02/15/2024 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB242 | |
| Confirmation Hearing(s)|| Board of Massage Therapists | |
| Executive Order 125 | |
| HB187 | |
| HB260 | |
| HB258 | |
| HB242 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
| *+ | HB 187 | TELECONFERENCED | |
| += | HB 260 | TELECONFERENCED | |
| += | HB 258 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 242 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 15, 2024
3:02 p.m.
DRAFT
MEMBERS PRESENT
Representative Mike Prax, Chair
Representative Justin Ruffridge, Vice Chair
Representative CJ McCormick
Representative Dan Saddler
Representative Jesse Sumner
Representative Zack Fields
Representative Genevieve Mina
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 242
"An Act extending the Alaska senior benefits payment program;
and providing for an effective date."
- MOVED HB 242 OUT OF COMMITTEE
CONFIRMATION HEARING(S):
Board of Massage Therapists
Emily Foster - Palmer
- CONFIRMATION(S) ADVANCED
EXECUTIVE ORDER 125
- HEARD
HOUSE BILL NO. 187
"An Act relating to utilization review entities; exempting
certain health care providers from making preauthorization
requests for certain services; and providing for an effective
date."
- HEARD & HELD
HOUSE BILL NO. 260
"An Act repealing programs for catastrophic illness assistance
and medical assistance for chronic and acute medical
conditions."
- MOVED HB 260 OUT OF COMMITTEE
HOUSE BILL NO. 258
"An Act relating to general relief and burial assistance; and
providing for an effective date."
- MOVED CSHB 258(HSS) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 242
SHORT TITLE: EXTEND SENIOR BENEFITS PAYMENT PROGRAM
SPONSOR(s): REPRESENTATIVE(s) VANCE
01/16/24 (H) PREFILE RELEASED 1/8/24
01/16/24 (H) READ THE FIRST TIME - REFERRALS
01/16/24 (H) HSS, FIN
02/01/24 (H) HSS AT 3:00 PM DAVIS 106
02/01/24 (H) Heard & Held
02/01/24 (H) MINUTE(HSS)
02/15/24 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 187
SHORT TITLE: PRIOR AUTH EXEMPT FOR HEALTH PROVIDERS
SPONSOR(s): REPRESENTATIVE(s) SUMNER
05/03/23 (H) READ THE FIRST TIME - REFERRALS
05/03/23 (H) HSS, L&C
02/15/24 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 260
SHORT TITLE: CATASTROPHIC ILLNESS/MEDICAL ASSISTANCE
SPONSOR(s): REPRESENTATIVE(s) STAPP
01/16/24 (H) PREFILE RELEASED 1/12/24
01/16/24 (H) READ THE FIRST TIME - REFERRALS
01/16/24 (H) HSS, FIN
02/01/24 (H) HSS AT 3:00 PM DAVIS 106
02/01/24 (H) Heard & Held
02/01/24 (H) MINUTE(HSS)
02/15/24 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 258
SHORT TITLE: GENERAL RELIEF & BURIAL ASSISTANCE
SPONSOR(s): REPRESENTATIVE(s) STAPP
01/16/24 (H) PREFILE RELEASED 1/12/24
01/16/24 (H) READ THE FIRST TIME - REFERRALS
01/16/24 (H) HSS, FIN
02/08/24 (H) HSS AT 3:00 PM DAVIS 106
02/08/24 (H) Heard & Held
02/08/24 (H) MINUTE(HSS)
02/15/24 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
REPRESENTATIVE SARAH VANCE
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As prime sponsor, presented HB 242.
EMILY FOSTER, Appointee*
Palmer, Alaska
POSITION STATEMENT: Testified as appointee to the Board of
Massage Therapists.
HEIDI HEDBERG, Commissioner
Department of Health
Anchorage, Alaska
POSITION STATEMENT: Provided background on EO 125 and answered
questions.
GENE WISEMAN, Section Chief
Rural & Community Health Services
Department of Health
Anchorage, Alaska
POSITION STATEMENT: Provided background on EO 125 and answered
questions.
WILMA VINTON, representing self
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of EO 125.
ROBERTA LEICHTY, representing self
Sitka, Alaska
POSITION STATEMENT: Testified in support of EO 125.
BRIAN WEBB, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of EO 125.
CYNTHIA LYNN, representing self
Petersburg, Alaska
POSITION STATEMENT: Expressed concern that the EO would curtail
access to care.
REPRESENTATIVE JESSE SUMNER
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As prime sponsor of HB 187, presented the
sponsor statement.
SARENA HACKENMILLER, Staff
Representative Sumner
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis for HB 187
on behalf of Representative Sumner, prime sponsor.
PAM VENTGEN, Executive Director
Alaska State Medical Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 187.
EZEQUIEL SILVA, MD, Member
Texas Medical Association
San Antonio, Texas
POSITION STATEMENT: Testified in support of HB 187.
LORI WING-HEIER, Director
Division of Insurance
Alaska Department of Commerce, Community, and Economic
Development
Anchorage, Alaska
POSITION STATEMENT: Answered questions about HB 187.
REPRESENTATIVE WILL STAPP
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As prime sponsor, introduced HB 260;
as prime sponsor of HB 258, answered questions related to
amendments.
HONOR MILLER-AUSTIN, Staff
Representative Will Stapp
Alaska State Legislature
POSITION STATEMENT: Presented background on HB 258 on behalf of
Representative Will Stapp, prime sponsor.
DEB ETHERIDGE, Director
Division of Public Assistance
Department of Health
Juneau, Alaska
POSITION STATEMENT: Answered questions regarding HB 258.
ACTION NARRATIVE
3:02:14 PM
CHAIR PRAX called the House Health and Social Services Standing
Committee meeting to order at 3:02 p.m. Representatives
Ruffridge, Sumner, Fields, Mina, and Prax were present at the
call to order. Representatives Sumner and McCormick arrived as
the meeting was in progress.
HB 242-EXTEND SENIOR BENEFITS PAYMENT PROGRAM
3:04:30 PM
CHAIR PRAX announced that the first order of business would be
HOUSE BILL NO. 242, "An Act extending the Alaska senior benefits
payment program; and providing for an effective date."
3:04:53 PM
REPRESENTATIVE VANCE, Alaska State Legislature, as prime sponsor
of HB 242, explained the bill simply extends the senior benefits
payment program by ten years.
