Legislature(2021 - 2022)DAVIS 106
05/05/2022 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB132 | |
| SB98 | |
| HB176 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 132 | TELECONFERENCED | |
| += | SB 98 | TELECONFERENCED | |
| + | HB 176 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
May 5, 2022
3:07 p.m.
MEMBERS PRESENT
Representative Liz Snyder, Co-Chair
Representative Tiffany Zulkosky, Co-Chair
Representative Ivy Spohnholz
Representative Zack Fields
Representative Ken McCarty
Representative Mike Prax
Representative Christopher Kurka
MEMBERS ABSENT
COMMITTEE CALENDAR
SENATE BILL NO. 132
"An Act exempting veterinarians from the requirements of the
controlled substance prescription database."
- MOVED HCS SB 132(HSS) OUT OF COMMITTEE
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
HOUSE BILL NO. 176
"An Act relating to insurance; relating to direct health care
agreements; and relating to unfair trade practices."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 132
SHORT TITLE: CONTROLLED SUB. DATA: EXEMPT VETERINARIAN
SPONSOR(s): SENATOR(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
05/03/22 (H) Heard & Held
05/03/22 (H) MINUTE(HSS)
05/05/22 (H) HSS AT 3:00 PM DAVIS 106
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
05/03/22 (H) Heard & Held
05/03/22 (H) MINUTE(HSS)
05/05/22 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 176
SHORT TITLE: DIRECT HEALTH AGREEMENT: NOT INSURANCE
SPONSOR(s): RASMUSSEN
04/16/21 (H) READ THE FIRST TIME - REFERRALS
04/16/21 (H) L&C, HSS
05/03/21 (H) L&C AT 3:15 PM BARNES 124
05/03/21 (H) Heard & Held
05/03/21 (H) MINUTE(L&C)
05/07/21 (H) L&C AT 8:00 AM GRUENBERG 120
05/07/21 (H) Heard & Held
05/07/21 (H) MINUTE(L&C)
05/12/21 (H) L&C AT 3:15 PM BARNES 124
05/12/21 (H) <Bill Hearing Canceled>
03/23/22 (H) L&C AT 3:15 PM BARNES 124
03/23/22 (H) Heard & Held
03/23/22 (H) MINUTE(L&C)
04/06/22 (H) L&C AT 3:15 PM BARNES 124
04/06/22 (H) -- MEETING CANCELED --
04/11/22 (H) L&C AT 3:15 PM BARNES 124
04/11/22 (H) Heard & Held
04/11/22 (H) MINUTE(L&C)
04/20/22 (H) L&C AT 3:15 PM BARNES 124
04/20/22 (H) Moved CSHB 176(L&C) Out of Committee
04/20/22 (H) MINUTE(L&C)
04/25/22 (H) L&C RPT CS(L&C) NEW TITLE 3DP 3NR
04/25/22 (H) DP: NELSON, FIELDS, SPOHNHOLZ
04/25/22 (H) NR: KAUFMAN, SCHRAGE, SNYDER
04/25/22 (H) FIN REFERRAL ADDED AFTER HSS
04/25/22 (H) BILL REPRINTED
05/05/22 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
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
Juneau, Alaska
POSITION STATEMENT: Answered questions on amendments to SB 132.
TRACY WARD, DVM, President
Alaska Veterinary Medical Association
Juneau, Alaska
POSITION STATEMENT: Answered questions on amendments to SB 132.
SCOTT FLAMME, DVM, Former Member
Board of Veterinary Examiners
Fairbanks, Alaska
POSITION STATEMENT: Answered questions on amendments to SB 132.
JUSTIN RUFFRIDGE, PharmD
Alaska Board of Pharmacy
Soldotna, Alaska
POSITION STATEMENT: Answered questions on amendments to SB 132.
JOHN LEE, Director
Division of Senior and Disabilities Services
Department of Health and Social Services
Palmer, Alaska
POSITION STATEMENT: Presented CSSB 98(FIN), on behalf of the
bill sponsor, Senate Rules by request of the governor.
TONY NEWMAN, Deputy Director
Division of Senior and Disability Services
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions on CSSB 98(FIN), on
behalf of the bill sponsor, Senate Rules by request of the
governor.
CRYSTAL KOENEMAN, Staff
Representative Sara Rasmussen
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: On behalf of Representative Rasmussen,
prime sponsor, gave a sectional analysis of HB 176 and answered
questions.
ACTION NARRATIVE
3:07:00 PM
CO-CHAIR TIFFANY ZULKOSKY called the House Health and Social
Services Standing Committee meeting to order at 3:07 p.m.
