Legislature(2021 - 2022)DAVIS 106
05/03/2022 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB98 | |
| SB132 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 98 | TELECONFERENCED | |
| += | SB 132 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
May 3, 2022
3:09 p.m.
MEMBERS PRESENT
Representative Tiffany Zulkosky, Co-Chair
Representative Ivy Spohnholz
Representative Zack Fields
Representative Ken McCarty
Representative Mike Prax
MEMBERS ABSENT
Representative Liz Snyder, Co-Chair
Representative Christopher Kurka
COMMITTEE CALENDAR
CS FOR SENATE BILL NO. 98(FIN)
"An Act relating to adult adoption; relating to medical
assistance for recipients of adult home care services;
establishing an adult home care home license and procedures;
providing for the transition of individuals from foster care to
adult home care settings; and providing for an effective date."
- HEARD & HELD
SENATE BILL NO. 132
"An Act exempting veterinarians from the requirements of the
controlled substance prescription database."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 98
SHORT TITLE: ADULT HOME CARE; ADULT ADOPTION
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
03/03/21 (S) READ THE FIRST TIME - REFERRALS
03/03/21 (S) HSS, FIN
03/18/21 (S) HSS AT 1:30 PM BUTROVICH 205
03/18/21 (S) Heard & Held
03/18/21 (S) MINUTE(HSS)
03/30/21 (S) HSS AT 1:30 PM BUTROVICH 205
03/30/21 (S) Moved SB 98 Out of Committee
03/30/21 (S) MINUTE(HSS)
03/31/21 (S) HSS RPT 4DP 1NR
03/31/21 (S) DP: WILSON, BEGICH, COSTELLO, HUGHES
03/31/21 (S) NR: REINBOLD
04/07/21 (S) FIN AT 9:00 AM SENATE FINANCE 532
04/07/21 (S) Heard & Held
04/07/21 (S) MINUTE(FIN)
03/31/22 (S) FIN AT 9:00 AM SENATE FINANCE 532
03/31/22 (S) <Bill Hearing Canceled>
04/05/22 (S) FIN AT 9:00 AM SENATE FINANCE 532
04/05/22 (S) Heard & Held
04/05/22 (S) MINUTE(FIN)
04/12/22 (S) FIN AT 1:00 PM SENATE FINANCE 532
04/12/22 (S) Moved CSSB 98(FIN) Out of Committee
04/12/22 (S) MINUTE(FIN)
04/15/22 (S) FIN RPT CS 4DP NEW TITLE
04/15/22 (S) DP: STEDMAN, BISHOP, HOFFMAN,
WIELECHOWSKI
04/27/22 (S) TRANSMITTED TO (H)
04/27/22 (S) VERSION: CSSB 98(FIN)
04/29/22 (H) READ THE FIRST TIME - REFERRALS
04/29/22 (H) HSS, FIN
05/03/22 (H) HSS AT 3:00 PM DAVIS 106
BILL: SB 132
SHORT TITLE: CONTROLLED SUB. DATA: EXEMPT VETERINARIAN
SPONSOR(s): HOLLAND
04/28/21 (S) READ THE FIRST TIME - REFERRALS
04/28/21 (S) HSS, L&C
02/03/22 (S) HSS AT 1:30 PM BUTROVICH 205
02/03/22 (S) Heard & Held
02/03/22 (S) MINUTE(HSS)
02/08/22 (S) HSS AT 1:30 PM BUTROVICH 205
02/08/22 (S) Moved SB 132 Out of Committee
02/08/22 (S) MINUTE(HSS)
02/09/22 (S) HSS RPT 4DP
02/09/22 (S) DP: WILSON, REINBOLD, BEGICH, HUGHES
02/23/22 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
02/23/22 (S) Heard & Held
02/23/22 (S) MINUTE(L&C)
03/02/22 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
03/02/22 (S) Moved SB 132 Out of Committee
03/02/22 (S) MINUTE(L&C)
03/04/22 (S) L&C RPT 2NR 1DP
03/04/22 (S) NR: COSTELLO, REVAK
03/04/22 (S) DP: GRAY-JACKSON
03/04/22 (S) FIN REFERRAL ADDED AFTER L&C
03/17/22 (S) FIN AT 9:00 AM SENATE FINANCE 532
03/17/22 (S) Heard & Held
03/17/22 (S) MINUTE(FIN)
03/22/22 (S) FIN AT 9:00 AM SENATE FINANCE 532
03/22/22 (S) Moved SB 132 Out of Committee
03/22/22 (S) MINUTE(FIN)
03/23/22 (S) FIN RPT 7DP
03/23/22 (S) DP: STEDMAN, BISHOP, HOFFMAN, WILSON,
WIELECHOWSKI, OLSON, VON IMHOF
03/28/22 (S) TRANSMITTED TO (H)
03/28/22 (S) VERSION: SB 132
04/04/22 (H) READ THE FIRST TIME - REFERRALS
04/04/22 (H) HSS, L&C
04/14/22 (H) HSS AT 3:00 PM DAVIS 106
04/14/22 (H) Scheduled but Not Heard
04/19/22 (H) HSS AT 3:00 PM DAVIS 106
04/19/22 (H) -- MEETING CANCELED --
04/26/22 (H) HSS AT 3:00 PM DAVIS 106
04/26/22 (H) Heard & Held
04/26/22 (H) MINUTE(HSS)
04/28/22 (H) HSS AT 3:00 PM DAVIS 106
04/28/22 (H) Heard & Held
04/28/22 (H) MINUTE(HSS)
05/03/22 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
JOHN LEE, Director
Division of Senior and Disabilities Services
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Explained the changes in CSSB 98(FIN), on
behalf of the bill sponsor, Senate Rules by request of the
governor and answered questions.
