9, and if  there were five  or more  of these                                                               
dysfunctions, it was  361 percent more likely.   He declared that                                                               
the utilization  of population-based  data helped to  predict the                                                               
effective  placement  of  resources for  prevention,  to  provide                                                               
services adequately to the families, and to identify those who                                                                  
need these services.                                                                                                            
                                                                                                                                
3:25:21 PM                                                                                                                    
                                                                                                                                
DR. BALDWIN-JOHNSON paraphrased slide 26, "National estimates:"                                                                 
which read:                                                                                                                     
                                                                                                                                
     In the US ANNUALLY                                                                                                         
                                                                                                                                
     Lifetime burden                                                                                                            
                                                                                                                                
     Between $433.7 billion and $2 trillion (2016 USD)                                                                          
                                                                                                                                
DR. BALDWIN-JOHNSON addressed slide 27, "Alaska estimates:"                                                                     
which read:                                                                                                                     
                                                                                                                                
     Between $631 million to $10.7 billion ANNUALLY                                                                             
                                                                                                                                
     Alaska research suggests:                                                                                                  
                                                                                                                                
        Costs for SUBSTANTIATED reports: $82 million for                                                                        
    childhood   health   care,   child   welfare,   special                                                                     
     education                                                                                                                  
                                                                                                                                
       40.6% adult Medicaid enrollment linked to Adverse                                                                        
     Childhood Experiences (ACEs)                                                                                               
                                                                                                                                
     Decreasing  ACEs and  improving our  response to  child                                                                    
     maltreatment   could  save   our  state   ~$92  million                                                                    
     annually in  costs related just to:  Medicaid, smoking,                                                                    
     diabetes, binge drinking, arthritis, obesity                                                                               
                                                                                                                                
DR. BALDWIN-JOHNSON addressed slide 29, "What can we do?" which                                                                 
read:                                                                                                                           
                                                                                                                                
     Reasons for hope:                                                                                                          
                                                                                                                                
     Healing is possible                                                                                                        
                                                                                                                                
     Our brains can always learn                                                                                                
                                                                                                                                
     We can all help build resilience in children                                                                               
                                                                                                                                
     We can all help protect children                                                                                           
                                                                                                                                
DR.  BALDWIN-JOHNSON moved  on to  slide 30,  "Early &  effective                                                               
intervention," which read:                                                                                                      
                                                                                                                                
     Child Advocacy Centers                                                                                                     
                                                                                                                                
     Multidisciplinary response                                                                                                 
                                                                                                                                
     Child focused                                                                                                              
                                                                                                                                
     Forensic interview                                                                                                         
                                                                                                                                
     Medical exam                                                                                                               
                                                                                                                                
     Mental health services                                                                                                     
                                                                                                                                
     Support & advocacy                                                                                                         
                                                                                                                                
     Information sharing                                                                                                        
                                                                                                                                
DR.  BALDWIN-JOHNSON shared  slide 31,  "Children seen  at Alaska                                                               
CACs," pointing out that many  hub communities had child advocacy                                                               
centers, which had provided service  to more than 30,000 children                                                               
and their families.                                                                                                             
                                                                                                                                
3:27:58 PM                                                                                                                    
                                                                                                                                
DR.  BALDWIN-JOHNSON presented  slide 32  "How do  we create  the                                                               
best future for our children's  lives?" and slide 33 "Development                                                               
influenced  by   both  negative  and  positive   factors."    She                                                               
expressed  a   desire  for  only   positive  factors,   with  the                                                               
prevention of any negative experience  or trauma.  She pointed to                                                               
slide 34 "Protective Factors: Focus on adults," which listed:                                                                   
                                                                                                                                
     Supportive, nurturing, stable family                                                                                       
                                                                                                                                
     Supportive social networks                                                                                                 
                                                                                                                                
     Caring adults outside family                                                                                               
                                                                                                                                
     Household rules, monitoring of child                                                                                       
                                                                                                                                
     Parental employment                                                                                                        
                                                                                                                                
     Adequate housing                                                                                                           
                                                                                                                                
     Access to health care, other services                                                                                      
                                                                                                                                
     Community safety                                                                                                           
                                                                                                                                
     Community involvement                                                                                                      
                                                                                                                                
3:29:11 PM                                                                                                                    
                                                                                                                                
DR. BALDWIN-JOHNSON addressed  slide 35 "Dare to be  the one" and                                                               
reminded  the  committee  that April  was  National  Child  Abuse                                                               
Prevention Month  and that the motto  for this year was  "Dare to                                                               
be the  one."  She  shared slide 36 and  slide 37, "What  can you                                                               
do?" which read:                                                                                                                
                                                                                                                                
     Realize this affects ALL of us in Alaska                                                                                   
                                                                                                                                
     Break the silence!                                                                                                         
                                                                                                                                
       Make your decisions using a trauma- informed lens                                                                        
     "It's not what's wrong with you, it's what happened to                                                                     
     you"                                                                                                                       
                                                                                                                                
     Support system-wide approaches to strengthen children                                                                      
     and families                                                                                                               
                                                                                                                                
     "Strengthening Families" program                                                                                           
                                                                                                                                
     "Help me grow"                                                                                                             
                                                                                                                                
     "Alaska Resilience Initiative"                                                                                             
                                                                                                                                
     Think big - "Collective Impact"                                                                                            
                                                                                                                                
     Support community based initiatives                                                                                        
     Examples:                                                                                                                  
     ROCK MatSu (Raising our Children with Kindness)                                                                            
                                                                                                                                
        MAPP (Mobilizing for Action through Planning and                                                                        
     Partnerships)                                                                                                              
                                                                                                                                
3:31:18 PM                                                                                                                    
                                                                                                                                
DR. BALDWIN-JOHNSON shared slide 38, "Our data suggests that:"                                                                  
which read:                                                                                                                     
                                                                                                                                
       Many Alaskan adults bear the burden of a lifetime                                                                        
     accumulation of family violence and dysfunction                                                                            
                                                                                                                                
     Alaskan  children  start   accumulating  these  adverse                                                                    
     events early in life                                                                                                       
                                                                                                                                
     Our economy and our society bear the costs                                                                                 
                                                                                                                                
DR. BALDWIN-JOHNSON concluded with slide 39 "To reduce this                                                                     
burden we need:" which read:                                                                                                    
                                                                                                                                