Representatives Kurka, Prax, Spohnholz, Fields, Snyder, and
Zulkosky were present at the call to order. Representative
McCarty arrived as the meeting was in progress.
The committee took an at-ease from 3:07 p.m. to 3:08 p.m.
SB 132-CONTROLLED SUB. DATA: EXEMPT VETERINARIAN
3:08:32 PM
CO-CHAIR ZULKOSKY announced that the first order of business
would be SENATE BILL NO. 132, "An Act exempting veterinarians
from the requirements of the controlled substance prescription
database."
3:08:28 PM
The committee took an at-ease from 3:08 p.m. to 3:10 p.m.
3:10:33 PM
REPRESENTATIVE SNYDER moved to adopt Amendment 1 to SB 132,
labeled, 32-LS0861\A.1, Ambrose, 4/27/22, which read as follows:
Page 1, line 1:
Delete "exempting veterinarians from the
requirements of"
Insert "relating to"
Page 1, line 4, through page 2, line 6:
Delete all material and insert:
"* Section 1. AS 17.30.200(k) is amended to read:
(k) In the regulations adopted under this
section, the board shall provide
(1) that prescription information in the
database shall be purged from the database after two
years have elapsed from the date the prescription was
dispensed;
(2) a method for an individual to challenge
information in the database about the individual that
the person believes is incorrect or was incorrectly
entered by a dispenser;
(3) a procedure and time frame for
registration with the database;
(4) that a practitioner review the
information in the database to check a patient's
prescription records before dispensing, prescribing,
or administering a schedule II or III controlled
substance under federal law to the patient; the
regulations must provide that a practitioner is not
required to review the information in the database
before [DISPENSING, PRESCRIBING, OR ADMINISTERING]
(A) dispensing, prescribing, or
administering a controlled substance to a person who
is receiving treatment
(i) in an inpatient setting;
(ii) at the scene of an emergency or in an
ambulance; in this sub-subparagraph, "ambulance" has
the meaning given in AS 18.08.200;
(iii) in an emergency room;
(iv) immediately before, during, or within
the first 48 hours after surgery or a medical
procedure;
(v) in a hospice or nursing home that has
an in-house pharmacy; [OR]
(B) dispensing, prescribing, or administering a
nonrefillable prescription of a controlled substance
in a quantity intended to last for not more than three
days; or
(C) prescribing a controlled substance if
the practitioner is a veterinarian."
Renumber the following bill sections accordingly.
Page 2, line 8, following ""practitioner"":
Insert "means"
Page 2, line 9:
Delete "means"
Page 2, line 10, following "investigator,":
Insert "veterinarian,"
Page 2, line 14:
Delete "means"
Page 2, lines 17 - 18:
Delete ";
(C) does not include a veterinarian"
Page 2, line 19:
Delete all material.
CO-CHAIR ZULKOSKY objected for the purpose of discussion.
REPRESENTATIVE SNYDER shared that Amendment 1 resulted from
multiple conversations with veterinarians, and it would address
veterinarian concerns, public health concerns, and interests of
the state. She explained that if veterinarians prescribe
opioids but do not dispense the drugs, the veterinarians are
still required to report to the Prescription Drug Management
Program (PDMP). She noted that some exemptions exist. She
stated that Amendment 1 would exempt veterinarians who prescribe
Schedule II, III, or IV controlled substances, but do not
dispense the drugs, from reviewing the PDMP in all instances.
She stated that the amendment would shift the responsibility of
querying PDMP to pharmacists who dispense the controlled
substances.
3:12:31 PM
REPRESENTATIVE KURKA questioned whether pharmacists experience
the same issues with animal data as veterinarians, and if so, he
questioned how the pharmacy would track the animal data in PDMP.
REPRESENTATIVE SNYDER stated that, according to conversations
with stakeholders, the Alaska Board of Pharmacy, and PDMP
reports, pharmacists are more adept at properly utilizing PDMP.
She recognized that the issue of human and animal data
comingling would not be solved by the amendment; however, she
voiced the opinion that it would relieve some pressure from
veterinarians, while maintaining opioid tracking. She suggested
that additional work to the functionality of PDMP would still be
needed.
REPRESENTATIVE KURKA questioned how Amendment 1 would address
the issue of entering data for animals without owners, such as
those living in animal shelters.
REPRESENTATIVE SNYDER expressed uncertainty and deferred to the
PDMP manager.
3:15:29 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
with the amendment, any prescribed Schedule II, III, or IV
controlled substances would still need to be reported.
