05/07/2021 08:00 AM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| SB40 | |
| HB44 | |
| HB176 | |
| HB58 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 44 | TELECONFERENCED | |
| += | HB 176 | TELECONFERENCED | |
| + | HB 58 | TELECONFERENCED | |
| += | SB 40 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE LABOR AND COMMERCE STANDING COMMITTEE
May 7, 2021
8:03 a.m.
DRAFT
MEMBERS PRESENT
Representative Zack Fields, Co-Chair
Representative Ivy Spohnholz, Co-Chair
Representative Calvin Schrage
Representative Liz Snyder
Representative David Nelson
Representative James Kaufman
Representative Ken McCarty
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 40
"An Act relating to veterans' benefits services and veterans'
benefits appeal services."
- MOVED SB 40 OUT OF COMMITTEE
HOUSE BILL NO. 44
"An Act relating to the practice of accounting."
- 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
HOUSE BILL NO. 58
"An Act relating to insurance coverage for contraceptives and
related services; relating to medical assistance coverage for
contraceptives and related services; and providing for an
effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 40
SHORT TITLE: VETERANS' BENEFITS SERVICES; DISCLOSURE
SPONSOR(s): SENATOR(s) REVAK
01/25/21 (S) PREFILE RELEASED 1/15/21
01/25/21 (S) READ THE FIRST TIME - REFERRALS
01/25/21 (S) STA, L&C
03/04/21 (S) STA AT 3:30 PM BUTROVICH 205
03/04/21 (S) Heard & Held
03/04/21 (S) MINUTE(STA)
03/11/21 (S) STA AT 3:30 PM BUTROVICH 205
03/11/21 (S) Heard & Held
03/11/21 (S) MINUTE(STA)
03/18/21 (S) STA AT 3:30 PM BUTROVICH 205
03/18/21 (S) Moved SB 40 Out of Committee
03/18/21 (S) MINUTE(STA)
03/19/21 (S) STA RPT 4DP
03/19/21 (S) DP: SHOWER, HOLLAND, COSTELLO, REINBOLD
03/19/21 (S) OBJECTION (REGARDING REPORTING OUT OF
COMMITTEE PROCESS)
03/19/21 (S) POSTPONE QUESTION TO MARCH 24 Y14 N2
E3 A1
03/22/21 (S) OBJECTION WITHDRAWN (REGARDING
REPORTING OUT OF COMMITTEE PROCESS)
03/29/21 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
03/29/21 (S) Moved SB 40 Out of Committee
03/29/21 (S) MINUTE(L&C)
03/31/21 (S) L&C RPT 5DP
03/31/21 (S) DP: COSTELLO, REVAK, GRAY-JACKSON,
HOLLAND, STEVENS
04/09/21 (S) TRANSMITTED TO (H)
04/09/21 (S) VERSION: SB 40
04/12/21 (H) READ THE FIRST TIME - REFERRALS
04/12/21 (H) MLV, L&C
04/22/21 (H) MLV AT 1:00 PM GRUENBERG 120
04/22/21 (H) Heard & Held
04/22/21 (H) MINUTE(MLV)
04/27/21 (H) MLV AT 1:00 PM GRUENBERG 120
04/27/21 (H) Moved SB 40 Out of Committee
04/27/21 (H) MINUTE(MLV)
04/28/21 (H) MLV RPT 6DP
04/28/21 (H) DP: CLAMAN, RAUSCHER, TARR, STORY,
NELSON, TUCK
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
BILL: HB 44
SHORT TITLE: PRACTICE OF ACCOUNTING; LICENSURE
SPONSOR(s): REPRESENTATIVE(s) THOMPSON
02/18/21 (H) PREFILE RELEASED 1/8/21
02/18/21 (H) READ THE FIRST TIME - REFERRALS
02/18/21 (H) STA, L&C
03/11/21 (H) STA AT 3:00 PM GRUENBERG 120
03/11/21 (H) Heard & Held
03/11/21 (H) MINUTE(STA)
03/16/21 (H) STA AT 3:00 PM GRUENBERG 120
03/16/21 (H) Heard & Held
03/16/21 (H) MINUTE(STA)
03/23/21 (H) STA AT 3:00 PM GRUENBERG 120
03/23/21 (H) Moved CSHB 44(STA) Out of Committee
03/23/21 (H) MINUTE(STA)
03/24/21 (H) STA RPT CS(STA) 6DP 1AM
03/24/21 (H) DP: CLAMAN, STORY, KAUFMAN, VANCE,
TARR, KREISS-TOMKINS
03/24/21 (H) AM: EASTMAN
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
BILL: HB 176
SHORT TITLE: DIRECT HEALTH AGREEMENT: NOT INSURANCE
SPONSOR(s): REPRESENTATIVE(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
BILL: HB 58
SHORT TITLE: CONTRACEPTIVES COVERAGE:INSURE;MED ASSIST
SPONSOR(s): REPRESENTATIVE(s) CLAMAN
02/18/21 (H) PREFILE RELEASED 1/15/21
02/18/21 (H) READ THE FIRST TIME - REFERRALS
02/18/21 (H) HSS, L&C
04/15/21 (H) HSS AT 3:00 PM DAVIS 106
04/15/21 (H) Heard & Held
04/15/21 (H) MINUTE(HSS)
04/20/21 (H) HSS AT 3:00 PM DAVIS 106
04/20/21 (H) Moved CSHB 58(HSS) Out of Committee
04/20/21 (H) MINUTE(HSS)
04/22/21 (H) HSS RPT CS(HSS) 5DP 2DNP
04/22/21 (H) DP: FIELDS, SPOHNHOLZ, MCCARTY,
ZULKOSKY, SNYDER
04/22/21 (H) DNP: PRAX, KURKA
05/03/21 (H) L&C AT 3:15 PM BARNES 124
05/03/21 (H) <Bill Hearing Canceled>
05/07/21 (H) L&C AT 8:00 AM GRUENBERG 120
WITNESS REGISTER
REPRESENTATIVE STEVE THOMPSON
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As prime sponsor, provided information
during the hearing on HB 44.
SARA CHAMBERS, Director
Division of Corporations, Business, and Professional Licensing
Department of Commerce, Community, and Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
44.
KAREN TARVER, CPA
Elgee Rehfeld, LLC
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
44.