TONY NEWMAN, Deputy Director
Division of Senior and Disability Services
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Gave the sectional analysis for CSSB
98(FIN), on behalf of the bill sponsor, Senate rules by request
of the governor and answered questions.
CRAIG BAXTER, Program Manager
Residential Life
Division of Health Care Services
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Responded to questions during the hearing
on CSSB 98(FIN).
STEPHANIE WHEELER, Long Term Care Ombudsman
Department of Revenue
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 98.
MICHELE GIRAULT, Executive Director
Hope Community Resources
Anchorage, Alaska
POSITION STATEMENT: Testified in favor of the concept of SB 98.
LIZETTE STIEHR, Executive Director
Alaska Association on Developmental Disabilities
Chugiak, Alaska
POSITION STATEMENT: Testified during the hearing on SB 98.
JIM DELKER, DVM, Legislative Liaison
Alaska Veterinary Medical Association
Soldotna, Alaska
POSITION STATEMENT: Gave invited testimony during the hearing
on SB 132.
TRACY WARD, DVM, President
Alaska Veterinary Medical Association
Juneau, Alaska
POSITION STATEMENT: Gave invited testimony during the hearing
on SB 132.
LAURA CARRILLO, MPH, Executive Administrator
Alaska Board of Pharmacy
Prescription and Drug Monitoring Program
Division of Corporations, Business and Professional Licensing
Department of Commerce, Community & Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on SB
132.
MCKAYLA DICK, DVM, Past President
Alaska Veterinary Medical Association
North Pole, Alaska
POSITION STATEMENT: Answered questions during the hearing on SB
132.
HAL GEIGER, PhD, Member
Board of Veterinary Examiners
Juneau, Alaska
POSITION STATEMENT: Provided information during the hearing on
SB 132.
SARA CHAMBERS, Director
Division of Corporations, Business and Professional Licensing
Department of Commerce, Community and Economic Development
Juneau, Alaska
POSITION STATEMENT: Provided information during the hearing on
SB 132.
NICHOLAS PAPACOSTAS, MD, FACEP
Alaska Chapter American College of Emergency Physicians
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the hearing on SB
132.
ACTION NARRATIVE
3:09:12 PM
CO-CHAIR ZULKOSKY called the House Health and Social Services
Standing Committee meeting to order at 3:09 p.m.
Representatives Spohnholz, Fields, McCarty, and Zulkosky were
present at the call to order. Representative Prax arrived as
the meeting was in progress.
SB 98-ADULT HOME CARE; ADULT ADOPTION
3:10:32 PM
CO-CHAIR ZULKOSKY announced that the first order of business
would be SENATE BILL NO. 98, "An Act relating to medical
assistance for recipients of adult foster care services;
establishing an adult foster care home license and procedures;
and providing for the transition of individuals from foster care
to adult foster care homes." [Before the committee was CSSB
98(FIN), reported out of the Senate Finance Committee on April
12, 2022.]
3:11:09 PM
JOHN LEE, Director, Division of Senior and Disabilities
Services, Department of Health and Social Services (DHSS), on
behalf of the bill sponsor, Senate Rules by request of the
governor, explained the changes to CSSB 98(FIN) made by the
Senate Finance Committee. He stated that the bill was amended
to widen its reach and strengthen the home- and community-based
support for Alaska's vulnerable populations. He said that the
changes were inspired by one central idea - whether adult foster
care services could be extended to more people than just those
aging out of the foster care system. When this question was
asked to stakeholders, he reported, the response was "an
enthusiastic 'yes.'" He explained that the change would mean
more opportunities for community-based care, create options less
expensive than group homes, have less demanding staffing
requirements, and allow care to be provided in a home-like
setting. He added that the intention would be to have the
regulations mirror child foster parent and home expectations.
He stated that these changes would allow more seniors to receive
care within their communities instead of having to move to urban
areas where senior living facilities were more available. He
posited that there could also be an economic benefit. He said
that there would be some additional staff required for
monitoring this new type of care setting, but otherwise
providing the service would be cost neutral to the state.
CO-CHAIR ZULKOSKY asked for a review of the sectional analysis.
3:14:32 PM
TONY NEWMAN, Deputy Director, Division of Senior and Disability
Services, Department of Health and Social Services, on behalf of
the bill sponsor, Senate Rules by request of the governor, gave
the sectional analysis for CSSB 98(FIN) [included in the
committee packet], which read as follows [original punctuation
provided]:
Section 1: Amends AS 25.23, Who May Adopt, to allow
for the adoption of an adult by only one member of a
married couple as long as the spouse consents to the
adoption.
Section 2: Adds a new section to AS 47.07, Medicaid
Assistance for Needy Persons, to create a new program-
adult home care services for individuals. Adult home
care services will be available for individuals at
least 18 years of age or older who are enrolled in a
home and community-base[d] waiver. The Department of
Health will develop regulations establishing the
standards and rates of the program and providing an
efficient process to allow existing foster homes to
transition into the new adult home care license.
Section 3: Amends AS 47.32.010(b) to add a new
setting, "adult home care homes," that shall be
subject to the centralized licensing functions of the
Department of Health.