REPRESENTATIVE SNYDER added that with Amendment 1, veterinarians
who prescribed and dispensed opioids to animals onsite would
still be required to query and report to PDMP. She mentioned
that the upcoming Amendment 2 would further address exemptions
based on the length of the prescription, and she explained that
the intention of both amendments would be to reduce the burden
on veterinarians, while maintaining tracking capabilities.
3:18:41 PM
REPRESENTATIVE MCCARTY expressed the opinion that if PDMP is not
working as intended with the animal data, the amendment would be
shifting the burden of dealing with a broken system to the
pharmacist. He pointed out that the person who takes the animal
to the veterinarian may not be the same person picking up the
prescription from the pharmacist. He questioned whether this
issue would be addressed.
REPRESENTATIVE SNYDER explained that the Alaska Board of
Pharmacy has given positive feedback concerning the shift of
PDMP responsibility to pharmacists. She expressed the belief
that the state could improve the tracking of animal data within
PDMP, and she expressed support for maintaining pressure on the
administration to fix the data entry for animals.
REPRESENTATIVE MCCARTY questioned whether veterinarians had
National Provider Identifier (NPI) numbers and if they did not,
would Amendment 1 put the pharmacist "on the line" since their
NPI would be the only one associated with the prescriptions.
3:22:25 PM
The committee took a brief at-ease.
3:22:53 PM
CO-CHAIR ZULKOSKY deferred the question to the invited
testifiers.
3:23:09 PM
TRACY WARD, DVM, President, Alaska Veterinary Medical
Association, in response to Representative McCarty's question,
stated that veterinarians are not required to have NPI numbers.
She stated that the only requirement for veterinarians to
prescribe opioids is to present a Drug Enforcement Agency (DEA)
license to the pharmacy when a prescription is called in.
REPRESENTATIVE MCCARTY stated that PDMP requires a NPI number to
be entered when making a query or a report and opined that the
amendment would require the queries about animal prescriptions
to be tied to the pharmacist's NPI number. He posited that this
could lead to confusion during an investigation and stressed the
need for systematic changes to PDMP.
3:25:06 PM
REPRESENTATIVE PRAX shared the understanding that PDMP serves as
a check for other prescriptions human clients may have had
before. He posited that if pharmacists are querying the system
for animal prescriptions, they still would not be entering the
prescriptions into the PDMP.
MS. CARRILLO explained that there is a requirement to enter
animal information, including the person's last name, when a
review or investigation is made. She said that Amendment 1
would put the responsibility on the pharmacist to make those
entries.
REPRESENTATIVE PRAX requested clarification on when a human
client goes to a pharmacist to pick up a prescription for a pet,
in this situation the pharmacist would query the human client's
name; however, the prescription for the pet would not be entered
under the client's name.
MS. CARRILLO confirmed that Representative Prax's understanding
is correct. She said that the pharmacist would use the pet's
profile to enter information, and the prescription would not be
linked to the human client's profile.
REPRESENTATIVE PRAX questioned whether a human client could pick
up a prescription from one pharmacy and fill the same
prescription at another pharmacy, as a way to "defeat the
system."
MS. CARRILLO clarified that reviewing PMDP and reporting to PMDP
are two separate things. She explained that a pharmacy would be
able to see whether a prescription was already filled.
3:30:02 PM
JUSTIN RUFFRIDGE, PharmD, Alaska Board of Pharmacy, in response
to a question from Representative Spohnholz, explained that NPI
stands for National Provider Identification. In response to a
follow-up question, he stated that a NPI number is associated
with the provider but not with the patient.
3:30:41 PM
MS. CARRILLO, in response to a question from Representative
Prax, explained that the DEA registration number is the
identifier required for access to PDMP, and any query or report
made is associated with this number. She stated that NPI is
used for insurance purposes and is not required for use of PDMP.
3:32:39 PM
CO-CHAIR ZULKOSKY removed her objection to Amendment 1.
REPRESENTATIVE PRAX objected.
A roll call vote was taken. Representatives Sponholz, Fields,
Snyder, and Zulkosky voted in favor of Amendment 1 to SB 132.
Representatives McCarty, Prax, and Kurka voted against it.
Therefore, Amendment 1 was adopted by a vote of 4-3.
3:33:25 PM
The committee took an at-ease from 3:33 p.m. to 3:34 p.m.
3:34:07 PM
REPRESENTATIVE SNYDER moved to adopt Amendment 2 to SB 132, as
amended, labeled, 32-LS0861\A.2, Ambrose, 4/27/22, which read as
follows:
Page 1, line 1:
Delete "exempting veterinarians from the
requirements of"
Insert "relating to"
Page 1, lines 4 - 8:
Delete all material.