     Prevention                                                                                                                 
                                                                                                                                
     Early recognition                                                                                                          
                                                                                                                                
     Early, effective, timely intervention                                                                                      
                                                                                                                                
     Effective treatment                                                                                                        
                                                                                                                                
     A  focus  on  supporting  healthy, stable  ,  safe  and                                                                    
     nurturing families and communities  so our children can                                                                    
     be healthy & successful adults                                                                                             
                                                                                                                                
3:32:28 PM                                                                                                                    
                                                                                                                                
MIKE HOPPER, PhD, Child & Adolescent Psychologist, shared some                                                                  
of his experiences and paraphrased from a prepared statement,                                                                   
which read [original punctuation provided]:                                                                                     
                                                                                                                                
     I  have  been  tasked  with   putting  a  face  on  the                                                                    
     statistics   you  just   witnessed?  I   have  been   a                                                                    
     practicing child/adolescent  psychologist for  the past                                                                    
     40 years  and have  been working  with abused  kids for                                                                    
     that  entire time  but it  took  me most  of the  first                                                                    
     decade  to understand  that?The  faces  that come  most                                                                    
     readily  are  the ones  I  failed  to recognize  during                                                                    
     those early years.                                                                                                         
                                                                                                                                
     My first  patient, Kenny, I  met, sort of, as  he raced                                                                    
     sliding on  stocking feet  down the  halls of  a locked                                                                    
                                              th                                                                                
     long-term psychiatric  facility on the  8  floor  of LA                                                                    
     County Medical Center. He  was laughing hysterically at                                                                    
     the  staff that  chased after  him. I  wanted him  as a                                                                    
     patient on  sight. I  was told  he was  an incorrigible                                                                    
     delinquent  who had  attempted  to  hang himself  after                                                                    
     setting his  room at  an LA  detention center  on fire.                                                                    
     Senior staff assured  me he had only done  so to escape                                                                    
     his  correctional   consequences.  If  so,   he  didn't                                                                    
     succeed. I stayed  in touch with Kenny  over the course                                                                    
     of the  next 20 years  he spent incarcerated.  He ended                                                                    
     up in  the Supermax  at Pelican  Bay for  assaulting an                                                                    
     inmate  accused  of  molesting children.  He  would  be                                                                    
     about  56 y/o  today. But  he died  years ago,  3 weeks                                                                    
     after  being  let out  on  a  compassionate release.  I                                                                    
     never did  ask him why  he tried  to kill himself  as a                                                                    
     teenager.                                                                                                                  
                                                                                                                                
     Likewise  I  didn't  ask  the   crippled  15  year  old                                                                    
     prostitute I was asked to  visit on an emergency unit 2                                                                    
     floors  below Kenny's  why she'd  jumped off  a 4-story                                                                    
     parking structure. I was told she was just depressed.                                                                      
                                                                                                                                
     And I didn't  stand up for the 14 y/o  pregnant teen in                                                                    
     that same unit  who complained that one  of the nursing                                                                    
     staff  had fondled  her. That  was quietly  swept under                                                                    
     the rug.  Nobody bothered to  ask her about  the father                                                                    
     of her child and so neither  did I. We all just assumed                                                                    
     she was a loose woman.                                                                                                     
                                                                                                                                
     I didn't  know to ask  these kids the hard  but obvious                                                                    
     questions.  For  a  time I  accepted  the  professional                                                                    
     party line:  They were  disturbed and  disturbing kids.                                                                    
     But I couldn't forget them.  But it wasn't until I went                                                                    
     to  work  in  the  early 80's  in  the  nation's  first                                                                    
     residential  facility  specifically   for  "abused  and                                                                    
     neglected children" in the dry  hills near Palm Springs                                                                    
     that I began to understand  them. I came to Alaska soon                                                                    
     after  and  it  has  been Alaska's  children  who  have                                                                    
     tutored me ever since.                                                                                                     
                                                                                                                                
     I have  come to recognize  that it is child  abuse, and                                                                    
     especially   child  sexual   abuse,   that  is   indeed                                                                    
     "disturbed and  disturbing", not the kids  who survive.                                                                    
     But survivors don't easily  or typically disclose. They                                                                    
     prefer to  "tell" in behaviors  that can make  you feel                                                                    
     the way  many will  feel their whole  lives: Helplessly                                                                    
     angry, fearful  and hopeless. But I  have to constantly                                                                    
     remind myself that those feelings  are not my own; they                                                                    
     are being shared  with me by the kids I  work with. And                                                                    
     so I have  to tell myself that I am  not helpless; I am                                                                    
     not hopeless  or fearful.  But I am  angry. I  am angry                                                                    
     that now  that we know,  now that we can  recognize the                                                                    
     survivors    we  can  still turn  away from  disturbing                                                                    
     children of all ages and  not ask the hard questions or                                                                    
     seek the real  answers. It is the face of  one of those                                                                    
     more recently forgotten children  that haunts my nights                                                                    
     from time to time.                                                                                                         
                                                                                                                                
     You  could see  her clearly  in numerous  on-line child                                                                    
     pornography videos the FBI confiscated.  She was the 26                                                                    
     y/o  woman  cheerfully   helping  very  young  children                                                                    
     perform horrible  sex acts. Over  the course  of nearly                                                                    
     12  hours   of  interview  in  FCC   this  young  woman                                                                    
     patiently explained  in the voice  and words of  a five                                                                    
     year   old,  that   she   learned  to   do   so  as   a                                                                    
     kindergartener  caught up  in a  sado-masochistic child                                                                    
     sex ring in Milwaukee she  called "The Play House". The                                                                    
     only  way she  could help  the other  children not  get                                                                    
     hurt was  to show them how  to please a circle  of sick                                                                    
     men  with unbelievably  sick  needs. Abused  throughout                                                                    
     her  childhood  even  when eventually  taken  into  the                                                                    
     State of  Alaska's custody,  she remained  most fearful                                                                    
     still of  the men of the  Play House as a  young adult.                                                                    
     She  thought   she'd  found  sanctuary  with   her  co-                                                                    
     defendant,  an older  man who  promised he  would never                                                                    
     let anyone hurt  her. When he turned  out be interested                                                                    
     in very  young girls and wanted  her help photographing                                                                    
     them, well that all seemed  normal and she did what she                                                                    
     could to make sure they didn't get hurt.                                                                                   
                                                                                                                                
