Legislature(2015 - 2016)CAPITOL 106
04/05/2016 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB345 | |
| HB334 | |
| HB315 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 345 | TELECONFERENCED | |
| += | HB 334 | TELECONFERENCED | |
| += | HB 315 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 5, 2016
3:05 p.m.
MEMBERS PRESENT
Representative Paul Seaton, Chair
Representative Liz Vazquez, Vice Chair
Representative Neal Foster
Representative David Talerico
Representative Geran Tarr
Representative Adam Wool
MEMBERS ABSENT
Representative Louise Stutes
COMMITTEE CALENDAR
HOUSE BILL NO. 345
"An Act relating to insurance coverage for contraceptives and
related services; relating to medical assistance coverage for
contraceptives and related services; and providing for an
effective date."
- HEARD & HELD
HOUSE BILL NO. 334
"An Act relating to visitation and child custody."
- HEARD & HELD
HOUSE BILL NO. 315
"An Act relating to an electronic visit verification system for
providers of certain medical assistance services."
- MOVED CSHB 315(HSS) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 345
SHORT TITLE: INSURANCE COVERAGE FOR CONTRACEPTIVES
SPONSOR(s): REPRESENTATIVE(s) CLAMAN
02/24/16 (H) READ THE FIRST TIME - REFERRALS
02/24/16 (H) HSS, FIN
04/05/16 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 334
SHORT TITLE: CHILD CUSTODY;DOM. VIOLENCE;CHILD ABUSE
SPONSOR(s): REPRESENTATIVE(s) MUNOZ
02/22/16 (H) READ THE FIRST TIME - REFERRALS
02/22/16 (H) HSS, JUD
03/22/16 (H) HSS AT 3:00 PM CAPITOL 106
03/22/16 (H) Heard & Held
03/22/16 (H) MINUTE(HSS)
03/24/16 (H) HSS AT 3:00 PM CAPITOL 106
03/24/16 (H) <Bill Hearing Rescheduled to 3/29/16>
03/29/16 (H) HSS AT 3:00 PM CAPITOL 106
03/29/16 (H) Heard & Held
03/29/16 (H) MINUTE(HSS)
04/05/16 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 315
SHORT TITLE: ELECTRONIC VISIT VERIFICATION: MEDICAID
SPONSOR(s): REPRESENTATIVE(s) VAZQUEZ
02/17/16 (H) READ THE FIRST TIME - REFERRALS
02/17/16 (H) HSS
03/22/16 (H) HSS AT 3:00 PM CAPITOL 106
03/22/16 (H) Heard & Held
03/22/16 (H) MINUTE(HSS)
03/24/16 (H) HSS AT 3:00 PM CAPITOL 106
03/24/16 (H) Heard & Held
03/24/16 (H) MINUTE(HSS)
04/05/16 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
MEGAN CAVANAUGH, Staff
Representative Matt Claman
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the changes to HB 345, on behalf
of Representative Claman, prime sponsor.
REPRESENTATIVE MATT CLAMAN
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HB 345, as prime sponsor.
DIANA GREENE FOSTER, Researcher
University of California, San Francisco
San Francisco, California
POSITION STATEMENT: Testified during discussion of HB 345.
KENNI PSENAK LINDEN
Palmer, Alaska
POSITION STATEMENT: Testified in support of HB 345.
ROBIN SMITH
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 345.
CATRIONA REYNOLDS, Clinic Manager
Kachemak Bay Family Planning Clinic
Homer, Alaska
POSITION STATEMENT: Testified in support of HB 345.
STEVEN SAMUELSON
Petersburg, Alaska
POSITION STATEMENT: Testified in support of HB 345.
ELIZABETH FIGUS
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 345.
CHRISTINE NIEMI
The League of Women Voters - Alaska
Douglas, Alaska
POSITION STATEMENT: Testified in support of HB 345.
ALYSON CURREY
Planned Parenthood of the Great Northwest
and the Hawaiian Islands
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 345.
SAMANTHA SAVAGE
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 345.
CAITLIN HEDBERG
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 345.
MAXINE DOOGAN
Community United for Safety and Protection
Fairbanks, Alaska
POSITION STATEMENT: Testified in support for HB 345.
MARGARET BRODIE, Director
Division of Health Care Services
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
345.
CRYSTAL KOENEMAN, Staff
Representative Cathy Munoz
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Answered questions on HB 334, on behalf of
the Representative Munoz, prime sponsor.
KEELEY OLSON, Executive Director
Standing Together Against Rape (STAR)
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 334.
CHRISTINE PATE, Legal Program Director
Alaska Network on Domestic Violence & Sexual Assault (ANDVSA)
Sitka, Alaska
POSITION STATEMENT: Testified against proposed HB 334.
LINDA BRUCE, Attorney
Legislative Legal Services
Legislative Affairs Agency
Juneau, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
334.
NANCY MEADE, General Counsel
Administrative Staff
Office of the Administrative Director
Alaska Court System
Anchorage, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
334.
TANEEKA HANSEN, Staff
Representative Paul Seaton
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions during
discussion of HB 315.
DEB ETHERIDGE, Deputy Director
Central Office
Division of Senior and Disabilities Services
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during the discussion of
HB 315.
ACTION NARRATIVE
3:05:07 PM
CHAIR PAUL SEATON called the House Health and Social Services
Standing Committee meeting to order at 3:05 p.m.
Representatives Seaton, Foster, Wool, and Talerico were present
at the call to order. Representatives Vazquez and Tarr arrived
as the meeting was in progress.