CHAIR PRAX confirmed that a public hearing had been held for the
bill. He expressed an interest in moving the bill forward and
entertained a motion.
3:05:38 PM
REPRESENTATIVE RUFFRIDGE moved to report HB 242 out of committee
with individual recommendations and the accompanying fiscal
notes.
3:06:05 PM
REPRESENTATIVE FIELDS objected and explained he was going to
offer an amendment to index the benefits to inflation. He
observed that the Senate version was in its second reading on
the Senate floor and would pass first anyway.
3:06:25 PM
The committee took an at-ease from 3:06 p.m. to 3:07 p.m.
3:07:36 PM
REPRESENTATIVE RUFFRIDGE withdrew his motion.
3:07:46 PM
REPRESENTATIVE FIELDS moved Conceptual Amendment 1 to index the
senior benefits in the bill to inflation.
REPRESENTATIVE SADDLER explained he generally opposes indexing
financial decisions because the state has an ever-moving fiscal
situation, and the state constitution does not allow for
dedicated funds. It erodes the authority of the legislature to
lock in benefit levels for inflation.
REPRESENTATIVE MINA said she supports inflation adjusting
because many Alaskans do rely on the benefit program and have
relied on it for decades.
REPRESENTATIVE FIELDS requested to hear the bill sponsor's
response to Conceptual Amendment 1.
REPRESENTATIVE SADDLER said he did not want anyone to
misinterpret his objection to inflation proofing because he does
support the senior benefits program.
3:09:46 PM
REPRESENTATIVE VANCE spoke to the concept of inflation-proofing
by explaining it should be approached cautiously because of the
fiscal impacts. She pointed out the growing number of seniors
who are becoming eligible, and it is a robust though valid
discussion.
3:10:32 PM
REPRESENTATIVE SUMNER asked Representative Fields what he
envisioned happening in the case of deflation, particularly
because of the housing component of the Consumer Price Index
(CPI). He discussed a hypothetical situation where the current
increased cost of housing would be reversed and wondered if the
inflation index would adjust downwards.
3:11:21 PM
REPRESENTATIVE FIELDS suggested the amendment leave the
potential for deflation or clarify that the index is a floor not
a ceiling.
3:12:02 PM
A roll call vote was taken. Representatives McCormick, Fields,
and Mina voted in favor of Conceptual Amendment 1 to HB 242.
Representatives Ruffridge, Saddler, Sumner, and Prax voted
against it. Therefore, Conceptual Amendment 1 failed to be
adopted by a vote of 3-4.
3:12:59 PM
CHAIR PRAX suggested the committee table HB 242 to be taken up
later.
REPRESENTATIVE RUFFRIDGE moved to table HB 242. There being no
objection, it was so ordered.
^CONFIRMATION HEARING(S)
^BOARD OF MASSAGE THERAPISTS
CONFIRMATION HEARING(S)
BOARD OF MASSAGE THERAPISTS
3:13:28 PM
CHAIR PRAX announced that the next order of business would be
consideration of the governor's appointee, to the Board of
Massage Therapists.
3:14:09 PM
EMILY FOSTER, Appointee, Board of Massage Therapists explained
that she was encouraged to apply to the Board of Massage
Therapists and described her background as a licensed massage
therapist for 23 years. She talked about her experiences in the
chiropractic industry, as a small business owner, and as a
massage therapist and how her perspective would be a benefit to
the board.
3:15:24 PM
The committee took an at-ease at 3:15 p.m.
3:15:56 PM
REPRESENTATIVE SADDLER asked Ms. Foster to clarify her name for
the record and explain whether Emily Foster and Emma Hardy are
the same person.
MS. FOSTER explained that her daughter, Emma Hardy, had been
using the computer, and the daughter's resume was attached by
mistake.
3:17:03 PM
REPRESENTATIVE FIELDS pointed out that the Board of Massage
Therapists has been working on several important issues
including fingerprinting and identification to discourage human
trafficking through illicit massage parlors. He asked Ms.
Foster to share her views regarding combating human trafficking
as a human rights violation as well as how to support legitimate
massage therapy.
3:17:43 PM
MS. FOSTER discussed several ways the issue of illicit massage
therapy can be addressed, including identifying red flags during
the application process. She defined it as a public safety
issue and described her experiences and the difficulties the
profession has encountered on the road to becoming a legitimate
medical profession.
3:19:36 PM
CHAIR PRAX opened public testimony on the confirmation hearing
for the governor's appointee to the Board of Massage Therapists.
After ascertaining there was no one who wished to testify, he
closed public testimony.
3:20:09 PM
CHAIR PRAX stated that the House Health and Social Services
Committee has reviewed the qualifications of the governor's
appointee and recommends that the following name be forwarded to
a joint session for consideration: Emily Foster, Board of
Massage Therapists. He said that signing the report regarding
appointments to boards and commissions in no way reflects an
individual member's approval or disapproval of the appointee,
and the nomination is merely forwarded to the full legislature
for confirmation or rejection.
3:20:46 PM
The committee took an at-ease from 3:20 p.m. to 3:21 p.m.
3:21:33 PM
^EXECUTIVE ORDER 125
EXECUTIVE ORDER 125
3:21:40 PM
CHAIR PRAX announced that the next order of business would be
consideration of Executive Order 125, Transfer of Function of
the Alaska Council on Emergency Medical Services to the
Department of Health.
CHAIR PRAX announced the committee would hear invited testimony.
3:22:13 PM
HEIDI HEDBERG, Commissioner, Department of Health, began her
invited testimony with a PowerPoint presentation [hardcopy
included in the committee packet], titled "State of Alaska,
Department of Health, Executive Order 125." She showed slide 2,
Executive Order (EO) 125, which read as follows [original
punctuation provided]:
• Removes the Alaska Council on Emergency Medical
Services (ACEMS) from Alaska Statute and transfers the
responsibilities to the Department of Health
• Transferring the responsibilities does not change
the original intent
COMMISSIONER HEDBERG explained that the intent of the order is
to create an EMS advisory council or committee that would
represent the full spectrum of emergency medical care, also
known as pre-hospital care. Much has changed since the council
was first created.