     I explained to  her judge at sentencing  that hers were                                                                    
     not  the acts  of a  criminal, but  acts of  a kind  of                                                                    
     heroism  I  have  seen  before  only  in  the  insanely                                                                    
     abusive, secret  world of child sexual  exploitation. I                                                                    
     will  forever  be  angry and  haunted  that  the  judge                                                                    
     turned away  from this heroic young  lady and sentenced                                                                    
     her  to   22  years  in  federal   prison,  righteously                                                                    
     insisting "She should have known better".                                                                                  
                                                                                                                                
     But  in a  way  he  was right:  She  should have  known                                                                    
     better. And  it is  responsibility of  those of  us who                                                                    
     have to see that all children in AK know better.                                                                           
                                                                                                                                
     Children  like  the  36  y/o  mother  whose  two  young                                                                    
     children  were recently  taken into  foster care  after                                                                    
     she left  them alone  during a black  out drunk.  I sat                                                                    
     across  from her  in a  coffee  shop along  the way  to                                                                    
     Anchorage.  She   couldn't  afford   the  trip   in  to                                                                    
     Fairbanks. I wanted a little  history to help her 5 y/o                                                                    
     son. Her tired  eyes were my first  clue. She explained                                                                    
     that she  never sleeps  and suffers from  chronic panic                                                                    
     attacks. She  even offered that she  had been diagnosed                                                                    
     as bipolar  and a borderline personality  disorder, was                                                                    
     on psychiatric  medication and  had been  in counseling                                                                    
     for  12 years  with one  therapist in  Louisiana before                                                                    
     coming north  with her children, where  she'd now found                                                                    
     another. But nothing  really seemed to help.  As a rule                                                                    
     she  didn't  drink     her  hated  mother  was  a  mean                                                                    
     alcoholic; father, an addict    but she'd found that if                                                                    
     occasionally  she drank  to the  point of  blackout she                                                                    
     would hit  a sort of  a "reset button" and  could start                                                                    
     over and keep going.                                                                                                       
                                                                                                                                
     This was  all she  knew about  herself, after  years of                                                                    
     mental health  support. She'd accepted  that she  was a                                                                    
     broken person  who was  periodically under  attack from                                                                    
     her own feelings.                                                                                                          
                                                                                                                                
      She  herself had  survived a  childhood with  divorced                                                                    
     parents  who fought  bitterly  over  their 3  children.                                                                    
     Both parents partied hard, every  night as the children                                                                    
     bounced between  a rock and  a hard place.  Our mother,                                                                    
     the oldest, had  no memory from the age of  8 to 13 y/o                                                                    
     except  for  the  fact  that  during  those  years  she                                                                    
     discovered her  love of horses  which sustained  her to                                                                    
     this  day.  Her  two  young  siblings  eventually  both                                                                    
     became psychiatrically disabled.  For reasons she could                                                                    
     not fathom her younger brother hated her bitterly.                                                                         
                                                                                                                                
     A loving grandmother gave her  shelter growing up, paid                                                                    
     for  riding lessons  and saved  her  life. She  married                                                                    
     young to  a much older  man she loved, bred  and raised                                                                    
     race  horses, and  had a  son. She  left them  after 10                                                                    
     years  for reasons  she  couldn't  understand; she  was                                                                    
     afraid to continue caring for her son.                                                                                     
                                                                                                                                
     She hadn't slept  for more than a couple  hours a night                                                                    
     for as long as she can remember.                                                                                           
                                                                                                                                
     This is  the face of  abuse you  so often see  with OCS                                                                    
     parents,  folks that  survive  things  they can  barely                                                                    
     remember  and  yet  constantly fear.  This  poor  woman                                                                    
     wasn't   having  "panic   attacks":   She  was   having                                                                    
     repetitive  "daymares"  from chronic  REM  deprivation;                                                                    
     nightmares from  an abusive  childhood that  could find                                                                    
     no safe release and maybe  resolution in the privacy of                                                                    
     her sleeping mind and so  exploded into her waking life                                                                    
     without  context.  Why  chronic sleep  problems?  As  a                                                                    
     child, she  and her sibs  were told to remain  in their                                                                    
     room no  matter what  while her parents  partied, every                                                                    
     night: alone, unprotected and I  am certain prey to all                                                                    
     sorts of  predators. Her adult mind  could only protect                                                                    
     her so  much from  the memory of  that happened  to her                                                                    
     and from what  she learned to do. It  could not protect                                                                    
     her from the reminders of  her own children, and so her                                                                    
     fears worsened; her  vigilance remained constant; sleep                                                                    
     unthinkable.                                                                                                               
                                                                                                                                
     Her tired  eyes filled with  tears as I assured  her of                                                                    
     the strength of her mind  and goodness of her heart and                                                                    
     explained her  shattered life. She  slept 5  hours that                                                                    
     night  after   crying  for  three.  She   now  has  the                                                                    
     difficult but  I am convinced,  doable task  of putting                                                                    
     together  a life  that won't  repeat her  past. She  is                                                                    
     what  we call  a  survivor and  she  should have  known                                                                    
     better.                                                                                                                    
                                                                                                                                
     So we are here to make  sure you know better. Know that                                                                    
     1/3 of the children of  Alaska come to the attention of                                                                    
     OCS by the time they are  8 y/o. That is a large silent                                                                    
     constituency  that needs  your voice  and understanding                                                                    
     in any  budgetary discussion. And they  need the can-do                                                                    
     genius of  Alaska's frontier if  we are ever to  make a                                                                    
     dent in that startling statistic. Thank you.                                                                               
                                                                                                                                
                                                                                                                                
3:44:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE DRUMMOND  shared her  support for  the questioning                                                               
of young mothers for their pre-natal and pre-pregnancy lives.                                                                   
                                                                                                                                
3:45:45 PM                                                                                                                    
                                                                                                                                
DR. HOPPER shared  that there was a world  of expertise available                                                               
for help in any aspect.                                                                                                         
                                                                                                                                
3:46:13 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ noted  that the  data created  an opportunity                                                               
for Alaska to  ensure that service and support went  to the right                                                               
people.  She asked about the  next steps to address the necessary                                                               
support.                                                                                                                        
                                                                                                                                