CORI HONDOLERO, Executive Administrator
Board of Public Accountancy
Divisions of Corporations, Business, and Professional Licensing
Department of Commerce, Community, and Economic Development
Anchorage, Alaska
POSITION STATEMENT: Provided information during the hearing on
HB 44.
LYNETTE BERGH, Staff
Representative Steve Thompson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
44 on behalf of Representative Thompson, prime sponsor.
SPACIA STRALEY, CPA
Eagle River, Alaska
POSITION STATEMENT: Testified in support of HB 44.
KELLY WARD, CPA
Robinson and Ward
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 44.
KAREN TARVER, CPA
Elgee Rehfeld, LLC
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 44.
CRYSTAL KOENEMAN, Staff
Representative Sara Rasmussen
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Provided information on HB 176 on behalf of
Representative Rasmussen, prime sponsor.
JAY KEESE, Executive Director
Direct Primary Care Coalition
Washington, D.C.
POSITION STATEMENT: Presented a PowerPoint during the hearing
on HB 176.
CLINT FLANAGAN, MD, Chief Executive Officer
Nextera Healthcare
Longmont, Colorado
POSITION STATEMENT: Answered questions during the hearing on HB
176.
LORI WING-HEIER, Director
Division of Insurance
Department of Commerce, Community, and Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
176.
CLINT FLANAGAN, MD, Chief Executive Officer
Nextera Healthcare
Longmont, Colorado
POSITION STATEMENT: Testified in support of HB 176.
WADE ERICKSON, MD, Owner and Founder
Capstone Clinic
Wasilla, Alaska
POSITION STATEMENT: Testified in support of HB 176.
BETHANY MARCUM, Chief Executive Officer
Alaska Policy Forum
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 176.
ROSE LARSON
Wasilla, Alaska
POSITION STATEMENT: Testified in support of HB 176.
OAKLEY JACKSON
Wasilla, Alaska
POSITION STATEMENT: Testified in support of HB 176.
PORTIA NOBLE
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 176.
SARAH HETEMI
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 176.
CRYSTAL NYGARD, Deputy Administrator
City of Wasilla
Wasilla, Alaska
POSITION STATEMENT: Testified in support of HB 176.
SERENE O'HARA JOLLY
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 58.
MORGAN LIM
Planned Parenthood Alliance Advocates
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 58.
JAN CAROLYN HARDY
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 58.
PATTY OWEN, Policy and Advocacy Committee
Alaska Public Health Association
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 58.
JACOB POWELL
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 58.
HEIDI ZIMMER
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 58.
LYNETTE PHAM
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 58.
CANDACE CAHILL
Denali, Alaska
POSITION STATEMENT: Testified in support of HB 58.
VALORRAINE DATTAN
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 58.
ELIZABETH FIGUS
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 58.
KRISTIN MAHLEN
Cordova, Alaska
POSITION STATEMENT: Testified in support of HB 58.
GABE CANFIELD
Ketchikan, Alaska
POSITION STATEMENT: Testified in support of HB 58.
LIZZIE KUBITZ, Staff
Representative Matt Claman
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Provided information and answered questions
during the hearing on HB 58 on behalf of Representative Claman,
prime sponsor.
RENEE GAYHART, Director
Division of Health Care Services
Department of Health & Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
58.
ACTION NARRATIVE
8:03:05 AM
CO-CHAIR ZACK FIELDS called the House Labor and Commerce
Standing Committee meeting to order at 8:03 a.m.
Representatives Fields, Schrage, McCarty, and Snyder were
present at the call to order. Representatives Spohnholz,
Nelson, and Kaufman arrived as the meeting was in progress.
SB 40-VETERANS' BENEFITS SERVICES; DISCLOSURE
8:03:34 AM
CO-CHAIR FIELDS announced that the first order of business would
be SENATE BILL NO. 40, "An Act relating to veterans' benefits
services and veterans' benefits appeal services."
8:03:55 AM
CO-CHAIR FIELDS opened public testimony on SB 40. After
ascertaining that no one wished to testify, he closed public
testimony.
8:04:19 AM
REPRESENTATIVE SCHRAGE moved to report SB 40 out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, SB 40 was reported out of the
House Labor and Commerce Standing Committee.
8:04:47 AM
The committee took an at-ease from 8:04 a.m. to 8:05 a.m.
HB 44-PRACTICE OF ACCOUNTING; LICENSURE
8:05:42 AM
CO-CHAIR FIELDS announced that the next order of business would
be HOUSE BILL NO. 44, "An Act relating to the practice of
accounting."
[Before the committee was CSHB 44(STA).]
8:05:58 AM
REPRESENTATIVE STEVE THOMPSON, Alaska State Legislature, as
prime sponsor, shared that the proposed legislation would update
Alaska's public accountancy statutes to bring Alaska more in
line with national standards. The updates would help ensure a
uniform approach to the regulation of accounting in Alaska, he
said, which would protect the public's interest.
8:07:30 AM
REPRESENTATIVE MCCARTY referred to the term "mobility model,"
which would allow business entities outside the state to provide
services within the state. He asked whether those out-of-state
professions currently pay professional license fees as well as a
business license fee.
REPRESENTATIVE THOMPSON deferred to Ms. Chambers.
8:08:40 AM
SARA CHAMBERS, Director, Division of Corporations, Business, and
Professional Licensing (CBPL), Department of Commerce,
Community, and Economic Development (DCCED), shared that other
states that have implemented mobility measures have not
experienced a meaningful increase in investigative expenses
targeting out-of-state practitioners. She noted that only those
out-of-state practitioners performing non-attestation functions
would be able to practice without a license; anyone performing
the higher-level attestation functions would be required to have
a license within the state. She compared the proposed
legislation to the Nurse Licensure Compact and said that of the
35 states that have adopted the compact, there have not been any
reports of legitimate, demonstrable problems for the
jurisdiction.
REPRESENTATIVE MCCARTY asked Ms. Chambers to clarify whether a
professional licensed in another state could provide services in
Alaska without paying licensing fees.
MS. CHAMBERS said, "Yes, that's what this bill is proposing
under certain circumstances." She explained that not all out-
of-state firms or individuals would be able to practice in
Alaska without a license, but there are some practices that
could take place with a business license but not a professional
license.
REPRESENTATIVE MCCARTY asked whether Alaska would waive the fees
for in-state licensees.
MS. CHAMBERS responded, "That is not my understanding." She
explained that a professional's home state bears the
responsibility for due diligence and ensuring public protection.