HB 345-INSURANCE COVERAGE FOR CONTRACEPTIVES
3:05:49 PM
CHAIR SEATON announced that the first order of business would be
HOUSE BILL NO. 345, "An Act relating to insurance coverage for
contraceptives and related services; relating to medical
assistance coverage for contraceptives and related services; and
providing for an effective date."
3:06:28 PM
REPRESENTATIVE TALERICO moved to adopt the proposed committee
substitute (CS) for HB 345, labeled 29-LS1503\H, Wallace,
3/22/16, as the working document.
CHAIR SEATON objected for discussion.
3:07:24 PM
MEGAN CAVANAUGH, Staff, Representative Matt Claman, Alaska State
Legislature, shared the changes to the proposed committee
substitute, Version H. She relayed that Version H removes the
provisions that applied to over-the-counter contraceptives in
the original bill on page 1, lines 11 - 12; page 2, lines 16 -
17; and page 3, lines 18 - 19.
3:08:15 PM
REPRESENTATIVE MATT CLAMAN, Alaska State Legislature, as prime
sponsor of HB 345, paraphrased from the sponsor statement
[included in members' packets], which read as follows [original
punctuation provided]:
Unintended pregnancies have significant and negative
consequences for individual women, their families, and
society as a whole. Research links births resulting
from unintended or closely spaced pregnancy to adverse
maternal and child health outcomes and other social
and economic challenges. With Alaska's fiscal
challenges, we should look for ways to reduce costs in
the shortterm and long-term. House Bill 345 will
reduce costs associated with unintended pregnancies by
making oral contraceptives more easily available to
Alaskan women.
In 2010, 48% of all pregnancies in Alaska were
unintended. Alaska's unintended pregnancy rate in 2010
was 54 per 1,000 women aged 15-44. Of those unintended
pregnancies, 60% resulted in births, 26% resulted in
abortions, and the remainder resulted in miscarriages.
Most unintended pregnancies are associated with
significant public costs. In 2010, 64.3% of unplanned
births in Alaska were publically funded, which
resulted in a $42.9 million cost to the state.
House Bill 345 seeks to reduce the costs of unintended
pregnancies by making oral contraceptives more easily
available to Alaskan women. A research study shows
that women who were dispensed a 12-month supply of
oral contraceptives were 30% less likely to have an
unintended pregnancy than women who received a 1- or
3-month prescription. The study concluded that health
insurance programs and public health programs may
avert costly unintended pregnancies by increasing
dispensing limits on oral contraceptives to a 1-year
supply.
HB 345 requires health care insurers, including
Medicaid services, to cover 12 months of prescriptive
oral contraceptives at a time. Alaskan women often
face challenges while trying to access prescription
contraceptives. Women living in rural Alaska have less
access to healthcare services and therefore less
reliable access to prescriptive contraceptives.
Fisherwomen working on a boat for two or three months
at a time need longer supplies of prescription oral
contraceptives. This bill looks to reduce health care
costs in Alaska by preventing unintended pregnancies
and providing Alaskan women greater access to family
planning options.
3:09:19 PM
MS. CAVANAUGH clarified that the recently distributed fiscal
note reflected the original version and not the proposed
committee substitute, Version H. She explained that,
additionally, a fiscal note was written for the Senate companion
bill, SB 156, and reflected a $1.3 million cost savings for the
state.
CHAIR SEATON pointed out that the fiscal note for SB 156 was
located in the committee packets.
MS. CAVANAUGH reported that the proposed bill mandated that
health care insurers provide coverage for a prescriptive
contraceptive up to 12 months at one time. She defined
prescriptive contraceptives as self-administered, hormonal
contraceptives, namely oral contraceptives that do not require
insertion or other types of administration by a medical
professional. She said this was explained in Section 1 of the
proposed bill, which contained a religious exemption as well as
a definition for health care insurer, which included a self-
insured employer, such as the State of Alaska. She moved on to
explain that Section 2 of the proposed bill directed the
Department of Health and Social Services to cover the 12 month
supply of prescription contraceptives for eligible recipients of
medical assistance. Section 3 of the proposed bill allowed for
the 12 month supply of prescription contraceptives to be made
available to Medicaid recipients, and Section 4 of the proposed
bill related to the effective date.
MS. CAVANAUGH stated that a major premise behind the proposed
bill was that offering women greater access and availability to
contraceptives reduced unintended pregnancies. This reduction
in unintended pregnancies had a direct cost savings to the
state, which was reflected in the provided fiscal note, which
was drafted to the Senate version. She directed attention to
the study [included in members' packets], which reported that,
in 2010, 48 percent of pregnancies, about 8,000 pregnancies in
Alaska, were unintended. She pointed out that the study had
used the Centers for Disease Control and Prevention definition
of an unintended pregnancy to mean either "mistimed, or the
woman did not want to become pregnant at that time." She added
that the study estimated that 3,000, or 64.3 percent of the
unplanned pregnancies in 2010, were publicly funded. She
reported that Alaska had spent almost $113 million on unintended
pregnancies, that 70.8 percent was federally funded, while 42.9
percent was funded by the state. She relayed that these costs
also had impacts on programs down the line, including foster
care, and on the child's overall well-being. She shared that an
additional study [included in members' packets] reviewed 84,000
women in California provided with varying amounts of oral
contraceptives, and that those researchers observed a 30 percent
reduction in the odds of pregnancy when given a year-long supply
of oral contraceptives. Also reported in this study, the
California family planning program paid $99 more annually for
women who received three cycles of oral contraceptives and $44
more annually for women who received one cycle of oral
contraceptives than it did for women who received the 12-month
supply all at once. She shared that the additional costs were a
result of pregnancy tests and associated visits. She noted that
the proposed bill did not change who was eligible for coverage
or what kind of prescriptions were being covered, the bill only
allowed that women who currently received coverage for
prescription contraceptives could receive the prescription for
12 months at one time, if they choose. She shared that there
had been concerns expressed from the Small Business Association
for whether the bill would apply to self-insured entities. She
stated that the sponsor would continue to work with the group to
address these concerns. She pointed out that an important
inclusion to the proposed bill was for the definition of a
health care insurer to include a self-insured entity, which did
help to address some of the concerns. She declared that
proposed HB 345 would offer "huge advantages for Alaskan women,
from eliminating the inconvenience of refilling the prescription
every one or three months at a time to the real inability for
some Alaskan women to make it to the clinic, hospital, or
pharmacy to refill that prescription at all." She listed the
difficulties that many women faced in refilling prescriptions.