3:47:07 PM                                                                                                                    
                                                                                                                                
DR. PARRISH  stated that  the initial part  about having  any new                                                               
data was for educating yourself  and understanding the context of                                                               
the situation before  there can be any  targeting for prevention.                                                               
He emphasized that  the Division of Public  Health was addressing                                                               
the  issue because  it related  to all  the health  effects which                                                               
they were attempting  to prevent.  He shared that  he had learned                                                               
that the  data was not  real until he could,  as a member  of the                                                               
community, contextualize them  into his life.   He reported that,                                                               
as  many children  were reported  as neglected,  if there  were a                                                               
system to help with support for  the families early on, these may                                                               
never require any use of resources  from OCS.  He reported on the                                                               
use of this program with other states and the pooling of data.                                                                  
                                                                                                                                
3:49:17 PM                                                                                                                    
                                                                                                                                
DR. BALDWIN-JOHNSON  acknowledged that there were  several models                                                               
for targeting high risk families.   She added that the data would                                                               
help  ensure the  targeting  of the  right  intervention for  the                                                               
right people and  to try to find targeted  alternatives with less                                                               
expensive interventions.                                                                                                        
                                                                                                                                
3:50:09 PM                                                                                                                    
                                                                                                                                
DR.  HOPPER  shared  that  there  were  great  opportunities  for                                                               
information and learning from the boys  in the youth centers.  He                                                               
pointed out  that much of  the chronic mental illness  was really                                                               
"unbelievable stories  of massive abuse and  neglect" and "hiding                                                               
from those histories."                                                                                                          
                                                                                                                                
3:52:48 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  offered her belief that  this underscored the                                                               
need for appropriate  response and support for  young people that                                                               
have been  hurt and incarcerated.   She  stated that it  was also                                                               
necessary  to look  "upstream" to  help  prevent the  incidences.                                                               
She said  that the child welfare  system begins with a  report of                                                               
harm and  then being drawn  into the system creates  more trauma,                                                               
whereas  creative approaches  to support  at-risk families  could                                                               
prevent  this.   She  pointed  to work  being  done with  at-risk                                                               
families in  the Matanuska-Susitna  area and the  appropriate use                                                               
of information  sharing to help  with the necessary  supports and                                                               
services.                                                                                                                       
                                                                                                                                
             HB22-EXTEND SUICIDE PREVENTION COUNCIL                                                                         
                                                                                                                                
3:55:39 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ announced  that  the next  order of  business                                                               
would be  HOUSE BILL  NO. 22, "An  Act extending  the termination                                                               
date of  the Statewide Suicide Prevention  Council; and providing                                                               
for an effective date."                                                                                                         
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
3:56:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  said that  she did  not have  any additional                                                               
information but that she was available for any questions.                                                                       
                                                                                                                                
3:57:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE DRUMMOND  moved to report  HB 22 out  of committee                                                               
with  individual  recommendations  and  the  accompanying  fiscal                                                               
notes.  There being no objection,  HB 22 was moved from the House                                                               
Health and Social Services Standing Committee.                                                                                  
                                                                                                                                
3:57:33 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:57 p.m. to 4:00 p.m.                                                                       
                                                                                                                                
            HB 29-INSURANCE COVERAGE FOR TELEHEALTH                                                                         
                                                                                                                                
4:00:53 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ announced  that  the next  order of  business                                                               
would  be  HOUSE BILL  NO.  29,  "An  Act relating  to  insurance                                                               
coverage for benefits provided  through telehealth; and providing                                                               
for an effective date."                                                                                                         
                                                                                                                                
4:00:58 PM                                                                                                                    
                                                                                                                                
BERNICE  NESBIT,  Staff,  Representative  Ivy  Spohnholz,  Alaska                                                               
State Legislature,  paraphrased from  the Sectional  Analysis for                                                               
HB 29 [Included in members' packets], which read:                                                                               
                                                                                                                                
     Section 1.                                                                                                             
       AS 21.42.422 has been amended to require insurance                                                                       
    coverage   for   health   benefits   provided   through                                                                     
     telehealth technology.                                                                                                     
                                                                                                                                
     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, 2020. As  a preliminary                                                                    
     matter, note that a sectional  summary of a bill should                                                                    
     not  be considered  an authoritative  interpretation of                                                                    
     the bill  -- the bill  itself is the best  statement of                                                                    
     its contents.                                                                                                              
                                                                                                                                
4:01:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE DRUMMOND  moved to report  HB 29 out  of committee                                                               
with  individual  recommendations  and  the  accompanying  fiscal                                                               
notes.  There being no objection,  HB 29 was moved from the House                                                               
Health and Social Services Standing Committee.                                                                                  
                                                                                                                                
4:02:20 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
         HB 97-TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS                                                                      
                                                                                                                                
4:03:52 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ announced that the next order of business                                                                    
would be HOUSE BILL NO. 97,  "An Act relating to the prescription                                                               
of drugs by a physician assistant without physical examination."                                                                
                                                                                                                                
4:04:02 PM                                                                                                                    
                                                                                                                                
REID  HARRIS,  Staff,   Representative  Jonathan  Kreiss-Tomkins,                                                               
Alaska State Legislature, paraphrased  from the Sponsor Statement                                                               
[Included in members' packets], which read:                                                                                     
                                                                                                                                
     The 2016 Medicaid Reform Bill  (SB 74) provided for the                                                                    
     use of telehealth, revising  Alaska statutes to require                                                                    
     the  Alaska State  Medical Board  to adopt  regulations                                                                    
     and  guidelines for  physicians rendering  a diagnosis;                                                                    
     providing  treatment;  or prescribing,  dispensing,  or                                                                    
     administering a  prescription drug to a  person without                                                                    
     first  conducting  a   physical  examination  under  AS                                                                    
     08.64.364.                                                                                                                 
                                                                                                                                
     However,  SB  74  only  addressed  physicians  and  the                                                                    
     Board's interpretation  was that the  bill's provisions                                                                    
     should not  apply to physician assistants  (PA's). This                                                                    
     effectively barred  PA's from  practicing telemedicine,                                                                    
     requiring    them    to   first    conduct    in-person                                                                    
     examinations.                                                                                                              
                                                                                                                                
     House Bill  97 aligns  statute with  the intent  of the                                                                    
     Medicaid Reform Bill, clarifying  that PA's can provide                                                                    
     telemedicine  in  collaboration   with  and  under  the                                                                    
     oversight of  physicians. Under HB97, PA's  are subject                                                                    
     to   the  same   statutory   oversight  as   physicians                                                                    
     regarding the practice of telemedicine,  as well as the                                                                    
     same disciplinary sanctions when appropriate.                                                                              
                                                                                                                                