A professional with an unencumbered license who meets the other
standards within HB 44, she said, could practice within Alaska.
She said the question of equity is addressed by allowing Alaskan
licensees the privilege of practicing in other states.
REPRESENTATIVE MCCARTY wondered whether there is an agreement
between Washington and Alaska regarding mobility.
MS. CHAMBERS responded that under a compact, like the Nurse
Licensure Compact, there's a standard agreement adopted by the
legislatures. Under the less formal "mobility model," she said,
states which meet the national standards for requirements
independently adopt the standards.
8:15:18 AM
REPRESENTATIVE THOMPSON reminded committee members that the
purpose of the proposed legislation is to bring Alaska's
statutes up-to-date in order to operate under the same national
standards as other licensing jurisdictions.
8:15:44 AM
KAREN TARVER, CPA, Elgee Rehfeld, LLC, explained that the
American Institute of Certified Public Accountants introduced
the practice of "firm mobility" in 2014; since then, 30 of the
55 licensing jurisdictions have adopted it. She said that the
model provides greater oversight by the jurisdictional licensing
boards because a professional is subject to the regulations and
statutes in the state in which the professional is providing
services.
REPRESENTATIVE MCCARTY expressed the view that losing
accreditation does not mean that an individual is no longer able
to practice their profession. He then asked, "Where is the
equitableness of this, and ... where's the arm of enforcement
upon this?"
MS. TARVER responded, "The equity through firm mobility is that
I, as an Alaska CPA, could provide services outside the state as
well [as] in a state that has firm mobility without having to
get a permit in that state." The regulatory oversight, she
said, is ultimately held by the licensee's home state; Alaska
retains the ability to sanction an out-of-state licensee under
Alaska's statutes and regulations. She added that there is a
national database of CPAs, which facilitates a smooth process of
information sharing.
REPRESENTATIVE MCCARTY expressed understanding of the equitable
nature of the mobility model.
8:22:11 AM
CO-CHAIR SPOHNHOLZ asked for clarification on the enforcement
mechanism.
8:23:30 AM
MS. CHAMBERS explained that the proposed legislation would
provide explicit language stating that the board has the ability
to relieve a practitioner of the right to practice within the
state; the prohibition would be communicated through the
national database to the licensee's home state.
CO-CHAIR SPOHNHOLZ asked Ms. Chambers to clarify whether Alaska
would "rely on a national database to protect Alaskans from bad
actors."
MS. CHAMBERS responded that the national database would let all
of the other licensing jurisdictions know of the complaints
against the individual. Alaska's licensing board would
undertake a regular investigation.
CO-CHAIR SPOHNHOLZ stated that professional licensing is the
enforcement mechanism in the state. She said that she doesn't
understand what the enforcement mechanism is if, as a result of
the proposed legislation, the state no longer requires licensing
of accountants.
MS. CHAMBERS replied that there is a section in the proposed
legislation that would specifically authorize the Board of
Public Accountancy to prohibit someone with an out-of-state
license from being able to practice in Alaska.
CO-CHAIR SPOHNHOLZ said, "We are, in fact, asking another state
to enforce ... Alaskan licensing practice standards, by adopting
this."
MS. CHAMBERS replied that the Board of Public Accountancy would
be enforcing Alaska's practice standards by prohibiting the out-
of-state individual from practicing within Alaska. She said
that this prohibition would then be communicated to other states
in a manner similar to what is currently done by other state
licensing boards; in the health care profession, she said, a
licensee who is disciplined is reported to the national
database, and other states in which the practitioner is licensed
may investigate the licensee for similar issues. She said that
Alaska would be similarly reliant on other states to determine
whether an accountant is qualified.
CO-CHAIR SPOHNHOLZ said that all healthcare practitioners are
currently required to be licensed in Alaska, and that the state
licensing board may revoke their license at any time. She
suggested that the proposed legislation could mean that Alaska's
licensees would be paying for enforcement against practitioners
in another state. She expressed the belief that the proposed
legislation would give other states control over Alaska
licensing regulations.
8:31:55 AM
CO-CHAIR FIELDS asked for an example of an out-of-state
practitioner being disciplined within their home state.
MS. CHAMBERS replied that the mechanism has been working for
many years in other states that have adopted the firm mobility
language.
8:33:34 AM
LYNETTE BERGH, Staff, Representative Steve Thompson, Alaska
State Legislature, pointed out that Mr. Neill previously
discussed a case in Washington. He also testified that the
mobility method works, because other licensing jurisdictions are
made aware of any disciplinary actions against a licensee.
CO-CHAIR FIELDS asked who operates the national database.
MS. CHAMBERS deferred to Ms. Hondolero.
8:35:21 AM
CORI HONDOLERO, Executive Administrator, Board of Public
Accountancy, Divisions of Corporations, Business, and
Professional Licensing, Department of Commerce, Community, and
Economic Development, said that the National Association of
State Boards of Accountancy runs the Accountancy Licensee
Database (ALD), which 55 licensing jurisdictions participate in.
She said that the investigator for Alaska's Board of Public
Accountancy has access to the database.
CO-CHAIR FIELDS said, "I have no confidence that a state like
Alabama would ever be capable of overseeing this or, frankly,
any other, program." He hypothesized about a situation in which
an Alabama licensee failed to live up to standards, and Alabama
subsequently declined to discipline the licensee. He asked what
recourse the Board of Public Accountancy would have.
MS. HONDOLERO replied that Alaska could issue a cease and desist
order prohibiting the out-of-state practitioner from operating
in Alaska.
CO-CHAIR FIELDS asked what legal threshold would need to be
crossed in order to issue a cease and desist order if there is
no proof of misbehavior in the licensee's home state.
8:37:30 AM
MS. CHAMBERS pointed out that the Board of Public Accountancy is
constantly in the process of determining whether an individual
should be allowed to practice in Alaska. In Representative
Fields' example, she said, the board would independently
determine whether the out-of-state practitioner was allowed to
practice in Alaska. She said that, through use of the database,
Alaska's board can be aware of any issues in other states and
prohibit any individual from practicing within Alaska. She said
that while a licensee's home state could act on the individual's
license, Alaska's board would not be waiting for the other state
to act and could issue a cease and desist order with no other
information.
CO-CHAIR FIELDS asked whether there would be a mechanism to
require that out-of-state licensees to pay a fee to stay in the
system.
8:40:33 AM
REPRESENTATIVE THOMPSON said that those licensed in Alaska don't
have to pay fees to practice in Washington.