Section 4: Adds a new section to AS 47.32 that defines
the conditions under which the department may license
an adult home care home. A person may be licensed to
operate such a home for up to two persons age[d] 18 or
older who are enrolled in home and community-based
waiver services. This section requires the department
to streamline the application process necessary for
the person to be approved as an adult home care home
provider and requires that the department approve
variances of building code requirements to the extent
permitted by state, local, or federal law.
Section 5: Amends uncodified law by adding a new
section that requires the Department of Health to
submit for approval by the United States Department of
Health and Human Services an amendment to the state
medical assistance plan, waivers, or an 1115
demonstration waiver as necessary to allow eligible
individuals to receive adult come care services and
other long-term care services that are not
duplicative.
Section 6: Amends uncodified law adding a new section
related to the conditional effect of section 4 and the
required state plan amendments submitted to the United
States Department of Health and Social Services.
Requires the department to notify the revisor of
statutes of the approval of state plan amendments.
Section 7: Effective date related to the requirement
for the department to provide notification of the
revisor of statutes of approval of state plan
amendments.
Section 8: Provides for a July 1, 2022 effective date
to align with the effective date of Executive Order
121 and the change of the applicable department to the
Department of Health.
3:17:33 PM
REPRESENTATIVE FIELDS referred to language on page 4 of the bill
which would require DHSS to give instruction to adult foster-
care applicants on acquiring a variance for their application if
their home does not meet building code requirements. He posited
that the new setting envisioned in CSSB 98(FIN) would include
family homes and asked why the department would advise a
variance rather than requiring the applicant to improve the home
to meet safety standards.
3:18:19 PM
CRAIG BAXTER, Program Manager, Residential Life, Division of
Health Care Services, Department of Health and Social Services,
explained that meeting many of the building codes for
traditional care facilities would require changes which could be
cost prohibitive for families providing the care, such as
installing a sprinkler system. He stated that the new setting
would be residential homes and voiced the understanding that
there are no codes currently in effect for residential care in
these new facilities. However, if building codes change in the
future, he explained that this provision of the bill would allow
DHSS to direct adult foster-care applicants to obtain a
variance; this is included to showcase the department's
willingness to help applicants go through the process if needed.
He reiterated that current residential-care building codes
require more updates only if the household is caring for three
or more people; therefore, most of the people targeted by this
bill would not be asked to comply.
REPRESENTATIVE FIELDS asked how many people per home the bill
would address.
MR. BAXTER explained that CSSB 98(FIN) would create a new
license for homes providing care for two or fewer individuals,
in comparison to facilities which care for three or more. He
explained that current building codes effect only home care
settings serving three or more people.
REPRESENTATIVE FIELDS expressed the understanding that fire
codes would not be an issue for the new applicants.
3:21:44 PM
REPRESENTATIVE MCCARTY noted that the proposed bill would limit
each home providing adult home care services to two or fewer
individuals. He questioned the inclusion of language which
would allow this number to be increased at the discretion of
DHSS.
MR. LEE replied that the intent is for two or fewer and
explained that there are possible scenarios where the state
would want to grant an exception. He stated that being able to
keep families together is the intent behind this language.
REPRESENTATIVE MCCARTY questioned the frequency of multiple
family members with adult foster care needs who would request
waivers.
MR. LEE explained that it is not common but does occur, and he
referred to a current case where three family members are being
served on waivers.
REPRESENTATIVE MCCARTY expressed the belief that the language
which would address this is "wide open" and questioned whether
it should be fine-tuned to be more specific to family-based
exceptions.
MR. LEE explained that the regulations would be made to manage
exceptions.
3:24:45 PM
REPRESENTATIVE SPOHNHOLZ shared her experience with having her
own home licensed for foster care and explained the coding
requirements. She expressed concern that treating adult foster
care homes as a subset of assisted living homes could introduce
a building code work-around for assisted living homes. She
asked why the adult foster-care licensing process is not being
conducted the same way as child foster care licensing.
3:26:18 PM
MR. BAXTER explained that for adult care facilities, local and
state fire codes would not differentiate between the type of
residence, rather the consideration would be the number of
adults being served. He stated that municipalities enforce
these codes based on the thresholds within the code and not on
how the service is labeled. He restated that the intent is for
DHSS to assist applicants who exceed the code thresholds, as
there are currently no fire codes within Alaska which require
the installation of a sprinkler system for homes serving two or
fewer adults.
REPRESENTATIVE SPOHNHOLZ noted that the proposed bill would
allow the licensing of adult foster care homes as foster care,
but they would be treated as assisted living homes. She asked
whether a new standard could be created for adult foster homes
to differentiate them from assisted living homes. She explained
that if the bill is truly "creating a whole new category" of
licensing for adult foster care, then the license should not be
subject to standards for a different type of care. She
suggested that the language of the bill be "tidied up" to
prevent the mixing of regulations.
3:29:47 PM
MR. NEWMAN explained that the intent of the bill is to "thread
the needle" to create a setting between foster care and assisted
living, and this aligns with the needs of stakeholders. He
explained that the language would be a safety net to allow
variances if needed later.
REPRESENTATIVE SPOHNHOLZ suggested that she may draft an
amendment to specify when variances could be made to increase
the limit of adults.
3:30:44 PM
REPRESENTATIVE FIELDS expressed opposition to including
variances, citing the possibility of a single caregiver being
unable to manage three adults with disabilities in the event of
an emergency like a fire. He argued that the department should
not be encouraging variances, and the language should be
stricken from the bill entirely. He continued that, if the
proposed legislation does not pass, those affected may not
receive appropriate care. He pointed out the difference between
staying at home or moving into an assisted living facility.
