Legislature(2021 - 2022)DAVIS 106
04/20/2021 03:00 PM House HEALTH & SOCIAL SERVICES
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| HB133 | |
| HB145 | |
| HB58 | |
| HB153 | |
| HB58 | |
| HB153 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 133 | TELECONFERENCED | |
| + | HB 145 | TELECONFERENCED | |
| += | HB 58 | TELECONFERENCED | |
| *+ | HB 153 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 20, 2021
3:08 p.m.
MEMBERS PRESENT
Representative Liz Snyder, Co-Chair
Representative Tiffany Zulkosky, Co-Chair
Representative Ivy Spohnholz
Representative Zack Fields
Representative Ken McCarty
Representative Mike Prax
Representative Christopher Kurka
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 133
"An Act relating to the Alaska savings program for eligible
individuals; relating to education savings programs; relating to
the Education Trust of Alaska; relating to the Alaska advance
college tuition savings fund; relating to the Alaska education
savings program for children; and relating to the Governor's
Council on Disabilities and Special Education."
- HEARD & HELD
HOUSE BILL NO. 145
"An Act relating to the Board of Pharmacy; relating to health
care services provided by pharmacists and pharmacy technicians;
and relating to the practice of pharmacy."
- HEARD & HELD
HOUSE BILL NO. 58
"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."
- MOVED CSHB 58(HSS) OUT OF COMMITTEE
HOUSE BILL NO. 153
"An Act relating to the identification, location, and
notification of specified family members of a child who is in
state custody."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 133
SHORT TITLE: AK ED SAVINGS PROGRAMS/ELIGIBILITY
SPONSOR(s): LABOR & COMMERCE
03/10/21 (H) READ THE FIRST TIME - REFERRALS
03/10/21 (H) L&C, FIN
03/17/21 (H) L&C AT 5:45 PM BARNES 124
03/17/21 (H) <Bill Hearing Canceled>
03/19/21 (H) L&C AT 3:15 PM BARNES 124
03/19/21 (H) Heard & Held
03/19/21 (H) MINUTE(L&C)
03/24/21 (H) L&C AT 3:15 PM DAVIS 106
03/24/21 (H) Moved CSHB 133(L&C) Out of Committee
03/24/21 (H) MINUTE(L&C)
03/24/21 (H) L&C AT 5:45 PM DAVIS 106
03/24/21 (H) -- MEETING CANCELED --
03/25/21 (H) L&C RPT CS(L&C) 6DP 1NR
03/25/21 (H) DP: SNYDER, SCHRAGE, MCCARTY, NELSON,
SPOHNHOLZ, FIELDS
03/25/21 (H) NR: KAUFMAN
04/07/21 (H) HSS REPLACES FIN REFERRAL
04/07/21 (H) BILL REPRINTED
04/20/21 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 145
SHORT TITLE: EXPAND PHARMACIST AUTHORITY
SPONSOR(s): SNYDER
03/24/21 (H) READ THE FIRST TIME - REFERRALS
03/24/21 (H) L&C, HSS
04/12/21 (H) L&C AT 3:15 PM BARNES 124
04/12/21 (H) Heard & Held
04/12/21 (H) MINUTE(L&C)
04/16/21 (H) L&C AT 8:00 AM GRUENBERG 120
04/16/21 (H) Moved HB 145 Out of Committee
04/16/21 (H) MINUTE(L&C)
04/19/21 (H) L&C RPT 6DP 1NR
04/19/21 (H) DP: SCHRAGE, MCCARTY, SNYDER, NELSON,
FIELDS, SPOHNHOLZ
04/19/21 (H) NR: KAUFMAN
04/20/21 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 58
SHORT TITLE: CONTRACEPTIVES COVERAGE:INSURE;MED ASSIST
SPONSOR(s): CLAMAN
02/18/21 (H) PREFILE RELEASED 1/15/21
02/18/21 (H) READ THE FIRST TIME - REFERRALS
02/18/21 (H) HSS, L&C
04/15/21 (H) HSS AT 3:00 PM DAVIS 106
04/15/21 (H) Heard & Held
04/15/21 (H) MINUTE(HSS)
04/20/21 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 153
SHORT TITLE: CHILD IN NEED OF AID; NOTICE OF PLACEMENT
SPONSOR(s): CRONK
03/26/21 (H) READ THE FIRST TIME - REFERRALS
03/26/21 (H) HSS, JUD
04/20/21 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
CATHY GIESSEL
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 133.
ALLIANA SALANGUIT, Staff
Representative Liz Snyder
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Provided the sectional analysis on behalf
of Representative Snyder, prime sponsor of HB 145.
GRETCHEN GLASPY, Pharm.D., President
Alaska Pharmacists Association
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 145.
JUSTIN RUFFRIDGE, Pharm.D., Member
State Board of Pharmacy
Soldotna, Alaska
POSITION STATEMENT: Testified in support of HB 145.
TOM WADSWORTH
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 145.
AMY PAUL, Pharm.D., Faculty Clinical Pharmacist
Providence Family Medicine Center
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 145.
SARA CHAMBERS,MD, Director
Commercial Business Professional Licensing (CBPL)
Department of Commerce, Community & Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
145.
CHARLES MCKEE
Anchorage, Alaska
POSITION STATEMENT: Testified during the hearing on HB 145.
KYLE POHL, M.D.
Nome, Alaska
POSITION STATEMENT: Testified in support of HB 145 on behalf of
Dr. Kyle Pohl.
NATALIE MCCAY, Pharm.D.
Petersburg, Alaska
POSITION STATEMENT: Testified in support of HB 145.
SUSAN WHEELER, Pharm.D.
Bethel, Alaska
POSITION STATEMENT: Testified in support of HB 145.
DIRK WHITE, Pharm.D.
Sitka, Alaska
POSITION STATEMENT: Testified in support of HB 145.
DOUG BARTKO, Pharm.D.
Palmer, Alaska
POSITION STATEMENT: Testified in support of HB 145.
BARRY CHRISTENSEN, Pharm.D.
Ketchikan, Alaska
POSITION STATEMENT: Testified in support of HB 145.
RENEE ROBINSON
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 145.
REPRESENTATIVE MATT CLAMAN
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
58 as prime sponsor.
RENEE GAYHART, Director
Division of Healthcare Services
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
58.
TINA TOMSEN, MD
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
58.
LORI WING-HEIER, Director
Division of Insurance
Department of Commerce, Community & Economic Development (DCCED)
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
58.
REPRESENTATIVE MIKE CRONK
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As prime sponsor, presented HB 153.
CHRISSY VOGELEY, Community Relations Manager
Office of Children's Services (OCS)
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
153.
ACTION NARRATIVE
3:08:14 PM
CO-CHAIR TIFFANY ZULKOSKY called the House Health and Social
Services Standing Committee meeting to order at 3:08 p.m.
Representatives Spohnholz, Fields, Kurka, Snyder and Zulkosky
were present at the call to order. Representatives McCarty and
Prax arrived as the meeting was in progress.