3:24:13 PM
GENE WISEMAN, Section Chief, Rural & Community Health Services,
Department of Health, continued the PowerPoint and presented
slides 3 and 4, which read as follows [original punctuation
provided]]:
[Slide 3]
Alaska Council on Emergency Medical Services
• ACEMS was formed in 1977 when EMS was still emerging
as a new industry
• The composition of ACEMS members is a reflection of
their early formative years
[Slide 4]
Why is EO 125 needed?
• Flexibility
• EMS has changed in the last 47 years
• Representation
• ACEMS is codified in statute Transitioning
the composition to DOH will allow other
stakeholders a voice
• Partnership
• Allow DOH to bring in subject matter experts
and partners
• Responsive
• Advance the development of Alaska's EMS system
in a more agile approach
MR. WISEMAN gave a brief history of ACEMS and described how
emergency medical care has changed in terms of technology,
client care, stakeholders, and areas served. Because the 11
members of the council are codified in statute, it has not been
able to represent the current EMS system. By moving the
advisory committee to the Department of Health and the
commissioner, the EMS system can evolve to meet future needs.
The new structure will help with coordination, collaboration,
efficiency, effectiveness, and a more rounded representation.
3:27:06 PM
REPRESENTATIVE RUFFRIDGE asked Commissioner Hedberg if a
commissioner can create an advisory council or if that must be
done in statute.
COMMISSIONER HEDBERG explained that divisions have the authority
to create advisory committees without legislative action. She
emphasized the intent and the importance of involving
stakeholders who can help identify gaps in service. She pointed
out that ACEMS was effective when it was created, but so much
has progressed since that time. The department needs to stay in
line with current needs for pre-hospital care.
REPRESENTATIVE RUFFRIDGE inquired whether the Alaska EMS council
has met often and whether it drafts regulations. He explained
his general concern with many of the executive orders and how
eliminating boards such as this may miss the "boots on the
ground" approach.
COMMISSIONER HEDBERG replied that ACEMS meets quarterly, and has
three subcommittees: EMS for children, training, and medical
directors. She explained how the subcommittees currently
function and what changes the executive order would bring. She
compared the proposed changes to how the department's trauma
committee functions. She further suggested that an EMS
committee within the department would be able to coordinate with
the trauma committee to provide an improved continuum of care.
3:31:25 PM
REPRESENTATIVE MINA enquired about the modernization proposed
with a department's EMS committee.
MR. WISEMAN described the composition of the current ACEMS,
pointing out that not all relevant voices are at the table, so
ACEMS is unable to address advancing needs of emergency services
through the current membership. Examples include quality
assurance; electronic patient care reporting; mobile-integrated
health; dispatch and communication; behavioral health; and air
medical. The limited scope of the existing council does not
meet those needs.
3:34:38 PM
REPRESENTATIVE SADDLER asked whether ACEMS itself could be
restructured if the emergency medical system has become more
complicated.
COMMISSIONER HEDBERG explained that the department has
recognized the need for change to the composition of the EMS
system for a number of years. They did meet with ACEMS members
from the seven EMS regions to discuss the issue. She emphasized
that the department has staffing and administrative support for
all the subject matter experts. In addition, the department has
many advisory committees that are not in statute.
REPRESENTATIVE SADDLER reiterated his question.
COMMISSIONER HEDBERG responded that EO 125 seeks to do that by
transferring the 11-member board so it can change over time.
REPRESENTATIVE SADDLER again questioned the need to eliminate
the council instead of revising it to meet current needs. He
questioned whether eliminating the council is the only means of
changing the emergency medical system to meet current needs.
COMMISSIONER HEDBERG replied that the executive order does not
actually eliminate the council but rather removes it from
statute and moves the authority to the Department of Health.
REPRESENTATIVE SADDLER asked again why the council could not be
modified to meet changing needs.
COMMISSIONER HEDBERG pointed out that the original duty of the
statute was to create an EMS system, and that has been
accomplished. However, since that time, approaches to emergency
medicine have changed, but the current council does not reflect
those changes.
3:39:58 PM
REPRESENTATIVE RUFFRIDGE asked whether the department already
performs emergency medical regulatory functions.
COMMISSIONER HEDBERG answered that the state already performs
and updates the regulatory duties of EMS.
REPRESENTATIVE RUFFRIDGE explained that if ACEMS performs an
advisory function, and the department performs the regulatory
functions, then he understands the executive order more clearly.
3:40:58 PM
REPRESENTATIVE SADDLER drew attention to the statement of cost
and asked who the members of the task force would be.
MS. HEDGERG explained that the EMS for children, training, and
medical directors subcommittees would continue.
REPRESENTATIVE SADDLER asked whether the members of these
subcommittees are current members of ACEMS.
3:41:54 PM
MR. WISEMAN reviewed the history of ACEMS, explaining that those
three subcommittees existed concurrently with ACEMS and then
they were moved "underneath" ACEMS and are in the bylaws.
REPRESENTATIVE SADDLER asked for clarification that the
subcommittees that are doing the work of ACEMS and are
themselves ACEMS members currently and whether ACEMS members are
entirely different members than the subcommittees.
MR. WISEMAN explained that they are not appointed by Boards and
Commissions, so they are not official members of ACEMS, but each
subcommittee has at least one member of ACEMS.
3:44:07 PM
CHAIR PRAX explained that if the committee has no objection to
the executive order, they can simply let it go forward. If
there is an objection, a member would need to draft a
resolution.
3:44:46 PM
CHAIR PRAX opened public testimony on Executive Order 125.
WILMA VINTON, representing self, discussed her background as an
EMS and a paramedic in Alaska. She said she supports EO 125
because she feels an advisory council in the Department of
Health in partnership with the office of EMS would better
represent the stakeholders and the people of Alaska.
REPRESENTATIVE MINA asked whether there are lots of applicants
to the council.
MS. VINTON responded that there were currently two openings, and
they have been open almost a year. She gave example of some
difficulties in staffing due to the appointment process.
3:49:26 PM
ROBERTA LEICHTY, representing self, reviewed her history as a
first responder of EMS. She described ACEMS as a solid
foundation and EO 125 as an evolution not an elimination. Now
the state is divided into seven EMS regions, and EO 125 could
help with some of the difficulties that come from each region's
diverse issues. This would positively affect outcomes, she
predicted.
3:52:17 PM
The committee took an at-ease at 3:52 p.m.