8:40:47 AM
MS. CHAMBERS reminded committee members that license fees cover
the costs of operation for all professional boards in Alaska.
She said that in any program, whenever there's an unlicensed
practice concern, the licensees have to cover that cost. The
bigger pictures, she said, is that there's no mechanism to
recover costs, which is something that has been brought before
the legislature in the past. She said that HB 44 contains a
provision that the board may require that disciplinary costs
against an out-of-state licensee be covered by the defendant,
but other mechanisms would need to be included for the board to
have the ability to receive funding. She stressed that
licensees pay the costs of all investigations, whether or not
the individual is licensed. She said the proposed legislation
would give the board more authority than that which is specified
under current law, allowing the "good actors" to face less
bureaucracy, along with stronger language and oversight for the
"bad actors."
8:43:48 AM
REPRESENTATIVE KAUFMAN asked how many states are aligned in
similar processes.
MS. CHAMBERS pointed out that Ms. Tarver testified that 30
states are already part of the network.
REPRESENTATIVE KAUFMAN asked, "In the 30 other states that are
operating under this model, do we have indications of serious
problems - upon adopting this, have they spun out of control?"
MS. CHAMBERS responded that other states have reported that they
have not had any problems out of the ordinary. They have
reported, she said, that the model reduces bureaucracy without
forgoing jurisdictional authority.
REPRESENTATIVE KAUFMAN asked Ms. Chambers what she thinks of the
proposed legislation in its current form.
MS. CHAMBERS responded that the proposed legislation would be a
good move for Alaska and would help keep Alaska, and Alaskan
firms, competitive with firms in other states.
8:47:30 AM
REPRESENTATIVE SNYDER asked for documentation on the lack of
problems experienced by other states.
MS. CHAMBERS responded that CBPL will work with AICPA on
documentation.
8:48:18 AM
REPRESENTATIVE SCHRAGE asked for more discussion on the issue of
enforcement costs being paid for by license fees.
MS. CHAMBERS explained that CBPL oversees 43 licensing programs
and 21 boards, and that each program and board is funded by fees
from its licensees. She stressed that when someone is
practicing without a license, the licensees cover the costs of
investigations. She said that investigations and appeals, which
can go all the way through the court system, sometimes cost as
much as $100,000, which must be covered by licensees. She said,
"When you hear complaints about licensing fees ... if the fees
go up, that's often because there is a very expensive
investigation and disciplinary action and appeal of that, that
licensees are required by state law to cover - not the bad
actor." She said that CPBL would enjoy the opportunity to look
at legislation to make the system fairer to those licensees who
are practicing in accordance with their licenses.
REPRESENTATIVE SCHRAGE discussed the possibility of legislation
allowing boards to recoup investigation fees from defendants who
are found guilty. He expressed that the national database would
provide transparency in the case of a "bad actor" who moves from
state to state.
MS. CHAMBERS stated her agreement with his comment about the
national database, pointing out that the database currently
exists and is utilized by the State Board of Accountancy.
8:52:42 AM
CO-CHAIR FIELDS asked Ms. Chambers to talk about enforcement of
the provisions under HB 44.
MS. CHAMBERS said:
"We don't feel the bill needs any enforcement
augmentation, just the fee recovery model, and if
we're able to accomplish that with this bill, that
would be great ... we currently don't have a problem,
don't see a problem, and are not hearing from other
jurisdictions that this is a problem."
CO-CHAIR FIELDS asked whether Ms. Chambers was referring to fee
recovery when she mentioned possible additions to the proposed
legislation.
MS. CHAMBERS said yes.
8:53:47 AM
CO-CHAIR FIELDS suggested looking at the possibility of an
addition to the proposed legislation to address fee recovery.
8:55:12 AM
CO-CHAIR FIELDS opened public testimony on HB 44.
8:55:30 AM
SPACIA STRALEY, CPA, stated her support for HB 44 as the owner
of a small accounting firm in Alaska.
8:56:08 AM
KELLY WARD, CPA, Robinson and Ward, stated her support of HB 44.
8:56:44 AM
KAREN TARVER, CPA, Elgee Rehfeld, LLC, stated that she "wholly
supports" HB 44, and she shared her appreciation for committee
members who are working to ensure that the proposed legislation
"gets it right." She pointed out that AICPA has a website that
addresses firm mobility and contains resources regarding the
experience of other states.
8:57:40 AM
CO-CHAIR FIELDS, after ascertaining that no one else wished to
testify, closed public testimony on HB 44.
[HB 44 was held over.]
HB 176-DIRECT HEALTH AGREEMENT: NOT INSURANCE
8:58:00 AM
CO-CHAIR FIELDS announced that the next 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."
8:58:21 AM
CRYSTAL KOENEMAN, Staff, Representative Sara Rasmussen, Alaska
State Legislature, on behalf of prime sponsor Representative
Rasmussen, told committee members that direct primary care (DPC)
agreements would encompass all of the healthcare profession
licenses under Title 8, including doctor's visits, mental health
counseling, or marriage and family counseling. She clarified
that the agreements would not include emergency services or
urgent care.
9:00:18 AM
JAY KEESE, Executive Director, Direct Primary Care Coalition,
presented a PowerPoint on HB 176 [hard copy included in the
committee packet]. He said the Direct Primary Care Coalition
represents approximately 1,500 direct primary care practices
nationwide, and he noted that 35 states have passed legislation
relating to direct primary care agreements. He began his
presentation with slide 2, "Status of Direct Primary Care in
2021," which displayed a map of the U.S. with green, red, and
blue points in various jurisdictions and which read as follows
[original punctuation provided]:
? Capitated Monthly Fee Payment model
? Personal relationship with primary care physician
Care delivered in any setting virtual, telehealth,
at home, in-person
? Innovative, affordable, value-based monthly payment
model ? Over 1,400 practices nationwide
? Bipartisan Legislative History:
? Defined in ACA Section 1301 (a) (3)
? 30 + Bipartisan State Laws and Regulations
? CMS Innovation Center to demo Direct
Contracting in Medicare
? Presidential Executive Order 13877
? IRS Proposed Rule 2020 12213
? Primary Care Enhancement Act: S. 2999 Cassidy
HR 3707 Blumenauer passed House in 2018,
Included in original CARES Act
MR. KEESE presented slide 3, "DPC Laws/Regs Passed in 34
States," which displayed a map of the U.S. showing states with
DPC laws in place or proposed, along with a list of the
governing legislation in each state. He then presented slide 4,
"DPC Reduced Overall Cost of Care," which read as follows
[original punctuation provided]:
25.4% reduction in total claims costs**
4.7% reduction in risk scores
ER Visits down 53%***
Advanced Radiology down 66%
Surgeries down 77%
Hospital admission down 33%*
Specialist visits down 43%
Non-MD Specialists down 39%
Primary care visits up 133%
12% reduction from baseline HBA1C
Up to 41% reduction in cost of care for chronically
ill patients Increased compliance for preventive
screenings
Why?