HB 133-AK ED SAVINGS PROGRAMS/ELIGIBILITY
3:09:29 PM
CO-CHAIR ZULKOSKY announced that the first order of business
would be HOUSE BILL NO. 133, "An Act relating to the Alaska
savings program for eligible individuals; relating to education
savings programs; relating to the Education Trust of Alaska;
relating to the Alaska advance college tuition savings fund;
relating to the Alaska education savings program for children;
and relating to the Governor's Council on Disabilities and
Special Education."
3:09:43 PM
REPRESENTATIVE FIELDS presented HB 133, as prime sponsor. He
offered a PowerPoint presentation, entitled "HB 133: Able
Update." He began on slide 1, "What is an Able Account?" which
read as follows [original punctuation provided]:
? ABLE: "Achieving a Better Life Experience"
? Tax-free savings account for individuals with
qualifying disabilities
? Funds may be used to pay for items such as
disability expenses, education, housing,
transportation
? Distributions into accounts are not counted against
individual in determining eligibility for Medicaid and
needs-based assistance programs
REPRESENTATIVE FIELDS proceeded to slide 4, "ABLE Act of 2013,"
which read as follows [original punctuation provided]:
Signed into federal law in December 2014 as part of
the Tax Extenders package
? Established 529A (ABLE) savings account exclusively
for individuals with disabilities
REPRESENTATIVE FIELDS noted that former Alaska State Senator
Cathy Giessel and former Alaska State Representative Dan Saddler
championed the Alaska ABLE Act two years after it was signed
into federal law which authorized a state ABLE program through
the Department of Revenue (DOR). This allowed Alaska to join
the National ABLE Alliance, which is a group of states that work
together on supporting the ABLE accounts. He shared his
understanding that the ABLE program has been successful in
Alaska considering the number of individuals that have ABLE
accounts.
REPRESENTATIVE FIELDS advanced to slide 7, "ABLE to Work Act,"
which read as follows [original punctuation provided]:
? Signed into law in 2017 as part of the Tax Cuts and
Jobs Act
? Increased annual contributions levels
? Incentivized employment by increasing the
contribution level for employed beneficiaries from
$15,000 to $27,060
REPRESENTATIVE FIELDS advanced to slide 9, "ABLE Age Adjustment
Act," which read as follows [original punctuation provided]:
? Will increase the age of eligibility from 26 to 46
? Will allow more participation in ABLE accounts
3:13:40 PM
REPRESENTATIVE FIELDS continued on slide 10, "HB 133 Proposed
Updates," which read as follows [original punctuation provided]:
? Reassigns department responsibility
? Expands age eligibility limits
? Allows greater flexibility in using funds to pay for
education expenses
Allows 529 program accounts to roll into an ABLE
account
? Aligns with federal regulations regarding program
savings accounts
REPRESENTATIVE FIELDS noted that former State of Alaska Senator
Cathy Giessel and her staff did most of the work on HB 133, and
he said he suspects it would have passed in 2020 had COVID-19
not intervened.
3:15:15 PM
CATHY GIESSEL, former State of Alaska Senator, testified in
support of HB 133. She reminded the committee that the ABLE Act
was signed into federal law in 2014, and wanted to ensure that
committee members are aware that the members of U.S. Congress
who originally put the bill forward originally on the federal
level were family members of individuals with disabilities, and
she presumed that these Congress members understood the
financial burden for individuals with disabilities, as well as
the constraints placed on these individuals. She shared her
understanding that these members of Congress wanted to create a
program that would increase the opportunities for financial
independence and greater self-sufficiency for individuals with
disabilities. She explained that this program allows a 529-A
ABLE savings account for individuals with disabilities, which
she said is a "game changer." She shared that, a few years ago,
it was estimated that about 13,000 Alaskans were eligible for
this type of account. She said that one of the things that she
tries to achieve when speaking with individuals with
disabilities is to make them aware of 529-A ABLE accounts. She
expressed her enthusiastic support for raising the age of onset
of disability from 26 to 46 years. She said that HB 133 would
comply with the new federal guidelines that allow even more
people to participate in ABLE accounts. She added that former
State of Alaska Representative, Dan Saddler had a family member
who had a disability, and she shared her understanding that this
meant that he knew what the costs associated with having a
disability were, and the limited opportunities available to
individuals with disabilities. She shared that about a year and
a half after the bill had passed and was signed, her sixth
grandson was born with significant disabilities, and she now
understands firsthand how easy it is for her to contribute to
her grandson's ABLE account. She expressed that this is a bi-
partisan "win-win" piece of legislation that would be
significant in helping individuals with disabilities and the
families of those individuals.
3:19:12 PM
REPRESENTATIVE KURKA asked Senator Giessel for clarification as
to the state's role in ABLE accounts. He opined that it sounded
like a "tax shield" due to it starting out as a federal program.
REPRESENTATIVE FIELDS responded that the 529 accounts are not
for tax shielding but for assisting people experiencing
disabilities to be as self-sufficient as possible. The accounts
allow those individuals and family members to save money on
qualifying expenses such as education, transportation, and
housing, he said, without making these individuals ineligible
for Medicaid. He made note of Medicaid's low wealth limit of
$2,000. He said it would be counterproductive to, for example,
bump someone off Medicaid due to an increased money stream that
is going to housing or college expenses.
REPRESENTATIVE KURKA asked Representative Fields for
confirmation that it was not for tax deduction, but instead
about preventing the recipient from being precluded from
Medicaid benefits.
REPRESENTATIVE FIELDS concurred and, regarding Representative
Kurka's earlier question about the state's role, explained that
the state has to participate in order for Alaskans to be able to
participate in the program.
3:21:54 PM
REPRESENTATIVE SPOHNHOLZ added that HB 133 would not simply
prevent people from losing Medicaid coverage, but would also
prevents people from losing access to other programs, such as
Social Security Disability Income. She added that some of these
programs can take many years to get into, and HB 133 would
prevent individuals with disabilities from being kicked out of
these programs as well, and would help improve the financial
independence of these individuals. She explained that this
increased level of independence would prevent
institutionalization, or the necessity for these individuals to
turn to more expensive levels of care.
3:23:26 PM
CO-CHAIR ZULKOSKY opened public testimony on HB 133. After
ascertaining that there was no one who wished to testify, she
closed public testimony.
CO-CHAIR ZULKOSKY announced that HB 133 was held over.
3:23:57 PM
The committee took an at-ease from 3:24 p.m. to 3:25 p.m.
HB 145-EXPAND PHARMACIST AUTHORITY
3:25:42 PM
CO-CHAIR ZULKOSKY announced that the next order of business
would be HOUSE BILL NO. 145, "An Act relating to the Board of
Pharmacy; relating to health care services provided by
pharmacists and pharmacy technicians; and relating to the
practice of pharmacy."
3:25:54 PM
CO-CHAIR SNYDER presented HB 145, as prime sponsor. She
explained that the intent of HB 145 is to increase access to
care and to protect pharmacists and ensure that pharmacists can
be reimbursed for providing services that they are permitted to
provide. She went on to read from the Sponsor Statement [hard
copies included in committee packets], which read as follows
[original punctuation provided]:
Passage of House Bill 145, "The Pharmacist
Mobilization Act," increases access to care and
ensures Alaska's pharmacists are reimbursed when
providing services.
I am introducing it at the request of the Alaska
Pharmacists Association in partnership with the Alaska
Board of Pharmacy and the University of Alaska/Idaho
State Doctor of Pharmacy Program.
The coronavirus pandemic has shown that pharmacists
can engage at an elevated level to help deliver
necessary healthcare to all Alaskans. Pharmacists have
provided COVID-19 testing, vaccinations, and
telehealth visits, and have helped patients manage
chronic health conditions. This bill will update
outdated statute so pharmacists can continue providing
these services.
HB 145 defines the patient care services that
pharmacists and pharmacy support staff can
independently provide, allows pharmacist technicians
to administer vaccines when under the direct
supervision of a licensed pharmacists, and empowers
the Board of Pharmacy to regulate pharmacists, student
pharmacists, and pharmacy support staff who provide
these services.
Furthermore, the bill updates the current provider
anti-discrimination statute to support insurance
coverage of these patient care services when provided
by a pharmacist. Currently, pharmacists are one of the
only healthcare professionals not listed in this
statute.
HB 145 largely updates outdated statutes to align with
current practices. Its passage benefits Alaskans by
increasing healthcare access during and after the
pandemic. Please support this common sense,
housekeeping bill that will help your local, patient-
oriented pharmacies continue to provide essential
services.
3:29:12 PM
ALLIANA SALANGUIT, Staff, Representative Liz Snyder, Alaska
State Legislature, provided the sectional analysis of HB 145 on
behalf of Representative Snyder, prime sponsor. She summarized
the Sectional Analysis [hard copies provided in committee
packets], which read as follows [original punctuation provided]:
Sec. 1: Adds language to AS 08.80.030(b) Powers and
Duties of the Board, statute that outlines the Board
of Pharmacy's powers, that allows the Board of
Pharmacy to adopt rules to regulate the independent
monitoring of drug therapy and independent pharmacist
prescribing of vaccines and naloxone.
Sec. 2: Adds a new subsection to AS 08.80.045
Nonprescription Drugs that aligns statute with the
current practice of pharmacists recommending non-
prescription medications and devices for treating
minor and self-limited conditions.
Sec. 3: Amends AS 08.80.155 Emergency Permit to
increase the Board of Pharmacy's flexibility to grant
emergency licenses for all relevant licenses used in
pharmacies.
Sec. 4: Amends AS 08.80.168(a) Administration of
Vaccines and Related Emergency Medications by adding
"prescribe" to existing vaccine administration
statute.
Sec. 5: Amends AS 08.80.168(b) by replacing "dispense"
with "prescribe and administer" in regards to
administering an opioid overdose drug.
Sec. 6: Adds a new subsection to AS 08.80.168 that
allows a pharmacy technician to administer a vaccine
or related emergency medication but only if they have
been authorized by the Board of Pharmacy to do so AND
if they are under the direct supervision of a licensed
pharmacist who meets the requirements in AS 08.80.168
(a).
Sec. 7: Adds language to AS 08.80.297(a) Prescription
Prices Available to Consumer that allows personnel who
are not licensed pharmacists to disclose the cost of
filling a prescription when directed by a pharmacist
working at the same institution.
Sec. 8: Amends AS 08.080 Pharmacists and Pharmacies by
adding a new section, AS 08.80.337 Other Patient Care
Services, that: ? Allows a pharmacist to provide
patient care services for a disease or condition with
an existing diagnosis under an agreement made with and
approved by a practitioner ? Limits patient care
services that pharmacists can provide to those that
are minor, selflimiting, and have a CLIA-waived
laboratory test which guides clinical decision making.
? Provides language that allows pharmacists to be
reimbursed for providing these services 04/07/21 Sec.
9: Amends AS 08.80.480 Definitions by removing "dosage
form" as a definition of "equivalent drug product".
This allows pharmacists to make minor, non-therapeutic
changes to prescriptions using clinical judgement and
expertise without contacting the prescriber for verbal
or written approval. This does not allow a pharmacist
to substitute a dosage form that would negatively
impact patient outcomes, safety, or cost
effectiveness. Examples of appropriate substitutions
under this section include changing from a tablet form
of medication to a capsule form of the same medication
and strength.
Sec. 10: Amends AS 08.80.480(30) by adding
"dispensing" and "independent prescribing" to the
definition of the "Practice of Pharmacy" to align with
the changes made in Section 4 & 5 (AS 08.80.168) of
this bill. These additions better represent actual
provision of naloxone and vaccine by pharmacists.
Sec. 11: Amends AS 21.36.090(d) Unfair Discrimination
to include "pharmacists" as protected health care
providers in the provider anti-discrimination statute.
This aligns the state statute with federal statute
(CFR 438.12) and afford pharmacists the same
protection as all other healthcare providers when
engaging health plans for covered services such as
ordering laboratory tests, point-of-care testing,
vaccine prescribing and administration, preventative
health services, managing minor self-limiting
conditions, and participating in collaborative disease
state management.
3:33:30 PM
GRETCHEN GLASPY, Pharm.D., President, Alaska Pharmacists
Association, testified in support of HB 145. She explained that
the Alaska Pharmacists Association (APA) represents over 200
pharmacists, pharmacy technicians, and student pharmacists
statewide. She said that she earned her Doctor of Pharmacy in
2007 and has been a practicing pharmacist in Alaska since 2014.
Currently, she works as the Clinical Informatics Pharmacist at
Bartlett Regional Hospital in Juneau, Alaska, which requires her
to merge information technology with clinical pharmacy practice.
She continued that HB 145 came about through collaboration
between the APA, the Board of Pharmacy, and the University of
Alaska Anchorage/Idaho State Doctor of Pharmacy Program. The
Board of Pharmacy began reviewing statutes at the request of
State of Alaska Governor Mike Dunleavy; however, the COVID-19
pandemic highlighted the ways in which the statutes are out of
date in regard to pharmacy practice. She continued that it also
seeks to add pharmacists to the Provider Antidiscrimination
Statute, as pharmacists are one of the only providers not
currently listed. She concluded that HB 145 would allow
pharmacists to engage at a much higher level, both during and
after COVID-19.
3:35:33 PM
JUSTIN RUFFRIDGE, Pharm.D., Board Member, State Board of
Pharmacy, testified in support of HB 145. He explained that he
is a pharmacist in Alaska and owner of a few pharmacies around
the state. He shared that, from the perspective of the State
Board of Pharmacy, HB 145 is an imperative piece of legislation
in order to properly regulate the pharmacy profession. The
expanded authority of the board that the bill proposes is not
currently represented well by the current statute, he opined,
and said that the board was told that statutory adjustments must
be made in order to regulate certain professions. He added that
the board considers the proposed bill to be a "housekeeping"
bill and that there is enough support for it to pass.
3:37:39 PM
TOM WADSWORTH testified in support of HB 145 and added that,
although he is an educator at the University of Alaska Anchorage
(UAA), the views are his own and do not reflect UAA. He said
that he is a practicing pharmacist of 19 years and an educator
of pharmacy students. He explained that the first class of
pharmacy students in the UAA system were graduated in 2020, and
another class will graduate in a few weeks [in 2021]. He
explained that pharmacists receive professional graduate
training of 4 years, with at least 2,000 hours of experiential
training, and most go on to begin post-graduate residency
programs, which offer additional training. Beyond that, he
continued, pharmacists can become board certified in various
fields, such as primary care and pediatrics. Over half of all
practicing pharmacists now practice outside of the pharmacy
community, he said, and the statutes do not reflect this
reality. Many pharmacists work in primary care in tribal or
veteran health care in capacities that have nothing to do with
dispensing medications, but instead focus on general health,
wellness, and medication management. He expressed that these
pharmacists are filling a vital need in Alaska, and pharmacists
can be a solution to healthcare shortages.
3:40:52 PM
AMY PAUL, Pharm.D., Faculty Clinical Pharmacist, Providence
Family Medicine Center, testified in support of HB 145. She
shared that Providence Family Medicine Center (PFMC) is a
patient-centered medical home and the only family medicine
residency in the state of Alaska. She said that her practice
includes 36 resident positions and about 30 faculty and staff
positions, and the center services over 10,000 Alaskans in the
Anchorage, Alaska area. The number one resource to treat
patients is medications, she opined, however most medical school
graduates receive only about a semester of pharmacology, yet
these graduates are expected to appropriately choose and utilize
the most optimal medication therapy for patients. Due to her
position, she is able to work alongside physicians in Alaska and
help determine the most appropriate medication for patients.
She noted that primary care physicians, partially due to the
time restraints at play, have to address the "what" when
diagnosing a patient, but are not able to address the "why."
She shared that she is able to fill this void and meet with
patients, educate patients about their diseases, and offer ideas
for lifestyle changes, so that patients can receive the most
benefit with the least side effects.
MS. PAUL offered an example of this in which she met with a
patient who had been diagnosed with diabetes for over 20 years
and had never been taught to use an insulin pen at mealtimes.
She helped this patient learn how to use the device and she was
also able to help this patient obtain a glucose monitor so that
the patient could have more data on appropriate doses. She also
spoke to this patient about quitting smoking, and together
developed a plan to help the patient quit. Later, she
continued, this patient sent her a message expressing how she
wished every clinic had "a pharmacist like you." She concluded
with the hope that it is obvious that utilizing clinical
pharmacists to optimize patient care like this allows for
providers to meet with patients about acute needs, and allows
for patient and provider satisfaction. Unfortunately, many of
these services are not reimbursed by insurance due to current
regulations, despite the fact that the same services are
reimbursed when provided by a different type of clinician. This
makes these kinds of services unsustainable in primary care
facilities, she expressed, but the patients who have experienced
services provided by a pharmacist in the private sector
understand the benefits.
3:46:54 PM
REPRESENTATIVE MCCARTY asked Mr. Wadsworth about a letter from
Sara Chambers, Division Director of Department of Commerce,
Community, & Economic Development (DCCED) [hard copy included in
the committee packet]. He quoted line 3, paragraph 3 of the
letter, which read as follows [original punctuation provided]:
Since this statute specifically calls out vaccinations
and related emergency medications, it effectively
prohibits pharmacists from independently rendering
other patient care services.
REPRESENTATIVE MCCARTY asked whether Mr. Wadsworth could address
this statement about the concern of professional licensing.
MR. WADSWORTH answered that that opinion came about as a result
of an inquiry by the Board of Pharmacy from the Department of
Law as the board attempted to promulgate some regulations. What
the letter effectively states and the reason for including it,
he continued, is that HB 145 would not expand pharmacist
prescriptive authority. The three items listed for prescriptive
authority stand at vaccines, Naloxone, and situations that exist
under the pharmacist collaborative agreement. He explained that
the collaborative agreement allows for pharmacists to enter into
a practice in collaboration with a primary provider, which
allows the pharmacists to write prescriptions for treatment,
like the example Dr. Paul shared earlier in the committee
meeting. He said that model of interpreting statute or
regulation essentially says that, if those items are
specifically stated, then every other prescriptive authority is
excluded from the statute.
CO-CHAIR SNYDER offered clarification that the letter from Sara
Chambers was received by the committee in response to some
questions that arose in a House Labor and Commerce Standing
Committee meeting on April 12, 2021. She shared that
Representative Kaufman had expressed concern that HB 145 would
"open the barn door," and the letter was intended to assuage his
fears.
3:51:19 PM
SARA CHAMBERS, Director, Commercial Business Professional
Licensing (CBPL), Department of Commerce, Community & Economic
Development, explained that the question refers to current law
and the proposed legislation and reiterated that it was in
response to the earlier House Labor and Commerce Standing
Committee meeting. She asked for further clarification on the
type of additional information Representative McCarty was
seeking.
REPRESENTATIVE MCCARTY responded that he is curious about the
proposition in the bill that would expand the services that
pharmacists would be able to administer, which he said he
understands was crafted with legal counsel. Alternatively, he
said that Ms. Chambers' letter says that according to legal
counsel, pharmacists cannot practice beyond the three criteria
mentioned previously.
CO-CHAIR SNYDER responded that there is specific language about
Naloxone and vaccinations in HB 145. The remaining services
mentioned in the bill, she continued, are consistent with the
practice of pharmacy as it is in its current state. The bill
works to provide some clarification and details around the
practice of pharmacy so that the board is then empowered to
regulate the field, she added.
MS. CHAMBERS offered clarification that, because this question
was raised in a different committee, the letter address the
state of the current law and does not address HB 145. The
current law states that there are restrictions to what
pharmacists can do because vaccinations and emergency
medications are specifically stated. The question was not an
interpretation of the bill, and she presumed that this is where
the confusion lies.
3:54:51 PM
REPRESENTATIVE PRAX offered his understanding that the
assumption is that pharmacists can't "do anything" until given
permission and told that the proper regulations are in place.
He asked whether it's true that pharmacists need to be given
permission to do something beyond the normal scope of practice.
MR. WADSWORTH responded that when one reads the Pharmacy Act,
which is what HB 145 seeks to amend, it's clear that there is
already a definition about pharmaceutical care and patient care
services. There needs to be a differentiation between
medication and prescriptive authority, he continued, as there
are many providers that offer patient care services that do not
prescribe medicine, such as social workers. Similarly, he said,
pharmacists provide patient care services but do not necessarily
prescribe medication. He explained that Dr. Paul is already
performing the actions that are proposed in HB 145, but the
intended consequence of the bill is to expand the definition of
pharmaceutical care and bring clarity to the definition of
"patient care services," which are the services that pharmacists
can do independently that do not result in a prescription, such
as smoking cessation or diabetes education. He said that these
services are already in statute, but are not delineated with
enough clarity, which is what brings about the "Negative-
Implication Canon" indicated in Ms. Chambers' letter. He
explained that clarity is sought after so that the board can
promulgate and regulate these issues.
MR. RUFFRIDGE added that the board speaks the easiest on this
issue since that is where the "Negative-Implication Canon" term
first originated. The request for the letter to be included in
the packet of information is to ensure that there are no
questions as to what pharmacists can and should be able to do,
he said. Pharmacists are not seeking to expand the authority to
prescribe medications; there is already a means by which to do
this. He noted that in other meetings across the state, there
have been similar questions raised on whether expanding
pharmacists' authority is what is being proposed. Consequently,
the board sought a legal opinion on whether there would be any
way that a pharmacist would obtain expanded prescriptive
authority, and it is a definitive "no." The answer, he relayed,
is that pharmacists may prescribe only under a collaborative
practice agreement, for vaccines, or for Naloxone. He continued
that HB 145 is regarding the other area of pharmacists' duties
[patient-care services] that many pharmacists are already
actively engaged in across the state. He said that the board
has attempted to regulate what those services look like, who is
engaged in the services, and what requirements exist in order to
engage in the services, but since it is not well-defined in
statue, the board cannot regulate it.
4:00:05 PM
REPRESENTATIVE SPOHNHOLZ asked Mr. Ruffridge and Mr. Wadsworth
what the most common services are that are not being reimbursed,
and whether reimbursement is being denied by both private and
public payors.
MR. RUFFRIDGE replied that there were a wide variety of issues
that arose during the COVID-19 pandemic through his professional
capacity as a pharmacist. For example, COVID-19 testing was the
most prominent issue, and as pharmacists are not able to
credential or contract for Clearwave [a patient engagement
platform] COVID-19 tests due to the current statutory
limitations, many insurance companies chose to not cover a
pharmacist who was asking for a Clearwave test. He expressed
that the pharmacist community was restricted in this way until
federal action was taken, and that federal action is limited.
He shared his understanding that in order to engage pharmacists
in the future and to ensure that this problem does not happen
again in the future, action is needed. In addition to the
"worrisome" case of COVID-19 testing, he added that there is a
large number of other areas in which pharmacists are engaged in,
such as the diabetes testing mentioned earlier in the meeting by
Dr. Paul, but pharmacists continue to be engaged in these
avenues at a lower level due to the inability to contract or
credential with health plans such as Clearwave because
pharmacists are not recognized.
MR. WADSWORTH added that there is an active program inside the
tribal programs and the VA where pharmacists have been operating
as clinical pharmacists and already providing the services that
Dr. Paul mentioned earlier in the meeting. These pharmacists
work alongside the nurses, physician's assistants (PA), and
physicians, and have been operating in this capacity for at
least three decades. He noted that this uptick has not been
seen in the private sector, and that Dr. Paul is one of three
primary care pharmacists in a private practice setting in all of
Alaska. He said that the reason for this is due to the
difficulty experienced by pharmacists attempting to enroll with
the health plan on their medical benefit in the same way that a
PA or a nurse practitioner or physician would enroll. Many
states, he continued, have addressed this issue, and in the
state of Washington, for example, insurance companies are
allowing pharmacists to enroll with commercial insurances. For
this reason, these pharmacists are able to submit the same
claims that a physician would, because these services are now
recognized as in the scope of practice as it falls under the
collaborative practice agreement. He explained that this is how
Dr. Paul operates. The difficulty comes when some commercial
payors and some state payors are either not able to enroll, or
those services are being deemed as not eligible due to a "so-
called" scope of practice issue. He noted that HB 145 would
allow pharmacists to offer more services at which they excel,
but cannot currently offer due to restrictions.
4:05:47 PM
CO-CHAIR ZULKOSKY opened public testimony on HB 145.
4:06:10 PM
CHARLES MCKEE, testified on HB 145. He spoke about a personal
legal case that he said came about because Governor Dunleavy
"veto-ed Medicaid/Medicare." He explained that he went to the
hospital in an emergency situation and there were no funds
available for his medical bills.
4:08:35 PM
KYLE POHL, MD, had his testimony in support of HB 145 presented
by Kylie Goff. Ms. Goff said that Dr. Pohl works for the Alaska
Native Tribal Health Consortium, but his comments being relayed
by Ms. Goff are his own. Ms. Goff said Dr. Pohl has provided a
full spectrum of pediatric care throughout the state of Alaska
for the past five years, practicing in Anchorage, Alaska, Nome,
and the surrounding villages. He has noticed that, at all of
these locations, he could not be as effective as he is without
the help of an "outstanding group of pharmacists." His work in
rural Alaska has relied heavily on the support of skilled
pharmacists, and the pediatric well-child immunization campaign
has been the result of a combined effort of physicians and
pharmacists. Through this campaign, the number of children who
are up to date on immunizations has drastically increased, as
well as the number of children who have been provided a well-
child check, which offers screening on critical birth and
development and routine lab studies in the region. A program
has also been created to help care for the complex adult
population, which includes strategies to manage chronic diseases
such as diabetes, heart disease, hypertension, and chronic
kidney disease. Pharmacists have been critical in helping to
create pathways to improve screening for cervical cancer, colon
cancer, breast cancers, and many other diseases, and have been
critical in each stage of the process.
4:11:04 PM
NATALIE MCCAY, Pharm.D., testified in support of HB 145. She
shared that she is a pharmacy technician at Petersburg Rexall
Drug (PRD) in Petersburg, Alaska. She noted that PRD is locally
owned by two sisters, and said that she has noticed that the
owners are often the first people that patients come to with
questions or to ask for advice. She opined that HB 145 is
especially important for rural communities such as Petersburg,
and that allowing pharmacists to provide additional healthcare
services will provide increased access for patients where it can
otherwise be limited. She added that allowing technicians to
administer vaccines while supervised would allow more of the
community to get vaccinated, which is especially important
during the COVID-19 pandemic.
4:12:16 PM
SUSAN WHEELER, Pharm.D., testified in support of HB 145. She
said that she is a pharmacist working at the Yukon Kuskokwim
Corporation (YKC). She shared that the pharmacists at YKC are
already providing many of the services that would be impacted by
changes proposed in HB 145. The pharmacists are fully
integrated with the other providers, nurses, and healthcare
professionals in the corporation; however, due to an inability
to enroll pharmacists as billing providers, YKC is unable to
receive compensation for the services provided by its
pharmacists. She shared her understanding that pharmacists are
the most readily available healthcare professionals, yet at this
time in Alaska, pharmacists are the only healthcare
professionals that are not listed in the provider
antidiscrimination statutes. This means that the most readily
available healthcare professionals are compensated minimally, if
at all, for providing the same services that would be otherwise
covered if provided by other healthcare professionals, she said.
She explained that the lack of compensation makes it difficult
to provide the uncompensated services that pharmacists are well-
prepared and eager to provide. She noted that this makes these
services less readily available, which may prevent some patients
from receiving some of the services that pharmacists could
quickly, easily, and competently provide.
4:14:18 PM
DIRK WHITE, Pharm.D., testified in support of HB 145. He shared
that he and his wife have been practicing in a community
pharmacy in Sitka, Alaska, over 30 years. He expressed that the
field has changed immensely throughout his lifetime, and
predicted that more changes are to come. He commented that
regulations need to be updates to reflect those changes, and to
anticipate future changes. He noted that, in addiction to
testing for COVID-19, pharmacists would like to also be able to
test for streptococcus ("strep"), for the flu, testing for
diabetics, lipid panels, and more. He opined that HB 145 would
allow for these changes to happen.
4:16:02 PM
DOUG BARTKO, Pharm.D., testified in support of HB 145. He
stated that he had a small pharmacy in Wasilla, Alaska from the
1990s through the year 2008, and one of the largest problems he
had was receiving rejection of claims when billing insurance
companies. He said that HB 145 would give student pharmacists
status as a provider, and reiterated that pharmacists are the
only healthcare professionals without provider status.
4:17:22 PM
BARRY CHRISTENSEN, Pharm.D., testified in support of HB 145. He
said that he is a community pharmacist in Ketchikan, Alaska, and
he and his family have practiced as pharmacists since Ketchikan
was founded over 47 years ago. He is a second-generation
pharmacist, and two of his daughters have also become
pharmacists. He disclosed that he is also co-chair of the
legislative committee for the Alaska Pharmacist Association. He
said pharmacy has changed significantly since his father began
practicing in 1974, and that HB 145 recognizes the changes and
that modern pharmacists are in a better position to help
patients meet pharmaceutical needs. He opined that pharmacists
need the statutory language in HB 145 in order to best serve
patients.
4:18:38 PM
RENEE ROBINSON, testified in support of HB 145. She said that
she is an associate professor at the University of Alaska/Idaho
State University College of Pharmacy. She also serves as
president-elect of the Alaska Pharmacists Association, as well
as the co-principal investigator on a CDC and Department of
Health and Social Services funded seven-month demonstration
project that supports reimbursement of pharmacists providing
health services to ensure an increased access to rural and
underserved Alaskans. Her career has also included the training
of future pharmacists. She opined that HB 145 would resolve
long-standing regulatory issues that impede continued progress.
4:20:36 PM
CO-CHAIR ZULKOSKY, after ascertaining that there was no one else
who wished to testify, closed public testimony on HB 145.
CO-CHAIR ZULKOSKY announced that HB 145 was held over.
HB 58-CONTRACEPTIVES COVERAGE:INSURE;MED ASSIST
4:20:54 PM
CO-CHAIR ZULKOSKY announced that the next order of business
would be HOUSE BILL NO. 58, "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."
4:21:08 PM
The committee took an at-ease from 4:21 p.m. to 4:26 p.m.
4:26:21 PM
REPRESENTATIVE MATT CLAMAN, Alaska State Legislature, answered
questions during the hearing of HB 58, as prime sponsor. He
reminded the committee that HB 58 would make contraception more
readily available for individuals who choose to use it, but it
does not require anyone to use contraception. He said the bill
would make it easier in particular for individuals who
oftentimes have difficulty getting long-term prescriptions.
4:27:07 PM
CO-CHAIR ZULKOSKY asked Renee Gayhart to speak to the change in
the fiscal note from a cost-savings fiscal note to a zero fiscal
note.
4:27:24 PM
RENEE GAYHART, Director, Division of Health Care Services,
Department of Health and Social Services, stated that the
Division of Healthcare Services is looking at a neutral fiscal
note and a zero fiscal note for 2021. She expressed that the
division supports the policy and shared her understanding that
the program could absorb any potential costs with the change and
the disbursement to 12 months. She added that the cost would be
absorbed in the existing appropriation, and similar to other
healthcare market utilization trends. The zero fiscal note, she
said, means that the cost avoidance of previous fiscal notes is
not a guarantee. She reiterated that the division supports the
policy, and explained that it would be looking retrospectively
at claims to consider what the savings were in areas such as
labor and delivery and prenatal care. She offered clarification
that the division is looking at cost of implementation, and
would retrospectively be looking at savings.
4:28:55 PM
REPRESENTATIVE MCCARTY asked Ms. Gayhart whether there are
changes that are necessary for regulation in the fiscal note.
MS. GAYHART responded that there would be regulations in
amendment changes, but the division does not see a change in the
fiscal note with implantation of the policy changes.
4:30:00 PM
REPRESENTATIVE FIELDS moved to adopt Amendment 1 to HB 58,
labeled 32-LS0259\A.1, Marx, 4/16/21, which read as follows:
Page 1, following line 10:
Insert a new subparagraph to read:
"(B) emergency contraception, including
over-the-counter emergency contraception, approved by
the United States Food and Drug Administration; the
insurer may not require a prescription for coverage of
over-the-counter emergency contraception under this
subparagraph;"
Reletter the following subparagraphs accordingly.
Page 6, line 23:
Delete "and"
Page 6, following line 23:
Insert a new paragraph to read:
"(2) emergency contraception, including
over-the-counter emergency contraception, approved by
the United States Food and Drug Administration; the
department may not require a prescription for coverage
of over-the-counter emergency contraception under this
paragraph; and"
Renumber the following paragraph accordingly.
CO-CHAIR ZULKOSKY objected for discussion purposes.
REPRESENTATIVE FIELDS explained that, during the House Health
and Social Services Standing Committee on April 15, 2021, he
learned that there are circumstances under which emergency
contraception, or the "morning-after pill," would not be covered
by insurance if it were to be purchased over the counter, but it
would be covered if an individual were able to obtain a doctor's
prescription. He opined that it is unreasonable that an
individual with insurance would not be able to receive insurance
coverage for a covered product simply because there are
circumstances that prevent them from getting in contact with a
doctor. He explained that Amendment 1 addresses this inequity,
and that it would allow emergency contraception to be covered by
insurance regardless of the presence of a doctor's note.
4:31:05 PM
REPRESENTATIVE KURKA expressed his concern about the use of the
term "emergency contraception." He shared his understanding
that it does not simply refer to contraception, but also to
"abortabations." He opined that one of the purposes of the
morning-after pill is to prevent implantation of an "already
created human embryo," which he understands to be ending a human
life. He said he opposes this perceived consequence.
4:31:51 PM
REPRESENTATIVE MCCARTY asked for clarification on whether there
is a window of opportunity for a physician to prescribe
emergency contraception otherwise it is not effective.
REPRESENTATIVE FIELDS responded yes, that is his understanding
as well.
REPRESENTATIVE MCCARTY asked if he understands correctly that an
individual might seek out emergency contraception in instances
of rape or domestic violence.
REPRESENTATIVE FIELDS responded yes, and expressed that those
instances are good reasons as to why insurance should cover
emergency contraception.
4:33:28 PM
REPRESENTATIVE CLAMAN noted that Dr. Tina Tomsen is available
for questions, and she may be able to offer a medical
perspective on the suggestions made by Representative Kurka.
4:33:44 PM
TINA TOMSEN, MD, shared that she retired at the end of 2020
after practicing medicine in obstetrics and gynecology for 34
years. She said that there is an older form of emergency
contraception called Plan B, which is approved for over-the-
counter administration and is available for purchase. If a
doctor were to write a prescription for a patient for Plan B and
that patient were to take it to a pharmacy, she explained, that
pharmacy would direct the patient to purchase Plan B over the
counter. She said that the patient would not need to get Plan B
from the pharmacists. However, there is a newer form of
emergency contraception that works over a longer period of time
and has a higher effectiveness rate, she said, and that form
does require a prescription, and a patient would have to get it
filled at a pharmacy. An example of a situation that might
arise, she continued, is that a patient might need emergency
contraception on a Friday night and there might be something
that makes the patient's physician unavailable, such as a long
weekend, which might necessitate that the patient purchase Plan
B out of pocket rather than the newer form of emergency
contraception with a prescription. She ensured the committee
that both forms of emergency contraception are effective, and
not considered by the American College of Obstetricians and
Gynecologists (ACOG), based on science, to be abortibations.
4:35:39 PM
REPRESENTATIVE SPOHNHOLZ expressed her support for the proposed
amendment. She shared her understanding that Amendment 1 would
correct an oversight that didn't get remedied as new medications
became available. She expressed support for efforts to increase
access to better medication, and divulged that, as someone who
has personally used emergency contraception, she views it as a
"common sense" measure.
4:36:20 PM
REPRESENTATIVE KURKA asked Dr. Tomsen whether the emergency
contraception she described that requires a prescription
prevents implantation once the embryo is formed.
DR. TOMSEN answered that she is not a physiologist and that is
not her area of expertise, but shared her understanding that the
position of ACOG is that none of the hormonal contraception
available, including emergency contraception, qualifies as
abortibations. She said that contraception makes implantation
more difficult, but also interrupts the quality of ovulation.
CO-CHAIR ZULKOSKY removed her objection to the motion to adopt
Amendment 1.
4:37:33 PM
REPRESENTATIVE KURKA objected.
4:37:35 PM
REPRESENTATIVE FIELDS stated that he looks to the will of
committee members as to whether the committee would like to
adopt Amendment 1 or if it would prefer that he withdraw it. He
said that he understands that there are some tradeoffs and is
interested in the opinions of committee members.
4:37:54 PM
The committee took an at-ease from 4:37 p.m. to 4:38 p.m.
4:38:14 PM
A roll call vote was taken. Representatives Spohnholz, Fields,
McCarty, Zulkosky, and Snyder voted in favor of Amendment 1 to
HB 58. Representatives Prax and Kurka voted against it.
Therefore, Amendment 1 was adopted by a vote of 5-2.
4:39:03 PM
REPRESENTATIVE KURKA moved to adopt Amendment 2 to HB 58,
labeled 32-LS0259\A.2, Marx, 4/17/21, which read as follows:
Page 3, line 5:
Delete "a religious"
Insert "an"
Page 3, line 7:
Delete "religious" in both places.
Page 3, lines 8 - 9:
Delete "and is an organization that meets the
criteria set out in 26 U.S.C. 6033(a)(3)(A)(i) or
(iii) (Internal Revenue Code of 1986), as amended"
Insert "on religious grounds"
REPRESENTATIVE FIELDS objected.
REPRESENTATIVE SPOHNHOLZ objected.
REPRESENTATIVE KURKA explained that proposed Amendment 2 spoke
to a perceived error in constitutional provisions. He shared
his understanding that the bill limits the religious exception
for non-profit organizations that identify as religious, and not
for religious people that are business owners. He cited Supreme
Court case Burwell v. Hobby Lobby Stores, Inc., and stated that
the court's ruling in favor of Hobby Lobby showed that the
"conscious rights of Americans" is not limited to non-profits,
but also includes individual business owners. He opined that HB
58 would violate Supreme Court precedent, and that proposed
Amendment 2 would protect the conscious rights of individuals.
4:40:13 PM
REPRESENTATIVE SPOHNHOLZ spoke to her objection by noting that
her understanding of the proposed amendment would essentially
"gut" the bill, which intends to expand the insurance coverage
for contraception. She expressed that expert testimony has
indicated that providing contraception reduces unintended
pregnancy, which, in Alaska and nationwide, makes up 50 percent
of all pregnancies. She continued by stating that it has been
shown that reducing unintended pregnancy reduces child abuse and
neglect, as well as the need for abortions. She said the
underlying bill should remain intact, and therefore she will
continue to oppose proposed Amendment 2.
REPRESENTATIVE FIELDS asked whether Director Lori Wing-Heier
could speak to the bill language, and whether it might cause
problems with respect to insurance exemptions to religious
organizations.
4:41:35 PM
LORI WING-HEIER, Director, Division of Insurance, Department of
Commerce, Community & Economic Development (DCCED), said that
Representative Kurka is not wrong to bring up Amendment 2. She
shared that DCCED did some research and found that the
administration of former U.S. President Donald Trump had a rule
that allowed employers to decide to not provide contraceptive
care. This was upheld in July of 2020 by the Supreme Court, she
said, which means that employers can decide to not provide
contraception in policy. The policies in Alaska today all write
for the Affordable Care Act (ACA) and do provide contraceptive
care. If an employer were to ask an insurance company to not
provide contraception within a policy, then the division working
with the insurer would be required to allow that. However, if
the employer did not bring this objection to providing
contraception to an insurer, the plan would automatically
include it.
REPRESENTATIVE FIELDS asked Ms. Wing-Heier, if HB 58 were to
pass and an employer were to approach the division [to remove
contraceptive care from the employer's insurance policy],
whether that would insure compliance with case law and the
previous administrative decision.
MS. WING-HEIER answered yes, the employer would have to ask the
division to allow for a plan without contraceptive care.
4:43:35 PM
REPRESENTATIVE MCCARTY asked Ms. Wing-Heier whether there is
"discrimination" in other policies in which a company or
provider can determine the items that are covered under a
policy.
MS. WING-HEIER answered that, under the ACA which a benchmark
that health plans must meet, there are 10 essential health
benefits. Mandates were then added to these health benefits by
the states, such as mammograms in the state of Alaska, she
explained. The benchmarks of the essential health benefits
allow for contraception, she said, but the issue is that
employers can now decide to not provide contraceptive care. She
reiterated that this is something the division has to allow,
even though the ACA has defined contraception as one of the 10
essential health benefits.
REPRESENTATIVE MCCARTY shared his understanding that, as a
health care professional, if a patient were to come in to his
place of work with a limited policy due to the patient's
employer's allowances, it would be important to clarify the
specifics of the plan because another patient could come in with
a plan that does not have the same restrictions. He said that
he experiences that type of discrimination with insurance
companies often in his practice. He asked for clarification on
whether his understanding is correct.
MS. WING-HEIER responded that she would not determine it as
discrimination, but there definitely would be a difference in
plans. She noted that these differences exist in plans now with
differing deductibles and co-pays. Whether the plan provides
for contraception would just be another element to check when
verifying insurance information, she said.
REPRESENTATIVE MCCARTY asked for clarification on whether this
would be out of the ordinary, as it seems to exist already based
on her comments.
MS. WING-HEIER answered yes.
4:45:57 PM
REPRESENTATIVE PRAX asked Ms. Wing-Heier whether the insurance
company would then have to offer a completely separate plan for
those who may object to contraceptive coverage, or whether that
would be dealt with on an individual level.
MS. WING-HEIER answered that it would be dependent on each
employer. For example, if one employer determined that it wants
to provide contraceptive care and another employer does not,
these two plans would be different.
REPRESENTATIVE PRAX asked for clarification on whether the plans
would necessarily be pre-approved by the division.
MS. WING-HEIER responded yes, the division will approve all
plans, including those that do not include contraceptive care.
She explained that determination is part of what the division
does on a regular basis, which involves determining whether
filings are compliant with state law and offer consumer
protections
4:47:19 PM
REPRESENTATIVE FIELDS commented that, if the committee were to
reject proposed Amendment 2, it seems to him that the division
already has an effective plan for complying with federal law,
and for that reason he said he doesn't see the need for the
amendment.
4:47:47 PM
REPRESENTATIVE KURKA asked Ms. Wing-Heir for clarification that,
currently, there isn't an option for an employer to "check a
box" to determine the inclusion of contraceptive care, but it
instead defaults to being included in a policy. He asked
whether an employer would have to request an exemption that is
not listed.