3:52:51 PM
BRIAN WEBB, representing self, discussed the early days of ACEMS
when it was under the Department of Public Safety. Currently,
it is a circuitous route to get things done, and the membership
reflects EMS from the 1970s when ACEMS was formed. He explained
that EO 125 would create a situation more reflective of Alaska's
needs than the current ACEMS.
3:56:34 PM
CYNTHIA LYNN, representing self, touched upon the issues of
living in a small community. She expressed concern that EO 125
would create a less personal system which would be difficult for
small communities to access.
3:59:00 PM
CHAIR PRAX closed public testimony on EO 125.
HB 187-PRIOR AUTH EXEMPT FOR HEALTH PROVIDERS
3:59:18 PM
CHAIR PRAX announced that the next order of business would be
HOUSE BILL NO. 187, "An Act relating to utilization review
entities; exempting certain health care providers from making
preauthorization requests for certain services; and providing
for an effective date."
4:00:00 PM
REPRESENTATIVE JESSE SUMNER, Alaska State Legislature, as prime
sponsor, gave the sponsor statement for HB 187 [included in the
committee packet], which read as follows [original punctuation
provided]:
Sponsor Statement
HB 187: Prior Auth Exempt for Health Providers
HB 187 aims to reduce the wait time for certain health
care services by exempting health care providers from
making preauthorization requests for said services.
Currently, Alaskans who need certain health care
services must wait days and even weeks at a time to
get pre-authorized to receive health care services
because of the processing time between the health care
provider and insurance companies. This bill would help
Alaskans receive health care services immediately,
especially health care services that could save their
lives.
This bill would create a utilization review entity
that may evaluate whether a health care provider
continues to qualify for an exemption if during the
most recent 12- month period, the utilization review
entity has approved or would approve at least 80% of
the prior authorization requests submitted by the
health care provider for that health care service.
The Health Care provider is not required to request an
exemption to qualify for an exemption. A utilization
review may not deny or reduce payment for a health
care service that is exempted.
Other states with prior authorization exemptions have
seen increased frequency of patients who receive the
health care services they need expediently.
This bill will help Alaskans receive fast, efficient,
and quality healthcare when they need it without
waiting for a preauthorization process that could
cause their health to decline even more.
4:01:42 PM
SARENA HACKENMILLER, Staff, Representative Jesse Sumner, Alaska
State Legislature, on behalf of Representative Sumner, prime
sponsor, presented the sectional analysis for HB 187 {included
in the committee packet] which read as follows [original
punctuation provided]:
HB 187: Prior Auth Exempt for Health Providers
Sectional Analysis
Section 1: AS 21.07.005(a) is amended to insert the
following language into sub-section (1) under (a) so
it reads "the structure and operation of utilization
review and benefit determination processes, including
processes for utilization review entities under AS
21.07.100".
Sec. 2. AS 21.07 is amended by adding a new section
called Sec. 21.07.100. Utilization Review Entities to
implement the following:
A utilization review entity may not require a health
care provider to complete a prior authorization for a
health care service for a covered person to receive
coverage for the health care service if, during the
most recent 12 month period, the utilization review
entity has approved or would have approved at least 0
percent of the prior authorization requests submitted
by the health care provider for that health care
service.
A utilization review entity may evaluate whether a
health care provider continues to qualify for an
exemption not more than once every 12 months. A
utilization review entity is not required to evaluate
an existing exemption, and nothing prevents a
utilization review entity from establishing a longer
exemption period. A health care provider is not
required to request an exemption to qualify for an
exemption.
If a health care provider does not receive an
exemption, the health care provider may, once every 12
months of providing health care services, request the
utilization review entity to provide a determination
to deny a prior authorization exemption under (a) of
this section. The utilization review entity shall
provide to the health care provider an explanation of
how to appeal the determination.
A utilization review entity may revoke an exemption
after 12 months if the utilization review entity does
the following:
• Decides that the health care provider would not have
met the 80% approval criteria based on a retrospective
review of the claims for the health care service for
which the exemption applies for the previous three
months or the period needed to reach a minimum of 10
claims for review.
Provides the health care provider with the
information used by the utilization review entity to
make the determination to revoke the exemption.
• Provides an explanation to the health car provider
on how to appeal the determination.
The exemption remains in effect until the 30th day
after the date the utilization review entity notifies
the health care provider of its determination to
revoke the exemption or, if the health care provider
appeals the determination, the fifth day after the
revocation is upheld on appeal.
A determination to revoke or deny an exemption by a
utilization review entity must be made by a health
care provider licensed in Alaska with the same or
similar specialty as the health care provider being
consider for an exemption and must have experience in
the health care service, they are providing for which
the requested exemption applies.
A utilization review entity must provide a health care
provider who receives an exemption of this section
with a notice that includes the following:
• A statement that the health care provider qualifies
for an exemption from a prior authorization
requirement and the duration of the exemption.
• A list of health care services for which the
exemption applies.
A utilization review entity may not deny or reduce
payment for a health care service exempted from a
prior authorization requirement, including a health
care service performed or supervised by another health
care provider when the health care provider who
ordered the service received a prior authorization
exemption, unless the health care provider providing
the health care service does the following:
• Knowingly and materially misrepresented the health
care service in a quest for payment submitted by the
utilization review entity with the specific intent to
deceive and obtain an unlawful payment form a
utilization review entity.
Failed to substantially perform the health care
service(s)
In this sectional analysis, the following are defined:
• "Health care services" means the following:
o The provision of pharmaceutical products, services,
or durable medical equipment
o A health care procedure, treatment, or service
provided in a health care facility licensed in Alaska
or by a Doctor of Medicine, Doctor of Osteopathy, or
within the scope of practice of a health care
professional who is licensed in Alaska.
• "Health maintenance organization" has the meaning
given in AS 21.86.900.
• "Prior authorization" means the process used by a
utilization review entity to determine the medical
necessity or medical appropriateness of a covered
entity to determine the medical necessity or medical
appropriateness of a covered health care service
before the health care service is provided or a
requirement that a covered person or health care
provider notify a health care insurer or utilization
review entity before providing a health care service.
• "Utilization review entity" means an individual or
entity that performs prior authorization for the
following:
o An employer in Alaska with employees covered under a
health benefit plan or health insurance policy.
o A health care insurer
o A preferred provider organization
o A health maintenance organization
o An individual or entity that provides, offers to
provide, or administers hospital, outpatient, medical,
prescription drug, or other health care benefits to a
person treated by a health care provider licensed in
Alaska under a health care policy, plan, or contract.
Sec. 3. This Act takes effect immediately under AS
01.10.070(c)
4:07:54 PM
CHAIR PRAX announced the committee would hear invited testimony
on HB 187.
4:08:09 PM
PAM VENTGEN, Executive Director, Alaska State Medical
Association, expressed her support for HB 187. She explained
how prior authorization works and how it is often a barrier to
treatment. She gave statistics and examples of prior
authorization having a negative impact on patient care, and said
oncology is especially impacted by the prior authorization
issue.
4:11:04 PM
REPRESENTATIVE MINA asked how often claims are denied due to
prior authorization and how much time goes into appealing those
claims by patients trying to get services.
MS. VENTGEN replied that the American Medical Association has
that data, and she will forward that information to the
committee members.
4:12:17 PM
REPRESENTATIVE RUFFRIDGE described how much time goes into
processing prior authorizations, leaving less time for patient
care.
MS. VENTGEN agreed with Representative Ruffridge and responded
with specific examples.
4:13:38 PM
REPRESENTATIVE MINA asked Ms. Ventgen what feedback she receives
from insurance companies regarding the potential for waste and
fraud under this scenario.
MS. VENTGEN explained that insurance companies claim a bill such
as this leads to waste and fraud. However, similar bills in
other states have shown that when 80 percent of claims are
approved, incidents of fraud and waste go down considerably. If
half of the physician's prior authorization requests are denied,
that raises more of a question. That is why the bill sets the
number at 80 percent. Physicians who have a lower percentage of
reliable authorizations will still need to use prior
authorization.
4:15:51 PM
EZEQUIEL SILVA, MD, Member, Texas Medical Association, shared
his experience with issues caused by delayed or denied prior
authorizations. He gave examples of significant lags in care
because of slow authorizations. The serious adverse events
motivated the Texas State Legislature to pass a bill similar to
HB 187, and since that time, Texas has seen positive results.
He expressed support for HB 187.
4:17:52 PM
LORI WING-HEIER, Director, Division of Insurance, Alaska
Department of Commerce, Community, and Economic Development,
explained that the prior authorization issue is very emotional
for many people, "because when you want your health care
service, you want it now." On the other hand, people want
affordable health care. The providers claim this bill will
reduce costs, but insurers say if there is no review of
treatment, it may be even more costly. She explained how the
external review process works.
4:19:59 PM
CHAIR PRAX questioned whether the division has data regarding
the records of physicians who no longer need prior authorization
because their treatment authorizations are correct 80 percent of
the time.
MS. WING-HEIER replied that she didn't have that data but would
see what was available.
CHAIR PRAX asked whether the percent of appeals was significant.
MS. WING-HEIER explained that not many people go directly to
insurance companies with grievances about authorizations. She
would have to ask the insurance companies about the numbers, and
it would take several weeks to get the information about how
many grievances insurance companies had regarding prior
authorizations.
4:21:48 PM
REPRESENTATIVE SADDLER questioned what constitutes a utilization
review entity as referenced on page 4 of HB 187and whether there
were any in Alaska.
MS. WING-HEIER replied that there are utilization review
entities in Alaska. She described the procedure a person would
go through when a prior authorization is denied. She would get
the names of utilization review entities to the committee.
REPRESENTATIVE SADDLER reiterated his understanding of the
workflow for prior authorizations grievances and reviews.
MS. WING-HEIER said the review process starts with the insurance
company saying yes or no. If the patient or physician is not
happy with the answer, then it goes to the division. At that
point the division asks for an external review. Once the
external review is returned to the division, it informs all the
parties: the insurer, the provider, and the patient.
4:24:16 PM
CHAIR PRAX reiterated his understanding that once a service
provider proves that 80 percent of the prior authorizations have
been accepted, then that provider would not need to request
prior authorization review. He asked whether that was a
lifetime exemption.
4:25:12 PM
REPRESENTATIVE SUMNER called attention to Section 2, line 8.
CHAIR PRAX requested clarification concerning an insurer's point
of view.
REPRESENTATIVE SUMNER described how the utilization review
entity would make that determination.
4:27:13 PM
CHAIR PRAX announced HB 187 was held over.
HB 260-CATASTROPHIC ILLNESS/MEDICAL ASSISTANCE
4:27:20 PM
CHAIR PRAX announced that the next order of business would be
HOUSE BILL NO. 260, "An Act repealing programs for catastrophic
illness assistance and medical assistance for chronic and acute
medical conditions."
4:28:11 PM
REPRESENTATIVE FIELDS explained that he and Representative Mina
had discussed HB 260 with the sponsor, and they agreed that it
should be advanced from the committee with no amendments.
4:28:54 PM
REPRESENTATIVE RUFFRIDGE moved to report HB 260 out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, HB 260 was reported out of the
House Health and Social Services Standing Committee.
4:29:15 PM
CHAIR PRAX announced there being no objections, HB 260 is moved
out of committee.
4:29:21 PM
The committee took an at-ease from 4:29 to 4:34 p.m.
HB 258-GENERAL RELIEF & BURIAL ASSISTANCE
4:34:28 PM
CHAIR PRAX announced that the next order of business would be
HOUSE BILL NO. 258,"An Act relating to general relief and burial
assistance; and providing for an effective date."
4:35:41 PM
REPRESENTATIVE FIELDS moved to adopt Amendment 1 to HB 258,
labeled 33-LS1020\B.2, Bergerud, 2/11/24, which read as follows:
Page 4, following line 31:
Insert new bill sections to read:
"* Sec. 7. AS 47.25.300(3) is amended to read:
(3) "needy person" means a needy resident of
the state who is not eligible for aid from another
public agency or department providing similar services
in the state and who has personal resources of $1,500
or less;
* Sec. 8. AS 47.25.300 is amended by adding a new
paragraph to read:
(5) "personal resources" does not include
credit."
Renumber the following bill sections accordingly.
Page 5, following line 8:
Insert a new bill section to read:
"* Sec. 10. 7 AAC 47.160(c)(4) is annulled."
Renumber the following bill section accordingly.
[REPRESENTATIVE SUMNER] objected.
REPRESENTATIVE FIELDS explained that Amendment 1 takes the
current statutory $500 resource threshold and updates it to
$1,500. He explained his rationale for the amendment and gave
examples of how general relief has been used.
4:37:15 PM
REPRESENTATIVE SADDLER asked the bill sponsor for his thoughts
on Amendment 1.
REPRESENTATIVE WILL STAPP, Alaska State Legislature, as prime
sponsor of HB 258, addressed several concerns he had with the
amendment. First, the cost of the program would go up. People
would qualify for the program who are additionally enrolled in
other programs. He pointed out issues that would ensue with the
word "credit" being included. He asked Representative Fields
how he arrived at the amount of $1,500.
4:38:31 PM
REPRESENTATIVE FIELDS responded that the number was calculated
by figuring the value of a very old car in Anchorage under the
scenario of people living in their car and seeking shelter.
4:38:54 PM
CHAIR PRAX asked Representative Sumner if he maintained his
objection. [The response was in audible.]
4:39:00 PM
A roll call vote was taken. Representatives Mina, McCormick,
and Fields voted in favor of Amendment 1 to HB 258.
Representatives Sumner, Saddler, and Prax voted against it.
Therefore, Amendment 1 failed to be adopted by a vote of 3-3.
4:39:45 PM
The committee took a brief at-ease at 4:39 p.m.
4:40:15 PM
REPRESENTATIVE FIELDS moved to adopt Amendment 2 to HB 258,
labeled 33-LS1020\B.3, Bergerud, 2/12/24, which read as follows:
Page 4, following line 16:
Insert a new bill section to read:
"* Sec. 5. AS 47.25.150 is amended to read:
Sec. 47.25.150. Application for assistance. A person
requesting burial assistance shall apply for it,
either personally or through another person, in a
format and manner prescribed in regulations adopted by
the department. Regulations adopted under this section
must establish an electronic application for
assistance and allow an applicant to submit an
application in electronic format or in other formats
required by state and federal law. The electronic
application must inform an applicant that a false
statement made on the application will be investigated
and is punishable under AS 11.56.210. If a person has
been referred to the general relief and burial
assistance program by the department, or has applied
for and been denied assistance under all other
programs administered by the department under this
chapter, the department shall determine whether the
person is eligible for assistance under AS 47.25.120 -
47.25.300. If the department finds that the person is
eligible for assistance, the department shall grant
assistance without collecting further information from
the person. In this section, "electronic application"
means an application for benefits or renewal of
benefits, whether the department exclusively
administers the benefits or administers the benefits
in coordination with another state agency or federal
agency, electronically completed and submitted through
the department's Internet website."
Renumber the following bill sections accordingly.
[REPRESENTATIVE SUMNER] objected.
REPRESENTATIVE FIELDS explained the rationale for Amendment 2 is
to provide "relief of last resort." He suggested the wording
makes it more efficient for the department to administer that
relief.
REPRESENTATIVE STAPP responded that he was not entirely sure if
it would work that way. He suggested that it would create more
work for the department rather than less.
4:42:32 PM
CHAIR PRAX asked Representative Sumner if he maintained his
objection. [The response was inaudible.]
4:42:38 PM
A roll call vote was taken. Representatives Fields, Mina, and
McCormick voted in favor of Amendment 2 to HB 258.
Representatives Ruffridge, Saddler, Sumner, and Prax voted
against it. Therefore, Amendment 2 to HB 258 failed by a vote
of 3-4.
4:43:14 PM
REPRESENTATIVE FIELDS moved to adopt Amendment 3 to HB 258,
labeled 33-LS1020\B.4, Bergerud, 2/12/24, which read as follows:
Page 4, following line 16:
Insert a new bill section to read:
"* Sec. 5. AS 47.25.170 is amended to read:
Sec. 47.25.170. Granting of assistance. Upon the
completion of its investigation, the department shall
decide whether the applicant is eligible for and
should receive assistance promptly under AS 47.25.120
- 47.25.300, the amount of assistance, the manner of
paying or providing it, and the date on which the
assistance shall begin. The department may approve an
applicant for a period of up to six months and may
provide the assistance in monthly installments or as a
lump sum. The department shall notify the applicant of
its decision."
Renumber the following bill sections accordingly.
REPRESENTATIVE SUMNER objected.
REPRESENTATIVE FIELDS pointed to the extremely low threshold of
the general relief statute and explained that Amendment 3
provides the department authority to meet the overall relief
threshold for a six-month period in a lump sum.
4:44:40 PM
REPRESENTATIVE STAPP addressed the mechanics of the utilities
assistance and how the department negotiates with third-party
providers. However, the main objection comes from information
provided by staff's discussion with a homeless coordinator.
HONOR MILLER-AUSTIN, Staff, Representative Will Stapp, on behalf
of Representative Stapp, prime sponsor of HB 258, described what
she learned from Bryan Wilson, one of Juneau's homeless
coordinators. He referenced programs that worked for him
including Section 8 housing, emergency housing vouchers, and
emergency rental assistance programs.
4:46:54 PM
REPRESENTATIVE MINA addressed the need for additional general
relief when costs for housing are rising and people are
struggling. There is often a delay in the programs mentioned,
and people need emergency options.
4:47:38 PM
REPRESENTATIVE STAPP said he did not believe that time-sensitive
emergency benefits should go through the Division of Public
Assistance, and that is generally the nucleus of the bill.
4:48:10 PM
DEB ETHERIDGE, Director, Division of Public Assistance,
Department of Health, discussed the issue of payment for
emergency shelter. She talked about evictions, duplicate
applications, and the maximum allowable amount of $120 a month
for hotels.
REPRESENTATIVE SADDLER asked Ms. Etheridge to respond to
Amendment 3 with its lump sum payment in light of the monthly
benefit amount.
MS. ETHERIDGE responded that an individual must apply for the
$120 benefit each month, so the lump sum would affect their
ability to apply.
4:50:34 PM
REPRESENTATIVE FIELDS explained that the intent of the amendment
is to allow the six-month amount of $70 a month to be used at
one time. He said that he also reached out to several people
who work with the homeless, and there is not complete agreement
as to how best to address the problem.
4:51:37 PM
REPRESENTATIVE SADDLER reiterated that the monthly amount of
$120 would equal $720. He enquired whether that would
contradict the allowable amount of assistance of $120 a month.
REPRESENTATIVE STAPP answered that it might eliminate the
eligibility entirely because it is capped at a certain amount.
He deferred to Ms. Etheridge.
MS. ETHERIDGE explained that the general relief program is not a
benefit paid to the individual but rather to a vendor. The
asset limit is $500.
REPRESENTATIVE SADDLER requested clarification regarding whether
there are time limits to benefits paid on a monthly basis.
MS. ETHERIDGE responded that the division's calculations are
based on a monthly amount rather than a lump sum.
4:53:49 PM
CHAIR PRAX questioned whether the emergency benefits were
available on a 24-hour basis and how someone could take
advantage of these benefits.
MS. ETHERIDGE replied that the Department of Public Assistance
operates on an eight to five basis, Monday through Friday,
taking emergency requests during those times.
4:54:33 PM
REPRESENTATIVE FIELDS reiterated the main points of Amendment 3.
4:55:30 PM
CHAIR PRAX asked Representative Sumner if he maintained his
objection. [The response was inaudible.]
4:55:34 PM
A roll call vote was taken. Representatives Fields, Mina, and
McCormick voted in favor of Amendment 3 to HB 258.
Representatives Sumner, Ruffridge, Saddler, and Prax voted
against it. Therefore, Amendment 3 failed to be adopted by a
vote of 3-4.
4:56:10 PM
REPRESENTATIVE MINA moved to adopt Amendment 4 to HB 258,
labeled 33-LS1020\B.1, Bergerud, 2/10/24, which read as follows:
Page 4, lines 26 - 31:
Delete all material and insert:
"* Sec. 6. AS 47.25.300(1) is amended to read:
(1) "assistance" means financial assistance
to or on behalf of a needy person for [, INCLUDING]
subsistence (food, shelter, fuel, clothing, and
utilities), [AND] transportation, medical needs,
funeral and [(INCLUDING, BUT NOT LIMITED TO,
HOSPITALIZATION, NURSING, AND CONVALESCENT CARE),]
burial expenses, and other determined needs;"
[CHAIR SUMNER] objected.
REPRESENTATIVE MINA explained that Amendment 4 retains the rent
and utility assistance part of general relief while keeping the
part of the bill that addresses the burial services. She
pointed out that $120 doesn't seem like a big amount, but it is
significant for people who are at risk of homelessness. She
pointed out that the processing time for these benefits is
nominal, so the benefits outweigh the administrative burden. In
addition, she referenced a letter from the Disability Law Center
which said deleting the references of shelter from the bill
would affect a different line item which is general relief for
assisted living homes. The referenced general relief for
assisted living is a last resort for individuals who cannot
qualify for a Medicaid waiver but who are in need of assisted
living services such as people being discharged from
corrections, psychiatric institutes, and hospitals. Since there
are not enough general relief behavioral health assisted living
homes, it is costing the state a lot more. There is a concern
that deleting this language would impact other programs.
4:58:49 PM
REPRESENTATIVE STAPP addressed the two aspects brought up by
Representative Mina. He explained he is concerned with results-
based budgeting, and the cost to deliver this nominal service is
astronomical. Regarding the second aspect, he thinks there is
another amendment which would address that concern.
REPRESENTATIVE MINA pointed out that the amendment refers to
shelter, so it also addresses utilities. She prefers to keep
the language that is currently in statute to allow some
flexibility in how it is administered.
5:01:11 PM
REPRESENTATIVE SUMNER maintained his objection to Amendment 4.
5:01:15 PM
A roll call vote was taken. Representatives Fields and Mina
voted in favor of Amendment 4 to HB 258. Representatives
Saddler, Ruffridge, and Prax voted against it. [Representative
Sumner passed.]
5:01:51 PM
The committee took a brief at-ease at 5:02 p.m.
5:02:08 PM
CHAIR PRAX voided the roll for Amendment 4 to HB 258.
5:02:18 PM
A roll call vote was taken. Representatives Fields and Mina
voted in favor of Amendment 4 to HB 258. Representatives
Ruffridge, Sadler, Sumner, and Prax voted against it.
Therefore, Amendment 4 failed to be adopted by a vote of 2-4.
5:02:51 PM
The committee took an at-ease from 5:02 to 5:04 p.m.
5:04:16 PM
CHAIR PRAX moved to adopt Amendment 5 to HB 258, labeled 33-
LS1020\B.5, Bergerud, 2/12/24, which read as follows:
Page 4, line 29, following "needs,":
Insert "assisted living facility expenses,"
There being no objection, Amendment 5 was adopted.
5:04:57 PM
REPRESENTATIVE RUFFRIDGE moved to report HB 258, as amended, out
of committee with individual recommendations and the
accompanying fiscal notes.
5:05:17 PM
The committee took a brief at-ease at 5:05 p.m..
5:05:33 PM
CHAIR PRAX announced there being no objection, CSHB 258(HSS) was
reported from the House Health and Social Services Standing
Committee.
5:05:49 PM
The committee took an at-ease from 5:05 to 5:08 p.m.
HB 242-EXTEND SENIOR BENEFITS PAYMENT PROGRAM
5:08:51 PM
CHAIR PRAX announced that the next order of business would be a
return to HOUSE BILL NO. 242, "An Act extending the Alaska
senior benefits payment program; and providing for an effective
date."
5:08:57 PM
REPRESENTATIVE RUFFRIDGE moved to take HB 242 off the table.
There being no objection, HB 242 was once again before the
committee.
5:09:13 PM
REPRESENTATIVE FIELDS moved to adopt Amendment 2 to HB 242,
labeled (NEED TO FIND THE AMENDMENT)
REPRESENTATIVES SUMNER and SADDLER objected.
REPRESENTATIVE FIELDS explained that Amendment 2 ensures senior
benefits are paid at the statutory level which is higher than
they have paid out the past five or six years, and they have
been administratively reduced for the last five or six years.
He provided context for the amendment by pointing out currently
the department has additional administrative authority beyond
the legislature's ability to appropriate. The amendment would
ensure the greatest likelihood of paying out at the statutory
level.
5:10:39 PM
The committee took an at-ease from 5:10 p.m. to 5:12 p.m.
5:12:09 PM
REPRESENTATIVE VANCE, Alaska State Legislature, as prime sponsor
of HB 242, said she remained neutral regarding Amendment 2 at
that point because she did not know whether it would change the
fiscal note. She appreciated people being able to appeal the
amount of distribution. By principle she likes to apply things
equally across law, and this may create a conflict with other
monetary distribution people receive from the state.
5:13:10 PM
REPRESENTATIVE SUMNER explained he is not certain that deleting
this language from statute would have the result the amendment's
sponsor believes it would have in the event of an insufficient
appropriation.
CHAIR PRAX asked for input from someone from the administration.
5:14:05 PM
DEB ETHERIDGE, Director, Division of Public Assistance,
Department of Health, explained that the appropriations would
have to be included in the division's base budget. Furthermore,
it would require knowing exactly the number of individuals who
would be applying at which benefit level. If the division
didn't have the appropriations, it would have to ask for
additional funds through ratification, otherwise it could impact
other general fund programs.
5:14:54 PM
REPRESENTATIVE SADDLER said he was inclined to not support the
amendment and let the division know the issue is likely to come
up in the future.
REPRESENTATIVE FIELDS asked whether Legislative Legal Services
could answer questions about the amendment.
5:15:35 PM
REPRESENTATIVE SUMNER posed a hypothetical, asking if this
amendment passed, and the appropriation was not made, would
other programs be impounded in order to pay off the benefit.
MS. ETHERIDGE explained that she needed additional time to
review the impact of the amendment.
5:16:08 PM
REPRESENTATIVE SUMNER removed his objection to Amendment 2 to HB
242.
REPRESENTATIVE SADDLER [maintained his objection].
REPRESENTATIVE RUFFRIDGE reiterated his understanding that if
the division is not allowed to "short" the benefit if the
appropriation does not match, under statute the division would
have to find those dollars.
MS. ETHERIDGE said that was her understanding.
5:17:17 PM
REPRESENTATIVE SADDLER confirmed that he still maintained his
objection.
5:17:22 PM
A roll call vote was taken. Representatives Mina, Sumner, and
Fields voted in favor of Amendment 2 to HB 242. Representatives
Ruffridge, Sadler, and Prax voted against it. Therefore,
Amendment 2 242 failed to be adopted by a vote of 3-3.
5:18:18 PM
REPRESENTATIVE RUFFRIDGE moved to report HB 242 out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, HB 242 was reported out of the
House Health and Social Services Standing Committee.
5:18:42 PM
CHAIR PRAX called an at-ease from 5:18 p.m. to 5:20 p.m.
5:20:46 PM
ADJOURNMENT
There being no further business before the committee, the *House
Health and Social Services Standing Committee meeting was
adjourned at *5:20 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 187 Letter of Support - AHHA.pdf |
HHSS 2/15/2024 3:00:00 PM |
HB 187 |
| HB 187 Sponsor Statement.pdf |
HHSS 2/15/2024 3:00:00 PM |
HB 187 |
| HB 187 State Law Chart.pdf |
HHSS 2/15/2024 3:00:00 PM |
HB 187 |
| HB 187 Survey Data.pdf |
HHSS 2/15/2024 3:00:00 PM |
HB 187 |
| HB 187 Version A.pdf |
HHSS 2/15/2024 3:00:00 PM |
HB 187 |
| HB187 Sectional Analysis.pdf |
HHSS 2/15/2024 3:00:00 PM |
HB 187 |
| Emily Foster's Resume.pdf |
HHSS 2/15/2024 3:00:00 PM |
Governor's Appointee |
| Barbara Tyndall Application Redacted.pdf |
HHSS 2/15/2024 3:00:00 PM |
Governor's Appointee |
| Barbara Tyndall's Resume.pdf |
HHSS 2/15/2024 3:00:00 PM |
Governor's Appointee |
| HB 187 Fiscal Note DCCED.pdf |
HHSS 2/15/2024 3:00:00 PM |
HB 187 |
| EO 125 Transfer Function of AK Council on EMS to DOH.pdf |
HHSS 2/15/2024 3:00:00 PM |
EO 125 |
| EO 125 DOH Statement of Cost.pdf |
HHSS 2/15/2024 3:00:00 PM |
EO 125 |
| EO 125 legal memo.pdf |
HHSS 2/15/2024 3:00:00 PM |
EO 125 |
| HB 258 Amendment B.2 #1.pdf |
HHSS 2/15/2024 3:00:00 PM |
HB 258 |
| HB 258 Amendment B.3 #2.pdf |
HHSS 2/15/2024 3:00:00 PM |
HB 258 |
| HB 258 Amendment B.4 #3.pdf |
HHSS 2/15/2024 3:00:00 PM |
HB 258 |
| HB 258 Amendment B.1 #4.pdf |
HHSS 2/15/2024 3:00:00 PM |
HB 258 |
| HB 258 Amendment B.5 #5.pdf |
HHSS 2/15/2024 3:00:00 PM |
HB 258 |
| HB 187 Premera Letter.pdf |
HHSS 2/15/2024 3:00:00 PM |
HB 187 |
| HB 187 Letter from AETNA.pdf |
HHSS 2/15/2024 3:00:00 PM |
HB 187 |
| EO 125 Presentation 2.15.24.pptx.pdf |
HHSS 2/15/2024 3:00:00 PM |
EO 125 |
| Letter to House HSS regarding IRO 021624.pdf |
HHSS 2/15/2024 3:00:00 PM |
HB 187 |
| EO 125 SE Region EMS Council Testimony.pdf |
HHSS 2/15/2024 3:00:00 PM |
EO 125 |
| EO 125 Pam Ventgen Testimony.pdf |
HHSS 2/15/2024 3:00:00 PM |
EO 125 |
| EO 125 - Brian Webb.pdf |
HHSS 2/15/2024 3:00:00 PM |
EO 125 |
| HB 187 AK Medical Association Testimony.pdf |
HHSS 2/15/2024 3:00:00 PM |
HB 187 |
| HB 187 AHIP Comments AK.pdf |
HHSS 2/15/2024 3:00:00 PM |
HB 187 |
| HB 187 ANTHC Support.pdf |
HHSS 2/15/2024 3:00:00 PM |
HB 187 |
| HB 187 AK Medical Association Testimony.pdf |
HHSS 2/15/2024 3:00:00 PM |
HB 187 |