Legislature(2021 - 2022)DAVIS 106
04/22/2021 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB133 | |
| HB145 | |
| HB106 | |
| HB184 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 133 | TELECONFERENCED | |
| + | HB 106 | TELECONFERENCED | |
| *+ | HB 184 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 145 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 22, 2021
3:12 p.m.
MEMBERS PRESENT
Representative Liz Snyder, Co-Chair
Representative Tiffany Zulkosky, Co-Chair
Representative Ivy Spohnholz
Representative Zack Fields
Representative Ken McCarty
Representative Christopher Kurka
MEMBERS ABSENT
Representative Mike Prax
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."
- MOVED HB 133 OUT OF COMMITTEE
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."
- MOVED CSHB 145(HSS) OUT OF COMMITTEE
HOUSE BILL NO. 106
"An Act relating to missing persons under 21 years of age."
- HEARD & HELD
HOUSE BILL NO. 184
"An Act requiring state participation in a tribal child welfare
compact."
- 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
04/20/21 (H) Heard & Held
04/20/21 (H) MINUTE(HSS)
04/22/21 (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
04/20/21 (H) Heard & Held
04/20/21 (H) MINUTE(HSS)
04/22/21 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 106
SHORT TITLE: MISSING PERSONS UNDER 21 YEARS OLD
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
02/19/21 (H) READ THE FIRST TIME - REFERRALS
02/19/21 (H) STA, HSS
03/11/21 (H) STA AT 3:00 PM GRUENBERG 120
03/11/21 (H) Scheduled but Not Heard
03/16/21 (H) STA AT 3:00 PM GRUENBERG 120
03/16/21 (H) Heard & Held
03/16/21 (H) MINUTE(STA)
03/25/21 (H) STA AT 3:00 PM GRUENBERG 120
03/25/21 (H) -- MEETING CANCELED --
04/01/21 (H) STA AT 3:00 PM GRUENBERG 120
04/01/21 (H) Heard & Held
04/01/21 (H) MINUTE(STA)
04/08/21 (H) STA AT 3:00 PM GRUENBERG 120
04/08/21 (H) Moved HB 106 Out of Committee
04/08/21 (H) MINUTE(STA)
04/09/21 (H) STA RPT 5DP 2NR
04/09/21 (H) DP: CLAMAN, STORY, VANCE, TARR, KREISS-
TOMKINS
04/09/21 (H) NR: EASTMAN, KAUFMAN
04/22/21 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 184
SHORT TITLE: REQUIRE TRIBAL CHILD WELFARE COMPACT
SPONSOR(s): ZULKOSKY
04/21/21 (H) READ THE FIRST TIME - REFERRALS
04/21/21 (H) HSS, FIN
04/22/21 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
STUART SPIELMAN, Senior Vice President for Advocacy
Autism Speaks
Washington, DC
POSITION STATEMENT: Testified in support of HB 133.
PAMELA LEARY
Treasury Division
Department of Revenue (DOR)
Juneau, Alaska
POSITION STATEMENT: During the hearing of HB 133, answered
questions.
TOM WADSWORTH, PharmD, Administrative Director
University of Alaska/Idaho State University Doctor of Pharmacy
Program
Wasilla, Alaska
POSITION STATEMENT: During the hearing of HB 145, answered
questions.
JUSTIN RUFFRIDGE, PharmD
State Board of Pharmacy
Soldotna, Alaska
POSITION STATEMENT: During the hearing of HB 145, answered
questions.
KATHRYN MONFREDA, Director
Division of Statewide Services
Department of Public Safety
POSITION STATEMENT: Presented HB 106, sponsored by House Rules
by request of the governor, via a PowerPoint presentation,
entitled, "House Bill 106 Missing Persons Under 21 Years Old."
PAUL FUSSEY, Lieutenant
Alaska State Troopers
Department of Public Safety
POSITION STATEMENT: During the hearing of HB 106, answered
questions.
NICOLE BORROMEO, General Counsel and Executive Vice President
Alaska Federation of Natives
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 184.
MELANIE BAHNKE, President
Kawerak Organization
Nome, Alaska
POSITION STATEMENT: Testified in support of HB 184.
VIVIAN KORTHUIS, Chief Executive Officer
Association of Village Council Presidents
Bethel, Alaska
POSITION STATEMENT: Testified in support of HB 184.
ELIZABETH HENSLEY, General Counsel
Maniilaq Association
Anchorage, Alaska
POSITION STATEMENT: During the hearing of HB 184, answered
questions.
ACTION NARRATIVE
3:12:34 PM
CO-CHAIR TIFFANY ZULKOSKY called the House Health and Social
Services Standing Committee meeting to order at 3:12 p.m.
Representatives Fields, McCarty, Kurka, Zulkosky, and Snyder
were present at the call to order. Representative Spohnholz
arrived as the meeting was in progress.
HB 133-AK ED SAVINGS PROGRAMS/ELIGIBILITY
3:13:54 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."
REPRESENTATIVE FIELDS, as prime sponsor, offered to answer
questions on HB 133.
3:14:44 PM
STUART SPIELMAN, Senior Vice President for Advocacy, Autism
Speaks, testified in support of HB 133. He explained that
Autism Speaks is dedicated to promoting solutions across the
spectrum and throughout the lifespan for the needs of
individuals with autism spectrum disorder (ASD) and their
families. He highlighted that one of the needs of the community
is to provide for the expenses that are incurred as a result of
disability. He noted that Autism Speaks has supported the
Achieving a Better Life Experience (ABLE) Act and legislation
surrounding the ABLE Act, including the proposed legislation [HB
133]. He explained that individuals with autism often incur
extra expenses, and the ABLE Act allows for family members to
plan and provide for those expenses. He added that the ABLE Act
became law in 2014 and the first programs were established in
2017. He relayed that he has data that shows that, at the end
of 2020, there were 82,019 accounts with $643 million in assets
invested. He compared this to 2017 when there were no accounts.
He concluded that Autism Speaks supports HB 133 because it would
conform Alaska law to the changes in federal law.
3:17:08 PM
MR. SPIELMAN in response to Representative McCarty, noted that
the accounts and assets data was sourced from "ISS Market
Intelligence." In response to a follow-up question, he
clarified that the data relates to ABLE programs nationwide.
REPRESENTATIVE MCCARTY asked Mr. Spielman whether he has the
numbers for Alaska.
MR. SPIELMAN responded that he does not.
3:18:26 PM
PAMELA LEARY, Treasury Division, Department of Revenue (DOR),
responded to Representative McCarty's question, stating that
there are currently over 620 ABLE Accounts in Alaska which total
$5 million in assets.
3:19:06 PM
REPRESENTATIVE KURKA noted that it had been mentioned in a
previous hearing that a benefit of the proposed legislation is
that it would support individuals who require federal assistance
in becoming independent. He asked Representative Fields to
describe how the process would work and how it would facilitate
independence.
REPRESENTATIVE FIELDS responded with the example of his dad who
was a social worker, and some of his dad's clients would need a
lot of help, and some did not. He shared that some of his dad's
clients had jobs but didn't necessarily make enough money to
live independently. He explained that an ABLE account would
allow an individual able to live independently right now to save
up and invest in avenues such as education so that this
individual could become more independent in the future. It
would also ensure that, while working and saving up for
education, an individual wouldn't lose the critical support
necessary to get by. He agreed that a cap on provided public
assistance is necessary but opined that the caps are currently
so low that individuals can be disincentivized to save for
things like education.
REPRESENTATIVE KURKA offered his understanding that these
programs seem to be an "on or off switch," not a graduated
"weaning off." He said that it seemed to him like a
disincentive to being independent and to working within one's
capacity. He applauded the concept of allowing individuals to
find personal freedom and provide for themselves.
3:22:29 PM
REPRESENTATIVE SPOHNHOLZ commented that many benefits being
discussed are related to financial subsidies, but many others
are related to home and community-based waivers services that
are designed to pay for people who do the kind of work like
Representative Fields' dad did, or like she herself did early on
in her career. She shared that part of her work involved going
into the homes of people with disabilities who lived
independently in the community, most of whom had jobs, but due
to cognitive disabilities, these individuals were not able to
earn enough money to live financially independently and needed
people to help them do things like balance their checkbooks and
go grocery shopping. She shared that if these individuals'
income got too high, these services would no longer be available
to them, and these individuals would have to go live in an
assisted living facility or something similar. A facility like
this, she noted, costs the state much more money and allows for
less autonomy and dignity for the individuals.
3:24:31 PM
REPRESENTATIVE MCCARTY referred to page 2, section 6, lines 30-
31 of HB 133, which read:
(1) "department" means the Department of Health and
Social 31 Services [REVENUE];
REPRESENTATIVE MCCARTY asked Representative Fields the reason
for removing revenue if the bill deals with the management of
money.
REPRESENTATIVE FIELDS responded that he understands
Representative McCarty to be referring to a draft of the bill
that was originally considered in a House Labor and Commerce
Standing Committee, but that committee passed a committee
substitute [CSHB 133 (L&C)] to change it back to the
responsibility of the Department of Revenue (DOR). He explained
that individuals had different perspectives on the most logical
department to house the proposed legislation, and the committee
decided to leave it in DOR.
REPRESENTATIVE MCCARTY asked which draft is being considered.
REPRESENTATIVE ZULKOSKY offered clarification that the version
before members should be [CSHB 133 (L&C)].
REPRESENTATIVE FIELDS added that that was the one substantive
change that was made to the previous version of the bill
introduced during the Thirty-First Alaska State Legislature.
3:26:35 PM
CO-CHAIR SNYDER moved to report CSHB 133 (L&C) out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, CSHB 133(L&C) was reported
from the House Health and Social Services Standing Committee.
3:27:03 PM
The committee took an at-ease from 3:27 p.m. to 3:30 p.m.
HB 145-EXPAND PHARMACIST AUTHORITY
3:30:15 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."
3:30:56 PM
REPRESENTATIVE SPOHNHOLZ moved to adopt Amendment 1 to HB 145,
labeled 32-LS0720\A.1, Fisher, 4/19/21, which read as follows:
Page 5, following line 18:
Insert a new bill section to read:
"* Sec. 12. AS 21.42 is amended by adding a new
section to read:
Sec. 21.42.440. Coverage for costs of services
provided by pharmacists. A policy, contract, or
prepaid plan for individual or group health insurance
issued or delivered in the state that provides
coverage for services within the scope of practice of
a pharmacist licensed under AS 08.80 must provide for
coverage of and reimbursement for the services if
performed by a pharmacist for a person covered under
the policy, contract, or plan."
3:30:58 PM
CO-CHAIR ZULKOSKY objected for discussion purposes.
3:31:01 PM
REPRESENTATIVE SPOHNHOLZ explained that the purpose of Amendment
1 would be to require insurance to cover services that
pharmacists are trained to provide, but for which pharmacists
are not currently able to receive reimbursement. She said that
this would help provide health care in the community.
3:31:40 PM
CO-CHAIR SNYDER commented that the amendment would add language
to the bill that would further ensure that pharmacists could be
reimbursed for the services provided.
3:32:10 PM
CO-CHAIR ZULKOSKY removed her objection. There being no further
objection, Amendment 1 was adopted.
3:32:22 PM
REPRESENTATIVE MCCARTY moved to adopt Amendment 2 to HB 145,
labeled 32-LS0720\A.2, Fisher, 4/19/21, which read:
Page 4, following line 12:
Insert a new subsection to read:
"(c) This section does not authorize a
pharmacist to prescribe a prescription drug that the
pharmacist is not otherwise authorized to prescribe."
Reletter the following subsection accordingly.
3:32:27 PM
CO-CHAIR ZULKOSKY objected for discussion purposes.
3:32:31 PM
REPRESENTATIVE MCCARTY explained that Amendment 2 would insert a
new section that would recognize the authorization of a
pharmacist under the guidelines of the scope of practice for
pharmacy. It would ensure that pharmacists would not be able to
prescribe beyond the scope of practice, he added.
3:33:06 PM
REPRESENTATIVE KURKA shared his understanding that, when a
doctor prescribes a new medication, the doctor looks at all the
other medications the patient might be taking to ensure that the
medications will not react poorly with each other. He asked
whether prescribing pharmacists would have access to the same
information to ensure that there would be no negative reactions
with a patient's other medications.
CO-CHAIR SNYDER responded that Amendment 2 aims to further
narrow the scope of pharmacists, which may address
Representative Kurka's concern, and deferred the question to
invited testifiers.
3:34:31 PM
TOM WADSWORTH, PharmD, Administrative Director, University of
Alaska/Idaho State University Doctor of Pharmacy Program,
responded absolutely, and explained that pharmacists have a
patient care process that is similar to all patient care
processes. He said that it includes collaboration with
documentation, which includes collecting Electronic Medical
Records (EMR), paper records, referrals, laboratory studies,
past medical histories, and histories of the chief complaint of
the patient. He explained that pharmacists have access to all
this information, and if for some reason that information is
missing, pharmacists either order or ask for the information.
He opined that it would be unprofessional for a pharmacist to
proceed without proper access to that information.
MR. WADSWORTH referenced Section 8 of HB 145, which discusses
the collaborative authority of pharmacists, and said that the
collaborative practice agreements that pharmacists already have
with physicians involve drawing up specific protocols and
procedures in the patient care process that the pharmacist and
the collaborating provider will adhere to. He explained that
those protocols and procedures are reviewed by the Board of
Pharmacy and the Board of Medicine in Alaska before they can be
implemented. He said that these precautions prevent pharmacists
from going outside of their area of expertise or scope of
practice.
3:38:32 PM
JUSTIN RUFFRIDGE, PharmD, State Board of Pharmacy, added that
the information flow between pharmacists and providers goes both
directions. Pharmacists, he said, access medical histories of
patients to ascertain if there may be any medication conflicts
or other potential issues. He explained that many pharmacies
keep and use those records if a patient transfers to a different
prescriber or goes into the hospital. Pharmacists are involved
in reviewing patient charts with the intake nurse if a patient
were to enter a hospital or intake facility, he said.
3:40:04 PM
The committee took an at-ease from 3:40 p.m. to 3:41 p.m.
3:41:38 PM
CO-CHAIR ZULKOSKY removed her objection. There being no further
objection, Amendment 2 was adopted.
3:41:56 PM
CO-CHAIR SNYDER said she sees the need for legislation that
would ensure that the Board of Pharmacy can oversee pharmacists,
and that pharmacists can be reimbursed for the services
provided. She also emphasized the need for clarity to ensure
that pharmacists' scope of practice is not being expanded by the
proposed legislation. She said she would offer a conceptual
amendment to accomplish this.
3:43:58 PM
CO-CHAIR SNYDER moved to adopt Conceptual Amendment 3 to HB 144,
as follows [original punctuation provided]:
Page 4, Line 1:
Delete "for a disease or condition with an
existing diagnosis and for a condition that does not
require a new diagnosis."
Page 4, Line 5:
Delete "and
Insert "or"
Page 4, Line 6:
Delete "optimization of medication therapy for"
REPRESENTATIVE FIELDS objected for discussion purposes.
CO-CHAIR SNYDER explained her conceptual amendment would further
clarify that the bill would not interfere with the collaborative
practice authority (CPA) regulation and would remove language so
as not to imply an expansion of pharmacists' prescribing
authority.
3:45:30 PM
MR. WADSWORTH expressed his support for Conceptual Amendment 3.
He explained that, in working with the Alaska State Medical
Association, he realized the language that was chosen in the
bill sought to modify the CPA regulation that's been in place
since 2002. He said that the intent is not to modify or change
that process as it already works well in its current state. He
shared his understanding that other language in the bill seemed
to broaden independent prescriptive authority for pharmacists,
and Conceptual Amendment 3 would clarify the intent of the bill
and ensure that prescriptive authority would not be broadened.
3:47:02 PM
REPRESENTATIVE MCCARTY asked whether there would be a need for a
period after "services" in Section 8 of HB 145, on page 4, line
1, ["provide patient care services"], given that Conceptual
Amendment 3 proposes the deletion language on page 4, line 1,
[text provided previously].
CO-CHAIR ZULKOSKY responded that when a motion comes before the
committee, there will likely be a recommendation to make
technical and conforming changes as needed. She said those
changes would be made by Legislative Legal Services.
CO-CHAIR SNYDER commented that she would request that
Legislative Legal Services add a period as it is needed.
3:47:59 PM
REPRESENTATIVE KURKA asked for clarification of the changes
being made by the amendment, and whether it would widen the
scope of pharmacists.
CO-CHAIR SNYDER responded that the first part of Conceptual
Amendment 3, which proposes the deletion of language on page 4,
line 1, would make HB 145 consistent with the CPA. She
explained that it is not about widening or narrowing the scope
of pharmacists, but simply making it consistent with existing
CPA regulations. She added that the second component of the
conceptual amendment would further clarify that the scope of
services that pharmacists can provide is not being broadened.
3:49:43 PM
REPRESENTATIVE FIELDS removed his objection. There being no
further objection, Conceptual Amendment 3 was adopted.