MS. WING-HEIER responded that there is no question on the
application that asks whether employers would like to cover
contraceptive care.
REPRESENTATIVE KURKA commented that he still sees the importance
in the proposed amendment. He shared his understanding that the
oath to uphold the constitution goes beyond the Supreme Court
decision. He said that he has been surprised to hear insistence
that whatever the Supreme Court says is law.
4:49:14 PM
A roll call vote was taken. Representatives McCarty, Prax, and
Kurka voted in favor of Amendment 2 to HB 58. Representatives
Spohnholz, Fields, Zulkosky, and Snyder voted against it.
Therefore, Amendment 2 failed to be adopted by a vote of 3-4.
4:49:58 PM
CO-CHAIR SNYDER moved to report HB 58, as amended, out of
committee with individual recommendations and the accompanying
fiscal notes.
REPRESENTATIVE KURKA objected.
4:50:38 PM
A roll call vote was taken. Representatives Fields, McCarty,
Prax, Spohnholz, Zulkosky, and Snyder voted in favor of moving
HB 58, as amended, out of committee with individual
recommendations and the accompanying fiscal notes.
Representative Kurka voted against it. Therefore, CSHB 58(HSS)
was reported out of the House Health and Social Services
Standing Committee by a vote of 6-1.
HB 153-CHILD IN NEED OF AID; NOTICE OF PLACEMENT
4:51:25 PM
CO-CHAIR ZULKOSKY announced that the final order of business
would be HOUSE BILL NO. 153, "An Act relating to the
identification, location, and notification of specified family
members of a child who is in state custody."
4:51:37 PM
REPRESENTATIVE MIKE CRONK, Alaska State Legislature, as prime
sponsor, presented HB 153. He explained that HB 153 came about
after discovering the extent of the delays in finding close
friends or relatives when placing children in the most
appropriate homes. He opined that using language, such as "the
department completes the search in the shortest time feasible"
[sourced from House Bill 151, passed during the Thirtieth Alaska
State Legislature], does not provide sufficient time to ensure
family searches are completed in a timely manner. He added that
turnover at the division continues to be above 50 percent, with
children's cases being handled by multiple case workers,
increasing the time frame for the family search to be
accomplished. He expressed his concern that any delay in the
search for placement of Alaska Native children in appropriate
family members' homes as close to the child's home in injurious
to the child as well as to the child's cultural connections.
REPRESENTATIVE CRONK expressed additional concern over the
[United States] Fifth Circuit Court of Appeals decision to
strike portions of the Indian Child Welfare Act's (ICWA's)
preference to indigenous family placements and how that may
impact Alaska. Any delay in the family or cultural placement,
he continued, could mean a return to the 85 percent non Native
household placement rate, which was the rate that was
experienced prior to the ICWA's implementation. He reiterated
that it is important for children to be placed in a home as
close to the child's family home as possible, and to be placed
with relatives or family friends, as this ensures that the life
of the child is not unnecessarily upended and provides the child
with the cultural grounding. He expressed that this has been
proven to be the best placement option for a child.
REPRESENTATIVE CRONK shared a personal anecdote from his time
working as a teacher where his family took in a child who he had
previously taught who was taken away from her family home. He
explained that there seemed to be nothing his family could do to
alleviate her sorrow as she was not with her family and her
brothers had been placed in different homes. He shared that
this was an impactful experience for him. He noted that HB 153
originally was spearheaded by former State of Alaska
Representative Dave Talerico. He concluded that putting a 30-
day time limit on the search to find a family placement is
vital.
4:54:33 PM
REPRESENTATIVE MCCARTY asked Representative Cronk whether the
language in the bill definitively states that a child must be
placed in an appropriate home within 30 days.
REPRESENTATIVE CRONK responded that he understands that Alaska
is a big state and that a child may or may not be placed within
30 days, but it is important that everything possible is done to
place a child in the most appropriate home as possible.
4:55:43 PM
CO-CHAIR SNYDER asked Representative Cronk about the description
of Section 3, of HB 153, found in the Sectional Analysis, as
follows [original punctuation provided]:
Sec. 3. This section allows the department to provide
for emergency placement of a child while conducting
due diligence.
CO-CHAIR SNYDER asked how the sectional analysis relates to the
language in Section 3, lines 6 - 11, of HB 153, which read as
follows [original punctuation provided]:
* Sec. 3. The uncodified law of the State of Alaska is
amended by adding a new section to read: TRANSITION:
REGULATIONS. The Department of Health and Social
Services may adopt regulations necessary to implement
the changes made by this Act. The regulations take
effect under AS 44.62 (Administrative Procedure Act),
but not before the effective date of the law
implemented by the regulation.
CO-CHAIR SNYDER asked how the language in Section 3 of HB 153
differs from current practice.
4:57:54 PM
CHRISSY VOGELEY, Community Relations Manager, Office of
Children's Services (OCS), Department of Health and Social
Services, stated that she is equally confused by the difference
in content between the description of Section 3 in the Sectional
Analysis and Section 3 of HB 153.
REPRESENTATIVE CRONK noted that he has had some questions
similar to this, but expressed that the goal of the proposed
legislation is for children to not get lost, noting the high
turnover at OCS as a potential cause of this, and for there to
be an individual who is responsible for searching for
appropriate families within 30 days.
4:49:20 PM
CO-CHAIR SNYDER asked Ms. Vogeley how what is proposed in HB 153
differs from or augments what is currently happening.
MS. VOGELEY answered that federal law requires OCS to conduct
diligent and regular relative searches within the first 30 days
to notify adult family members of the removal of a child from
the child's home. She stated that this is already happening.
She shared that OCS also continues searching past the initial
30-day timeframe, and per the federal relative placement
preferences, OCS expands the search to find as many relatives as
possible in an attempt to place a child with a relative.
5:00:43 PM
REPRESENTATIVE SPOHNHOLZ commented that, while she supports the
intent of the bill, there may be some "clean-up" required. She
noted that Section 2 references an effective date in the bill,
but that there is no effective date. The referenced section
[Section 2, lines 1 - 15] read as follows [original punctuation
provided]:
* Sec. 2. The uncodified law of the State of Alaska is
amended by adding a new section to read:
APPLICABILITY. Section 1 of this Act applies to a
child in the custody or under the supervision of the
Department of Health and Social Services under AS
47.10 on or after the effective date of sec. 1 of this
Act.
REPRESENTATIVE SPOHNHOLZ noted the aforementioned difference
between the description of Section 3 in the Sectional Analysis
and Section 3 of HB 153 as another aspect that needs to be
cleaned up, and suggested that Representative Cronk consider
drafting some amendments to give the bill more structure.
5:01:46 PM
REPRESENTATIVE KURKA shared his understanding that there is a
default effective date for every bill, and that it is not
necessary to state an effective date explicitly. He asked
Representative Spohnholz for clarification on what she is
looking for regarding the effective date.
REPRESENTATIVE SPOHNHOLZ responded, observing that the way
[Section 3 of] HB 153 is drafted in its current state references
an effective date in Section 1 of HB 153 but there is none
listed. She said that she presumed that this was a drafting
error.
[HB 153 was held over.]
5:03:52 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:04 p.m.