MR. LEE confirmed that most of the individuals affected would be
served with in-home support or with assisted living, and the
intent of the bill is to create a new option. He clarified that
the intent is not to divert clients from other options, but
instead to lower the barriers of providing care to create more
options across the state and increase access to care in places
where it would not otherwise exist. He shared that stakeholder
feedback supported creating another choice, as this would be
valuable for those wanting to remain in their communities or not
wanting to live in a group home.
REPRESENTATIVE FIELDS pointed to the higher cost associated with
the proposed setting as compared to receiving services through a
personal care attendant (PCA) and inquired about the differences
in workload between the two options.
MR. LEE explained that there are many ways in which people can
receive care and services from the state; however, this depends
on the individual's condition, and CSSB 98(FIN) would open
"certain avenues of support" for individuals to receive these
services. He deferred to Mr. Newman for further detail.
3:35:04 PM
MR. NEWMAN confirmed that the department's vision for the new
adult home care license is to target the needs of patients,
specifically the elderly, who are just starting to need at-home
assistance a few hours a week. He explained that, under current
practice, those people can receive services only within an
assisted living setting, and he posited that the proposed bill
would allow these people to continue living in a family home
setting and receive services, even as the services increase over
time. He described the proposed setting as a place one could
"stop at during the journey of your life."
REPRESENTATIVE FIELDS questioned the stakeholder input and
whether the money allocated through the new setting would be
enough to provide proper care.
MR. LEE explained that the reimbursement rate for adult home
care would need to be established and, because each person
requires a different level of service, the plans are "person-
centered," with the cost depending on the individual. He noted
that the costs spoken about during the presentation were all
example figures; the actual costs would vary based on each
person's needs.
3:37:16 PM
REPRESENTATIVE SPOHNHOLZ posited that the creation of the adult
home care setting could function as a workaround to assisted
living care by allowing compensation for similar care at a lower
rate.
MR. LEE reiterated that the goal is to create a care option
which is less restrictive and easier to procure licensure. He
pointed out that other states with similar policies have proven
to have valuable and viable care settings. He explained that a
new setting type must be established for the new license type to
be created.
MR. NEWMAN added that the main difference between the proposed
setting type and an assisted living home is the habilitation
requirements associated with the medical plan model of assisted
living facilities. He reported that many stakeholders have
expressed the desire to have a care option without habilitation
goals. He explained that the new setting for an adult home care
license would allow for service delivery without the
habilitation goals.
3:39:55 PM
REPRESENTATIVE MCCARTY reiterated the understanding that some
minors in foster care "age out" but still require care for a
mental or physical disability, and the proposed legislation
would allow them to stay with the foster family, with whom they
have a relationship, and continue to receive services. After
listening to testimony, he expressed the understanding that the
bill would be focused on allowing elderly people to move into a
home care situation without a prior relationship with their
caregiver, and this would allow other licensed facilities to be
bypassed. He questioned the situation the bill would be
addressing.
MR. LEE explained that the bill started with a focus on those
aging out of foster care; however, after hearing from
stakeholders and community members, it was rewritten to be
inclusive of other care recipients.
REPRESENTATIVE MCCARTY asked whether the new category in this
bill would allow for an elderly person to move in with an
extended family member [who gets the new license type] and have
the state pay for the services.
MR. LEE replied that the intent of the bill is to allow people
to choose a setting which best fits their needs. He explained
that people who have the space within their home and the desire
to provide services would be allowed to apply for the license,
and this would become an option for people receiving care. He
provided the scenario where an elderly person wished to remain
in his/her current home with a family member, who already
resided in the home. This family member would need the required
license to give the needed care. He pointed out that this
scenario would need to be addressed through regulation, as it
was not the original intention of the bill.
REPRESENTATIVE MCCARTY referenced the service waivers for people
with developmental disabilities and shared his concern that the
pool of eligible recipients would be widened too much by the
proposed legislation. He sought clarification on who would be
eligible to receive services.
MR. LEE explained that in order to receive services in the
proposed setting, an individual would have to already be on a
waiver.
3:45:25 PM
REPRESENTATIVE SPOHNHOLZ recollected that, for individuals who
need care past the age of 18, the House companion bill of CSSB
98(FIN) would only allow for the continuation of foster-care
services with the same family. She voiced support for the
House's version of the legislation. She shared her appreciation
of the intent to move away from the medical model of care for
people with intrinsic disabilities or needs which will never "go
away;" however, she voiced concern that the senior and
disabilities services waiver qualification would be mixing two
disparate groups. She suggested that expanding a bill intended
for extending foster care to also include senior care within a
new setting could lead to the creation of substandard assisted
living homes. She expressed discomfort in mixing foster care
and assisted living policy because they are two different levels
of service which are treated differently in eligibility
determination and licensing standards. She opined that the new
setting and licensure pathway the bill proposes is not the same
as a continuation of a family-like living model. She expressed
opposition to mixing the two.
MR. LEE referenced other states' plans which have created more
options for the aging population. These plans, along with
listening to feedback from stakeholders, informed the decision
to create a new service type for the benefit of older Alaskans.
He reiterated that the proposed setting would allow for more
care opportunities in rural areas where establishing assisted
living facilities would be much harder.