3:49:55 PM
REPRESENTATIVE KURKA shared his understanding that the bills
main purpose is to expand the ability of pharmacists to help
consult patients and administer tests, particularly COVID-19
tests. He asked to what extent the scope of pharmacists would
be increased or not increased should HB 145 pass.
CO-CHAIR SNYDER answered that the intent is to provide
clarification on the range of practices that pharmacists are
already engaged in to ensure that "out of date" statutes reflect
the current state of practice. She mentioned testing,
vaccination, and administration of Naloxone as additional
details that needed to be captured. She explained that the
final intent of the bill is that pharmacists have already been
providing this type of care for an extended period of time, but
pharmacists were not able to be reimbursed by insurance due to a
lack of language [in statute].
3:52:12 PM
MR. RUFFRIDGE added that the Board of Pharmacy is attempting to
regulate the areas in which pharmacists are engaged, ensure that
pharmacists are seen as practicing within their scope, and
pharmacists are able to be reimbursed for their practices. He
emphasized that pharmacists both dispense medications and act as
a "middle manager" in health care. He said that pharmacists
rarely find themselves in entities such as hospitals where
insurances can be billed for the services that pharmacists
provide. He said the conceptual amendment wouldn't change the
ways in which pharmacists dispense medications but would remove
limitations to ensure that pharmacists are able to perform fully
as a "manager of care in the middle." He offered clarification
that pharmacists are providers of services, not just dispensers,
and said that the proposed legislation with the conceptual
amendment would allow for that.
3:54:42 PM
REPRESENTATIVE MCCARTY requested clarification on the potential
for pharmacists to offer treatment through the dispensing of
Buprenorphine.
MR. RUFFRIDGE responded that work needs to be done nationwide on
this issue. He noted that there are other requirements to be a
part of a medication-assisted treatment (MAT) program, one of
which is a federal change that would have to happen. He said
that pharmacists are already engaged in this in primary care
settings. As far as a wider offering [of the medication] that
Representative McCarty is suggesting, HB 145 is a step in that
direction, he said. He explained that the bill would well-
position the state to be available to implement those additional
types of therapies should the federal changes be made.
REPRESENTATIVE MCCARTY commented that he hopes the state stays
within the guidelines of the Substance Abuse and Mental Health
Services Administration (SAMHSA) and the MAT program.
3:57:51 PM
REPRESENTATIVE FIELDS moved to report HB 145, as amended, out of
committee with individual recommendations and the accompanying
fiscal notes. There being no objection, CSHB 145(HSS) was
reported from the House Health and Social Services Standing
Committee.
HB 106-MISSING PERSONS UNDER 21 YEARS OLD
4:01:11 PM
CO-CHAIR ZULKOSKY announced that the next order of business
would be HOUSE BILL NO. 106, "An Act relating to missing persons
under 21 years of age."
4:01:26 PM
KATHRYN MONFREDA, Director, Division of Statewide Services,
Department of Public Safety, presented HB 106, sponsored by
House Rules by request of the governor, via a PowerPoint
presentation, entitled, "House Bill 106 Missing Persons Under 21
Years Old." She explained that the bill would bring state law
into compliance with federal law as it relates to missing
persons aged 18 through 21. She began on page 2, "Federal
Reporting Requirements," which read as follows [original
punctuation provided]:
• Suzanne's Law: P. LAW 108-21, Title II, Section 204
• Requires law enforcement to enter records for
missing persons under the age of 21 into the National
Crime Information Center (NCIC) database (2003)
• Adam Walsh Act: P. LAW 109-248 Section 154
• Requires law enforcement to enter records for
missing persons under the age of 21 into the NCIC
database within two hours of being reported missing
(2006)
MS. MONFREDA continued to slide 3, "Current Statutory Language,"
which read as follows [original punctuation provided]:
• AS 18.65.620 requires reporting missing minors to
the state's Missing Persons Clearinghouse if not
located within 48-hours after first reported missing
• AS 47.10.141 requires reporting missing minors into
state and national databases no later than 24- hours
after completing the missing person report
• AS 47.10.390 defines 'runaway minor' as a person
under 18 years of age
MS. MONFREDA advanced to slide 4, "Summary of Statutory
Changes," which read as follows [original punctuation provided]:
• Changes required for AS 47.10.141 and AS 18.65.620
to comply with the two federal laws regarding
• Entry into state and national databases for missing
persons under age 21 instead of the state requirement
of age 18
• Entry of the records into state and national
databases within 2-hours instead of the state
requirement of 24-hours
4:04:53 PM
MS. MONFREDA proceeded to slide 5, "Current Procedures,"
which read as follows [original punctuation provided]:
• Statewide training for law enforcement is already in
place regarding the more restrictive federal
requirements
• Most state and local law enforcement agencies are
already complying with the more restrictive federal
requirements
• Programming for the state database, Alaska Public
Safety Information Network (APSIN), has already been
completed to allow law enforcement to enter reports to
comply with the more restrictive federal requirements
MS. MONFREDA addressed slide 6, "Benefits," which read as
follows [original punctuation provided]:
• Remove conflicting, less restrictive state statutory
requirements
• Faster state and nationwide notification of missing
person records for those under age 21
• The National Center for Missing and Exploited
Children monitors national databases and proactively
offers assistance
Improved response for the vulnerable, college-age
population of missing persons
MS. MONFREDA spoke to slide 7, "Sectional Analysis," which
read as follows [original punctuation provided]:
• Section 1: Includes conforming language related to
the duty of law enforcement agencies to reflect
changes made in section 2.
• Section 2: Adds a new subsection to AS 18.65.620,
requiring law enforcement agencies to transmit a
missing person's report for a person under the age of
21 to the Alaska Public Safety Information Network and
the National Crime Information Center as soon as
practicable, but not later than two hours after
completing the report. If the person is later found,
the agency shall remove that information from those
databases as soon as practicable, but not later than
24 hours after learning the person has been located.
• Section 3: Contains conforming language to AS
47.10.141, runaway and missing children, to the
changes made in section 2. All reporting procedures
for persons under the age of 21 are moved to AS 18.65,
as amended in section 2 of the bill.
4:07:07 PM
REPRESENTATIVE KURKA asked about the current process of
establishing that someone is a missing person, including how
persons of different ages are treated, and how long it would
take to consider a person to be missing.
MS. MONFREDA deferred the question to invited testifier Paul
Fussey.
4:07:59 PM
PAUL FUSSEY, Lieutenant, Alaska State Troopers (AST), Department
of Public Safety, responded to Representative Kurka's question.
He explained that if someone reports a missing person, there is
no time limit or time frame the reporter must abide by; a person
can be considered missing after any period of time.
REPRESENTATIVE KURKA asked at what point the officer taking the
information would take action and begin searching for a missing
person.
MR. FUSSEY replied that the officer would take action as soon as
the officer takes the report. The officer would immediately
start looking into the location of the missing person.
REPRESENTATIVE KURKA asked whether the process would be any
different if the missing person were a minor or an adult.
MR. FUSSEY responded that age is not a differentiating factor.
4:09:25 PM
REPRESENTATIVE SPOHNHOLZ asked about the proposed removal of
reference to AS 47.10.141, which she said refers to runaways and
missing minors. She asked him for a description of the thought
process behind that decision.
MS. MONFREDA responded that it would be removed from AS 47.10
because it would be covered under AS 18.65, which she said would
prevent conflicting information.
REPRESENTATIVE SPOHNHOLZ asked for clarification that the
reasoning behind the decision is to ensure that the two sections
of law would not be conflicting.
MS. MONFREDA replied that AS 47.10.141 requires that missing
minors be reported to state and national databases within 24
hours of the missing person report being completed. She said
that AS. 18.65 would now contain that information and cover the
current reporting of missing persons, consolidating it into one
statute, and change the time frame to two hours.
REPRESENTATIVE SPOHNHOLZ asked for clarification that
AS.47.10.141 is being copied over to AS 18.65. She noted that
AS 47.10.141 is several pages long. She said she wonders what
else might be missing.
MS. MONFREDA responded that the only thing that is being removed
is the reference to the 24-hour reporting period, but everything
else would stay the same.
4:12:10 PM
The committee took an at-ease from 4:12 p.m. to 4:14 p.m.
4:14:06 PM
REPRESENTATIVE MCCARTY asked Ms. Monfreda about the reasoning
behind the omission of AS 47.10.141, and whether that content is
necessary.
MS. MONFREDA answered that the only thing that would be changed
is [subsection] (a) [of AS 47.10.141]; the other paragraphs
would remain the same. It would remove that reference to the
24-hour time frame for searching for a missing person, and the
reporting to the Alaska Public Safety Information number. That
information would simply be moved from AS 47.10 to AS 18.65.
REPRESENTATIVE MCCARTY asked for confirmation that the language
in AS. 47.10 would not be removed. He shared his understanding
that the time frame of reporting remains necessary but is not
necessary in resolving the issue in HB 106.
MS. MONFREDA confirmed that that is correct.
REPRESENTATIVE MCCARTY asked, regarding the National Database,
whether there would be a need for computer systems to allow law
enforcement to access the database.
MS. MONFREDA responded that law enforcement agencies already
have the capabilities to access the systems and make the
necessary entries.
4:17:29 PM
REPRESENTATIVE KURKA asked whether there's an estimate for the
percentage of cases in Alaska that already comply with the
federal guideline.
MS. MONFREDA answered that she does not have that information
because it is not tracked or audited by her department. She
said that the agencies would need to develop tracking mechanisms
to show that cases are being entered in a timely manner in
compliance with the law.
4:18:38 PM
CO-CHAIR ZULKOSKY opened public testimony on HB 106. After
ascertaining that there was no one who wished to testify, she
closed public testimony.
CO-CHAIR ZULKOSKY announced that HB 106 was held over.
HB 184-REQUIRE TRIBAL CHILD WELFARE COMPACT
4:19:01 PM
CO-CHAIR ZULKOSKY announced that the final order of business
would be HOUSE BILL NO. 184, "An Act requiring state
participation in a tribal child welfare compact."
4:19:22 PM
The committee took an at-ease from 4:19 p.m. to 4:20 p.m.
4:20:54 PM
CO-CHAIR ZULKOSKY presented HB 184, as prime sponsor, via a
PowerPoint presentation entitled, "HB184 Tribal Child Welfare
Compact," [hard copy included in the committee packet]. She
explained that the bill seeks to protect implementation of the
"historic and landmark" Tribal Child Welfare Compact (TCWC) by
codifying it in Alaska statute. She said that the TCWC is an
agreement between tribes and the state that seeks to help
address deep, structural inequities in the way that Alaska
children are cared for across the state. She began on slide 2,
"Why the work began," which read as follows [original
punctuation provided]:
Significant Disparities
• Alaska Native Children make up 15% of the state's
general population but represent 60% of the
children in state custody
• Disparities of this nature indicate a system
failure in our child welfare system
OCS Retention Difficulties
• Office of Children's Services (OCS) typically
operates at a 50% vacancy rate and require
frontline workers to carry caseloads more than 3x
the national average
• The goal of HB 151 (2018) was to lower turnover
and vacancy rates, but despite increased funding,
turnover rates have not decreased
CO-CHAIR ZULKOSKY continued on slide 3, "How the work began,"
which read as follows [original punctuation provided]:
Tribal State Collaboration Group
• A 25-year partnership between state, tribal
representatives, and invited stakeholders
• Goals:
• Strengthen Alaska's compliance with the Indian Child
Welfare Act (ICWA) of 1978.
• ICWA is a Federal law that established standards for
the removal and placement of American Indian children
and enabled Tribes and families to be involved in
child welfare cases.
• Reduce the disproportionality of Alaska Native
children in state custody
• Build & strengthen working relationships
Tribal Title IV-E Agreements
• Provides Federal funding to states and tribes for
foster care, transitional independent living programs,
guardianship assistance, and adoption assistance
• Tribes also receive a higher reimbursement rate than
states for covered services, resulting in significant
General Fund savings.
CO-CHAIR ZULKOSKY proceeded to slide 4, "What is Alaska's
Child Welfare Compact?" The slide read as follows
[original punctuation provided]:
• The Alaska Tribal Welfare Compact (Compact) is a
government-to-government agreement to improve the life
outcomes for Alaska's children and families by
transferring specific, negotiated child welfare
services and supports (including revenue streams) from
the Office of Children's Services (OCS) to the Tribal
Co-Signers
• The Compact was signed in 2017 by Governor Walker and
18 Tribal Co-Signers; representing 161 Federally-
recognized Tribes and Tribal Organizations and
continued under Governor Dunleavy in 2019
CO-CHAIR ZULKOSKY addressed slide 5, "Implementation
Timeline," which read as follows [original punctuation
provided]:
FY2018
• Tribal Co-Signers developed their programs, built
capacity and infrastructure
• OCS began sharing Protective Services Reports (PSRs or
'screen ins' or 'screen outs'), and provided training
and technical support
FY2019
• Tribal Co-Signers began performing Initial Diligent
Relative Searches
• The Parties negotiated four new Scopes of Work for
Ongoing Relatives Searches, Family Contact, Licensing
Assists, and Safety Evaluations
• However, the State declined to sign due to a change in
Administration
4:24:19 PM
CO-CHAIR ZULKOSKY spoke to slide 6, "Implementation
Timeline," which read as follows [original punctuation
provided]:
FY2020
• Parties worked out differences and signed all five
previously-negotiated Scopes:
• Initial Diligent Relative Searches (IDRS)
• Ongoing Relative Searches (ORS)
• Family Contact
• Licensing Assists
• Safety Evaluations
FY2021
• Negotiations will take place in May 2021
CO-CHAIR ZULKOSKY advanced to slide 7, "Advantages," which
read as follows [original punctuation provided]:
• Provides higher quality services, closer to home, at a
lower cost through leveraging Tribal resources
• Strengthens state services by engaging Tribes, often
the most local government, on an issue of shared
interest
• Increased public trust through existing family
relationships with Tribes
CO-CHAIR ZULKOSKY proceeded to slide 8, "Adverse Childhood
Experiences (ACES)," which read as follows [original
punctuation provided]:
Adverse Childhood Experiences (ACEs) have a tremendous
impact on future violence victimization and
perpetration, and lifelong health outcomes.
ACEs are potentially traumatic events that occur in
childhood (0-17 years):
• Experiencing violence, abuse, or neglect
• Witnessing violence in the home or community
• Having a family member attempt or die by suicide
• Growing up in a household with substance abuse, mental
health problems, instability due to parental
separation or household members in prison
ACEs are linked to:
• Chronic health problems
• Mental illness
• Substance abuse problems in adulthood
Increased incarceration rates ACEs can negatively
effect:
• Education
• Job opportunities
• Earning potential
4:26:08 PM
CO-CHAIR ZULKOSKY discussed slide 9, "Adverse Childhood
Experiences (ACES)," which read as follows [original punctuation
provided]:
Adverse Childhood Experiences (ACEs) have a tremendous
impact on future violence victimization and
perpetration, and lifelong health outcomes.
How big is the problem?
• ACEs are common. 61% of adults surveyed across 25
states reported that they had experienced at least one
type of ACE, and nearly 1 in 6 reported they had
experienced four or more types of ACEs.
• Preventing ACEs could potentially reduce a large
number of health conditions. For example, up to 1.9
million cases of heart disease and 21 million cases of
depression could have been potentially avoided by
preventing ACEs.
• Women and several racial/ethnic minority groups are at
greater risk for having experienced 4 or more types of
ACEs.
• ACEs are costly. The economic and social costs to
families, communities, and society totals hundreds of
billions of dollars each year.
CO-CHAIR ZULKOSKY continued on slide 10, "Sectional Analysis,"
which read as follows [original punctuation provided]:
Section 1: Amends AS 47.05 to add a new section to
article 1 requiring the State to participate in a
Tribal Child Welfare Compact.
4:29:16 PM
NICOLE BORROMEO, General Counsel and Executive Vice President,
Alaska Federation of Natives, testified in support of HB 184.
She stated that the bill is necessary to cement the compact in
law and make it no longer at the will of the administration.
She said the bill would allow for opportunity to improve the
child welfare system.
4:30:36 PM
MELANIE BAHNKE, President, Kawerak Organization, testified in
support of HB 184. She shared that Kawerak is a regional tribal
consortium in the Bering Strait region of Alaska and has been
providing services for over 40 years, including operating a
child advocacy center. She expressed that more local control
results in better outcomes, whether it's the health care system,
the Bureau of Indian Affairs (BIA) programs, or child welfare
programs. She echoed Ms. Borromeo's statement that it is
important to codify the compact in statute to protect it from
being "wiped away" with an incoming administration. She said
that significant resources are being invested as part of the
negotiation process, and all participating Kawerak staff are
being compensated through Kawerak funds. She added that Kawerak
is willing and capable of taking on this work and would
appreciate the assurance that the state will not write off the
compacting process, but instead codify it into law.