? More primary care utilization
? Reduction in specialty care /hospitalization
? Reduced overall health costs
? Reduced out of pocket costs for consumers
? Predictable fixed costs for employers/payers
? Significantly reduced administrative costs no
claims, no disputes, no appeals
Data Sources:
* Iora Dartmouth Health Connect Study June 2016
** Nextera/Digital Globe Case Study June 1 Dec. 31,
2015
*** Journal American Board of Family Medicine , Nov.
2015 Qliance employer claims data set 2011-13
MR. KEESE presented slide 5, which read as follows [original
punctuation provided]:
DPC is associated with a reduction in overall member
demand for health care services outside primary care:
? 19.90% lower claim costs for employers 40% fewer ER
visits that those in traditional plans.53.6% reduction
in ER claims cost.
? 25.54% lower hospital admissions on an unadjusted
basis.
Virtual Care and Telehealth are at the core of DPC
service offerings:
? 99% of all DPC practices surveyed were doing virtual
consults via text/phone as a part of the membership
fee (two years prior to COVID-19).
? 88% said they provided "telemedicine" benefits
(meaning expanded video or additional digital
communications assets).
DPC is Affordable Primary Care
? The average adult monthly DPC Fee is $73.92.
? Median age for DPC patient was 31.8 years old
? Concierge patients in MDVIP membership $1,650 -
$2,200 annual membership fee MDVIP also bills third-
party payers for all services provided to members.
9:06:47 AM
REPRESENTATIVE SNYDER referred to the map on slide 2 and asked
what the colored circles represent.
MR. KEESE explained that green indicates providers that offer
only DPC agreements, red represents practices that offer DPC,
and the blue and yellow represent practices that offer some
combination of DPC and fee-for-service arrangements.
REPRESENTATIVE SNYDER referred to slide 3 and asked about the
color legend.
MR. KEESE noted that the map is out of date. He said the states
in blue - Alaska, Minnesota, Wisconsin, Maryland, and the
District of Columbia - all have pending DPC legislation. He
said that the states in blue and green stripes - Colorado,
Oklahoma, Missouri, Iowa, Indiana, and Tennessee - are amending
existing legislation. He said the states in gray do not have a
law in place, either because there already exist statutes which
would render DPC-specific legislation redundant, or because the
states just haven't proposed the legislation.
9:10:00 AM
REPRESENTATIVE SCHRAGE acknowledged that offering a subscription
model makes sense from a business standpoint. He then asked
whether capacity has been an issue, and whether there is a
remedy for patients who are not able to book an appointment for
care due to capacity.
MR. KEESE replied that DPC providers usually have a smaller
patient panel compared to fee-for-service providers. He said
that he doesn't know of any capacity issues.
9:12:41 AM
CLINT FLANAGAN, MD, Chief Executive Officer, Nextera Healthcare,
expressed his agreement with Mr. Keese's statement that capacity
has not been a problem. He described the problems inherent with
the fee-for-service model, such as having to wait up to a month
for an appointment, that don't exist with the DPC model. He
said that fee-for-service practices often have a patient roster
of several thousand, while DPC practices have a patient roster
of between 500 and 1,000. He said, "Access and time are
definite pillars of direct primary care ... as a movement that
was created by physicians that solve problems in a fee-for-
service insurance model, we want to make sure our patients have
that access." He pointed out that DPC agreements are month-to-
month, and that if a patient is dissatisfied with the agreement,
it can be terminated.
9:14:45 AM
REPRESENTATIVE SCHRAGE asked whether the monthly agreement is
required, or whether there could be a longer minimum commitment.
MS. KOENEMAN responded that the proposed legislation has been
written so that providers could determine their own parameters,
and consumers could shop for the DPC agreement that best fits
their needs.
CO-CHAIR FIELDS asked who stands to benefit from a DPC
agreement, and what types of consumer protections should be
considered. He said, "If you have a direct primary care
agreement, and you still have to pay for health insurance for
your higher costs, how is that going to work in Alaska with the
plans that are out there?"
9:17:05 AM
LORI WING-HEIER, Director, Division of Insurance, Department of
Commerce, Community, and Economic Development, answered that
it's the opinion of the Division of Insurance that there is a
benefit to DPC agreements. For example, she said, a young
couple that has a health care plan with a deductible of $20,000
might still want regular primary care checkups. She said that
they could pay $100 per month for a DPC agreement and receive
primary care for non-serious ailments without having to use
their insurance. She pointed out the possibility of insurance
companies canceling someone's insurance due to the existence of
a DPC agreement, and she said that consumers deserve a way to
have complaints heard.
CO-CHAIR FIELDS asked whether the view is that DPC agreements
would primarily benefit those with high-deductible insurance
plans or people who "choose" not to have health insurance.
MS. WING-HEIER replied, "That's correct." She said many young
people have high-deductible plans, some people utilize health
sharing ministries, and it's possible that people who are on
Medicare may still be able to remain under the care of their
long-term providers.
CO-CHAIR FIELDS asked whether a DPC agreement would work for a
family physician in Anchorage.
MS. WING-HEIER responded that there has been interest over the
years from clinics in Anchorage and Fairbanks.
CO-CHAIR FIELDS asked whether there exists evidence from other
states that suggest that establishing such legislation tends to
have an impact on the availability of family physicians.
MS. WING-HEIER replied that there has been concern about what
would happen to Medicaid or lower-income patients if every
physician used a fee-for-service model.
9:21:16 AM
CO-CHAIR SPOHNHOLZ asked how DPC agreements could relate to
Affordable Care Act (ACA) provisions.
MS. WING-HEIER said, "In some ways, they complement them." She
said that an insurance company cannot credit an individual for
buying a DPC agreement, and that insurance would still be
required to provide the 10 essential health benefits under ACA.