3:14:50 PM
REPRESENTATIVE TARR pointed out that the fiscal note showed a
$1.3 million savings annually.
3:15:11 PM
CHAIR SEATON opened public testimony on HB 345.
3:15:24 PM
DIANA GREENE FOSTER, Researcher, University of California, San
Francisco, explained that she was working on research for the
State of California to evaluate and analyze the impact of year-
long supplies for oral contraceptives. She shared that her
research indicated that the benefits included a cost savings of
almost $100 annually per person. She reported that there were
fewer clinic visits and fewer pregnancy tests. She relayed that
a second study linked family planning dispensing to claims for
pregnancies, births, and abortions. The findings were that
women who received a one year supply were less likely to have
either a birth or an abortion in the subsequent year. She
stated that oral contraceptives were the most commonly used
reversible method of contraception in the United States, and
that most unintended pregnancies and most abortions occurred to
women using contraceptives inconsistently. She reported that
one in five women in abortion clinics reported that they had
unprotected sex because they ran out of birth control. She
allowed that this change would offer a higher potential for
women to avert unintended pregnancies.
3:17:50 PM
CHAIR SEATON noted that a synopsis of her research is included
in members' packets.
3:18:27 PM
KENNI PSENAK LINDEN shared that, as a college student, she had
been diagnosed with Stage 4 endometriosis and had been
prescribed hormonal birth control to allow for the future
possibility to have children. She reported on the difficulty of
maintaining consistent use of birth control while being only
allowed a one-month prescription, and stated that having a 12-
month supply readily available "would have been a huge relief
and would have given me much needed peace of mind about my
health and my ability to choose what was best for me in
consultation with my doctor." She asked that the proposed bill
address access to birth control by dependents. She relayed the
health difficulties of endometriosis, and shared that the
prescriptions for hormonal birth control allowed her to continue
with and graduate from college. She declared support for the
proposed bill.
3:20:23 PM
ROBIN SMITH stated that this was a good bill, and there was no
reason not to pass it as it offered cost savings. She declared
that this was a preventative care bill, as it prevented
unintended and unwanted births and abortions. She listed 10
reasons why a doctor might prescribe birth control pills, other
than to prevent pregnancy: protection against ovarian and
endometrial cancer; prevention of ovarian cysts; prevent and
treat endometriosis; prevent anemia; avoid migraines associated
with menstrual periods; treat PMS; treat acne, and excess hair
growth; and balance hormone deficiency. She declared that, as
it was beneficial for women to have access to birth control
pills, there were not any negatives associated with the proposed
bill.
3:23:58 PM
CATRIONA REYNOLDS, Clinic Manager, Kachemak Bay Family Planning
Clinic, pointed out that she had sent in two pages of facts and
data. She stated that consistent access to birth control should
not be dependent on an insurance carrier. She listed the
benefits for supplying 12 months of birth control protection,
which included consistent use.
3:26:32 PM
STEVEN SAMUELSON stated his support of the proposed bill, noting
that people should not be hindered by legislation in pursuit of
health, especially when discussed with a doctor. He pointed out
that many women were working in the field and did not have
immediate access to refills. He declared "people like sex, so
why not have them be prepared." He reiterated his support of HB
345.
3:28:48 PM
ELIZABETH FIGUS reported that during the summer fishing season
she did not have time to visit a doctor. She allowed that,
although some medical issues were unavoidable, it was "silly"
and "unnecessary" not to pre-approve a birth control
prescription. She declared that the proposed bill would save
money and time for individual women, and would save the costs
for unplanned pregnancies. She pointed out that, as
contraception was already legal, it was only necessary to make
the system be more fiscally efficient. She stated her support
for proposed HB 345.
3:30:53 PM
CHRISTINE NIEMI, The League of Women Voters - Alaska,
paraphrased from a prepared statement [included in members'
packets], which read as follows [original punctuation provided]:
The League of Women Voters of Alaska strongly supports
HB 345 (companion to SB 156), a bill related to
insurance coverage for contraceptives and other
services that reduce the risk of unintended
pregnancies. At the national level, the League of
Women Voters of the United States supports primary
care for all, care that includes "prenatal and
reproductive health." When women have the consistent
ability to plan their pregnancies, their families
benefit through greater financial well-being,
healthier living conditions, healthier children,
greater opportunities, and a myriad of additional
benefits. While improving the quality of life for
families, the ability to avoid unintended pregnancies
also reduces costs for state and federal governments.