     Alaska,  with  its  vast  geographical  challenges  and                                                                    
     limited access  to vital healthcare, stands  to benefit                                                                    
     from  this legislation.  HB  97  will increase  patient                                                                    
     access  to care,  extending the  reach  of medicine  to                                                                    
     medically underserved areas.                                                                                               
                                                                                                                                
4:05:58 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PRUITT asked for  clarification that this bill was                                                               
necessary because the State Medical  Board had interpreted Senate                                                               
Bill 74 as to not include  physician assistants.  He asked if Ms.                                                               
Stovern  believed  that the  intent  of  Senate  Bill 74  was  to                                                               
include physician assistants.                                                                                                   
                                                                                                                                
4:06:51 PM                                                                                                                    
                                                                                                                                
DEBORAH  STOVERN, Executive  Administrator, State  Medical Board,                                                               
Division of  Corporations, Business, and  Professional Licensing,                                                               
Department  of   Commerce,  Community  &   Economic  Development,                                                               
offered  her  belief  that  the State  Medical  Board  could  not                                                               
determine the  legislative intent regarding  physician assistants                                                               
so other stakeholders  asked that the proposed  bill clarify that                                                               
physician assistants would be covered under the statute.                                                                        
                                                                                                                                
4:07:58 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PRUITT  asked if  the State Medical  Board covered                                                               
physicians assistants as well as physicians.                                                                                    
                                                                                                                                
MS. STOVERN replied "yes, they do."                                                                                             
                                                                                                                                
REPRESENTATIVE  PRUITT shared  his concern  that, as  more people                                                               
were  allowed the  opportunity  to prescribe  up  to Schedule  II                                                               
drugs, there  may be a  challenge as physicians  assistants would                                                               
no longer  have to interact  with a patient for  these controlled                                                               
substances.                                                                                                                     
                                                                                                                                
MS.  STOVERN,  in  response,  stated that  part  of  the  statute                                                               
required  the board  to adopt  the nationally  published American                                                               
Medical  Association  guidelines  for  practicing  telehealth  by                                                               
physician  assistants.   She added  that  the collaborative  plan                                                               
with the  supervising physician determined the  scope of practice                                                               
by the physician assistant and  included the type of prescriptive                                                               
authority.                                                                                                                      
                                                                                                                                
4:11:49 PM                                                                                                                    
                                                                                                                                
CO-CHAIR   SPOHNHOLZ  asked   for  confirmation   that  physician                                                               
assistants  had  to  utilize  the  Prescription  Drug  Monitoring                                                               
Database (PDMP).                                                                                                                
                                                                                                                                
MS. STOVERN  said that  anyone prescribing  controlled substances                                                               
was required  to use  the PDMP and  this would  include physician                                                               
assistants engaging in prescriptions through telehealth.                                                                        
                                                                                                                                
4:12:45 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ closed public testimony.                                                                                     
                                                                                                                                
4:12:58 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  DRUMMOND moved  to  report CSHB  97, Version  31-                                                               
LS0695\M,   Marx,  3/21/19,   from   committee  with   individual                                                               
recommendations and  the accompanying fiscal notes.   There being                                                               
no objection,  CSHB97(HSS) was  moved from  the House  Health and                                                               
Social Services Standing Committee.                                                                                             
                                                                                                                                
4:13:23 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 4:13 p.m. to 4:16 p.m.                                                                       
                                                                                                                                
          HB 86-MENTAL HEALTH HOSPITAL: CONTRACTS/BIDS                                                                      
                                                                                                                                
4:16:17 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ announced  that the  final order  of business                                                               
would be  HOUSE BILL NO.  86, "An  Act relating to  a state-owned                                                               
inpatient mental health treatment  hospital; and providing for an                                                               
effective date."                                                                                                                
                                                                                                                                
4:16:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  DRUMMOND moved  to adopt  the proposed  committee                                                               
substitute (CS)  for HB 86,  labeled 31-LS0623\U,  Marx, 3/26/19,                                                               
as the working draft.                                                                                                           
                                                                                                                                
4:17:04 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ objected for discussion.                                                                                     
                                                                                                                                
4:17:06 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ZACH  FIELDS,  Alaska State  Legislature,  stated                                                               
that the  proposed bill would prevent  wholesale privatization of                                                               
Alaska  Psychiatric  Institute  (API),   although  it  would  not                                                               
prevent   partial  privatization   of   individual  services   or                                                               
components within API,  some of which already existed.   He noted                                                               
that  there was  concern for  "a rush  to judgement  in terms  of                                                               
contracting with a  specific company whose record I'll  get to in                                                               
a little  bit."  He  shared that  public forums in  Anchorage had                                                               
made  clear that  workers at  API  were committed  to the  public                                                               
mission of  API and  committed to  their patients,  although they                                                               
had lacked the resources and  managerial support to do their jobs                                                               
safely  and to  provide  for the  safety of  the  residents.   He                                                               
declared that the purpose of proposed  HB 86 was to provide for a                                                               
safe environment for both residents  and workers at API, which he                                                               
opined  "requires  public  management."     He  stated  that  the                                                               
proposed  bill  would  not  undo   the  temporary  contract  with                                                               
Wellpath,  nor  would  it  prevent  privatization  of  individual                                                               
components of  services which was consistent  with the consultant                                                               
report on privatization directed  by the Alaska State Legislature                                                               
under Senate Bill 74.  He presented a PowerPoint titled "CS                                                                     
House Bill 86," and paraphrased slide 3, titled "API:                                                                           
Background," which read in part:                                                                                                
                                                                                                                                
     Opened  in  1962  as  part   of  Alaska  Mental  Health                                                                    
     Enabling Act of 1956.                                                                                                      
                                                                                                                                
4:19:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FIELDS moved on to slide 4, "Patient Population                                                                  
and Care," which read:                                                                                                          
                                                                                                                                
     It  is   a  24/7  safety  net   provider  of  inpatient                                                                    
     psychiatric care                                                                                                           
                                                                                                                                
     Patients who need acute psychiatric care,                                                                                  
                                                                                                                                
     Title 47-involuntary commitment                                                                                            
                                                                                                                                
     Title  12-criminal/forensic   patients  awaiting  court                                                                    
     ordered examinations                                                                                                       
                                                                                                                                
     ADRD   (Alzheimer   Disease   and   Related   Disorder)                                                                    
     patients,  often placed  inappropriately because  there                                                                    
     is no community placement available                                                                                        
                                                                                                                                
     Others    are    patients    who    are    experiencing                                                                    
     intellectual/developmental   disabilities   and   where                                                                    
     there is no community support                                                                                              
                                                                                                                                
     API is key  for broader health system  reforms and cost                                                                    
     savings                                                                                                                    
                                                                                                                                
REPRESENTATIVE FIELDS addressed slide 5, "Background Literature                                                                 
on Privatization," and slide 6, "2017 Legislative Study                                                                         
recommends against privatization," which read in part:                                                                          
                                                                                                                                
     1999   Praat   and   Maahs   metastudy   of   33   cost                                                                    
     effectiveness  studies  found that  private  facilities                                                                    
     were no more cost effective than public studies                                                                            
                                                                                                                                
     2016 the  US Department of  Justice cited lack  of cost                                                                    
     savings  and lowered  delivery of  services in  private                                                                    
     prisons  as  reason  for cessation  of  private  prison                                                                    
     usage.                                                                                                                     
                                                                                                                                
       Alaska's own Legislature mandated a privatization                                                                        
     study in SB 74, working with the Alaska Mental Health                                                                      
     Trust and Public Consulting Group                                                                                          
                                                                                                                                
      Conclusion: Continue state management to attain cost                                                                      
     savings while preserving services                                                                                          
                                                                                                                                
      Cost benefit analysis showed that full privatization                                                                      
     carried risks of decreased quality of services, higher                                                                     
     cost over 5 year contract period                                                                                           
                                                                                                                                
REPRESENTATIVE FIELDS emphasized that  inadequacy of staffing was                                                               
an important  safety issue and  a threat to workers  safety often                                                               
had a ripple effect resulting in less patient safety at API.                                                                    
                                                                                                                                
4:21:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  FIELDS directed  attention  to slide  7 "A  Brief                                                               
Timeline of the GEO Group,  Correct Care Solutions, and Wellpath"                                                               
and stated that  it could get a bit confusing  when attempting to                                                               
ascertain  the relationship  between Wellpath  and GEO  Group and                                                               
Correct Care  Solutions.  He  stated that Correct  Care Solutions                                                               
and  Wellpath were  largely the  same company,  and that  the GEO                                                               
Group  had been  part of  Wellpath  going back  in the  corporate                                                               
history.  He  pointed out that these had been  the same companies                                                               
at different points in their history.                                                                                           
                                                                                                                                
4:22:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FIELDS shared  slide 8, "Death on  the Wards," and                                                               
declared that  Wellpath had a  "profoundly disturbing"  record as                                                               
it had been sued about 1400 times.   He noted that he had a "full                                                               
set of  media clippings and some  of them are horrifying  to read                                                               
through."   He shared the  story of  an individual in  a Wellpath                                                               
facility who  contracted a cold, which  progressed into pneumonia                                                               
with  vomiting and  bleeding,  and was  never  provided any  care                                                               
beyond cough  drops.  The  individual died without  receiving any                                                               
care  from Wellpath.    He  stated that  the  1400 lawsuits  were                                                               
direct results of "a profit  model that sacrifices patient safety                                                               
for profits."                                                                                                                   
                                                                                                                                
4:23:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  FIELDS  reviewed  slides   9  -  12,  "Wellpath's                                                               
history  of negligence,  deaths," and  stated that  "this is  the                                                               
record  of Wellpath.    It  is a  very  consistent,  it's a  very                                                               
troubling record... "  He  offered his belief that this troubling                                                               
record was the reason to pass proposed HB 86.                                                                                   
                                                                                                                                
4:23:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  asked if  most  of  the lawsuits  had  been                                                               
associated  with  the Wellpath  prison  facilities  and not  with                                                               
their  mental   health  facilities,  as  indicated   by  Wellpath                                                               
testimony.                                                                                                                      
                                                                                                                                
4:24:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FIELDS replied that  both facilities had lawsuits,                                                               
adding the  Geo Group had  the prison contracts and  Correct Care                                                               
had the  private mental  health hospital  contracts.   He offered                                                               
his belief that both groups had serious problems.                                                                               
                                                                                                                                
4:25:02 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  FIELDS added  that there  were "voluminous  media                                                               
reports  from locations  around  the country  where Wellpath  has                                                               
operated these facilities."  He  declared that it was "troubling"                                                               
where there  were credible detailed  media reports  from multiple                                                               
facilities  about highly  specific  incidents  of negligence  and                                                               
death as  a result  of inadequate  care.   He shared  his concern                                                               
that there had not been  any assurance from Wellpath for staffing                                                               
levels or  adequacy of care.   He pointed to slide  13, "Wellpath                                                               
has "no  plan," loses key  staff," and  stated that the  news was                                                               
consistent with  the company's record  for not having a  plan for                                                               
adequate staffing.   He  emphasized that the  history at  API had                                                               
shown that  adequate staffing  was essential  for safety  to both                                                               
patients  and workers.    He  declared that  he  did  not have  a                                                               
fundamental  objection to  a  different  management structure  at                                                               
API,  although   he  had  "extreme  concerns"   about  for-profit                                                               
management through  a company  with a  long record  of negligence                                                               
having a  flat budget as a  significant amount of money  would be                                                               
siphoned  off  for profits.    He  added  that the  ownership  of                                                               
Wellpath   was  a   "highly  leveraged   private  equity   firm,"                                                               
explaining  that   private  equity  firms  extracted   profit  by                                                               
shortchanging care,  driving down  costs, and  typically flipping                                                               
companies.                                                                                                                      
                                                                                                                                
4:27:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FIELDS  directed attention  to slide  14, "Putting                                                               
Alaskan's First,"  and he highlighted  that outsourcing API  to a                                                               
private equity firm  and Wellpath was a bad idea.   He pointed to                                                               
an  earlier  study  by  the  Alaska  State  Legislature  for  the                                                               
potential savings by privatization,  which had specifically cited                                                               
Wellpath  as  a reason  not  to  privatize.    He read  from  the                                                               
feasibility  study:    "The  expected  margin  for  a  for-profit                                                               
contractor  is  eight  percent.     This  estimate  is  based  on                                                               
reporting  form South  Florida State  Hospital."   He  reiterated                                                               
that  there was  a  flat  funded API  budget,  and  that, as  the                                                               
Department of  Health and Social  Services had not put  any "side                                                               
boards" on  the profits for  Wellpath in the contract,  there was                                                               
no guarantee for  the amount of money being spent  on care versus                                                               
profits for the company.                                                                                                        
                                                                                                                                
4:29:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR shared that she  was troubled with this cycle                                                               
of change  with the  formation of new  companies relative  to the                                                               
lawsuits.                                                                                                                       
                                                                                                                                
REPRESENTATIVE FIELDS  acknowledged that it was  "fairly common."                                                               
He emphasized  that Correct  Care Solutions had  a very  long and                                                               
very  troubling  history,  and that  Wellpath  was  substantially                                                               
Correct Care Solutions.   He pointed out that the  Geo Group also                                                               
had a long  and troubling history, although it  was not currently                                                               
associated with Wellpath.                                                                                                       
                                                                                                                                
4:30:25 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ shared  her personal  concern that  a "really                                                               
solid  company with  a great  reputation  is gonna  want to  keep                                                               
their  name the  same for  a long  time because  you build  brand                                                               
equity over time."  She said  that the level of frequency for re-                                                               
branding,  acquisition, or  sale  over the  years indicated  that                                                               
there was  not a lot  of brand value  and they were  not building                                                               
any brand  equity with a good  reputation.  She stated  that this                                                               
was a red flag for her.                                                                                                         
                                                                                                                                
4:31:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  FIELDS expressed  his agreement  and stated  that                                                               
this was  actually "a  toxic brand."   He noted  that legislative                                                               
bodies in other parts of  the United States had cancelled pending                                                               
contracts with  Correct Care  because it  had such  toxic history                                                               
and was such  a toxic brand, and he offered  his belief that this                                                               
was the reason for the re-naming as Wellpath.                                                                                   
                                                                                                                                
4:31:30 PM                                                                                                                    
                                                                                                                                
TRISTAN WALSH, Staff, Representative Zach Fields, Alaska State                                                                  
Legislature, paraphrased from the "Sectional Analysis for HB 86"                                                                
[Included in members' packets], which read:                                                                                     
                                                                                                                                
     Section 1.  This section amends  AS 36.30.300 to  add a                                                                  
     new   subsection  (f)   that   prohibits  creation   of                                                                    
     contracts relating to the ownership  or operation of an                                                                    
     inpatient mental health  treatment hospital established                                                                    
     under AS 47.30.660 (c) (see Section 4)                                                                                     
                                                                                                                                
     Section 2. This section  amends AS 36.30.310, the State                                                                  
     of   Alaska's   Emergency  Procurement   Statutes,   to                                                                    
     prohibit  the  use  of these  statutes  to  solicit  or                                                                    
     obtain  private contracts  to run  an inpatient  mental                                                                    
     health   treatment   hospital  established   under   AS                                                                    
     47.30.660 (c) (See Section 4)                                                                                              
                                                                                                                                
     Section  3. This  section amends  AS  47.30.660 (b)  to                                                                  
     correspond with  a new subsection in  AS 47.30.660 (c),                                                                    
     that is established in Section 4.                                                                                          
                                                                                                                                
     Section 4. This  section amends AS 47.30.660  to add an                                                                  
     additional   subsection,   (c),   that   requires   the                                                                    
     Department of  Health and  Social Services  operate and                                                                    
     maintain   an   "inpatient  mental   health   treatment                                                                    
     hospital"  in the  State. It  prohibits the  state from                                                                    
     delegating or contracting  for the ownership, operation                                                                    
     or  management of  such a  facility. It  also prohibits                                                                    
     the  state from  using  the  single source  procurement                                                                    
     statutes  in  AS  36.30.310   to  procure  supplies  or                                                                    
     services for this facility.  It also defines "inpatient                                                                    
     mental health  treatment hospital" for the  purposes of                                                                    
     this section.                                                                                                              
                                                                                                                                
     Section 5.  This section amends  the uncodified  law of                                                                  
     the State of Alaska to  define the applicability of new                                                                    
     subsections  established  in   Section  1,  Section  2,                                                                    
     Section  3 and  Section 4,  to contracts  entered into,                                                                    
     extended or  renewed after the  effective date  of this                                                                    
     Act.                                                                                                                       
                                                                                                                                
     Section 6.  This section amends  the uncodified  law of                                                                  
     the State of  Alaska to state if this  Act takes effect                                                                    
     after March  1st 2019, it  is retroactive to  March 1st                                                                    
     2019.                                                                                                                      
                                                                                                                                
     Section  7.  This  section provides  for  an  effective                                                                  
     date;  it  would  take effect  immediately  on  passage                                                                    
     under AS 01.10.070 (c)                                                                                                     
                                                                                                                                
4:34:10 PM                                                                                                                    
                                                                                                                                
MR. WALSH paraphrased from the "Summary of Changes: CS for HB                                                                   
86" [Included in members' packets], which read:                                                                                 
                                                                                                                                
     Several  changes were  made between  version M  and the                                                                    
     Committee  Substitute  (Version  U) of  House  Bill  86                                                                    
     (introduced on 3/16/19).                                                                                                   
                                                                                                                                
     The  administration voiced  concern  that  it would  be                                                                    
     unable to contract out for  various services handled by                                                                    
     local  vendors,  such  as  maintenance,  security,  and                                                                    
     laundry.  The Committee  Substitute  sought to  address                                                                    
     those concerns by making the following changes:                                                                            
                                                                                                                                
     Section  1. Deleted  "operation"  and "maintenance"  to                                                                  
     allow the  department to continue  to use  this limited                                                                    
     competition procurement statute  for certain aspects of                                                                    
     the operation and maintenance of the hospital.                                                                             
                                                                                                                                
     Section  2. Deleted  "operation"  and "maintenance"  to                                                                  
     allow the  department to continue  to use  this statute                                                                    
     for emergency  procurements for certain aspects  of the                                                                    
     operation and maintenance of the hospital.                                                                                 
                                                                                                                                
     Section 4.  Deleted "operate"  and "maintain"  to allow                                                                  
     the department to continue to  contract out for certain                                                                    
     aspects  of  the  operation   and  maintenance  of  the                                                                    
     hospital. This meant that section  4 (c) was reduced to                                                                    
     one subsection.                                                                                                            
                                                                                                                                
     Section   6.   This   change  reflects   the   accurate                                                                  
     retroactive date for Alaska Psychiatric Institute.                                                                         
                                                                                                                                
4:35:34 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ removed her objection.                                                                                       
                                                                                                                                
CO-CHAIR SPOHNHOLZ said that HB 86 would be held over.                                                                          
                                                                                                                                
4:36:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  PRUITT  asked  if   Section  4  of  the  proposed                                                               
committee  substitute would  prevent  any  outside management  or                                                               
ownership of API.                                                                                                               
                                                                                                                                
REPRESENTATIVE  FIELDS said  that  he would  consider a  friendly                                                               
amendment for  limited management of API  to either a state  or a                                                               
non-profit operator.   This would allow the  department to retain                                                               
the  authority to  go through  a competitive  procurement process                                                               
for  non-profit management.    He offered  his  belief that  this                                                               
would  address his  concerns for  patient and  worker safety  and                                                               
allow for partnerships to provide better services.                                                                              
                                                                                                                                
4:38:19 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 4:38 p.m.                                                                                                          

Document Name Date/Time Subjects
HB022 Supporting Document-Letter of Support from American Foundation for Suicide Prevention - Alaska Chapter 03.07.19.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 22
HB022 Supporting Document-Letter of Support from Suicide Prevention Council 2.25.19.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 22
HB022 Fiscal Note DHSS-SPC-3.22.2019.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 22
HB022 Supporting Document-Letter of Support from NAMI Alaska 3.6.19.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 22
HB022 Sponsor Statement 03.15.19.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 22
HB022 Supporting Document Legislative Audit of Suicide Prevention Council 3.6.2019.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 22
HB022 Supporting Document-Letter of Support from Sally Donaldson 2.25.19.pdf HHSS 3/28/2019 3:00:00 PM
HB 22
HB022 Supporting Document--Letter of Support from ALPHA.pdf HHSS 3/28/2019 3:00:00 PM
HB 22
HB022 Supporting Document-Letter of Support- Governor's Council on Diabilities & Special Education 3.26.19.pdf HHSS 3/28/2019 3:00:00 PM
HB 22
HB022 Supporting Documents-Letter of Support AFN 3.22.19.pdf HHSS 3/28/2019 3:00:00 PM
HB 22
HB029 Sectional Analysis ver A 2.25.19.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 29
HB029 Sponsor Statement 2.25.19.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 29
HB029 Supporting Document-Letter of Support 2.25.19.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 29
HB029 Fiscal Note DCCED-DOI 3.22.2019.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 29
HB029 Letter of Support Moda Health 03.25.2019.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 29
HB029 Presentation 03.25.2019.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 29
HB029 Letter of Support ACoA 03.25.2019.pdf HHSS 3/28/2019 3:00:00 PM
HB 29
HB0097 Supporting Document AK State Medical Bd Roster.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
HB0097 Supporting Document AAPA general overview.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
HB0097 Supporting Document AK State Medical Bd PA scope of practice.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
HB0097 Supporting Document DEA Drug Schedules.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
HB0097 Supporting Document HRSA -HPSA Underserved Primary Care Areas.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
HB0097 Supporting Document Medically Underserved Areas HRSA.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
HB0097 Supporting Document PA guidelines AK State Medical Bd.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
HB0097 Supporting Document PA Prescriptive Authority (AAC).pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
HB097 Draft Proposed Blank CS ver M 3.21.19.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 97
HB097 Fiscal Note DCCED-CBPL-3.22.19.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 97
HB097 Supporting Document Letters of Support for companion legislation SB44.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
SFIN 4/9/2019 9:00:00 AM
HB 97
SB 44
HB0097 Sectional.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 97
HB0097 Sponsor Statement.pdf HHSS 3/26/2019 3:00:00 PM
HHSS 3/28/2019 3:00:00 PM
HB 97
HB0097 Sectional Analysis 3.27.2019.pdf HHSS 3/28/2019 3:00:00 PM
HB 97
HB0097 Sponsor Statement 3.27.2019.pdf HHSS 3/28/2019 3:00:00 PM
HB 97
HB0097 Support Document--Orion BH Emails of Support.pdf HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
HB0097 Supporting Document Letter of support from ACOA 3.27.2019.pdf HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
HB0097 Supporting Document Letter of support from AK Policy Forum 3.27.2019.pdf HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
HB0097 Supporting Document Letter of support from Dietrich (OBHS) 3.27.2019.pdf HHSS 3/28/2019 3:00:00 PM
HL&C 4/15/2019 3:15:00 PM
HB 97
Childrens Justice Act Task Force Presentation 3.28.2019.pdf HHSS 3/28/2019 3:00:00 PM
Children's Justice Act Task Force
HB 86 Supporting Document-ITPI AK Letter for Support HB 86 3.27.19.pdf HHSS 3/28/2019 3:00:00 PM
HB 86
HB086 Draft Proposed Blank CS ver U 3.26.2019.pdf HHSS 3/28/2019 3:00:00 PM
HB 86
HB 86 Sponsor Statement 3.13.19.pdf HHSS 3/28/2019 3:00:00 PM
HB 86
HB 86 Sectional Analysis 3.13.19.pdf HHSS 3/28/2019 3:00:00 PM
HB 86
HB086 Fiscal Note DHSS-API 3.22.2019.pdf HHSS 3/28/2019 3:00:00 PM
HB 86
HB086 Fiscal Note DHSS-MS 3.22.2019.pdf HHSS 3/28/2019 3:00:00 PM
HB 86
HB 86 Sectional Analysis Version U 3.28.19.pdf HHSS 3/28/2019 3:00:00 PM
HB 86
HB 86 Summary of Changes Version M to Version U.pdf HHSS 3/28/2019 3:00:00 PM
HB 86
HB 86 Supporting Document-Letters of Support 3.28.19.pdf HHSS 3/28/2019 3:00:00 PM
HB 86
HB 86 Supporting Document Presentation 3.28.19.pdf HHSS 3/28/2019 3:00:00 PM
HB 86
HB 86 Supporting Documents-News Clips-3.28.19.pdf HHSS 3/28/2019 3:00:00 PM
HB 86