She said that someone cannot negotiate a different health
insurance plan simply due to the existence of a DPC agreement.
CO-CHAIR SPOHNHOLZ asked what some possible side boards would
be.
MS. WING-HEIER expressed that discrimination due to health
status needs to be addressed, and that providers should be able
to cap the number of patients they have. She said that
consumers would need to be clear that a DPC agreement doesn't
take the place of insurance.
CO-CHAIR SPOHNHOLZ noted the importance of transparency.
9:24:35 AM
CO-CHAIR SPOHNHOLZ pointed out that the proposed legislation
doesn't limit what types of health care may use DPC agreements.
She asked Dr. Flanagan whether his practice limits DPC
agreements to primary care.
DR. FLANAGAN responded that the focus was originally to form a
model for patient care that was better than the fee-for-service
model. He said that nationwide, Nextera has family medicine,
internal medicine, and pediatric doctors, as well as other
specialties; in Colorado, clinics include specialists in
orthopedics, cardiology, endocrinology, and rheumatology.
9:27:22 AM
REPRESENTATIVE KAUFMAN referred to slide 4 of Mr. Keese's
PowerPoint, and he asked for an explanation of "risk scores."
MR. KEESE explained that the numerous benefits that come from
utilization of DPC agreements result in lower levels of risk to
involved organizations such as employers and insurance
companies. He said liability insurance providers has looked at
the benefits of DPC agreements, and that insurance companies see
the agreements as "insurance against using your insurance."
REPRESENTATIVE KAUFMAN asked whether there exist metrics on the
difference between the time spent with patients versus time
spent on administrative tasks.
MR. KEESE said that there is "virtually no administration" for
practices with DPC agreements, versus an average of 40 percent
for fee-for-service providers. He said that the process of
working with insurance companies in filing the claim, then
trying to get paid, then appealing a denied claim, doesn't exist
in the DPC model.
9:32:11 AM
REPRESENTATIVE SNYDER asked about the attributes of fee-for-
service users versus DPC users, and whether those attributes
change after a DPC model is in place.
DR. FLANAGAN said that change is observable. He said that in a
fee-for-service model, a doctor sees one patient every 10 to 15
minutes; the appointment is often for the single, annual
checkup; and care is limited by what the insurance plan will
cover, so a patient with a chronic illness such as diabetes
won't return to the office for a follow-up because of the cost
concern. In contrast, he said, DPC patients can be seen six to
seven times per year, either in the office or through
telemedicine, and a deeper relationship develops between the
patient and providers. He shared that his clinic happens to
currently be doing a high number of sports physicals for
children, and one child was also having some issues with anxiety
and depression. The clinic is doing follow-up visits with the
child through video chat, at no additional cost to the parents.
In a fee-for-service model, he said, those visits may never have
happened, because his parents have a high-deductible health
plan. He would have gotten his sports physical through the
school instead of through his own doctor, and because the
financial barrier is removed, his other health issues are being
addressed.
9:36:43 AM
CO-CHAIR FIELDS opened public testimony on HB 176.
9:37:09 AM
CLINT FLANAGAN, MD, Chief Executive Officer, Nextera Healthcare,
stated his support for HB 176 and commented that doctors in DPC
practices call themselves "happy doctors," because the
challenges inherent to the fee-for-service world are removed.
He said that happy doctors have happy patients and, because 87
percent of Nextera Healthcare's clientele are employers, the
employers are happy. He commented that his fee-for-service
colleagues are "burned out."
9:38:14 AM
WADE ERICKSON, MD, Owner and Founder, Capstone Clinic, stated
his support for HB 176. He shared that there is a standard in
the American Academy of Family Practice called "quadruple aim,"
which is to increase access, reduce costs, improve quality of
care, and improve physician quality of life. He said that DPC
agreements would help accomplish that aim. He said that his
practice, which has been in business for 20 years, currently
sees administration taking up 50 percent of its time, which
would be greatly improved through the use of DPC agreements.
Regarding the concerns mentioned earlier in the meeting
regarding access and capacity, he said that access is an issue
with fee-for-service providers, and that the market would
determine access.
9:40:41 AM
BETHANY MARCUM, Chief Executive Officer, Alaska Policy Forum,
stated the Alaska Policy Forum's support for HB 176 and said
that she can personally attest to the benefits of the DPC model.
She said that her access to her provider is unlimited, she pays
$75 per month, and that he does not bill insurance for her care.
She pointed to studies that found that, when county employees
were offered a DPC benefit option, there was a 99 percent
satisfaction rate with a 26 percent decrease in monthly costs
compared to employees covered by regular insurance. She said
that members reported spending almost twice the amount of time
with their physician, and 79 percent of patients reported that
their health improved. A 2020 case study, she said, found that
emergency room visits by DPC patients were 40 percent lower than
those with a standard model of insurance. She said that the DPC
model has the ability to transform the healthcare landscape in
Alaska.
9:42:57 AM
ROSE LARSON stated her support for HB 176. She said that she is
an independent contractor and business developer, and often
works with businesses that experience difficulty in insuring
their employees.
9:44:17 AM
CO-CHAIR FIELDS asked how Ms. Larson found out about the DPC
model.
MS. LARSON replied through the Young Republican Party.
9:44:26 AM
OAKLEY JACKSON testified in support of HB 176. She said that
it's difficult to find health insurance that is both affordable
and worth the cost, so being able to access primary care would
be good for the younger community.
CO-CHAIR FIELDS asked whether she would buy a DPC plan or health
insurance.
MS. JACKSON said she would pursue a DPC plan over regular health
insurance because of the flat rate and the level of support
afforded by DPC agreements. She said many people don't go to a
doctor unless they're dying, due to the excessive costs.
CO-CHAIR FIELDS asked whether she thinks $1,200 per year is
affordable.
MS. JACKSON said, "Overall, absolutely."
9:46:59 AM
CO-CHAIR SPOHNHOLZ asked whether she has tried to get health
insurance.
MS. JACKSON replied yes.
CO-CHAIR SPOHNHOLZ asked whether she looked on the ACA
marketplace.
MS. JACKSON replied that plans on the marketplace ranged from
$450 to $600 per month. She said that she can't afford health
insurance, so she deals with any health issues on her own.
CO-CHAIR SPOHNHOLZ asked whether she is eligible for any
subsidies on the ACA marketplace, and she said that the average
Alaskan pays $80 per month, due to subsidies.
MS. JACKSON replied that she hasn't had that option.
9:48:13 AM
PORTIA NOBLE testified in support of HB 176. She shared her
personal experience with DPC in another state and said that she
received consistent care that focused on health, supplemental
nutrition, exercise, and long-term wellness. She said that she
never had any anxiety regarding the cost of the service. "Lower
cost, more access, gave me more choice and control of health
care for my daughter and I," she said. She said that she valued
the sense of privacy within the DPC agreement, having vetted her
own provider instead of having to select from in-network
providers and have a third party involved in her health care.
9:51:00 AM
SARAH HETEMI testified in support of HB 176. She said that as a
young professional, she knows how hard it can be to find good
insurance, and that self-employed Alaskans would love to have
affordable medical care for themselves and their families. She
said DPC agreements would expand access to services while
increasing the quality and lowering the cost of health care.
9:53:38 AM
REPRESENTATIVE MCCARTY asked whether Ms. Hetemi was saying that
certain insurance companies require a patient to visit a doctor
in their preferred network.
MS. HETEMI expressed confusion at the suggestion that she made
that claim.
9:54:24 AM
CRYSTAL NYGARD, Deputy Administrator, City of Wasilla, testified
in support of HB 176. She said that she has years of experience
helping small business navigate health insurance and finding
health care for herself and her family. She said that she has
experienced "drastic" savings by simply asking how much a
service costs, and that she has worked directly with providers
and insurers on payments, navigating the red tape inherent in
the system. She said that she has been a purchaser of health
care plans for 25 years, and that health care is one of the top
four expenses of small businesses.
9:58:41 AM
CO-CHAIR FIELDS, after ascertaining that no one else wished to
testify, closed public testimony on HB 176.
[HB 176 was held over.]
HB 58-CONTRACEPTIVES COVERAGE: INSURE; MED ASSIST
9:58:49 AM
CO-CHAIR FIELDS announced that the final order of business would
be HOUSE BILL NO. 58, "An Act relating to insurance coverage for
contraceptives and related services; relating to medical
assistance coverage for contraceptives and related services; and
providing for an effective date."
CO-CHAIR FIELDS opened public testimony on HB 58.
9:59:11 AM
SERENE O'HARA JOLLY testified in support of HB 58. She said
that her doctor recommended oral birth control and that, even
though she had a prescription for one year, she was only able to
access it one month at a time. She said that the medication
worked, but that she had to tell her boss why she needed the
entire day off to drive from an outlying area to a pharmacy.
She said that no one should have to tell their boss their
medical information in order to obtain an already-prescribed
medication, and that she missed a day of work each month in
order to fill a prescription that was deemed both safe and
necessary. She said she has been told that limiting birth
control refills to one month is necessary because of the
perception that women lose their birth control pills, a claim
she described as insulting, noting that she has been allowed
multiple months of other medications by the same insurance
company. She pointed out that she was lucky to live on the road
system and to have an understanding boss.
10:02:02 AM
MORGAN LIM, Planned Parenthood Alliance Advocates, testified in
support of HB 58. He noted that part of the Affordable Care Act
mandate is that people have affordable access to contraceptive
care. He said being forced into monthly refills is a burden for
residents of Alaska, especially in the aftermath of COVID-19,
and the risk of unintended pregnancy is increased. He said one
in three women have reported difficulty in accessing consistent
birth control during the pandemic.
10:03:39 AM
JAN CAROLYN HARDY testified in support of HB 58. She read a
statement, which read as follows [original punctuation
provided]:
Each year at my annual physical my doctor goes over my
prescriptions with me to confirm use and efficacy.
Each year if I still want or need the prescription my
doctor issues a script for 12 months. Not one month,
not six months. 12 months. This is this cost effective
in that I do not need to meet with my doctor on a
monthly basis or an every six month basis in order to
get a refill of a standard, ongoing prescription.
Why should this procedure be any different for birth
control prescriptions?
Can you imagine how costly, time consuming, and
oftentimes impossible it is to meet with your doctor
every month? Think of child care. Think of the expense
of transportation. Think of unpaid time away from
work. Think of access. If a patient lives in the
villages where medical attention is negligible how
could she possibly renew a prescription if required to
meet with her doctor prior to receiving a script?
Limiting access to birth control is draconian. It is
oppressive against a certain segment of our
population.
Again, thank you for your attention. I am in support
of HB 58.
10:05:08 AM
PATTY OWEN, Policy and Advocacy Committee, Alaska Public Health
Association, testified in support of HB 58. She said HB 58
would improve health care by allowing access to prescribed
medication and lowering direct health care costs, allowing
individuals the ability to use contraceptives consistently and
as prescribed.
10:06:25 AM
JACOB POWELL testified in support of HB 58. He said that he
takes medication and was recently able to move from monthly
refills to an extended period of time between refills, a change
he described as "life-changing." He said that when he was
having to refill every month, he would miss work or would have
to scramble and pay out of pocket if he was out of state. He
said that it's ridiculous that women aren't able to access
contraceptives consistently.
10:07:47 AM
HEIDI ZIMMER testified in support of HB 58. She said that she's
disappointed, but not surprised, to be well into the twenty-
first century and still be debating access to birth control.
She said that birth control allows couples and families to make
choices about family structure and timing, and that requiring
monthly visits for refills is not feasible. She reminded the
committee that contraceptives aren't dangerous, addictive, or
sold on the black market, but are basic medical care that should
be accessible.
10:09:34 AM
LYNETTE PHAM testified in support of HB 58. She said that
passing HB 58 could help reduce the odds of unintended
pregnancy. Those living in rural areas, or those who can't
afford to travel monthly, would be helped by this legislation.
10:10:31 AM
CANDACE CAHILL testified in support of HB 58. She pointed out
that many people in Alaska lack access to transportation, and
that allowing consistent access to birth control would allow
families to plan children while saving month in the long run.
10:11:51 AM
VALORRAINE DATTAN testified in support of HB 58. She described
her health issues that are alleviated by hormonal birth control,
and she spoke of the importance of allowing consistent access to
prescribed medication.
10:13:21 AM
ELIZABETH FIGUS testified in support of HB 58. She said that
she captains a commercial fishing boat out of Sitka, and working
seven days a week makes it difficult to access care. Having to
alter schedules for something as simple as a refill for
prescribed medication is frustrating and unnecessary. She said
that committee members should understand the importance of
economic efficiency, and that HB 58 would save money and time.