Page 1, line 9:
Delete "Sec. 2"
Insert "Section 1"
Renumber the following bill sections accordingly.
Page 1, line 12, following "AS 08.98":
Insert "who is dispensing a prescription of a
controlled substance in a quantity intended to last
for not more than three days"
Page 2, line 8, following ""practitioner"":
Insert "means"
Page 2, line 9:
Delete "means"
Page 2, line 10, following "investigator":
Insert "veterinarian,"
Page 2, line 14:
Delete "means"
Page 2, lines 17 - 18:
Delete ";
(C) does not include a veterinarian"
Page 2, line 19:
Delete all material.
CO-CHAIR ZULKOSKY objected for the purpose of discussion.
REPRESENTATIVE SNYDER explained that Amendment 2 would reduce
the burden on veterinarians by limiting PDMP participation. She
stated that the amendment would remove the reviewing and
reporting requirement for veterinarians who prescribe and
dispense a Schedule II substance with a dosage lasting three
days or less. She reported that conversations with
veterinarians and other stakeholders informed the proposed
exemption, and she expressed the belief the prescription amounts
of three days or less to be a low risk concerning public health.
3:36:08 PM
REPRESENTATIVE MCCARTY expressed agreement with the amendment,
as it proposes similar protocol for prescribing human medicine.
3:36:28 PM
REPRESENTATIVE SNYDER confirmed that in existing statute there
are exemptions which apply to all physicians for PDMP reporting
and reviewing. She explained that the amendment would be
extending the existing exemption for veterinarians prescribing
these substances from 24 hours or less to 3 days or less.
3:37:16 PM
REPRESENTATIVE PRAX asked whether the exemption would also apply
to other practitioners, such as physicians and pharmacists.
REPRESENTATIVE SNYDER explained that the exemption is designed
only for veterinarians.
3:37:47 PM
REPRESENTATIVE KURKA questioned the percentage of veterinary
prescriptions of opioids which are 3 days or less. He asked the
veterinarians in the meeting whether the amendment would rectify
issues with PDMP.
3:38:54 PM
SCOTT FLAMME, DVM, Former Member, Board of Veterinary Examiners
(BOVE), explained that most of the controlled substance
prescriptions made by veterinarians are a type of seizure-
control medication.
3:39:25 PM
DR. WARD responded that she could not estimate a percentage;
however, she noted that most animal prescriptions are for short-
term pain control, such as after a dental procedure or
orthopedic surgery. She expressed agreement with Dr. Flamme,
that the most common long-term opioid prescription is
phenobarbital for seizures, with the next most common being a
cough suppressant.
REPRESENTATIVE KURKA expressed the opinion that the explanation
seemed to be in opposition to previous testimony the committee
has heard. He expressed the understanding that most opioid
prescriptions are short-term; however, it has been suggested
that it is common for veterinarians to make prescriptions for
longer than three days.
DR. WARD redefined "prescriptions" as a term of measurement and
explained that one patient may be on the same drug for many
years but, because there is a 90-day prescription limit, receive
multiple prescriptions. Although the number of long-term
prescriptions is "not negligible," she assured the committee
that the majority of patients are being prescribed short-term
supplies. She opined that exempting veterinarians who dispense
scheduled substances from zero-reporting would be beneficial.
She estimated that "definitely more than half" of opioid
prescriptions [by veterinarians] are short term; however, there
still would be many prescriptions requiring PDMP participation.
3:42:34 PM
REPRESENTATIVE KURKA expressed the belief that none of the
amendments would address the underlying barriers to veterinary
participation in PDMP, and he opined that PDMP could not be
altered to meet the needs of veterinarians.
3:43:03 PM
REPRESENTATIVE PRAX expressed agreement with Representative
Kurka. He stated that the proposed amendments would put "a new
coat of paint" on PDMP, but it would still be broken.
3:43:37 PM
REPRESENTATIVE SNYDER argued against the idea that the
amendments would be "trying to put a square peg in a round hole"
and the intention is to lessen the reporting burden for lower-
risk prescriptions, while still keeping track of longer-term
prescriptions. She expressed the concern that "we are in the
middle of an opioid crisis" and measures on the human medicine
side of the issue should be tightened. She deduced that putting
pressure on individuals to obtain opioids in other ways could
lead to veterinarian "shopping," which is a low concern at the
moment; however, as measures tightened elsewhere, prevention
would help avoid this from becoming a problem. She expressed
the belief that the amendments would greatly decrease the burden
experienced by veterinarians, while not "opening the door to a
whole other problem down the road."
3:45:31 PM
CO-CHAIR ZULKOSKY removed her objection.
REPRESENTATIVE PRAX objected and spoke to his objection. He
referred to a chart in the PDMP annual report showing the rate
of patient reviews and the rate of opioids dispensed since 2017,
when PDMP participation was put into place. He reported that
the chart shows a steady decrease in opioid prescriptions since
2018 but a sharp increase of patient reviews starting in 2019.
He deduced that the large increase of patient reviews has not
affected the amount of opioids dispensed. He opined that, in
comparison to larger societal conversations about lessening
opioid use, reporting and recording has not swayed prescription
habits. Because veterinarians are a small part of the problem,
he expressed the belief that, instead of asking veterinarians to
prove why they should not be included, it should be the
legislature's burden to show why veterinarians should be
included in the first place. He expressed agreement that the
amendments would make PDMP easier for veterinarians to use;
however, he argued that veterinarians should never have been
included in PDMP, and they should be completely exempt until the
state can prove participation beneficial and make it as
convenient as possible.
3:49:41 PM
A roll call vote was taken. Representatives Sponholz, Fields,
Zulkosky, and Snyder voted in favor of Amendment 2 to SB 132, as
amended. Representatives Kurka, McCarty, and Prax voted against
it. Therefore, Amendment 2 was adopted by a vote of 4-3.
3:50:26 PM
The committee took an at-ease from 3:50 p.m. to 3:53 p.m.
3:53:41 PM
REPRESENTATIVE SPOHNHOLZ moved to adopt Amendment 3 to SB 132,
as amended, labeled, 32-LS0861\A.4, Ambrose, 5/4/22, which read
as follows:
Page 1, line 1:
Delete "exempting veterinarians from the
requirements of"
Insert "relating to"
Page 1, lines 4 - 8:
Delete all material.
Page 1, line 9:
Delete "Sec. 2"
Insert "Section 1"
Renumber the following bill sections accordingly.
Page 1, line 12, following "AS 08.98":
Insert "who did not dispense a controlled
substance during the daily reporting period"
Page 2, line 8, following ""practitioner"":
Insert "means"
Page 2, line 9:
Delete "means"
Page 2, line 10, following "investigator,":
Insert "veterinarian,"
Page 2, line 14:
Delete "means"
Page 2, lines 17 - 18:
Delete ";
(C) does not include a veterinarian"
Page 2, line 19:
Delete all material.
CO-CHAIR ZULKOSKY objected for the purpose of discussion.
REPRESENTATIVE SPOHNHOLZ explained that, in the spirit of making
PDMP reporting easier for veterinarians, Amendment 3 would
remove the "zero-reporting" requirement, so veterinarians only
have to login to PDMP when prescribing or dispensing opioids.
She shared her belief that this would reduce the "red tape and
bureaucracy" for veterinarians.
3:54:55 PM
REPRESENTATIVE KURKA expressed the intention to not dismiss the
work done to make PDMP workable for veterinarians; however, he
expressed the opinion that the original bill [fully excluding
veterinarians from PDMP participation] solves the issue.
Considering the previous amendments being passed [and full
exemption being removed from the bill], he voiced support for
Amendment 3.
3:55:28 PM
REPRESENTATIVE PRAX questioned the login time PDMP. He argued
the login time could add to the length of customer interactions.
3:56:14 PM
REPRESENTATIVE SPOHNHOLZ explained that the PDMP administrators
have provided a tutorial video which suggests the logins happen
as part of a veterinarian's end of the day routine and should
only take about 30 seconds. However, she opined that it was an
unnecessary use of time and removing the requirement for daily
logins would make veterinarians feel more comfortable with PDMP
participation.
REPRESENTATIVE PRAX expressed agreement and asked for an opinion
from a veterinarian.
3:57:08 PM
DR. FLAMME confirmed that the process does take about 30
seconds; however, he stated that he always logs out of PDMP
after every interaction to ensure privacy for his human clients,
as their medical history would be available as well. He
explained that the biggest problem entering data into PDMP is,
"half the time" the information does not appear when making
queries later. He expressed uncertainty concerning this, which
caused worry concerning data entry and PDMP violations. He
stated that as a member of BOVE, there were over 100 open
investigations for PDMP violations. He expressed the belief
that this had been because veterinarians did not know the
process to enter the data correctly. He added that this led to
the creation of the tutorial video; however, when he tried to
enter data as instructed by the tutorial, he had encountered the
same issues with animal-patient history not appearing. He
stated that he mentioned this because not being able to
consistently see patient history is a major concern. He stated
that he had spent "hours and hours" addressing the problem with
the department.
REPRESENTATIVE PRAX questioned the frequently of veterinarians
logging in to the system. He posited that an upside of frequent
logins could be the process becomes "second nature."
REPRESENTATIVE SPOHNHOLZ clarified that the amendment would
remove the daily login requirement for veterinarians who
dispense opioids. She stated that this is one of the main
points of contention for veterinarians.
4:02:39 PM
REPRESENTATIVE MCCARTY expressed the belief that shifting the
reporting and querying responsibilities to pharmacists, per
Amendment 1, conflicts with the "grace period" which would be
established in Amendment 3.
REPRESENTATIVE SPOHNHOLZ explained that Amendment 1 would
address veterinarians who choose to only prescribe opioids and
do not dispense them, while Amendment 3 would assist the
remaining veterinarians who continue to dispense from their
office. She explained that the amendments complement each
other, with each narrowing the burden on veterinarians in a
different way.
REPRESENTATIVE MCCARTY questioned whether an increase of
investigations by the Alaska Board of Pharmacy would result. To
keep investigations from occurring, he asked whether
veterinarians could prove they had not participated in PDMP for
certain cases.
REPRESENTATIVE SPOHNHOLZ reiterated that veterinarians who
dispense opioid are currently required to log into PDMP on the
days when opioid prescriptions were not made, and this
requirement has been deemed "unnecessary" and a barrier to
efficiency for veterinarians. She pointed out that especially
since there is a shortage of veterinarians and veterinary
technicians in the state. She argued that Amendment 3 would
"make life easier" for veterinarians.
4:07:24 PM
CO-CHAIR ZULKOSKY removed her objection. There being no further
objection, Amendment 3 was adopted.
4:07:44 PM
The committee took an at-ease from 4:07 p.m. to 4:08 p.m.
4:08:42 PM
REPRESENTATIVE SPOHNHOLZ moved to report SB 132, as amended, out
of committee with individual recommendations and the
accompanying fiscal notes. There being no objection, HCSSB
132(HSS) was reported from the House Health and Social Services
Standing Committee.
4:09:37 PM
The committee took an at-ease from 4:09 p.m. to 4:12 p.m.
SB 98-ADULT HOME CARE; ADULT ADOPTION
4:12:42 PM
CO-CHAIR ZULKOSKY announced that the next 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.]
4:13:29 PM
JOHN LEE, Director, Division of Senior and Disabilities
Services, Department of Health and Social Services, presented
CSSB 98(FIN) on behalf of the bill sponsor, Senate Rules by
request of the governor. He thanked the committee for
considering the bill. He stated that he would be available for
any question.
4:14:10 PM
REPRESENTATIVE SPOHNHOLZ stated that she had supported the
original version of the bill; however, she expressed concerns in
the latest version about the inclusion of a new licensure
category. She shared her understanding that the intent behind
creating adult foster care is to establish continuity of care
for adults aging out of their foster-care placement. She
reported that a typical stipend for foster care is between $40
and $60, with a slight increase for foster children with
disabilities. She expressed concern that a proposed stipend of
$200 per day for adult foster care, combined with lower
licensure requirements, could provide a monetary incentive for
people to get licensed as a workaround of formal assisted living
facilities.
MR. LEE deferred to the deputy director.
4:17:58 PM
TONY NEWMAN Deputy Director, Division of Senior and Disability
Services, Department of Health and Social Services, answered
questions on CSSB 98(FIN), on behalf of the bill sponsor, Senate
Rules by request of the governor. He explained that the
estimated stipend would be about $349, and this number was given
to the committee to encompass all the possible services which
would need to be compensated for, including the daily rate of
$115, the costs of transportation, day habilitation, and other
services the providers would be providing. He offered to
provide the committee with a written breakdown of the different
service rates and how the division arrived at the larger daily
number. He reported that the division had consulted with the
Office of Child Services (OCS) on appropriate stipend amounts,
and the division had learned that a foster child could be
eligible for other waiver services, for which the state would
need reimbursement.
REPRESENTATIVE SPOHNHOLZ expressed appreciation for the
corrected stipend amount and pointed out the rate is five times
higher than the child foster-care rate.
4:20:39 PM
REPRESENTATIVE SNYDER expressed support for expanding care for
the state's elders and those with disabilities; however, she
pointed out the pushback on HB 292, which focuses on providing
the lowest cost for health insurance for individuals receiving
in-home care services. She reported that the concerns about HB
292 were in regard to maintaining and monitoring eligibility.
She posited that the creation of a new category in CSSB 98(FIN)
would introduce the same challenges. She requested
clarification from the department.
4:22:21 PM
MR. LEE explained that the two bills addressed completely
different issues, which explains the different responses from
the department. He stated that the full rates for adult foster
care would need to be decided, but the proposed daily stipend is
$115, which is not three to four times higher than child foster
care. He stressed that the bill would allow certain seniors to
transition from an institution to a home-like setting, and this
would open options for individuals to return to or remain in
their communities near loved ones while still receiving the
services and supports they need. He opined that it would be an
important option for the state to help manage costs as Alaska's
population continues to age.
4:24:50 PM
REPRESENTATIVE FIELDS shared his confusion about how the rates
would compare to rates in other settings. He questioned whether
the new setting would divert existing services from assisted
living facilities or provide additional services. He expressed
indecision on the breadth of the bill.
4:25:32 PM
REPRESENTATIVE SPOHNHOLZ expressed reticence concerning the
proposed legislation bill because of the fiscal note. She
questioned how home-care homes would fit into the spectrum of
service options. She expressed the need for more stakeholder
feedback. She reiterated her support for the "lighter" version
of the bill which focused on extending foster care services to
adults and allowed for the adoption of adults. She expressed
opinion that there is not enough understanding and stakeholder
engagement to make a decision on the creation of a new care
category. She opined that the fiscal notes were "a little
light," considering the higher daily rate. She suggested that a
more "granular" understanding of the issue is needed before
pushing to move people from formal assisted living into home-
care homes. She referenced conversations with professional care
providers and foster parents who had questions which required
very detailed answers. She stated that she is not prepared to
dig into the answers two weeks before the end of session. She
expressed appreciation of the intention of diversifying the
spectrum of care available; however, she would only be
comfortable with passing the House version of the bill which
focused on adult foster care. She surmised that creating a new
category requires more stakeholder alignment, along with a
better understanding of the fiscal impact, of which, there is
not time for this session.
4:29:10 PM
REPRESENTATIVE PRAX expressed agreement with giving consumers
another choice. He posited that creating a setting with lower
licensure requirements may lead to a "lower level of care," but
this could also be more affordable, create more business,
relieving the pressure on assisted living facilities. He said
he was in favor of additional options for care and offered
support for the proposed bill.
4:31:19 PM
CO-CHAIR ZULKOSKY announced that SB 98 was held over.
HB 176-DIRECT HEALTH AGREEMENT: NOT INSURANCE
4:31:26 PM
CO-CHAIR ZULKOSKY announced that the final order of business
would be HOUSE BILL NO. 176, "An Act relating to insurance;
relating to direct health care agreements; and relating to
unfair trade practices."
4:31:44 PM
CRYSTAL KOENEMAN, Staff, Representative Sara Rasmussen, Alaska
State Legislature, on behalf of Representative Rasmussen, prime
sponsor, gave a sectional analysis of HB 176. She stated that
HB 176 would establish direct health care agreements for medical
providers to provide Direct Primary Care (DPC) to patients. She
explained that DPC would be a membership based alternative
payment model where patients, employers, or health plans pay
primary care providers flat, simple periodic fees directly, in
exchange for access to a broad range of primary care services.
She reported that the previous committee of referral had done
quite a bit of work on the proposed legislation, and it
suggested going through the sectional analysis to better
understand all the many intricate parts of the bill.
CO-CHAIR ZULKOSKY requested a reading of the sectional analysis.
MS. KOENEMAN gave a sectional analysis of HB 176 [copy included
in the committee packet], which read as follows [original
punctuation provided]:
Section 1: AS 21.03.025 Direct health care
agreements. Adds a new section to AS 21.03 creating
direct health care agreements.
Subsection (a) outlines that a direct health care
agreement is between a health care provider and a
government entity, individual patient, employer of a
patient, or a representative of a patient.
Subsection (b) states the provider shall disclose the
services provided under the agreement and establish an
annual fee comparable to other agreements.
Subsection (c) The health care agreement must be
legible and in language an individual with no medical
training can understand. It must: Describe the
services to be provided by the health care provider;
Specify the annual fees associated with the agreement;
Prominently state that the agreement is not health
insurance and that it does not meet health insurance
mandates that may be required by federal law; Include
contact information for the person receiving and
addressing complaints; State the annual fee under the
agreement; and Specify the number of patients the
health care provider has the capacity to serve and the
number they are currently serving.
Subsection (d) allows for the policy to be terminated
within 30 days of entering into the agreement from the
patient.
Subsection (e) allows for the policy to be terminated
after a 30-day written notice from either party.
Subsection (f) allows for the policy to be terminated
in accordance with the agreement.
Subsection (g) allows for policy modification
Subsection (h) States that the services and agreements
are subject to consumer protection laws
Subsection (i) specifies that the offering or
execution of an agreement is not engaging in the
business of insurance or underwriting in the state.
Subsection (j) [states that a person may not make,
publish or disseminate an assertation that is untrue
or deceptive.]
Subsection (k) providers that enter into agreements
shall file a report with the Division of Insurance on
or before September 1 each year.
Subsection (l) defines the terms "health care
practice", "health care provider", and "health care
service"
Section 2: AS 45.45.915 Direct health care
agreements. Adds a new section under Trade Practices.
Subsection (a) prevents health care providers from
declining or terminating direct health care agreements
based on a patient's protected class under federal or
state law that prohibits discrimination.
Subsection (b) provides that a provider may decline or
terminate a direct health care agreement if the
provider is unable to provide the level or type of
care the patient requires. The provider shall ensure
the patient is referred to a health care provider who
is able to provide the level or type of care required
and agrees to provide said care.
Subsection (c) allows for a provider to decline to
enter into an agreement if they do not have the
capacity to accept new patients.
Subsection (d) defines the terms "direct health care
agreement" and "health care provider."
Section 3: AS 45.50.471(b) Unlawful acts and
practices. Updates definitions for "unfair methods of
competition" and "unfair or deceptive acts or
practices" to include violating direct health
agreements under AS 45.45.915.
Section 4: Amends uncodified law for the Division of
Insurance to adopt regulations.
Section 5: provides an immediate effective date for
Section 4.
Section 6: provides for a January 1, 2023, effective
date.
4:37:48 PM
REPRESENTATIVE PRAX pointed out that the proposed legislation
provides that DPC would not be insurance. He questioned why the
Division of Insurance would regulate DPC.
MS. KOENEMAN explained that the proposed legislation is similar
to the laws for air ambulance service. She stated that this
service is also not insurance; however, it does fall under Title
21, which allows for a regulatory authority to oversee the
agreements. She stated that other options were discussed, such
as placing the bill under Title 8 as a medical statute or giving
the Department of Health and Social Services oversight. She
reported that the Division of Insurance was chosen as this would
increase consumer protection, as the providers would be required
to provide documentation to the division.
4:39:23 PM
REPRESENTATIVE SPOHNHOLZ pointed out that the decision to put
the DPC under the Division of Insurance was made in the House
Labor and Commerce Standing Committee, which she co-chairs. She
explained that the choice was made based on the Division of
Insurance having the expertise to prioritize consumer protection
while implementing this novel way to access health care.
4:40:28 PM
REPRESENTATIVE FIELDS added that the House Labor and Commerce
Standing Committee, which he also co-chairs, wrote the "not
insurance, consumer protection" regulation language with the
director of the Division of Insurance. Instead of any problem
requiring a new bill, he expressed the need to allow for timely
resolutions to implementation issues. He stated that as a new
healthcare vehicle, it was decided the division would be the
best to have regulatory oversight. He cited the director of the
division's institutional knowledge and expertise in consumer
protection.
4:41:18 PM
CO-CHAIR ZULKOSKY asked whether similar types of agreements
between businesses and consumers existed in Alaska. She
questioned whether the framework would be a similar to other
agreements. She suggested that the proposed legislation could
create a brand-new consumer dynamic.
MS. KOENEMAN explained that because statute does not explicitly
prohibit these types of agreements, there are providers already
using them. She stated that it would be advantageous for the
state to create a regulatory system for these agreements based
on the framework which already exists. This way providers and
patients would have any future disputes addressed.
4:43:06 PM
REPRESENTATIVE PRAX referred to language in Section 2 which
addresses price discrimination. He expressed the understanding
that often life insurance costs less for women, while health
insurance costs more. He questioned whether this would be the
type of discrimination the language is trying to prevent.
MS. KOENEMAN explained that the intent of the legislation is to
facilitate fair and equitable agreements, which would allow
anyone to enter a DPC agreement without fear of discrimination.
MS. KOENEMAN, in response to a follow-up question, reiterated
that the intent is for there to be no price discrimination. She
reported that in states where DCP agreements have been legalized
there are set rates for individuals, families, adults, and
children, but there were no rates based on gender.
4:45:40 PM
REPRESENTATIVE FIELDS recollected that the language was written
to include "age bands" with different rates, but discrimination
between genders within these age bands would not be allowed. He
requested confirmation of this from the director of the
division.
CO-CHAIR ZULKOSKY explained that the committee would follow up
with the director outside of the meeting.
4:46:12 PM
CO-CHAIR ZULKOSKY announced that HB 176 was held over.
4:46:56 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:47 p.m.