REPRESENTATIVE SPOHNHOLZ asked how eligibility and access would
be determined for the new setting and how this would be
different from the existing waiver system. She expressed the
opinion that there is more demand for [waiver] services than the
state can meet. She questioned whether the proposed legislation
would increase the demand for services and whether the criteria
for waiver eligibility would be changed.
MR. LEE explained that new regulations would need to be put into
place, but that the eligibility criteria would not change. He
stated that, once a person has been determined eligible, the new
setting would be an additional option for receiving services.
3:51:24 PM
REPRESENTATIVE PRAX referred to a list of levels of available
care examples in the summary of CSSB 98(FIN) provided to the
committee, which read as follows [original punctuation
provided]:
• Live at home and receive personal care services and
waiver services. Daily Cost - $284
• Live in an Assisted Living Home and receive Group
Home Services and other waiver services. Daily Cost -
$416
Live in a Nursing Home and receive no waiver
services. Daily Cost - $771
REPRESENTATIVE PRAX asked whether the level of care for the
proposed setting would be between the levels detailed in the
first and second bullets.
MR. LEE responded in the affirmative.
3:52:11 PM
CO-CHAIR ZULKOSKY opened public testimony on SB 98.
3:52:38 PM
STEPHANIE WHEELER, Long-Term Care Ombudsman, Department of
Revenue, expressed support for SB 98. She explained that the
proposed legislation would give seniors alternatives to the
existing services and living environments. As part of her work
ensuring quality care for Alaska's seniors, she explained that
she conducts unannounced visits to assisted living facilities.
She reported that many elders within these facilities express
the desire to receive care closer to their communities and
families. She opined that SB 98 would help elders meet their
care needs in the community of their preference.
3:54:05 PM
MICHELE GIRAULT, Executive Director, Hope Community Resources,
testified in favor of the concept of SB 98, citing a need for
greater flexibility for providers of youth with intellectual and
developmental disabilities. She reported that many families
currently providing foster care to children with disabilities
have resisted transitioning to an adult assisted living license
because of the complexities and additional facility needs
associated with this licensure. This has caused individuals
with disabilities to be removed from the care of families, with
whom they have formed relationships. The individuals are then
placed in assisted living facilities, even though they often
need youth transition support well into their twenties. She
acknowledged some of the complications of the new service
setting but opined that the proposed legislation would simplify
the transition process for young adults with disabilities,
allowing them a continued sense of normalcy and sense of family,
and she reiterated support for SB 98.
3:56:11 PM
LIZETTE STIEHR, Executive Director, Alaska Association on
Developmental Disabilities (AADD), testifying on SB 98,
explained that the AADD is the trade association for care
providers who work with individuals with intellectual and
developmental disabilities and expressed that AADD is "thrilled"
by the proposed addition of a new service setting. She
expressed the opinion that adding more options for service
settings would allow recipients to live "meaningful" lives with
more choices. She spoke about the complexity of the regulations
concerning assisted living homes and stated that this has been a
barrier to families providing care. She continued that the
adult foster care license would be beneficial to many people
within the system. She explained that the bill would provide
broader options and lower costs for care. She posited that many
of the questions brought up by the committee would be answered
through regulation.
3:58:26 PM
CO-CHAIR ZULKOSKY, after ascertaining that there was no one else
who wished to testify, closed public testimony on SB 98.
3:58:34 PM
CO-CHAIR ZULKOSKY announced that SB 98 was held over.
SB 132-CONTROLLED SUB. DATA: EXEMPT VETERINARIAN
3:58:45 PM
CO-CHAIR ZULKOSKY announced that the final order of business
would be SENATE BILL NO. 132, "An Act exempting veterinarians
from the requirements of the controlled substance prescription
database."
3:58:55 PM
The committee took a brief at-ease.
3:59:58 PM
CO-CHAIR ZULKOSKY announced the committee would hear invited
testimony.
4:00:33 PM
JIM DELKER, DVM, Legislative Liaison, Alaska Veterinary Medical
Association (AKVMA), shared a conversation he had had with an
Alaska State Trooper. He stated that the trooper, with over 20
years of experience working on a drug task force as an
undercover agent, had not witnessed any cases of drug abuse
involving humans with veterinary prescriptions. Also, he
referenced numerous physicians, including emergency care and
drug treatment specialists, who sent in letters to attest they
had never treated a person with a drug overdose, where the
person had obtained the drugs through a veterinarian.
DR. DELKER reported that at the request of the legislature,
AKVMA met with the Alaska College of Emergency Physicians (ACEP)
and the Board of Emergency Physicians to discuss some of the
concerns. He described the dialogue between the boards as
positive, and despite concerns from the physicians, there were
no concrete examples of drug abuse of this type brought forward.
He stated that the boards had also discussed the two studies the
physicians had referred to in their letters of concern. He
shared that one was an unrandomized survey conducted of a small
portion of veterinarians in Colorado; these veterinarians had
influenced Colorado to keep veterinarians out of the
Prescription Drug Monitoring Program (PDMP).
DR. DELKER noted the other study was a properly randomized study
from Pennsylvania; however, it only took data from a single
large referral hospital. He stated that only 6 percent of
veterinarians in the country work in a similarly specialized
setting and opined that it was unfair to say the study was
indicative of the prescribing habits of most veterinarians. He
shared that, in their discussion, members from the boards had
expressed disagreement with letters of support from former ACEP
members, while current members unanimously support the ACEP's
letter of concern; however, he stated that this is in direct
conflict with the conversations he had with current members, who
stated that they had never heard of SB 132, or the letter of
concern. He stated that some of these members had submitted
their own letters of support for SB 132.