In 2010 according to the Guttmacher Institute, the
State of Alaska spent nearly $43 million on health
costs related to unintended pregnancies while the
federal government added another $71 million for a
total cost of $114 million. Guttmacher reports that
48% of all pregnancies in Alaska in 2010 were
unplanned and 64% of Alaska's unplanned pregnancies
were publicly funded, representing the $43 million
cost. In addition, the cost benefits of supporting
women in their efforts to plan their pregnancies goes
far beyond the cost of the pregnancy itself. A woman
who is able to plan a pregnancy can better guarantee
that her health is at optimum level prior to
pregnancy, reducing the risk of a difficult pregnancy
and trauma to the child. Such planning reduces the
possibility of increased health problems for the
child, problems which can follow the child for years
and require increased health and education costs for
the State. A planned pregnancy increases a woman's
ability to manage her role as income provider for a
family and allows that family the best opportunity to
remain as financially independent as possible.
Supporting affordable contraceptives prescribed on a
12-month basis will undoubtedly reduce the number of
unintended pregnancies in Alaska, thereby increasing
family wellbeing and reducing State costs. 2 HB 345
can assist women and families to plan pregnancies so
they are ready for the added responsibility of a
child. In addition, costs to the State for unintended
pregnancies can be reduced. This is a win-win bill
that deserves consideration by the Legislature
especially as it struggles with the budget crisis.
Thank you for your consideration.
3:32:36 PM
ALYSON CURREY, Planned Parenthood of the Great Northwest and the
Hawaiian Islands, stated support for insurance coverage for a 12
month supply of birth control when supplied by a health care
provider. She added that 1 in 4 women said they had missed
pills because of not being able to get them in time. She
reported that a one year supply dramatically improved consistent
use, lowered unintended pregnancies, and hence, reduced
abortions.
3:34:10 PM
SAMANTHA SAVAGE stated her support for HB 345 and she
paraphrased from a prepared statement [included in members'
packets], which read as follows [original punctuation provided]:
I am writing today to encourage you to support SB 156.
For many many women oral contraception is their method
of choice for various personal medical reasons.
Alaskan women face more barriers trying to access all
medications due to geographic and occupational reasons
(women who live and work in rural communities or on
fishing vessels for example). Speaking from my own
life as someone who left the Mat-Su Valley to attend
school in Fairbanks, trying to get my prescription
refilled was an incredible burden as I could only have
it refilled on a month by month basis. Having the
ability to have 12 months of birth control covered by
an insurance plan and Medicaid at one time saves in
costs related to doctors visits to the women seeking
medication, and it saves money related to unintended
pregnancy. I urge your support of this bill that would
have a positive impact on the lives of many Alaskan
women.
3:35:36 PM
CAITLIN HEDBERG urged support of the proposed bill. She shared
that she is a professional woman, and that she often traveled
for work. She noted that it was a burden having to re-supply
birth control, reporting that missing a pill or starting a new
cycle because of an interruption to access wreaks havoc on the
human body. She had experienced an unintended pregnancy due to
a lack of access for birth control. She pointed out that her
insurance would only allow a one month supply at a time. She
concluded that the proposed bill was the fiscally responsible
choice for the state and for the women of the state.
3:38:49 PM
MAXINE DOOGAN, Community United for Safety and Protection,
reported that she represented current and former sex workers in
Alaska, sex trafficking victims, and their allies. She declared
support for HB 345 as it expanded access to health care.
3:39:33 PM
CHAIR SEATON closed public testimony on HB 345 after
ascertaining no one further wished to testify.
3:39:41 PM
REPRESENTATIVE WOOL stated that he supported the proposed bill
as it "totally makes sense." He asked if this was an insurance
bill, and whether it had been previously possible for a 12 month
prescription for birth control pills.
MS. CAVANAUGH replied that currently women could not get a 12
month supply of oral contraceptives at one time, as it was
usually limited to one or three month supplies.
REPRESENTATIVE WOOL mused that the current state of insurance
regulations would not cover the payments for more than three
months.
3:41:32 PM
MARGARET BRODIE, Director, Director's Office, Division of Health
Care Services, Department of Health and Social Services,
explained that a Medicaid prescription was on a month-by-month
basis, with those individuals under 18 years of age able to get
a 3 month prescription. In response to Chair Seaton, she said
that the proposed bill would change the situation for a 12 month
prescription, but that it would be necessary to ensure that the
individual was eligible for all 12 months, and if not, the
department would have to reimburse the federal government for
its share of the prescription that the individual was not
eligible.
MS. BRODIE, in response to Chair Seaton, replied that private
insurance, dependent on the plan, was for either a one month or
a three month prescription.
REPRESENTATIVE WOOL directed attention to the benefit savings in
the analysis of the fiscal note, and asked about the difference
between the 9 percent failure rate and the 7 percent failure
rate, resulting in 120 unintended pregnancies. He questioned
whether all of the unintended pregnancies had resulted in
childbirth.
MS. BRODIE expressed her agreement that the 120 pregnancies
would not all result in live birth, and she offered her belief
that this had been taken into consideration in the calculations.
3:45:14 PM
CHAIR SEATON said that HB 345 would be held over.
3:45:45 PM
REPRESENTATIVE TARR declared that this problem with access had
been long standing. She pointed out that young families had not
testified, noting that they were very challenged with the
demands of parenthood and working. She opined that the proposed
bill would be very beneficial to young families.
3:46:58 PM
CHAIR SEATON removed his objection to the proposed committee
substitute. There being no further objection, Version H was
adopted as the working draft.
[HB 345 was held over.]
3:47:25 PM
The committee took a brief at-ease.