4:33:29 PM
VIVIAN KORTHUIS, Chief Executive Officer, Association of Village
Council Presidents (AVCP), testified in support of HB 184. She
explained that the (AVPC) represents 66 federally recognized
tribes on the Yukon-Kuskokwim Delta. She said that the top
three priorities of AVCP are public safety, economic
development, and community wellness. She stated that healthy
children and families are paramount to achieve community
wellness. She said that the TCWC presents an opportunity for
tribes and the government to work together. She added that the
experience and knowledge of the tribes make the tribes an
excellent resource in delivering child welfare services,
especially in rural Alaska. She noted that tribes have decades
of experience in working with the federal government in avenues
such as healthcare.
MS. KORTHUIS specified that there are approximately 500 tribal
children from the AVCP region in OCS custody, and these children
all rely on the tribes to make appropriate decisions that will
impact the lives of the children. She said she has over 15
years of experience working in tribal compacting, and is aware
that implementing a compact takes time, effort, funding, and
commitment. She shared an example of a child being removed by
OCS in November 2020 from the child's parents in Anchorage. She
said that AVPC was contacted to help place the child with a
relative and was able to successfully find an appropriate
relative in the village, which was possible only because of the
compact. She reiterated AVCP's support for codifying the
compact in law through HB 184.
4:39:59 PM
REPRESENTATIVE FIELDS asked Co-Chair Zulkosky whether Alaska is
the leading state in child welfare compacts.
CO-CHAIR ZULKOSKY responded yes and offered her understanding
that the proposed compact is the first of its kind.
REPRESENTATIVE FIELDS shared his understanding that it would
also be the first statutory requirement for a child welfare
compact. Noting that it would be the first statute of its kind,
he asked about the thought process behind the language of the
bill, what "participate" means in a legal sense, and what the
nature of a compact would be.
CO-CHAIR ZULKOSKY responded that the intention behind the
construct of the legislation as it is written is to give the
most latitude to the governor and the state in its negotiations,
as well as the tribes. It intends to not be "too prescriptive"
and ensure that there is flexibility.
4:43:17 PM
ELIZABETH HENSLEY, General Counsel, Maniilaq Association, in
response to Representative Fields' question, stated that the
term "participate" intends to indicate inclusion without being
too prescriptive. She explained that it intends to avoid
mandating the compact to look a particular way, and it intends
to allow for a unique agreement that affirms that there are two
governments, each with its own sovereign nature, coming together
into the agreement. She said the risk is that the state could
treat the tribes not as the unique entities that the tribes are,
but as "any old third party."
REPRESENTATIVE FIELDS asked Ms. Hensley whether she thinks that
the scope of a child welfare compact can change over time within
the parameters of the language.
MS. HENSLEY answered that the type of compact at hand is a child
welfare compact, and the Indian Child Welfare Act (ICWA), a
federal law, speaks to that. She explained that ICWA authorizes
states and tribes to enter into an agreement with respect to
child welfare, which connects it to federal law. She stated it
would be desirable for the compact to be able to evolve over
time to be most tailored to the needs of Alaska's children.
This is why there's an annual negotiation cycle in the compact,
she said, and the next negotiation is set to happen in May 2021.
CO-CHAIR ZULKOSKY recalled Ms. Korthuis mentioning in her
testimony that the tribal health compact has evolved over the
past 25 years. She said the health care community has made
great strides during those 25 years. She explained that the
brevity of the language is to ensure that those types of strides
and accomplishments can be achieved, while protecting the
compact in statute.
4:48:22 PM
REPRESENTATIVE KURKA said the timing of the bill seems awkward.
He opined that the agreement should be finalized before passing
the law to require conformance with it. He noted that Co-Chair
Zulkosky mentioned in her presentation that the negotiations
would be taking place in May.
CO-CHAIR ZULKOSKY responded that the compact is already in place
and ongoing; it was signed in 2017 and agreements have happened
both on the state and tribal sides. Annual negotiations to
update the agreements are in place to have any ongoing
discussions.
REPRESENTATIVE KURKA asked whether this would mean requiring the
state to comply with the parts of the compact that have been
negotiated and agreed upon, and not the new parts.
CO-CHAIR ZULKOSKY answered that the intention of the broadness
of the language is to protect the child welfare compact in
statute. It would require that the state and the tribes
participate in the compact, she said. The details related to
the different scopes of work are not included, and the ongoing
particulars about what has previously been negotiated is not
included intentionally because, as was mentioned in testimony,
those are updated from year to year. She explained that these
items might be negotiated upon again and there may be tribes
that opt to participate and others that may take on more scopes
of work. The bill, she said, would require that the compact
remain in place.
4:52:04 PM
REPRESENTATIVE SPOHNHOLZ offered her understanding that the
compact has already been signed, and that it is a policy
approach that has carried over from administration to
administration. What is being proposed in the bill, she said,
is to codify what it is that has already been happening without
being too prescriptive, telling Governor Dunleavy what he must
compact for, or telling tribes what they must compact for. It
instead would simply mandate participation in the compact. She
asked Co-Chair Zulkosky if she's correct in her understanding.
CO-CHAIR ZULKOSKY responded yes, and that it's not only to avoid
being over prescription, but it has been a compact agreement and
working relationship that has spanned multiple administrations.
She said that the intention of keeping it broad is to make sure
there is latitude for incoming administrations while protecting
the work that's been done to date.
REPRESENTATIVE SPOHNHOLZ stated that the language of the bill is
elegant and would allow the compact to grow, particularly
regarding health care compacting.
4:54:09 PM
REPRESENTATIVE MCCARTY requested a review of "the contract
arrangements."
CO-CHAIR ZULKOSKY asked Ms. Hensley to review the difference
between contracting and compacting, and what agreements are in
place for compacting.
4:55:14 PM
MS. HENSLEY stated that the compact is available on the
Department of Health and Social Services website. She said it
was a momentous occasion when the 18 cosigners and the state
signed the compact. The compact is a government-to-government
agreement and leaves it up to the discretion of the tribal
organization to dictate the process that is most appropriate for
that tribal organization. She stated that the compact ensures
that services be provided in a culturally appropriate manner,
and in a way that will help the child feel loved and rooted in
who they are as an Alaska Native person, as well as help the
child grow into a healthy adult and contributing member of
society. She explained that a contract dictates the scope of
work. Compacts allow for the tribes to draw on their 10,000
years of history and allow the tribes to use that expertise to
provide the service to the kids. This is the reasoning behind
choosing a compact over a contract, she added.
MS. BORROMEO noted that the compact was jointly drafted in
partnership with the Attorney General's office, not a draft
agreement crafted exclusively by tribal attorneys and presented
to the state. She added that the state will never have the
access of the tribe and the tribes will never have the resources
had by the state. She emphasized that to make the compact
stronger it needs to be codified in statute.
[HB 184 was held over.]
5:03:10 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:03 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| 10 CSHB 133 Fiscal Note UA-SYSBRA 3.13.21.pdf |
HHSS 4/22/2021 3:00:00 PM |
HB 133 |
| 1 CSHB 133 ver I Sponsor Statement 4.8.2021.pdf |
HHSS 4/22/2021 3:00:00 PM |
HB 133 |
| HB 133 Sponsor Presentation 3.30.21.pdf |
HHSS 4/22/2021 3:00:00 PM |
HB 133 |
| 2 CSHB0133 ver I.PDF |
HHSS 4/22/2021 3:00:00 PM |
HB 133 |
| 3 CSHB 133 Summary of Changes ver B to ver I 4.8.2021.pdf |
HHSS 4/22/2021 3:00:00 PM |
HB 133 |
| 4 Sectional Analysis CSHB 133 ver I 4.8.2021.pdf |
HHSS 4/22/2021 3:00:00 PM |
HB 133 |
| 5 HB0133 ver B.PDF |
HHSS 4/22/2021 3:00:00 PM |
HB 133 |
| 6 CSHB 133 Supporting Document - IRS ABLE Accounts Info 3.18.21.pdf |
HHSS 4/22/2021 3:00:00 PM |
HB 133 |
| 7 CSHB 133 Supporting Document - 10 Things You Should Know About ABLE 3.18.21.pdf |
HHSS 4/22/2021 3:00:00 PM |
HB 133 |
| 8 CSHB 133 Supporting Document - UA Press Release 3.18.21.pdf |
HHSS 4/22/2021 3:00:00 PM |
HB 133 |
| 9 CSHB 133 Fiscal Note DHSS, 3.18.21.pdf |
HHSS 4/22/2021 3:00:00 PM |
HB 133 |
| HB 145 DCCED Letter 4.14.21.pdf |
HHSS 4/22/2021 3:00:00 PM |
HB 145 |
| HB 145 Fiscal Note - DCCED, 4.09.21.pdf |
HHSS 4/22/2021 3:00:00 PM |
HB 145 |
| HB0145A.PDF |
HHSS 4/22/2021 3:00:00 PM |
HB 145 |
| HB 145, AK Pharmacists Assn. Fact Sheet.pdf |
HHSS 4/22/2021 3:00:00 PM |
HB 145 |
| HB 145, AK Pharmacists Assn. Talking Points.pdf |
HHSS 4/22/2021 3:00:00 PM |
HB 145 |
| HB 145, Sectional Analysis, Ver. A.pdf |
HHSS 4/22/2021 3:00:00 PM |
HB 145 |
| HB 145 LOS since 4.16.21.pdf |
HHSS 4/22/2021 3:00:00 PM |
HB 145 |
| HB 145, Sponsor Statement, Ver. A.pdf |
HHSS 4/22/2021 3:00:00 PM |
HB 145 |
| HB 106 Sectional Analysis 04.12.2021.pdf |
HHSS 4/22/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM |
HB 106 |
| HB 106 Sponsor Statement 04.12.2021.pdf |
HHSS 4/22/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM |
HB 106 |
| HB0106A.PDF |
HHSS 4/22/2021 3:00:00 PM |
HB 106 |
| HB 106 Additional Statistics 04.12.2021.pdf |
HHSS 4/22/2021 3:00:00 PM |
HB 106 |
| HB 106 DPS Fiscal Note 04.12.2021.pdf |
HHSS 4/22/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM |
HB 106 |
| HB 106 HSS Fiscal Note 04.12.2021.pdf |
HHSS 4/22/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM |
HB 106 |
| HB0184A.PDF |
HHSS 4/22/2021 3:00:00 PM HTRB 5/4/2021 8:00:00 AM |
HB 184 |
| HB 184 Sectional Analysis version A.pdf |
HHSS 4/22/2021 3:00:00 PM HTRB 5/4/2021 8:00:00 AM SHSS 3/31/2022 1:30:00 PM |
HB 184 |
| HB 184 Sponsor Statement version A.pdf |
HHSS 4/22/2021 3:00:00 PM HTRB 5/4/2021 8:00:00 AM SHSS 3/31/2022 1:30:00 PM |
HB 184 |
| HB 145 Amendments.pdf |
HHSS 4/22/2021 3:00:00 PM |
HB 145 |
| HHSS HB 106 DPS Presentation 04.22.2021.pdf |
HHSS 4/22/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM |
HB 106 |
| FHP Letter of Support for HB 145_4.20.2121.pdf |
HHSS 4/22/2021 3:00:00 PM |
HB 145 |
| HB 184 Powerpoint 4-22-21.pdf |
HHSS 4/22/2021 3:00:00 PM HTRB 5/4/2021 8:00:00 AM |
HB 184 |
| HB 184 Powerpoint 4-22-21.pptx |
HHSS 4/22/2021 3:00:00 PM |
HB 184 |