DR. DELKER related that veterinarians are frustrated with the
task of repeatedly entering data, which "disappears" and cannot
be accessed by other physicians or veterinarians. He expressed
disagreement with the idea that veterinarians are "out of touch"
with the opioid epidemic. He shared a personal experience
concerning loss because of opioid addiction, and he suggested
that other veterinarians have similar stories. He acknowledged
that the opioid crisis is serious and opined that veterinarians
want to do their part to help. He asked that their efforts not
be wasted but instead result in measurable benefits.
4:06:15 PM
TRACY WARD, DVM, President, Alaska Veterinary Medical
Association, reviewed the current regulations on PDMP use in the
veterinarian field. She explained that all veterinarians who
prescribe, administer, or dispense Schedule II or III drugs must
query PDMP before doing so. She further explained the "zero
reporting" regulations, stating that veterinarians who dispense
any Schedule II, III, and IV substances must report to PDMP
daily, including on days they do not dispense. She listed the
dispense reporting exemptions, which included substances
dispensed in an emergency department for a supply lasting less
than 24 hours, controlled substances administered to an
inpatient of a hospital, controlled substances used at the scene
of an emergency, controlled substances used during or within 48
hours before or after a surgery, and writing a non-refillable
prescription which lasts no more than three days.
4:08:42 PM
The committee took a brief at-ease.
4:09:11 PM
CO-CHAIR ZULKOSKY asked Laura Carrillo or Sara Chambers from the
Department of Commerce, Community & Economic Development (DCCED)
what recommendations and accommodations have been made by DCCED
to make the utilization of PDMP more streamlined for
veterinarians.
4:11:16 PM
LAURA CARRILLO, MPH, Executive Administrator, Alaska Board of
Pharmacy, Prescription and Drug Monitoring Program, Division of
Corporations, Business and Professional Licensing, Department of
Commerce, Community and Economic Development, explained that
when the original bill passed in 2017, the Board of Veterinary
Examiners (BOVE) had several questions for DCCED, including who
to query when prescribing controlled substances for nonhuman
patients. She stated that the department advised the board to
query the human client and have this posted with the licensure.
She shared the board's other concern about animal and human data
comingling. She stated that DCCED worked with the Department of
Law and the database vendor on ways to clarify the data entry
process. In response to this, she stated, DCCED posted
guidelines on its website about how to properly input species
codes and prevent comingling of data, and the vendor added an
animal graphic to help practitioners visually differentiate
between human and animal prescriptions. She added that the
department continued talks with various boards to adjust issues
and instated a biweekly PDMP meeting of chairs to continue the
conversation.
4:15:22 PM
CO-CHAIR ZULKOSKY asked how DCCED's improvements made the
process more user friendly for veterinarians.
4:16:27 PM
MCKAYLA DICK, DVM, Past President, Alaska Veterinary Medical
Association, explained that as a small animal veterinarian she
had seen no changes in PDMP and very little guidance on how to
use it in a clinic setting. She stated that "the system just
doesn't work" for veterinarians because of the fundamental
differences in human and animal data. These differences have
led veterinarians to be investigated for clerical issues rather
than deliberate misuse of the system. She opined that the
changes put into place by DCCED have not been properly conveyed
to practitioners and often did not work to solve the issues.
4:17:46 PM
HAL GEIGER, PhD, Member, Board of Veterinary Examiners, shared
that the private conversations with veterinarians were
consistent with their public testimony, which expressed that
changes made by DCCED were not helpful, and training had been
insufficient. He reported that veterinarians are confused and
frustrated with a system which they find to be "completely
unworkable."
CO-CHAIR ZULKOSKY asked about other efforts the department had
made in response to the feedback that the changes were not
enough.
SARA CHAMBERS, Director, Division of Corporations, Business and
Professional Licensing, Department of Commerce, Community and
Economic Development, expressed the belief that the department
had made all the changes brought to its attention and had
provided all information about the changes to the board. She
expressed the understanding that it was BOVE's responsibility to
disseminate that information. She opined that the board's
efforts to do so had "fallen by the wayside," and BOVE had not
posted the guidelines on its website or circulated them to
veterinarians. She posited that much of the frustration with
the system comes from the existential question of whether PDMP
is relevant to veterinarians and opined that, because
veterinarians believe their participation in PDMP to be
[useless], there is less motivation to implement the fixes
provided by the department. She expressed the belief that all
parties should buy in to PDMP and utilize the tools provided, or
statutory changes should be made.
4:22:39 PM
The committee took an at-ease from 4:22 p.m. to 4:26 p.m.
4:26:39 PM
REPRESENTATIVE SPOHNHOLZ referred to a report from DCCED on the
14 best practices for veterinary use of PDMP and asked Ms.
Carrillo to explain how the report was communicated to BOVE.
MS. CARRILLO explained that the Bureau of Justice Assistance
(BJA) compiled the report, and it was presented at the PDMP
training center in January 2022. She stated that the report
used studies conducted in other states to derive the best
practices. She shared that, to her knowledge, the report was
given to BOVE members during a board meeting, and it was
included in their meeting packet. In response to a follow-up
question, she said the report was presented to BOVE in February
of the same year.
REPRESENTATIVE SPOHNHOLZ opined that the best practices provided
by BJA were very detailed. She referenced a letter sent by Dr.
Papacostas to the Senate Finance Committee where he stated that
veterinarians now surpass dentists in the prescription of
morphine. She requested that Dr. Papacostas explain this
information and ACEP's stance on excluding veterinarians from
PDMP.