She stated that she has been testifying in support of the
proposed legislation since 2016, and that if it's not passed in
2021, she'll be back to testify again.
10:15:23 AM
KRISTIN MAHLEN testified in support of HB 58. She said that she
spends her time fishing out of Cordova, and she expressed that
it's important for women to access prescribed medication no
matter where they are working. She said that family planning is
important for everyone, including the state and insurance
companies, and that consistent access to birth control lowers
the risk of unintended pregnancy.
10:16:55 AM
GABE CANFIELD testified in support of HB 58. She said that safe
access to birth control is important.
10:17:39 AM
CO-CHAIR FIELDS, after ascertaining that no one else wished to
testify, closed public testimony on HB 58.
10:17:50 AM
REPRESENTATIVE NELSON asked for clarification on the fiscal
note.
10:18:12 AM
LIZZIE KUBITZ, Staff, Representative Matt Claman, Alaska State
Legislature, on behalf of Representative Claman, prime sponsor,
deferred to Ms. Gayhart.
10:18:31 AM
RENEE GAYHART, Director, Division of Health Care Services,
Department of Health & Social Services, said that the proposed
legislation carries a neutral fiscal note. She said that women
on Medicaid are currently eligible for either a one or three-
month supply, the cost of which can be absorbed. She said that
it's preferable to work on the cost of implementation, which she
noted would be "zero," and look at claims on the back end for
opportunities for cost avoidance.
REPRESENTATIVE NELSON pointed out the reference to mail order
prescriptions on one of the fiscal notes.
MS. GAYHART replied that there are certain prescriptions that
are available via mail, and that they would be eligible under HB
58.
REPRESENTATIVE NELSON said that the fiscal note seems to refer
to a contraceptive available in a 90-day supply.
MS. GAYHART clarified that birth control pills may be received
via mail.
10:21:58 AM
CO-CHAIR FIELDS announced that HB 58 was held over.
10:22:20 AM
ADJOURNMENT
There being no further business before the committee, the House
Labor and Commerce Standing Committee meeting was adjourned at
10:22 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 58 v. B 4.22.2021.PDF |
HL&C 5/7/2021 8:00:00 AM HL&C 5/12/2021 3:15:00 PM |
HB 58 |
| HB 58 Sponsor Statement v. B 4.22.2021.pdf |
HL&C 5/7/2021 8:00:00 AM HL&C 5/12/2021 3:15:00 PM HL&C 5/17/2021 3:15:00 PM |
HB 58 |
| HB 58 Sectional Analysis v. B 4.22.2021.pdf |
HL&C 5/7/2021 8:00:00 AM HL&C 5/12/2021 3:15:00 PM HL&C 5/17/2021 3:15:00 PM |
HB 58 |
| HB 58 Supporting Document - Guttmacher Alaska Statistics 2016 3.30.2021.pdf |
HL&C 5/7/2021 8:00:00 AM HL&C 5/12/2021 3:15:00 PM |
HB 58 |
| HB 58 Supporting Document - Guttmacher Public Costs from Unintended Pregnancies February 2015 3.30.2021.pdf |
HL&C 5/7/2021 8:00:00 AM HL&C 5/12/2021 3:15:00 PM |
HB 58 |
| HB 58 Supporting Document - UCSF Study Newspaper Article 2.11.2011.pdf |
HL&C 5/7/2021 8:00:00 AM HL&C 5/12/2021 3:15:00 PM |
HB 58 |
| HB 58 Supporting Document - Unintended Pregnancies Study March 2011 3.30.2021.pdf |
HL&C 5/7/2021 8:00:00 AM HL&C 5/12/2021 3:15:00 PM |
HB 58 |
| HB 58 Additional Document - HRSA Women’s Preventive Services Guidelines.pdf |
HL&C 5/7/2021 8:00:00 AM HL&C 5/12/2021 3:15:00 PM |
HB 58 |
| HB 58 Additional Document - Insurance Coverage of Contraceptives 4.1.2021.pdf |
HL&C 5/7/2021 8:00:00 AM HL&C 5/12/2021 3:15:00 PM |
HB 58 |
| HB 58 Fiscal Note DHSS-MS 4.9.2021.pdf |
HL&C 5/7/2021 8:00:00 AM HL&C 5/12/2021 3:15:00 PM HL&C 5/17/2021 3:15:00 PM |
HB 58 |
| HB 58 Fiscal Note DCCED-DOI 4.9.2021.pdf |
HL&C 5/7/2021 8:00:00 AM HL&C 5/12/2021 3:15:00 PM HL&C 5/17/2021 3:15:00 PM |
HB 58 |
| HB 58 Fiscal Note DOA-DRB 4.12.2021.pdf |
HL&C 5/7/2021 8:00:00 AM HL&C 5/12/2021 3:15:00 PM HL&C 5/17/2021 3:15:00 PM |
HB 58 |
| HB 58 Letters of Support as of 5.6.21.pdf |
HL&C 5/7/2021 8:00:00 AM HL&C 5/12/2021 3:15:00 PM HL&C 5/17/2021 3:15:00 PM |
HB 58 |
| SB 40 ver A 3.12.21.pdf |
HL&C 5/7/2021 8:00:00 AM |
SB 40 |
| SB 40 Sponsor Statement 2.23.21.pdf |
HL&C 5/7/2021 8:00:00 AM |
SB 40 |
| SB 40 Supporting Document - VSO duties 10.22.20.pdf |
HL&C 5/7/2021 8:00:00 AM |
SB 40 |
| SB 40 Testimony Received 4.25.2021.pdf |
HL&C 5/7/2021 8:00:00 AM |
SB 40 |
| SB 40 Fiscal Note - MVA 3.2.21.pdf |
HL&C 5/7/2021 8:00:00 AM |
SB 40 |
| SB 40 Letter of Support - Challenge Alaska 3.8.21.pdf |
HL&C 5/7/2021 8:00:00 AM |
SB 40 |
| SB 40 Letter of Support 3.3.21.pdf |
HL&C 5/7/2021 8:00:00 AM |
SB 40 |
| HB 176 Presentation - Direct Primary Care Coaltion 5.6.21.pdf |
HL&C 5/7/2021 8:00:00 AM |
HB 176 |
| HB 176 Letter of Support - AK Policy Forum, 5.7.21.pdf |
HL&C 5/7/2021 8:00:00 AM |
HB 176 |