HB 334-CHILD CUSTODY;DOM. VIOLENCE;CHILD ABUSE
3:47:47 PM
CHAIR SEATON announced that the next order of business would be
HOUSE BILL NO. 334, "An Act relating to visitation and child
custody."
3:48:30 PM
CRYSTAL KOENEMAN, Staff, Representative Cathy Munoz, Alaska
State Legislature, on behalf of Representative Munoz, prime
sponsor of HB 334, reported that the committee recommendations
had been taken into consideration and that she would provide a
proposed committee substitute (CS) for review and approval.
3:49:31 PM
The committee took a brief at-ease.
3:50:18 PM
CHAIR SEATON brought the committee back to order. He reopened
public testimony on HB 334, [which had been closed at the
previous bill hearing on 3/29/16].
3:50:56 PM
KEELEY OLSON, Executive Director, Standing Together Against Rape
(STAR), shared her background working against domestic violence
and sexual assault since 1989. She testified in opposition to
the proposed bill, as it did not provide the necessary
protections for the victims of domestic violence and their
children. She offered her belief that the requirement for
criminal conviction was too high a standard to be placed on the
victims of domestic violence when they were seeking civil and
legal protections. She suggested that the rebuttal of
presumption was a very effective tool to protect the safety of
victims and children, and that much of the testimony by
attorneys were complaints that this created havoc in the family
law courts. She stated that domestic violence was a messy
business, and was one of most underreported crimes in America.
She said that there would not be an increase of criminal law
convictions with this, and that the requirement for the
conviction would not offer any protection to the victims. She
declared that it was necessary to be cautious and to properly
vet the claimed experts of family law, as opposed to those who
have worked in the field and understand the dynamics of domestic
abuse. She said that for courts to take on the issue of
custody, it needed to be prepared to hear "some of the messy
business that goes on behind closed doors that is the typical
situation of domestic abuse." She stated her opposition to the
proposed bill.
3:56:13 PM
CHAIR SEATON relayed that the proposed CS had been revised to
change the standard from conviction to clear and convincing
evidence that there was a history of performing domestic
violence.
3:56:56 PM
CHRISTINE PATE, Legal Program Director, Alaska Network on
Domestic Violence & Sexual Assault (ANDVSA), stated opposition
to the proposed bill. She relayed that the legal program
provided civil legal assistance, primarily in family law cases,
to victims of domestic violence and sexual assault, as well as
legal advice and counsel to advocates in the ANDVSA member
programs. She shared her background in family law. She
expressed her understanding of how the custody statutes affected
victims, both before and since the enactment of the rebuttable
presumption law. She expressed concern for the effect on
children of this proposed legislation. She stated that the
rebuttable presumption law was enacted to protect Alaskan
children from the harmful effects of exposure to domestic
violence. She expressed agreement with the sponsor statement
that fathers were a critical part of a child's life; although,
she declared, it was most important for a child to have two
healthy parents. She stated that Alaska consistently ranked
near the top nationally for domestic violence and sexual
assault. She pointed out that the emotional, physical, and
mental health of children in homes with domestic violence was
detrimentally affected. She explained that the rebuttable
presumption against awarding a parent custody was enacted to
ensure that the court made consideration of domestic violence a
top priority in the decisions for custody of children, as prior
to this, domestic violence was only one of nine best interest
factors that could be considered by the court in these custody
decisions. She said that domestic violence was such an enormous
issue in Alaska that it needed to be more than one of the nine
best interest factors, declaring that the proposed bill would
return Alaska to these considerations unless there had been a
criminal conviction for domestic violence. She shared her
concerns for the proposed committee substitute regarding a clear
and convincing evidence standard. She offered her belief that
domestic violence was very hard to prove in court, as victims
often did not want to come forward because of fear or shame, and
often there was not extraneous evidence. She stated that the
clear and convincing standard made domestic violence even harder
to prove in a custody case, and she expressed support for the
removal of the criminal conviction standard. She opined that
this standard was an enormous burden to overcome, especially in
Rural Alaska. She stated that there was nothing in the
legislative history of the rebuttable presumption law that
indicated its purpose was to require a criminal history of
domestic violence, as the current law required a history of
perpetrating domestic violence to invoke the rebuttable
presumption. She reported that rebuttable presumption was
defined as one act which caused serious physical injury, a very
high standard, or more than one act of domestic violence found
by a preponderance of the evidence, 51 percent or more. She
declared that the history of domestic violence was well defined
in the statute. She stated that an accusation of domestic
violence was not enough to invoke the presumption and lose
custody of the children, as there had to be a finding by the
trial court that it was more likely than not, the civil legal
standard, that one incident of serious physical injury or two or
more incidences occurred. She pointed out that this finding
could not happen in an ex parte protection order hearing, but
could only occur after a long term domestic violence hearing, or
in a custody case where both parties had the opportunity to
fully present evidence and testify about the incidences. She
emphasized that courts are hesitant to make findings of domestic
violence in long term protection order cases because of an
understanding to the significance of the findings in a custody
case. She declared that supervised visitation was free in most
areas of Alaska.
CHAIR SEATON pointed out that the proposed bill would next go to
the House Judiciary Standing Committee.
4:04:00 PM
CHAIR SEATON closed public testimony on HB 334 after pointing
out that the above two testifiers had been cut off during the
previous hearing on HB 334 due to technical difficulties.
4:04:32 PM
REPRESENTATIVE TARR reflected that her struggle with the
proposed bill was that the testimony had been in such contrast.
She pointed out that the testimony regarding supervised visits
had ranged from not being available, to very costly at $75 per
hour, to being free in most communities.
4:05:58 PM
REPRESENTATIVE TALERICO moved to adopt the proposed committee
substitute (CS) for HB 334, Version 29-LS1409\N, Bruce, 4/5/16,
as the working draft. There being no objection, Version N was
before the committee.
4:06:38 PM
MS. KOENEMAN stated that the proposed bill was a complicated
issue, and that the sponsor was trying to find a more middle
ground for the best interest of the children. She directed
attention to the original intent language adopted by the
legislature in 1981, which essentially stated that it was in the
best interest for parents to share the rights and
responsibilities of child bearing. While actual physical
custody may not be practical or appropriate in all cases, it was
the intent of the legislature that both parents had the
opportunity to guide and nurture the child and to meet the needs
of the children on an equal footing beyond the considerations of
support or actual custody. She declared that the proposed bill
was seeking to ensure that the needs of the child were met.
CHAIR SEATON, in response to Representative Talerico, asked Ms.
Koeneman to explain the changes made for the proposed committee
substitute, Version N.
4:08:43 PM
MS. KOENEMAN directed attention to Section 1, which removed the
rebuttable presumption language in AS 25.24.150(g). She
reported that Section 2 added language for clear and convincing
evidence to establish a history of perpetrating domestic
violence, as well as the language for the conviction of a crime,
for the judge to use in determination of visitation rights. She
moved on to Section 3 which removed the rebuttable presumption
language. She explained the changes to Section 4 which dealt
with the delegation of visitation rights to a family member by
deployed parents. She relayed that Section 5 was the
modification of a custody or visitation order that removed the
rebuttable presumption. She pointed out that Section 6 removed
the rebuttable presumption language for military families for
the delegation of visitation rights to a family member. She
reported that Section 7 referenced AS 25.24.150(c)(6), which
removed the current language and changed it to "clear and
convincing evidence." She reported that Section 8 contained all
new language, which brought all the custody arrangements back to
AS 25.20.061 if there was any clear and convincing evidence of
domestic violence, and that language was set out in Section 2 of
the proposed bill. She noted that the court could order these
pieces referenced in Section 2. She pointed out that AS
25.24.150(m) added a time frame around the acts of domestic
violence. She shared that AS 25.24.150(n) was in regard to both
parents committing domestic violence, and the award of custody
to the parent least likely to perpetrate domestic violence, or
to a suitable third party as ordered by the court. She moved on
to the changes for Section 9 which repealed the rebuttable
presumption language as well as the language regarding both
parents committing a domestic violence crime. She concluded
with Section 10 which stated that this act only applied to
visitation or custody orders issued on or after the effective
date of the proposed bill.
CHAIR SEATON directed attention to page 5, line 14, and asked if
this language was applicable if this was a child of either one
of the parents.
MS. KOENEMAN replied that the intent was to include step-
children or foster children.
REPRESENTATIVE WOOL suggested that it could read "a child of
either of the two parents."
CHAIR SEATON opined that it would be a child within the family.
4:16:46 PM
LINDA BRUCE, Attorney, Legislative Legal and Research Services,
Legislative Affairs Agency, in response to Chair Seaton, said
that the language currently exists under AS 25.20.061, and that
it could be altered to apply to a child of either of the two
parents.
CHAIR SEATON asked if this would cover foster children in the
home.
MS. BRUCE offered her belief that the alteration would cover
this, although she would review this further and provide a
written response.
4:17:52 PM
NANCY MEADE, General Counsel, Administrative Staff, Office of
the Administrative Director, Alaska Court System, said that she
would defer to the Legislative Legal and Research Services for
the wording. She stated that definitions of domestic violence
and household member already exist.
4:18:20 PM
REPRESENTATIVE VAZQUEZ offered her belief that there was a
definition of child in the adoption chapter, AS 25.23.240. She
relayed that her problem was that it was very restrictive, and
she pointed out that if the child was not biological, and had
yet to be adopted, they would not be technically covered. She
suggested the use of "household member" or similar.
CHAIR SEATON asked if this could be resolved so to cover
domestic violence within the household.
MS. BRUCE said that she would.
4:19:20 PM
REPRESENTATIVE TARR asked about a circumstance with two adults
and a blended family of biological children from previous
relationships, although the adults were not legally married.
She asked about a time frame for legal custody or visitation
rights by each parent.
MS. MEADE replied that there were grandparent rights and that
she would research the rights for a person with a long standing
relationship with the child.
4:20:53 PM
CHAIR SEATON suggested a letter outlining the questions be sent
to the next committee of referral.
REPRESENTATIVE TARR asked that the circumstances around non-
married couples be addressed.
CHAIR SEATON reiterated that a letter asking House Judiciary
Standing Committee to address certain issues could be sent along
with the proposed bill. He directed attention to page 4, lines
11 - 14, and asked for an explanation.
MS. KOENEMAN expressed her agreement that the language should
also conform to "clear and convincing evidence" or "has
committed a crime" in order for there to be consistency in all
the areas.
MS. MEADE replied to an earlier question by Representative Tarr
about supervised visitation, and its availability in different
communities. She explained that she had also heard different
things. She stated that it was most common for the judge to
seek that the parties agree on a family friend or relative to
supervise the visitation, and only if there was not agreement
would there be the need for professional supervision. She
opined that there was no longer such an entity in Juneau,
although this did vary by community.
REPRESENTATIVE TARR asked about participation in a batterer
intervention program, offering her belief that the only programs
available would be prison based, as the funding for community
based programs was being eliminated. She opined that a judge
could not order this intervention if there was not a program
within fifty miles. She asked if this would impact the ability
for these situations to be resolved favorably.
MS. MEADE, in response to Representative Tarr, offered her
belief that, in Section 9, the presumption was eliminated, hence
there would not be any need for the batterers intervention
program; however, directing attention to page 2, lines 8 - 12,
she relayed that if there was a finding by clear and convincing
evidence of domestic violence or a conviction of domestic
violence, the court may order that the perpetrator go to one of
these programs. She noted that if a program did not exist, she
would not expect that the judge would order this.
4:28:39 PM
CHAIR SEATON, noting that telehealth programs had better results
as they had full attendance, asked if there was a batterers
program offered electronically.
MS. KOENEMAN relayed that there were batterer prevention
programs available on-line, although they were new and not yet
used in the state.
4:29:54 PM
The committee took a brief at-ease.
4:31:21 PM
CHAIR SEATON announced that HB 334 would be held over.
4:32:14 PM
The committee took an at-ease from 4:32 p.m. to 4:37 p.m.
HB 315-ELECTRONIC VISIT VERIFICATION: MEDICAID
4:37:41 PM
CHAIR SEATON announced that the final order of business would be
HOUSE BILL NO. 315, "An Act relating to an electronic visit
verification system for providers of certain medical assistance
services."
4:38:03 PM
REPRESENTATIVE VAZQUEZ moved to adopt the proposed committee
substitute (CS) for HB 315, labeled 29-LS1287\N, Glover, 4/1/16,
as the working draft.
CHAIR SEATON objected for discussion.
4:38:35 PM
TANEEKA HANSEN, Staff, Representative Paul Seaton, Alaska State
Legislature, explained that the proposed committee substitute
would narrow the approach for the electronic visit verification
(EVV) system for the first few years by directing the Department
of Health and Social Services to establish pilot projects for
these EVV systems. She reported that Section 1 of the proposed
CS was legislative intent language, stating that it was the
intent of the legislature to protect vulnerable Alaskans and the
integrity of the medical assistance program by reducing the
number of fraudulent claims and insuring that services were
provided to medical recipients. She relayed that it would use
technology to improve accountability for personal care services
and home and community based services delivered to medical
assistance recipients.
MS. HANSEN discussed Section 2, uncodified law, as this
established a pilot project and directed the Department of
Health and Social Services to adopt standards for an electronic
visit verification (EVV) system under this project. This system
would be used to verify visits conducted to provide personal
care services in the home or other setting and visits conducted
to provide home and community based services. She noted that
this should establish the providers eligible to participate and
require that the EVV system will document, at a minimum, the
name of the provider, or their employee, the recipient, the date
and time the contractor begins and ends the delivery of
services, and the location of services. She explained that
subsection (b) stated that DHSS would review the EVV systems
implemented under this section and prepare a report with
recommendations for statewide application of an EVV system,
which would be due on or before January 1, 2018, and delivered
to the Alaska State Legislature.
4:41:20 PM
CHAIR SEATON removed his objection to the proposed committee
substitute, Version N. There being no further objection, it was
adopted as the working draft.
REPRESENTATIVE WOOL asked whether the pilot program was at the
discretion of the department for hiring a vendor or creating it
in-house.
CHAIR SEATON explained that this would be clarified in a yet to
be introduced amendment. He offered some possibilities for the
pilot projects to ensure that the department had the flexibility
"to get something that will work and that people are willing to
participate in." In response to Representative Wool, he pointed
out that there was a fiscal note and testimony from the
department.
4:44:07 PM
DEB ETHERIDGE, Deputy Director, Central Office, Division of
Senior and Disabilities Services, Department of Health and
Social Services, asked for clarification to which fiscal note
was being referenced.
CHAIR SEATON clarified that the fiscal note was for the original
bill and included information about the vendor.
MS. ETHERIDGE said that she could speak on some of the
anticipated costs associated with the pilot project. She said
that she had not calculated the necessary statistically valid
sample for an effective pilot program, although consultations
with industry experts and other states had indicated that the
transaction fee per transaction was about $0.15, with each visit
consisting of two transactions. She noted that the cost would
depend on the number of services a person received each day.
She suggested that a pilot project for only personal care
services, and not for home and community based services, would
have fewer per day transactions. She reported that a person
could have personal care services three times each day, although
this could change if there were home and community based
services, as well. She stated that the draft fiscal note had
anticipated costs for two visits each day, five days each week,
and 20 days each month.
CHAIR SEATON asked if this yielded an overall savings.
MS. ETHERIDGE replied that the savings were associated with a
1.5 percent efficiency found in administrative claims for
Medicaid. She explained that there would be an actual time
associated, and there would be a savings as the time for service
would no longer be rounded.
4:48:31 PM
CHAIR SEATON pointed out that the savings in other states had
accrued in the first year, although, as the providers adjusted,
those savings did not continue.
MS. ETHERIDGE expressed her agreement, noting that there was
considerable savings in small populations, which did not always
continue when moved into a larger population. She stated that
the pilot program was a good way to ensure the savings.
CHAIR SEATON asked that the pilot program be large enough to be
statistically significant, so there would be a better idea for
its savings on a larger scale. He asked if the pilot would be
designed for different locations.
MS. ETHERIDGE replied that this would be necessary, as some
associated expenditures which were difficult to anticipate were
with connectivity, and it would be necessary to pay for a
solution. She relayed that it would be necessary to target
different areas in the state to ensure an understanding for the
costs, and then to realize the savings.
REPRESENTATIVE WOOL suggested that some savings would be a
result of reduction in fraud if the verification system was
working. He surmised that these savings would diminish as
"people sort of start playing by the rules."
MS. ETHERIDGE stated that the expectation was for ongoing
compliance and adherence when billing for services using the EVV
system, and an overall reduction and savings was anticipated for
each year. She referenced a concern by Representative Seaton
that some states had implemented the EVV system without
allocating enough funds for a system which provided recognition
of a service provider in the home. She said that this required
extra funding, noting that, without it, the verifications were
not as valid. She shared that it was necessary to weigh the
cost of the solution against the cost of the Medicaid program.
She reported that any additional administrative costs on the
service from the Medicaid program were captured in a cost report
and would be reflected in the reimbursement. She said that all
of these factors were considered when implementing programs for
the state.
REPRESENTATIVE WOOL mused that the EVV system would eliminate
fraud, and the resultant criminal convictions for fraud, as the
care and the time was accurately recorded. He suggested that
the costs should then stabilize.
MS. ETHERIDGE clarified that most authorized services were in 15
minute units, and it was anticipated that more people would
receive their authorized services.
REPRESENTATIVE VAZQUEZ added that there was also a quality
assurance component with the verification program, noting that
Florida and Oklahoma had savings over the first few years.
4:55:55 PM
REPRESENTATIVE WOOL observed that the system appeared to be
necessary, and that the pilot program could determine if it
would work and if there would be a savings.
CHAIR SEATON explained that the purpose of the pilot was to
determine if the data could be fully utilized and avoid
implementing a big system to cover the entire state and solve
all the problems at one time, which could then fail.
4:58:13 PM
CHAIR SEATON moved to adopt proposed Amendment 1, labeled 29-
LS1287\N.5, Glover, 4/5/16, which read:
Page 2, following line 19:
Insert a new subsection to read:
"(b) The Department of Health and Social Services
may consider a third-party vendor system for the pilot
project under this section."
Reletter the following subsection accordingly.
4:58:42 PM
REPRESENTATIVE VAZQUEZ objected for the purpose of discussion.
She said that she supported the proposed amendment as it
provided the department with further flexibility for
implementing the program.
4:59:03 PM
REPRESENTATIVE VAZQUEZ removed her objection. There being no
further objection, Amendment 1 was adopted.
4:59:29 PM
CHAIR SEATON moved to adopt proposed Conceptual Amendment 1,
which read:
Page 2 line 7: replace "and" with "or"
There being no objection, Conceptual Amendment 1 was adopted.
5:01:02 PM
CHAIR SEATON moved to adopt proposed Conceptual Amendment 2,
which read:
Page 2 line 23: Delete "January" and replace with
"July"
There being no objection, Conceptual Amendment 2 was adopted.
5:01:46 PM
CHAIR SEATON moved to adopt Conceptual Amendment 3, which read:
Page 2 lines 5, 8, 10: Delete "standards" and replace
with "regulations"
CHAIR SEATON explained that the purpose of this proposed
amendment was to clarify for the Department of Health and Social
Services that it was not necessary for a standards based pilot,
but instead, as they were adopting regulations, they had the
freedom to adopt a pilot with a vendor, from a current
provider's system, or another design.
5:02:35 PM
REPRESENTATIVE TARR objected for discussion. She asked if, as
it was a pilot program, this had been developed with standards
language, instead of regulations, because regulations would make
it necessary for the formal process of drafting regulations.
CHAIR SEATON asked if the use of "regulations" [in the proposed
conceptual amendment] would interfere with the interpretation of
formal regulations, or could "guidelines" replace "standards"
and retain the meaning.
MS. ETHERIDGE, in response, said that Department of Health and
Social Services would prefer to have "guidelines" or "standards"
[in the proposed conceptual amendment] for flexibility in order
to implement the pilot program on a timely basis and then the
department could adopt regulations if necessary to ensure
funding through the Medicaid program.
CHAIR SEATON asked which would be better.
REPRESENTATIVE VAZQUEZ interjected that the usage of
"regulations" was for a formal process, and could be overly
burdensome for a pilot project. She expressed her agreement
with the intent to avoid confusion by not imposing a standards
based. She suggested that "standards" be replaced by
"guidelines" [in the proposed conceptual amendment] to avoid any
confusion.
MS. ETHERIDGE expressed her agreement.
5:06:22 PM
REPRESENTATIVE VAZQUEZ moved to adopt a friendly amendment to
Conceptual Amendment 3, which read:
Page 2 lines 5, 8, 10 Delete "standards" and replace
with "guidelines"
[The committee treated the friendly amendment as adopted.]
REPRESENTATIVE TARR removed her objection. There being no
further objection, Conceptual Amendment 3, as amended, was
adopted.
5:07:40 PM
REPRESENTATIVE TARR pointed out that there needed to be
consideration for the unique circumstances of Alaska, that cost
effectiveness and quality assurance be considered, and that
expectations be realistic. She reminded that, as personal care
attendant services were only provided for individuals able to
live independently, a no-show was often reported by the client.
She declared her support of the personal care attendant program
to allow people to stay in their homes and be closer to their
families.
5:11:50 PM
REPRESENTATIVE VAZQUEZ moved to report CSHB 315, labeled 29-
LS1287\N, Glover, 4/1/16, as amended, out of committee with
individual recommendations and the accompanying fiscal notes.
There being no objection, CSHB 315(HSS) was moved from the House
Health and Social Services Standing Committee.
CHAIR SEATON said that new fiscal notes for Version N would be
forthcoming.
5:12:40 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
recessed at 5:12 p.m., until 4/6/16, at 3:30.