4:32:47 PM
NICHOLAS PAPACOSTAS, MD, FACEP, Alaska Chapter American College
of Emergency Physicians, confirmed that the statistic was
correct and clarified that both veterinarians and dentists
prescribe very low rates of opioids in comparison to medical
practitioners. He explained that the data was added in the
report for context because there was a discussion about
exempting veterinarians but not dentists from PDMP.
REPRESENTATIVE SPOHNHOLZ asked Dr. Papacostas to describe the
findings from the 2019 study published in the Journal of the
American Medical Association, which was cited in his letter.
DR. PAPACOSTAS explained that Dr. Delker was correct in his
testimony; the study had come from a single large veterinary
facility. He stated that the point of including this study is
because many veterinarians train at referral centers, so the
trend of increased opioid prescriptions at those facilities
could be indicative of the prescribing habits of veterinarians
in smaller, community-based practices as well.
REPRESENTATIVE SPOHNHOLZ requested that Dr. Geiger comment on
the information presented to BOVE during the February 2022 board
meeting concerning the best practices for veterinary
prescriptions. She questioned the material presented, the
discussions that occurred about implementing these practices,
and whether a more nuanced approach to veterinary participation
in PDMP is "out of the question."
4:35:50 PM
DR. GEIGER stated he was not prepared to speak about this
specific meeting, as there were many meetings where suggestions
were given by the department. He gave an example of a suggested
regulation which would not be possible to carry out. He
explained that the majority of testimony the board had heard
from veterinarians was that they try to use the PDMP but it
"just doesn't quite work" and has not worked since the
participation requirement was put into statute. He explained
that the requirement is to query the patient, but in the
veterinary world, the patient is the animal.
REPRESENTATIVE SPOHNHOLZ opined that, because of frustration
with the system, many veterinarians have chosen to see the
system as a failure rather than trying to find a solution. She
cited the earlier comparison to dentists and stated that
dentists prescribe fewer opioids a year than veterinarians, yet
there has been no push for an exemption from dentists. She
posited that this data is in direct opposition to the assertions
made during testimony. She requested Dr. Geiger's opinion.
DR. GEIGER replied that PDMP works for dentists and human
practitioners because PDMP was designed for human patients. He
shared that the board received a PDMP report which conveyed no
veterinarians had queried the system during a specific
timeframe, but during the discussion of the report, numerous
veterinarians and their staff reported they had queried the
system during the referenced timeframe. He expressed the
opinion that this exemplifies the system is not working for the
veterinary field.
4:39:58 PM
REPRESENTATIVE PRAX expressed the understanding that
veterinarians were required through regulation to query their
human clients' prescription drug use.
DR. GEIGER confirmed this understanding and spoke to
veterinarians' frustration around lack of clarity in who to
query.
4:41:01 PM
DR. WARD confirmed that the query is made to the person
physically in the room with the animal patient.
REPRESENTATIVE PRAX stated his opinion that this practice seemed
like a Health Insurance Portability and Accountability Act
(HIPAA) violation and asked whether the information about the
human client's prescription history was recorded. In response
to a request for clarification, he described a hypothetical
situation where someone goes to a veterinarian, discloses
his/her own medical history in order to receive medication for
the pet, and then later the person switches to a new
veterinarian. He asked whether the new veterinarian would be
able to see that the pet had previously been prescribed a
certain drug and whether this drug would now be a part of the
human client's history.
DR. WARD explained that before a veterinarian makes a
prescription, the human client's drug history would be
questioned. She posited that this would not affect the
veterinarian's decision on what to prescribe, because
veterinarians are not trained in human drug dosage. However,
she said, if the veterinarian decides to prescribe a scheduled
substance to an animal, this information would be entered under
the pet's name. She reported that a reoccurring issue is, when
a veterinarian tries to query PDMP for this pet later, the
information is often not visible. She added that the same issue
happens for medical doctors. She described the process as not
affecting public health, as veterinarians cannot interpret the
data from medical doctors and [doctors] cannot access the animal
data entered by the veterinarians. She confirmed that
veterinarians do prescribe more opioids than dentists; however,
this amount is less than one percent of all opioids prescribed
and does not include the types of opioids human addicts are
looking for. She stated that the focus has been on making PDMP
easier for veterinarians; however, she pointed out the lack of
productive data which results from this practice, which is the
main concern for veterinarians.
REPRESENTATIVE PRAX opined that veterinary participation in PDMP
"fundamentally" accomplishes nothing and potentially violates
the HIPAA rights of [the humans who bring in their pets].
DR. WARD expressed agreement with the statement. She stated
that "we are accomplishing nothing" in regard to drug prevention
and public health, while the process is done at a high cost [to
the state]. She reemphasized that the amount of opioids
prescribed by veterinarians is small in comparison to the amount
prescribed by physicians.
4:45:40 PM
REPRESENTATIVE MCCARTY referred to the statistic of opioid
prescriptions as being "data on morphine." He questioned
whether morphine is prescribed by vets more often.
DR. WARD explained that the data describes morphine milligram
equivalence (MME), which equates all the opioid class substances
to the relative equivalency with morphine; the statistic does
include all opioids prescribed.
REPRESENTATIVE MCCARTY questioned the data which suggests
veterinarians prescribe more opioids than dentists. He cited
his knowledge of dentist-related opioid addiction. He asked Dr.
Papacostas to provide the data behind the statement on
prescription amounts in his letter.
DR. PAPACOSTAS explained that the same data is in the white
paper in graph form, and it shows that from 2016 to 2018 the
amount of opioids prescribed by veterinarians had increased to
surpass the amount prescribed by dentists.
REPRESENTATIVE MCCARTY sought confirmation from Ms. Chambers
that the administration is taking a non-stance on the issue and
focusing on complying with the current statute.
MS. CHAMBERS responded in the affirmative.
REPRESENTATIVE MCCARTY recalled Ms. Chambers previous statement
which related that veterinary participation has been a challenge
for PDMP, and he remarked that there has been over a "hundred"
meetings a year between the different boards on this subject.
MS. CARRILLO explained that there have not been "hundreds" of
meetings on this specific issue, but it has been discussed, and
updates on PDMP have been a standing topic at all BOVE meetings.
REPRESENTATIVE MCCARTY shared his understanding that the
Division of Corporations, Business and Professional Licensing's
main objective with all state boards is to assist with their
professional duties to the state and ensure no harm is being
done.
MS. CHAMBERS confirmed his understanding.
REPRESENTATIVE MCCARTY acknowledged the division's effort to
follow statute and make the system workable for veterinarians;
however, he pointed out that BOVE has related the participation
in PDMP is "putting a square peg in a round hole." He shared
his belief that testimony points towards an unsolvable issue;
therefore, a change of statute is needed.
4:51:57 PM
MS. CHAMBERS voiced her belief that many tools are available to
the boards, and what boards do with the information directly
impacts veterinarians' ability to effectively use PDMP. She
expressed agreement that there is room for improvement; however,
there are options other than statute change still available.
She reiterated that many of the issues have been answered
through the resources created by the division. She argued that
many veterinarians feel frustrated by the system because they
were uninformed of the resources.
REPRESENTATIVE MCCARTY opined that the statute put into place in
2017 does not fit a certain group of professionals, and although
the division has done its part to make the system work according
to statute, PDMP does not work for veterinarians. He alluded
that the legislature should follow the suit of other states
which have exempted veterinarians.
4:54:09 PM
CO-CHAIR ZULKOSKY requested that Ms. Chambers confirm the
department had urged BOVE to adopt regulations which address the
challenges faced by PDMP.
MS. CHAMBERS responded in the affirmative.
CO-CHAIR ZULKOSKY questioned Dr. Geiger concerning the board's
response to the department, and its request to adopt regulation
regarding PDMP.
4:54:51 PM
DR. GEIGER explained that the board has received "high level
advice" which does not address the realities facing
veterinarians. He stated that there are "hundreds" of small,
day-to-day problems veterinarians must deal with, such as not
having internet access. He posited that getting all the
information to veterinarians for each of these issues is not an
easy task solved through regulation.
CO-CHAIR ZULKOSKY questioned whether the board has pursued
making any changes to regulations regarding PDMP, beyond the
more nuanced examples which have been given.
DR. GEIGER explained that the board did pass regulations trying
to make PDMP work. The board took the division's advice and put
the resources on the internet; however, the regulations have not
been able to get veterinarians the information they need.
CO-CHAIR ZULKOSKY asked Ms. Carrillo to supply the committee
with screenshots of PDMP for visual clarification, as well as a
list of the regulations put into place by BOVE. She questioned
the amount of nationwide PDMPs and whether there has been an
assessment completed on adapting PDMPs to meet the needs of
veterinarians.
MS. CARRILLO reported that the vendor used for PDMP has been
used by 43 other states. She offered to follow up to the
committee with additional information about adaptations for
veterinarians.
CO-CHAIR ZULKOSKY asked Dr. Papacostas about the tightening of
human medical documentation concerning controlled substances,
and how this could impact issues in the system. She also asked
for a layman's description of the difference between 5 million
and 2.9 million MME.
4:59:23 PM
DR. PAPACOSTAS explained that PDMP is a tool to identify
patients at risk of opioid addiction and get these patients into
treatment. He pointed out that it is "disturbing" if the data
veterinarians are entering is not visible to physicians. He
expressed the opinion that it is individual prescriptions which
expose people to opioids, and this is more of a concern than the
total amount of opioids being prescribed. He explained that
"catching" people misusing or diverting opioids is not the focus
of emergency physicians, but rather they want to determine how
patients are getting access to drugs, in hopes of intervening,
if needed. He restated that the total amount of opioids being
prescribed by veterinarians is not huge; however, he expressed
the belief that exposure to one prescription can make a
difference to a human patient. He voiced his support for
removing some of the restrictions on veterinary PDMP
participation and called for an investigation into why the
veterinary data is not visible. He iterated ACEP's support for
including veterinarians into the exemptions for very short-term
prescriptions, but it would still support veterinarians entering
long-term prescriptions into PDMP. He suggested that sending
prescriptions to pharmacists would help veterinarians who
struggle with entering prescriptions into PDMP.
[SB 132 was held over.]
5:02:54 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 |
|---|---|---|
| SB 98 Sectional Analysis Version GS 1708 W (4-19-22).pdf |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |
| SB 98-4-2-041522-DHS-N.PDF |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |
| SB 98-5-2-041522-DHS-Y.PDF |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |
| SB 98-6-2-041522-DHS-Y.PDF |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |
| SB 98 - ver. B.PDF |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |
| SB98 Summary of Changes v.W (4-29-22).pdf |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |
| SB98 Summary (May 2, 2022).pdf |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |