Legislature(2015 - 2016)BARNES 124

04/06/2016 03:15 PM LABOR & COMMERCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Delayed to 3:30 p.m. Today --
+ HB 234 INSURANCE COVERAGE FOR TELEMEDICINE TELECONFERENCED
Heard & Held
-- Public Testimony <Time Limit May Be Set> --
+ SB 148 EMPLOYER REPORT OF WORKPLACE INJURY/DEATH TELECONFERENCED
Moved CSSB 148(L&C) Out of Committee
-- Public Testimony <Time Limit May Be Set> --
+ SB 142 INSURANCE FOR ANTI-CANCER MEDICATION TELECONFERENCED
Heard & Held
-- Public Testimony <Time Limit May Be Set> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= HB 372 OMNIBUS INSURANCE TELECONFERENCED
Moved CSHB 372(L&C) Out of Committee
**Streamed live on AKL.tv**
                    ALASKA STATE LEGISLATURE                                                                                  
          HOUSE LABOR AND COMMERCE STANDING COMMITTEE                                                                         
                         April 6, 2016                                                                                          
                           3:32 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Kurt Olson, Chair                                                                                                
Representative Shelley Hughes, Vice Chair                                                                                       
Representative Jim Colver                                                                                                       
Representative Gabrielle LeDoux                                                                                                 
Representative Cathy Tilton                                                                                                     
Representative Andy Josephson                                                                                                   
Representative Sam Kito                                                                                                         
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Mike Chenault (alternate)                                                                                        
                                                                                                                                
OTHER LEGISLATORS PRESENT                                                                                                     
                                                                                                                              
Representative Lora Reinbold                                                                                                    
Representative Louise Stutes                                                                                                    
                                                                                                                              
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 372                                                                                                              
"An  Act   relating  to  insurance;  relating   to  expenses  for                                                               
insurance  examinations; relating  to  regulations for  insurance                                                               
utilization   review,   benefits   determination,   health   care                                                               
insurance grievance resolution  procedures, independent review of                                                               
adverse   determinations   or   final   adverse   determinations,                                                               
independent  review   organizations,  and   continuing  education                                                               
providers;  relating  to  required  provisions  for  health  care                                                               
insurance contracts and policies,  including health care provider                                                               
choice; establishing civil penalties  for insurers for failure to                                                               
provide  requested  records;  amending  the  definition  of  'wet                                                               
marine  and  transportation'  insurance; amending  provisions  on                                                               
limited licenses  to include crop  insurance; relating  to third-                                                               
party  administrator   notification  requirements;   relating  to                                                               
certification   filing  by   reinsurance  intermediary   brokers;                                                               
relating  to  rate filings,  delivery  of  insurance policies  or                                                               
endorsements;  relating to  refunds  of  variable life  insurance                                                               
policies  and  variable  annuities; establishing  limitations  on                                                               
issuance of  long- term care insurance;  relating to requirements                                                               
for group  health insurance policies; amending  the definition of                                                               
'group  health  insurance';  relating to  motor  vehicle  service                                                               
contracts;  relating  to  notice  requirements  for  meetings  of                                                               
stockholders  or members  of a  domestic insurer;  establishing a                                                               
definition of  'bona fide association'; relating  to requirements                                                               
and penalties  for committing a fraudulent  or criminal insurance                                                               
act; updating criteria for examinations;  relating to rate filing                                                               
deviations;  establishing  civil  penalties  for  certain  wilful                                                               
violations; and providing for an effective date."                                                                               
                                                                                                                                
     - MOVED CSHB 372(L&C) OUT OF COMMITTEE                                                                                     
                                                                                                                                
HOUSE BILL NO. 234                                                                                                              
"An  Act  relating  to  insurance   coverage  for  mental  health                                                               
benefits provided through telemedicine."                                                                                        
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
SENATE BILL NO. 148                                                                                                             
"An  Act  relating to  reporting  of  workplace injuries  to  the                                                               
division of labor standards and safety."                                                                                        
                                                                                                                                
     - MOVED CSSB 148(L&C) OUT OF COMMITTEE                                                                                     
                                                                                                                                
SENATE BILL NO. 142                                                                                                             
"An   Act  relating   to  insurance   coverage  for   anti-cancer                                                               
medications."                                                                                                                   
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 372                                                                                                                  
SHORT TITLE: OMNIBUS INSURANCE                                                                                                  
SPONSOR(s): LABOR & COMMERCE                                                                                                    
                                                                                                                                
03/21/16       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/21/16       (H)       L&C                                                                                                    
03/28/16       (H)       L&C AT 3:15 PM BARNES 124                                                                              
03/28/16       (H)       Heard & Held                                                                                           
03/28/16       (H)       MINUTE (L&C)                                                                                           
03/30/16       (H)       L&C AT 3:15 PM BARNES 124                                                                              
03/30/16       (H)       Heard & Held                                                                                           
03/30/16       (H)       MINUTE (L&C)                                                                                           
04/04/16       (H)       L&C AT 3:15 PM BARNES 124                                                                              
04/04/16       (H)       Heard & Held                                                                                           
04/04/16       (H)       MINUTE (L&C)                                                                                           
04/06/16       (H)       L&C AT 3:15 PM BARNES 124                                                                              
                                                                                                                                
BILL: HB 234                                                                                                                  
SHORT TITLE: INSURANCE COVERAGE FOR TELEMEDICINE                                                                                
SPONSOR(s): REPRESENTATIVE(s) VAZQUEZ                                                                                           
                                                                                                                                
01/19/16       (H)       PREFILE RELEASED 1/8/16                                                                                
01/19/16       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/19/16       (H)       HSS, L&C                                                                                               
03/15/16       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/15/16       (H)       Heard & Held                                                                                           
03/15/16       (H)       MINUTE (HSS)                                                                                           
03/17/16       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/17/16       (H)       Moved HB 234 Out of Committee                                                                          
03/17/16       (H)       MINUTE (HSS)                                                                                           
03/18/16       (H)       HSS RPT 3DP 1NR 1AM                                                                                    
03/18/16       (H)       DP: TARR, VAZQUEZ, WOOL                                                                                
03/18/16       (H)       NR: TALERICO                                                                                           
03/18/16       (H)       AM: SEATON                                                                                             
04/06/16       (H)       L&C AT 3:15 PM BARNES 124                                                                              
                                                                                                                                
BILL: SB 148                                                                                                                  
SHORT TITLE: EMPLOYER REPORT OF WORKPLACE INJURY/DEATH                                                                          
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
                                                                                                                                
01/19/16       (S)       READ THE FIRST TIME - REFERRALS                                                                        
01/19/16       (S)       L&C                                                                                                    
02/02/16       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                      
02/02/16       (S)       Heard & Held                                                                                           
02/02/16       (S)       MINUTE (L&C)                                                                                           
02/04/16       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                      
02/04/16       (S)       Moved CSSB 148(L&C) Out of Committee                                                                   
02/04/16       (S)       MINUTE (L&C)                                                                                           
02/08/16       (S)       L&C RPT CS 4DP NEW TITLE                                                                               
02/08/16       (S)       DP: COSTELLO, GIESSEL, MEYER, STEVENS                                                                  
02/24/16       (S)       TRANSMITTED TO (H)                                                                                     
02/24/16       (S)       VERSION: CSSB 148(L&C)                                                                                 
02/26/16       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/26/16       (H)       L&C                                                                                                    
04/06/16       (H)       L&C AT 3:15 PM BARNES 124                                                                              
                                                                                                                                
BILL: SB 142                                                                                                                  
SHORT TITLE: INSURANCE FOR ANTI-CANCER MEDICATION                                                                               
SPONSOR(s): SENATOR(s) GIESSEL                                                                                                  
                                                                                                                                
01/19/16       (S)       READ THE FIRST TIME - REFERRALS                                                                        
01/19/16       (S)       L&C                                                                                                    
02/04/16       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                      
02/04/16       (S)       Heard & Held                                                                                           
02/04/16       (S)       MINUTE (L&C)                                                                                           
02/16/16       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                      
02/16/16       (S)       Moved CSSB 142(L&C) Out of Committee                                                                   
02/16/16       (S)       MINUTE (L&C)                                                                                           
02/17/16       (S)       L&C RPT CS 4DP SAME TITLE                                                                              
02/17/16       (S)       DP: COSTELLO, GIESSEL, MEYER, STEVENS                                                                  
03/02/16       (S)       TRANSMITTED TO (H)                                                                                     
03/02/16       (S)       VERSION: CSSB 142(L&C) AM                                                                              
03/04/16       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/04/16       (H)       L&C                                                                                                    
04/06/16       (H)       L&C AT 3:15 PM BARNES 124                                                                              
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
KONRAD JACKSON, Staff                                                                                                           
Representative Kurt Olson                                                                                                       
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Presented  Amendment 1,  to the  committee                                                             
substitute (CS)  for HB 372,  on behalf of  Representative Olson,                                                               
Chair  of  the  House  Labor  and  Commerce  Standing  Committee,                                                               
sponsor,                                                                                                                        
                                                                                                                                
MEGAN WALLACE, Attorney                                                                                                         
Legislative Legal and Research Services                                                                                         
Legislative Affairs Agency                                                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during the hearing on HB                                                              
372.                                                                                                                            
                                                                                                                                
DONALD HALE, Insurance Specialist                                                                                               
Division of Insurance                                                                                                           
Department of Commerce, Community & Economic Development (DCCED)                                                                
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during the hearing on HB                                                              
372.                                                                                                                            
                                                                                                                                
FRED PARADY, Deputy Commissioner                                                                                                
Department of Commerce, Community & Economic Development (DCCED)                                                                
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during the hearing on HB                                                              
372.                                                                                                                            
                                                                                                                                
REPRESENTATIVE LIZ VAZQUEZ                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Introduced HB 234, as sponsor.                                                                           
                                                                                                                                
ANITA HALTERMAN, Staff                                                                                                          
Representative Liz Vazquez                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 234, on behalf of                                                                           
Representative Vazquez, sponsor.                                                                                                
                                                                                                                                
AROM EVANS M.D., Medical Director                                                                                               
Orion Behavioral Health Network                                                                                                 
Eagle River, Alaska                                                                                                             
POSITION STATEMENT:  Testified in support of HB 234.                                                                          
                                                                                                                                
JOE THOMAS, Deputy Commissioner                                                                                                 
Department of Labor & Workforce Development (DLWD)                                                                              
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Presented CSSB 148, on behalf of the Senate                                                              
Rules Committee by request of the governor.                                                                                     
                                                                                                                                
KARI NORE, Staff                                                                                                                
Senator Cathy Giessel                                                                                                           
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented Amendment 1 to CSSB 142, on                                                                    
behalf of Senator Giessel, prime sponsor.                                                                                       
                                                                                                                                
EMILY NENON, Alaska Government Relations Director                                                                               
American Cancer Society/Cancer Action Network                                                                                   
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of SB 142.                                                                          
                                                                                                                                
ERIC HANSEN, Spokesperson                                                                                                       
International Myeloma Foundation                                                                                                
Unknown Location                                                                                                                
POSITION STATEMENT:  Testified in support of SB 142.                                                                          
                                                                                                                                
KIMBERLY THEIS, Advocacy Manager                                                                                                
Leukemia & Lymphoma Society                                                                                                     
San Francisco, California                                                                                                       
POSITION STATEMENT:  Testified in support of SB 142.                                                                          
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:32:50 PM                                                                                                                    
                                                                                                                                
CHAIR KURT  OLSON called  the House  Labor and  Commerce Standing                                                             
Committee meeting to order at  3:32 p.m.  Representatives Tilton,                                                               
Kito, Josephson,  Hughes, and Olson  were present at the  call to                                                               
order.  Representatives Colver and  LeDoux arrived as the meeting                                                               
was in progress.                                                                                                                
                                                                                                                                
                    HB 372-OMNIBUS INSURANCE                                                                                
                                                                                                                                
3:33:05 PM                                                                                                                    
                                                                                                                                
CHAIR OLSON announced  that the first order of  business would be                                                               
HOUSE BILL  NO. 372, "An  Act relating to insurance;  relating to                                                               
expenses for insurance examinations;  relating to regulations for                                                               
insurance  utilization  review,  benefits  determination,  health                                                               
care  insurance  grievance   resolution  procedures,  independent                                                               
review    of   adverse    determinations    or   final    adverse                                                               
determinations, independent review  organizations, and continuing                                                               
education providers;  relating to required provisions  for health                                                               
care  insurance contracts  and  policies,  including health  care                                                               
provider choice;  establishing civil  penalties for  insurers for                                                               
failure to provide requested records;  amending the definition of                                                               
'wet  marine and  transportation' insurance;  amending provisions                                                               
on  limited  licenses  to include  crop  insurance;  relating  to                                                               
third-party administrator notification  requirements; relating to                                                               
certification   filing  by   reinsurance  intermediary   brokers;                                                               
relating  to  rate filings,  delivery  of  insurance policies  or                                                               
endorsements;  relating to  refunds  of  variable life  insurance                                                               
policies  and  variable  annuities; establishing  limitations  on                                                               
issuance of  long- term care insurance;  relating to requirements                                                               
for group  health insurance policies; amending  the definition of                                                               
'group  health  insurance';  relating to  motor  vehicle  service                                                               
contracts;  relating  to  notice  requirements  for  meetings  of                                                               
stockholders  or members  of a  domestic insurer;  establishing a                                                               
definition of  'bona fide association'; relating  to requirements                                                               
and penalties  for committing a fraudulent  or criminal insurance                                                               
act; updating criteria for examinations;  relating to rate filing                                                               
deviations;  establishing  civil  penalties  for  certain  wilful                                                               
violations; and providing for an effective date."                                                                               
                                                                                                                                
[Although  not  stated on  the  record  of  the House  Labor  and                                                               
Commerce  Standing Committee  meeting  of  4/4/16, the  committee                                                               
treated HB 372, Version H, as adopted and before the committee.]                                                                
                                                                                                                                
3:33:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HUGHES moved  to  adopt Amendment  1 labeled  29-                                                               
LS1379\H.1, Wallace, 4/5/16, which read:                                                                                        
                                                                                                                                
     Page 8, lines 16 - 22:                                                                                                     
          Delete all material and insert:                                                                                       
               "(15)  "emergency medical condition" means a                                                                     
     medical condition manifesting  itself by acute symptoms                                                                    
     of sufficient  severity, including severe pain,  that a                                                                    
     prudent person  who possesses  an average  knowledge of                                                                    
     health and  medicine could  reasonably expect  that the                                                                    
     absence of immediate medical  attention would result in                                                                    
     serious   impairment  of   bodily  functions,   serious                                                                    
     dysfunction of a  bodily organ or part,  or would place                                                                    
     the  person's health  or, with  respect  to a  pregnant                                                                    
     woman, the health of the  woman or her unborn child, in                                                                    
     serious jeopardy."                                                                                                         
                                                                                                                                
CHAIR OLSON objected for discussion purposes.                                                                                   
                                                                                                                                
3:33:57 PM                                                                                                                    
                                                                                                                                
KONRAD JACKSON, staff to Representative  Kurt Olson, Alaska State                                                               
Legislature, informed  the committee  that Amendment  1 addresses                                                               
concerns expressed  regarding page  8, Section  11, which  is the                                                               
definition  of  an  emergency medical  condition.    Amendment  1                                                               
changes the definition to more  closely mirror what exists in the                                                               
Patient Protection and  Affordable Care Act of 2010  (PPACA).  He                                                               
pointed out  that the  word "layperson" was  not included  in the                                                               
requested  change   in  order  to   conform  to  the   Manual  of                                                               
Legislative Drafting.                                                                                                           
                                                                                                                                
REPRESENTATIVE LEDOUX  asked if there  is a difference  between a                                                               
"reasonable person" standard and a "prudent person" standard.                                                                   
                                                                                                                                
3:35:31 PM                                                                                                                    
                                                                                                                                
MEGAN WALLACE,  Attorney, Legislative Legal  Counsel, Legislative                                                               
Legal Services, Legislative  Affairs Agency, asked Representative                                                               
LeDoux to repeat the question.                                                                                                  
                                                                                                                                
REPRESENTATIVE  LEDOUX  asked  for  the  difference  between  the                                                               
standards applied to define a  reasonable person versus a prudent                                                               
person.  Usually, she commented,  the term prudent person is used                                                               
with regard  to investment decisions;  whereas, a person  who has                                                               
committed a wrong  and, as a layperson, should  have known better                                                               
is characterized as a reasonable person.                                                                                        
                                                                                                                                
MS. WALLACE  replied that,  in this case,  the prudent  person is                                                               
modified  by   "a  prudent  person  that   possesses  an  average                                                               
knowledge of health and medicine" and  opined the term is not out                                                               
of  place.    She  deferred  to the  Division  of  Insurance  for                                                               
specialized  knowledge as  to which  term is  preferred; further,                                                               
neither  prudent  person  nor reasonable  person  is  defined  in                                                               
statute.                                                                                                                        
                                                                                                                                
3:38:05 PM                                                                                                                    
                                                                                                                                
DONALD  HALE,   Insurance  Specialist,  Division   of  Insurance,                                                               
Department  of   Commerce,  Community  &   Economic  Development,                                                               
deferred to an attorney.                                                                                                        
                                                                                                                                
REPRESENTATIVE LEDOUX  noted that her question  could be resolved                                                               
in the next committee of referral.                                                                                              
                                                                                                                                
CHAIR OLSON suggested  that the intent of the change  was also to                                                               
achieve compliance with PPACA.                                                                                                  
                                                                                                                                
REPRESENTATIVE JOSEPHSON  directed attention  to page  8, Section                                                               
11:  AS   21.07,  Patient  protections  under   the  health  care                                                               
insurance policies.   He noted that generally, there  is a desire                                                               
to keep people out of emergency  rooms unless necessary.  He then                                                               
observed that  the definitions of emergency  medical condition in                                                               
the proposed  legislation and in  the amendment as written  set a                                                               
high standard, and remarked:                                                                                                    
                                                                                                                                
     You  have to  find that  ... you  could suffer  serious                                                                    
     dysfunction, impairment,  or serious jeopardy.  ... Are                                                                    
     we saying  that, that an  insurance company  could deny                                                                    
     coverage at  an emergency  room, unless  it's plausible                                                                    
     that the  visitor or the  patient was  reasonably going                                                                    
     to expect some  of those types of  egregious or serious                                                                    
     conditions?  ... So,  I'm  just  wondering, where  this                                                                    
     definition gets applied.                                                                                                   
                                                                                                                                
MR.  HALE expressed  his  understanding that  the  purpose is  to                                                               
protect someone who seeks emergency  care "and [their problem] is                                                               
not what they thought it was."                                                                                                  
                                                                                                                                
REPRESENTATIVE  JOSEPHSON  repeated  Mr.  Hale's  statement  that                                                               
"it's not what they thought it  was or it could be precisely what                                                               
they thought it was."                                                                                                           
                                                                                                                                
MR. HALE agreed.                                                                                                                
                                                                                                                                
CHAIR OLSON opined that there  are enough safeguards built in and                                                               
the emergency room would err on the side of caution.                                                                            
                                                                                                                                
REPRESENTATIVE  KITO said  that, from  personal experience,  even                                                               
medical professionals will recommend  an emergency room visit out                                                               
of caution.  He said he  hoped the definition would protect those                                                               
individuals who  believe they are  in danger, or who  are advised                                                               
by medical professionals to go to an emergency room.                                                                            
                                                                                                                                
REPRESENTATIVE  LEDOUX,  noting  that  the  bill  does  not  have                                                               
another committee referral, requested  a definition of reasonable                                                               
person  versus prudent  person from  the  Division of  Insurance.                                                               
Prudent  person appears  to be  a stricter  standard in  that the                                                               
person must be smarter than a reasonable person, she said.                                                                      
                                                                                                                                
MS.  WALLACE  said a  quick  search  reveals that  "a  reasonably                                                               
prudent  person" and  a  "reasonable person"  have  been used  in                                                               
similar context.   She  opined that a  "prudent person"  does not                                                               
represent  a  higher standard  than  a  "reasonable person,"  but                                                               
merely is a minor differentiation.                                                                                              
                                                                                                                                
3:46:30 PM                                                                                                                    
                                                                                                                                
FRED  PARADY, Deputy  Commissioner, Office  of the  Commissioner,                                                               
Department   of  Commerce,   Community  &   Economic  Development                                                               
(DCCED), advised that  Amendment 1 is useful in  that the section                                                               
relates  to  patient  protections  under  health  care  insurance                                                               
policies, and  the Department of  Commerce, Community  & Economic                                                               
Development (DCCED)  seeks to  bring Alaska's  insurance statutes                                                               
up to  code with models  based on PPACA.   He offered  to provide                                                               
additional  guidance  from  the   director  of  the  Division  of                                                               
Insurance.                                                                                                                      
                                                                                                                                
REPRESENTATIVE HUGHES  expressed interest  in the context  of the                                                               
definition;  for example,  some residents  use an  emergency room                                                               
for  nonemergency   care,  and  she  asked   whether  the  [bill]                                                               
establishes in statute  that an insurance company  might not have                                                               
to cover a charge for a condition not described.                                                                                
                                                                                                                                
MR.  PARADY reiterated  that  he  would like  to  speak with  his                                                               
director  in this  regard.    He stated  that  statute holds  the                                                               
requirements for  contract provisions for health  care insurance,                                                               
one of which  is that there be a utilization  review process, and                                                               
the language  in the statute defines  the review.  He  opined the                                                               
definition is patient protection.                                                                                               
                                                                                                                                
REPRESENTATIVE HUGHES said one reason  health care costs are high                                                               
is because emergency  room care is used  for nonemergency medical                                                               
conditions.   She asked whether there  is an attempt here  to not                                                               
cover something  when a person goes  to the emergency room  for a                                                               
nonemergency medical condition.                                                                                                 
                                                                                                                                
CHAIR OLSON opined there is more coverage under PPACA, not less.                                                                
                                                                                                                                
3:50:28 PM                                                                                                                    
                                                                                                                                
CHAIR OLSON  removed his objection  to Amendment 1.   There being                                                               
no objection, Amendment 1 was adopted.                                                                                          
                                                                                                                                
3:51:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HUGHES  moved to  report the  committee substitute                                                               
for HB  372, Version 29-LS1379\H,  Wallace, 3/30/16,  as amended,                                                               
out  of   committee  with  individual  recommendations   and  the                                                               
accompanying  fiscal  notes.   There  being  no  objection,  CSHB                                                               
372(L&C)  was  reported  out  of the  House  Labor  and  Commerce                                                               
Standing Committee.                                                                                                             
                                                                                                                                
3:51:51 PM                                                                                                                    
                                                                                                                                
The committee took an at ease from 3:51 p.m. to 3:53 p.m.                                                                       
                                                                                                                                
           HB 234-INSURANCE COVERAGE FOR TELEMEDICINE                                                                       
                                                                                                                                
3:53:59 PM                                                                                                                    
                                                                                                                                
CHAIR OLSON  announced that the  next order of business  would be                                                               
HOUSE BILL  NO. 234, "An  Act relating to insurance  coverage for                                                               
mental health benefits provided through telemedicine."                                                                          
                                                                                                                                
3:54:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LIZ VAZQUEZ,  Alaska State Legislature, introduced                                                               
HB 234, to be presented by Anita Halterman.                                                                                     
                                                                                                                                
3:55:10 PM                                                                                                                    
                                                                                                                                
ANITA  HALTERMAN, staff  to  Representative  Liz Vazquez,  Alaska                                                               
State Legislature, speaking on  behalf of Representative Vazquez,                                                               
advised that  HB 234 is  a mental health  parity bill.   The bill                                                               
requires   that    the   health   insurance    industry   provide                                                               
reimbursement  for mental  health coverage  through the  delivery                                                               
mode  of  telemedicine.   Alaska  Medicaid  has paid  for  mental                                                               
health and substance abuse telemedicine  for many years; however,                                                               
only  one insurer  in Alaska  has  been providing  reimbursement.                                                               
The bill  requires that insurers reimburse  for telemedicine care                                                               
without  requiring  a  face-to-face visit,  which  could  improve                                                               
access  to  mental   health  services  for  15   percent  of  the                                                               
population in Alaska.   This bill does not  provide new coverage,                                                               
but  it provides  a new  means  of reimbursement  for a  coverage                                                               
option   currently  available   through   the  health   insurance                                                               
industry.                                                                                                                       
                                                                                                                                
3:56:21 PM                                                                                                                    
                                                                                                                                
MS.  HALTERMAN  said  one  concern  related  to  HB  234  is  the                                                               
prohibition of face-to-face visits.   She directed attention to a                                                               
document  entitled, "The  American  Telemedicine Association,  50                                                               
State Telemedicine  Gaps Analysis"  from the  National Conference                                                               
of  State  Legislators,  which   described  the  national  status                                                               
regarding telemedicine.   The analysis  indicated that  22 states                                                               
have laws  giving them  the highest  possible "grade"  and Alaska                                                               
received   an  A+   for   telemedicine  Medicaid   reimbursement.                                                               
However, Alaska  received an  F grade as  to the  private sector,                                                               
and this bill  is an effort to correct that  issue.  Most private                                                               
insurers cover reimbursement for  telemedicine without a face-to-                                                               
face visit;  the states of  Texas and  Arkansas appear to  be the                                                               
only states  with a  face-to-face requirement,  and the  state of                                                               
Arizona  is the  only  state requiring  a face-to-face  encounter                                                               
before mental health services can  be delivered.  She pointed out                                                               
that HB  234 does  not prohibit a  health care  professional from                                                               
requiring a  face-to-face visit,  but leaves  the decision  up to                                                               
the  medical  professional,  not   the  insurer.    Further,  she                                                               
stressed that this is an insurance bill, not a medical bill.                                                                    
                                                                                                                                
3:59:02 PM                                                                                                                    
                                                                                                                                
MS. HALTERMAN  advised that the  second concern  raised pertained                                                               
to  licensing within  Alaska,  and she  clarified  that the  bill                                                               
requires a  provider be licensed  in Alaska in order  to practice                                                               
within  the state.    The  third concern  was  a  request to  add                                                               
substance abuse  to the bill;  however, the Alaska  Statutes that                                                               
originally  required  that  substance   abuse  be  provided  were                                                               
repealed  in  1997.    She  said  she  has  received  input  from                                                               
stakeholders within the industry  about what definitions might be                                                               
useable, but  Alaska has no  clear definition of  substance abuse                                                               
in statute,  so the issue  of including substance abuse  has been                                                               
tabled.   Ms.  Halterman reiterated  that this  is a  parity bill                                                               
requiring the health  insurance industry to do  what Medicaid has                                                               
been doing for many years.                                                                                                      
                                                                                                                                
CHAIR  OLSON  cautioned  that the  substance  abuse  issue  would                                                               
complicate the bill.                                                                                                            
                                                                                                                                
MS. HALTERMAN agreed.  Returning  attention to the first concern,                                                               
she referred  to a  code of ethics  and other  guidance documents                                                               
with regard  to face-to-face requirements, and  other issues that                                                               
may affect this particular industry.                                                                                            
                                                                                                                                
REPRESENTATIVE  VAZQUEZ pointed  out that  she does  not want  to                                                               
attempt to micromanage  the medical profession and that  it is up                                                               
to them to require face-to-face visits.                                                                                         
                                                                                                                                
REPRESENTATIVE  COLVER  asked  for clarification  that  substance                                                               
abuse telemedicine is not included in the bill.                                                                                 
                                                                                                                                
MS.  HALTERMAN  advised  that  the  sponsor  had  been  asked  to                                                               
consider introducing a definition  for substance abuse, but after                                                               
consulting  with Legislative  Legal  and  Research Services,  and                                                               
individuals within  the insurance  industry, discovered  there is                                                               
no clean definition  available currently in Alaska  that has been                                                               
vetted by stakeholders in this industry.                                                                                        
                                                                                                                                
4:03:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  COLVER expressed  concern  that this  legislation                                                               
not "opt out" smoking cessation,  which is generally handled over                                                               
the telephone.   He also expressed concern  regarding someone who                                                               
just needs  counseling as to  where to go for  treatment services                                                               
for  substance abuse.    Representative  Colver restated  smoking                                                               
cessation can be provided over  the telephone, and urged that the                                                               
proposed legislation not opt out smoking cessation services.                                                                    
                                                                                                                                
MS.  HALTERMAN expressed  her understanding  that ICD-10  medical                                                               
codes  are  uniformly  used primarily  for  substance  abuse  and                                                               
mental  health.   She  explained  that  many individuals  require                                                               
services  that  are mental  health  in  nature, may  directly  be                                                               
substance abuse related,  and which may be covered  by this bill.                                                               
Insurers such as AETNA have indicated  that much of what would be                                                               
included  in  a definition  of  substance  abuse may  already  be                                                               
covered  because  of   the  uniform  use  of   ICD-10  codes  for                                                               
behavioral health.   She advised  stakeholder input is  needed to                                                               
determine what  is necessary to  ensure that  whatever additional                                                               
coverage might  not be provided  by this bill is  considered next                                                               
session.                                                                                                                        
                                                                                                                                
REPRESENTATIVE  HUGHES   observed  that  a  mental   health  care                                                               
provider  must  be  licensed  in  Alaska,  and  asked  whether  a                                                               
telemedicine, mental  health care provider could  be located out-                                                               
of-state.  She  asked whether this legislation  would broaden the                                                               
scope of access for Alaskans.                                                                                                   
                                                                                                                                
MS. HALTERMAN deferred the question to an invited witness.                                                                      
                                                                                                                                
REPRESENTATIVE  HUGHES   spoke  in  support  of   consistency  in                                                               
providers and  questioned whether  it is  advisable to  provide a                                                               
person's  mental  health  services totally  by  telemedicine,  or                                                               
whether there  should be  face-to-face contact.   If  so, out-of-                                                               
state providers  could not  provide that  service.   She stressed                                                               
the importance  of knowing  if the  bill allows  for out-of-state                                                               
providers.                                                                                                                      
                                                                                                                                
4:07:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE COLVER read  from the end of  the second paragraph                                                               
of  an  email  from  John   DeRuytern,  Hope  Counseling  Center,                                                               
addressed to  Representative Vazquez,  1/16/16, available  in the                                                               
committee  packet, which  read as  follows [original  punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
     However, I  am very concerned that  the bill's language                                                                    
     specifically prohibits a  requirement that face-to-face                                                                    
     evaluation  occur prior  to  telehealth services  being                                                                    
     reimbursed.  This prohibition is  a SIGNIFICANT end run                                                                    
     around Best  Practices and the safe  delivery of mental                                                                    
     health services using telehealth technologies.                                                                             
                                                                                                                                
REPRESENTATIVE  COLVER   asked  Ms.  Halterman  to   address  the                                                               
foregoing issue.                                                                                                                
                                                                                                                                
MS.  HALTERMAN  reminded  the  committee  that  the  bill  is  an                                                               
insurance  bill and  does  not  influence medical  professionals.                                                               
Therefore,  the  mandate  of  a  face-to-face  requirement  is  a                                                               
mandate  on  the  insurance  industry  and  not  on  the  medical                                                               
professionals.  There  is no intent to change  the best practices                                                               
of  the  medical professionals,  and  they  retain the  right  to                                                               
require a  face-to-face visit.   This bill directs  that insurers                                                               
not impose  a face-to-face requirement  and that the  decision is                                                               
left to medical professionals.                                                                                                  
                                                                                                                                
4:09:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOSEPHSON  assumed that some  face-to-face contact                                                               
improves the efficacy  of counseling.  He asked  whether a Juneau                                                               
citizen  could hire  someone in  Anchorage rather  than hiring  a                                                               
Juneau practitioner.                                                                                                            
                                                                                                                                
MS.  HALTERMAN confirmed  that the  bill allows  some flexibility                                                               
for  the  medical  professional,  and  it  will  be  up  to  that                                                               
professional to  determine whether  or not  it is  appropriate to                                                               
deliver   mental   health   services   without   a   face-to-face                                                               
requirement.  The  risk assumed for not  requiring a face-to-face                                                               
visit would rest  with the medical professional,  who retains the                                                               
right to establish practice rules allowing them to have a face-                                                                 
to-face requirement.   In  fact, it would  be their  liability if                                                               
they didn't require a face-to-face visit.  She said:                                                                            
                                                                                                                                
     ...  this   bill  is  not  to   influence  the  medical                                                                    
     practice,   but   rather   is   trying   to   influence                                                                    
     restrictions on  the insurance  industry that  they not                                                                    
     impose additional  obligations.  This bill  is strictly                                                                    
     restricting   them   from   imposing   a   face-to-face                                                                    
     requirement.    It  in no  way  restricts  the  medical                                                                    
     professional from making a decision  based on risk with                                                                    
     their patients to require a face-to-face ...                                                                               
                                                                                                                                
4:11:37 PM                                                                                                                    
                                                                                                                                
CHAIR OLSON asked whether using Skype would be considered face-                                                                 
to-face contact.                                                                                                                
                                                                                                                                
MS.  HALTERMAN referred  to the  previous  analysis document  and                                                               
opined Skype may be an option.   She noted that Texas has a face-                                                               
to-face requirement, but does not  clearly define whether it is a                                                               
physical  face-to-face  meeting.     Neither  Texas  nor  Arizona                                                               
describe "what that face-to-face obligation actually is."                                                                       
                                                                                                                                
CHAIR  OLSON   noted  that  a   telemedicine  program   has  been                                                               
operational in  Kotzebue and around  the North Slope  using Skype                                                               
or something similar.                                                                                                           
                                                                                                                                
MS. HALTERMAN  reiterated that Medicaid has  been reimbursing for                                                               
telemedicine in  Alaska since  1999-2005, when  Alaska introduced                                                               
the  first telemedicine  regulations in  the nation.   She  noted                                                               
Medicaid has  not had any  concerns with regard to  mental health                                                               
or  substance  abuse  services   delivered  via  telemedicine  in                                                               
Alaska.   For instance, [Alaska  Native health services]  and the                                                               
[U.S. Department of  Veterans Affairs] have a  lot of exceptions,                                                               
and  Medicaid has  been openly  reimbursing.   Previous testimony                                                               
from Director  Margaret Brodie, Health Care  Services, Department                                                               
of  Health  and  Social  Services, related  that  the  bill  will                                                               
benefit   Alaska   Medicaid   because  currently,   Medicaid   is                                                               
reimbursing for mental health  services through telemedicine, but                                                               
is  unable   to  process  a   third  party  recovery   for  those                                                               
reimbursements since the private sector  may not.  This bill, she                                                               
said, would  allow Medicaid to  possibly recoup some  monies from                                                               
the private sector.                                                                                                             
                                                                                                                                
CHAIR OLSON opined that Medicaid pays air travel expenses.                                                                      
                                                                                                                                
MS. HALTERMAN  agreed that transportation  from a remote  area in                                                               
order  for a  patient  to  receive a  face-to-face  visit can  be                                                               
costly  in Alaska,  and noted  that mental  health services  have                                                               
been  delivered  and  reimbursed  by  Medicaid  in  at  least  36                                                               
Medicaid states, with few problems.                                                                                             
                                                                                                                                
CHAIR OLSON opened public testimony.                                                                                            
                                                                                                                                
4:15:40 PM                                                                                                                    
                                                                                                                                
AROM  EVANS  M.D.,  Medical  Director,  Orion  Behavioral  Health                                                               
Network,   advised   that   Orion  Behavioral   Health   delivers                                                               
telemedicine throughout the  state.  Dr. Evans  explained that in                                                               
the past private  insurance primarily paid for  services, but the                                                               
funding has been  cut in the last three years,  which has reduced                                                               
care  to  many Alaskans  who  subsequently  lost their  insurance                                                               
benefits when  coverage changed  to a  third-party administrator.                                                               
The population  served by Orion  Behavioral Health  Network would                                                               
not receive care without telemedicine;  for example, patients who                                                               
are  homebound  or who  live  in  small communities  that  cannot                                                               
provide  direct  psychiatric  care.   He  said  the  bill  allows                                                               
services to reach individuals, even  those who do not qualify for                                                               
Medicaid,  such   as  adolescents  and   developmentally  delayed                                                               
adults, and  may prevent an emergency  situation from developing.                                                               
Dr. Evans clarified that the  bill affects insurance and does not                                                               
seek  to  change  licensing board  practices  and  current  rules                                                               
regarding  face-to-face contact,  which  are fairly  strict.   At                                                               
this  time  the [State  Medical  Board,  Department of  Commerce,                                                               
Community  & Economic  Development] does  not allow  out-of-state                                                               
providers  to   practice  telemedicine,  except   under  certain,                                                               
limited circumstances.                                                                                                          
                                                                                                                                
DR. EVANS  cautioned that, in some  cases, if a person  is unable                                                               
to  receive services  without a  face-to-face  visit, the  result                                                               
will  be that  the patient  doesn't receive  services due  to the                                                               
aging  of  Alaska's population  and  the  limited care  in  rural                                                               
communities.                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HUGHES understood  that the  bill would  increase                                                               
access to  care and  asked what  the best  practices are  for the                                                               
standard of  care for  treatment without  ever having  a face-to-                                                               
face visit.  She referred to related proposed legislation.                                                                      
                                                                                                                                
DR. EVANS advised that proposed  SB 74 requires the medical board                                                               
to adopt standards regarding  out-of-state providers.  Currently,                                                               
practice  by out-of-state  providers is  allowed only  in certain                                                               
circumstances.   As for the standard  of care, he said  that most                                                               
states  allow  for  care  via  telehealth  without  an  in-person                                                               
examination,  as  do  the ethical  guidelines  for  the  American                                                               
Telemedicine  Association.   In  his  practice,  Dr. Evans  said,                                                               
every effort  is made to  do a face-to-face visit.   Face-to-face                                                               
visits  are  provided  whenever   possible,  although  there  are                                                               
certainly  times when  it is  just  not possible,  and best  care                                                               
practices dictate administering service via telemedicine.                                                                       
                                                                                                                                
4:22:16 PM                                                                                                                    
                                                                                                                                
CHAIR OLSON announced that public testimony would remain open.                                                                  
                                                                                                                                
[HB 234 was held over.]                                                                                                         
                                                                                                                                
                                                                                                                                
4:22:41 PM                                                                                                                    
                                                                                                                                
The committee took an at ease from 4:22 p.m. to 4:23 p.m.                                                                       
                                                                                                                                
              SB 148-REPORTING WORKPLACE INJURIES                                                                           
                                                                                                                                
4:23:24 PM                                                                                                                    
                                                                                                                                
CHAIR OLSON  announced that the  next order of business  would be                                                               
CS  FOR  SENATE  BILL  NO.  148(L&C), "An  Act  relating  to  the                                                               
reporting  of  workplace  injuries   to  the  division  of  labor                                                               
standards and safety; and providing for an effective date."                                                                     
                                                                                                                                
4:23:54 PM                                                                                                                    
                                                                                                                                
JOE  THOMAS, Deputy  Commissioner,  Office  of the  Commissioner,                                                               
Department of Labor & Workforce  Development (DLWD), advised that                                                               
proposed  SB  148  amends current  workplace  accident  reporting                                                               
requirements  to include  reporting  of  incidents involving  the                                                               
loss of an eye or an  amputation.  These amendments are necessary                                                               
to  comport   with  the  federal  workplace   accident  reporting                                                               
standards  effective  January  1,   2015.    Alaska  operates  an                                                               
approved  state plan  under the  Federal Occupational  Safety and                                                               
Health  Act   of  1970,  which  requires   that  states  maintain                                                               
standards that  meet the federal  standards at a minimum,  and AS                                                               
18.60.030 established that Alaska  maintain requirements that are                                                               
at least  as effective as those  adopted by the U.  S. Department                                                               
of  Labor.   The Occupational  Safety  and Health  Administration                                                               
(OSHA) made changes to the  accident reporting requirements under                                                               
federal  regulation  29 CFR  1904  related  to the  reporting  of                                                               
industrial accidents  resulting in an  amputation or the  loss of                                                               
an  eye,  and  notified  the   state  that  failure  to  maintain                                                               
equivalency  could  jeopardize federal  funding  as  well as  the                                                               
state's  jurisdiction   over  occupational  safety   and  health.                                                               
Alaska  seeks to  maintain said  jurisdiction and  the associated                                                               
funding.    Mr.  Thomas  restated that  SB  148  brings  Alaska's                                                               
workplace  accident   reporting  standards  up  to   the  federal                                                               
standard, and urged for the committee's support.                                                                                
                                                                                                                                
REPRESENTATIVE HUGHES asked whether  the definition of amputation                                                               
includes digits, an ear, or another body part.                                                                                  
                                                                                                                                
MR. THOMAS opined that amputation is any loss of any body part.                                                                 
                                                                                                                                
4:26:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LEDOUX referred  to page 2, lines  7-9, Section 1,                                                               
which read as follows:                                                                                                          
                                                                                                                                
       The subsection does not apply to an employer that                                                                        
       first receives information of a fatality, [OR] in-                                                                   
     patient hospitalization, loss of an eye, or amputation                                                                 
     more than 30 days after the accident.                                                                                      
                                                                                                                                
REPRESENTATIVE  LEDOUX questioned  how an  employer would  not be                                                               
aware  of  an  accident  or   fatality  for  more  than  30  days                                                               
afterward.                                                                                                                      
                                                                                                                                
MR. THOMAS  agreed and said  any employee/employer  could provide                                                               
notice to DLWD.                                                                                                                 
                                                                                                                                
REPRESENTATIVE  LEDOUX  asked whether  it  is  an excuse  if  the                                                               
president of a company denies  knowledge but the job foreman knew                                                               
about it.                                                                                                                       
                                                                                                                                
MR. THOMAS  said his assumption  is that,  as long as  there were                                                               
people  on the  job  who knew  of an  accident,  the employer  is                                                               
expected to know, depending upon the severity of the situation.                                                                 
                                                                                                                                
4:28:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  LEDOUX  asked  for an  example  of  circumstances                                                               
under which an  employer would not know about an  accident for 30                                                               
days.                                                                                                                           
                                                                                                                                
MR. THOMAS suggested an employer, or  the owner of a company, may                                                               
be on vacation in a locale  where they are unable to be contacted                                                               
by  a  superintendent.   In  further  response to  Representative                                                               
LeDoux, Mr.  Thomas explained that  the term employer is  used to                                                               
indicate  that  anyone  on  the   job  can  report  an  incident.                                                               
Generally,  the owner  of a  company would  be made  aware of  an                                                               
accident during  some period of  time, but the supervisor  on the                                                               
job would  call an ambulance  and report a workplace  accident to                                                               
DLWD.                                                                                                                           
                                                                                                                                
REPRESENTATIVE LEDOUX asked what  happens if a supervisor doesn't                                                               
report it.                                                                                                                      
                                                                                                                                
MR. THOMAS  opined the  law would  hold the  employer responsible                                                               
for not reporting.                                                                                                              
                                                                                                                                
CHAIR OLSON advised that in the  case of an amputation or loss of                                                               
an eye,  the hospital would  call the employer and  the insurance                                                               
company to confirm  the person is an employee, and  that there is                                                               
insurance coverage by workers compensation insurance.                                                                           
                                                                                                                                
REPRESENTATIVE  LEDOUX  restated  her  interest  in  knowing  the                                                               
purpose of  the exception  for an employer  who does  not receive                                                               
notice   within  30   days  after   an   accident,  which   seems                                                               
unreasonable.                                                                                                                   
                                                                                                                                
MR. THOMAS  said, although  that situation  may never  arise, the                                                               
wording is  based upon  federal language and  was used  to ensure                                                               
compliance.                                                                                                                     
                                                                                                                                
REPRESENTATIVE HUGHES  asked whether  the word  employer includes                                                               
the superintendent.                                                                                                             
                                                                                                                                
MR. THOMAS said yes, that is the interpretation by DLWD.                                                                        
                                                                                                                                
REPRESENTATIVE HUGHES  surmised that  it would include  anyone at                                                               
the company or the  next person down from the top  of the list of                                                               
job titles.                                                                                                                     
                                                                                                                                
MR. THOMAS answered yes.                                                                                                        
                                                                                                                                
4:32:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LEDOUX suggested  an employer may not  be aware of                                                               
a situation at a remote site.                                                                                                   
                                                                                                                                
REPRESENTATIVE  COLVER  asked  for  statistics on  this  type  of                                                               
accident in Alaska.                                                                                                             
                                                                                                                                
MR. THOMAS  said he  was unsure  of the  variety of  accidents to                                                               
this degree.   However, this calendar year there  have been three                                                               
fatalities, and he offered to  provide further information to the                                                               
committee.                                                                                                                      
                                                                                                                                
REPRESENTATIVE  COLVER recalled  an incident  that occurred  in a                                                               
trench  in Anchorage  last summer,  and  asked for  clarification                                                               
that  there have  been  only three  [job  related] fatalities  in                                                               
2016.                                                                                                                           
                                                                                                                                
MR. THOMAS stated last calendar  year included the aforementioned                                                               
fatality and two  others.  In further  response to Representative                                                               
Colver,  he said  the other  two fatalities  were an  accident at                                                               
CMI's shop  in Anchorage, and the  death of a health  care worker                                                               
in a long-term  care home.  At  the CMI shop a jack  failed and a                                                               
worker was crushed.                                                                                                             
                                                                                                                                
4:34:45 PM                                                                                                                    
                                                                                                                                
CHAIR OLSON opened  public testimony.  After  ascertaining no one                                                               
wished to testify, closed public testimony.                                                                                     
                                                                                                                                
4:35:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HUGHES moved to report  CSSB 148(L&C), Version 29-                                                               
GS2801\W, out  of committee  with individual  recommendations and                                                               
the accompanying  fiscal notes.   There being no  objection, CSSB                                                               
148(L&C) was reported from the  House Labor and Commerce Standing                                                               
Committee.                                                                                                                      
                                                                                                                                
4:35:49 PM                                                                                                                    
                                                                                                                                
The committee took an at ease from 4:35 p.m. to 4:36 p.m.                                                                       
                                                                                                                                
          SB 142-INSURANCE FOR ANTI-CANCER MEDICATION                                                                       
                                                                                                                                
4:36:36 PM                                                                                                                    
                                                                                                                                
CHAIR OLSON announced  that the final order of  business would be                                                               
CS  FOR  SENATE  BILL  NO.  142(L&C)  am,  "An  Act  relating  to                                                               
insurance coverage for anti-cancer medications."                                                                                
                                                                                                                                
4:37:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HUGHES moved  to adopt  Amendment 1,  labeled 29-                                                               
LS1133\W.A.1, Wallace, 4/5/16, which read:                                                                                      
                                                                                                                                
     Page 1, line 1, following "medications":                                                                                 
         Insert "; and providing for an effective date"                                                                       
                                                                                                                                
     Page 2, following line 14:                                                                                                 
          Insert a new bill section to read:                                                                                    
        "* Sec. 3. This Act takes effect January 1, 2017."                                                                  
                                                                                                                                
CHAIR OLSON objected for discussion purposes.                                                                                   
                                                                                                                                
4:37:21 PM                                                                                                                    
                                                                                                                                
KARI   NORE,  Staff,   Senator   Cathy   Giessel,  Alaska   State                                                               
Legislature, advised that Amendment  1 changes the effective date                                                               
of  the  bill,  as  requested by  the  PREMERA  health  insurance                                                               
company,  in order  to ensure  it can  completely implement  this                                                               
change and not affect premiums or accrue additional costs.                                                                      
                                                                                                                                
4:38:02 PM                                                                                                                    
                                                                                                                                
CHAIR OLSON removed his objection to Amendment 1.                                                                               
                                                                                                                                
4:38:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  LEDOUX objected  to  Amendment  1 for  discussion                                                               
purposes.   She  said she  was aware  there are  certain times  a                                                               
cancer patient is  prescribed medication, which is  paid for, but                                                               
then receives  it in another  form and it is  not paid for.   She                                                               
expressed  her preference  for the  legislation  to be  effective                                                               
immediately instead of January 1, 2017.                                                                                         
                                                                                                                                
MS. NORE advised  that PREMERA's fiscal year 2016  filing must be                                                               
submitted by  May 6, 2015.   There  is concern that  the proposed                                                               
legislation,  as  written,  would  cause  PREMERA  to  amend  its                                                               
filings, causing a fiscal impact to consumers.                                                                                  
                                                                                                                                
CHAIR OLSON  commented that initially  all of the  contracts come                                                               
up on January 1; therefore,  there are already contracts in place                                                               
that are good until December 31.                                                                                                
                                                                                                                                
MS. NORE  added that  the bill  only applies  to new  and renewed                                                               
plans, and would not affect plans currently in place.                                                                           
                                                                                                                                
REPRESENTATIVE LEDOUX  surmised that if  the bill were  passed in                                                               
April [2016], PREMERA would have three weeks to respond.                                                                        
                                                                                                                                
MS. NORE  pointed out  that the sponsor  wishes to  avoid putting                                                               
any  additional burden  on consumers,  especially since  the bill                                                               
only applies to  renewed plans.  Ms. Nore  further explained that                                                               
SB  142  seeks  to  ensure that  both  intravenously  and  orally                                                               
administered  cancer  treatments  are   treated  fairly  and  are                                                               
equally available to  consumers.  She said currently,  there is a                                                               
disparity  between  what  patients  pay  for  intravenous  cancer                                                               
treatments  versus oral,  because oral  treatments are  billed as                                                               
prescriptions,  and there  is no  deductible to  meet.   However,                                                               
intravenous treatments  are often billed as  medical benefits, of                                                               
which  there  is a  deductible  to  reach,  and after  which  the                                                               
consumer no  longer pays.   Thus, although oral  cancer treatment                                                               
is much cheaper  for administration costs, it ends  up being more                                                               
expensive.   Also, certain cancer  treatments are  only available                                                               
in the oral  option; therefore, patients should not  be forced to                                                               
pay higher  premiums simply because  treatment is  only available                                                               
in the  oral form.  In  addition, the bill also  prevents the re-                                                               
classification of  benefits or increasing costs,  with respect to                                                               
both intravenous and oral cancer treatments.                                                                                    
                                                                                                                                
4:43:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  LEDOUX  relayed   her  personal  experience  with                                                               
typhoid  oral   and  inoculation  vaccines:     inoculations  are                                                               
reimbursed  by  insurance  and  oral   vaccines  are  not.    She                                                               
questioned why the bill is  limited to cancer treatments as there                                                               
are   probably  many   drugs  that   can  be   taken  orally   or                                                               
intravenously.                                                                                                                  
                                                                                                                                
MS.  NORE answered  that the  sponsor  chose to  focus on  cancer                                                               
medications,  and deferred  to the  director of  the Division  of                                                               
Insurance at DCCED.                                                                                                             
                                                                                                                                
CHAIR OLSON opened public testimony.                                                                                            
                                                                                                                                
4:44:56 PM                                                                                                                    
                                                                                                                                
EMILY  NENON,  Alaska  Government  Relations  Director,  American                                                               
Cancer  Society/Cancer Action  Network,  advised  that 40  states                                                               
have adopted this  measure.  She described it  as a modernization                                                               
of Alaska's insurance  statutes due to the  tremendous changes in                                                               
cancer research making many options  available in an oral form as                                                               
opposed to  infusion.   Ms. Nenon  stated that  the issue  is not                                                               
just about  whether a physician  prescribed chemo in the  pill or                                                               
the  infusion  form, but  that  some  chemo treatments  are  only                                                               
available in the oral form;  in fact, approximately 25 percent of                                                               
the new treatments in the  research pipeline for cancer are oral.                                                               
She  pointed out  that  oral medications  often  have fewer  side                                                               
effects  and  the  ease  of   administration  is  a  huge  issue,                                                               
particularly  with  the geographic  challenges  of  Alaska.   Ms.                                                               
Nenon expressed her organization's support for the bill.                                                                        
                                                                                                                                
4:46:39 PM                                                                                                                    
                                                                                                                                
ERIC HANSEN,  International Myeloma Foundation, advised  he is an                                                               
advocate for  patients - and  is also a  patient - as  four years                                                               
ago he was diagnosed with  Multiple Myeloma caused by exposure to                                                               
Agent Orange.   Multiple Myeloma  is incurable, but  treatable by                                                               
chemo, and  he noted that  research breakthroughs have  made some                                                               
insurance procedures obsolete; for  example, the pharmacy benefit                                                               
for  many  conditions is  insufficient,  when  applied to  cancer                                                               
medications.  He  opined that the issue for most  patients is not                                                               
so  much  the needles  and  the  toxicity  of chemo,  but  rather                                                               
[medical] access, especially  in Alaska.  For  example, in Juneau                                                               
there is  only one  nurse who  can administer chemo,  as it  is a                                                               
highly  specialized  procedure.   There  are  few places  in  the                                                               
entire state  where a person can  be infused with chemo  and some                                                               
patients need to  be infused twice per week.   The pills that are                                                               
now available  target cancers, unlike  chemo fluids,  which "just                                                               
kill  everything."   Mr.  Hansen  characterized cancer  treatment                                                               
pills as "a  godsend," because patients do not have  to adhere to                                                               
the administrator's  availability or spend four  hours to receive                                                               
an  infusion.   Further, a  patient's  veins can  collapse.   Mr.                                                               
Hansen said he  has been taking one pill per  day for three years                                                               
to treat  his cancer, although  he may have to  eventually return                                                               
to  infusion  chemo  pending  further research.    He  noted  the                                                               
difficulties  for  those who  live  far  from infusion  treatment                                                               
facilities and urged for this  "insurance glitch" to be resolved,                                                               
and restated his support for the bill.                                                                                          
                                                                                                                                
REPRESENTATIVE  LEDOUX asked  Mr. Hansen's  view of  changing the                                                               
effective date from immediately to January 1.                                                                                   
                                                                                                                                
MR. HANSEN,  speaking as a  patient, said  he would like  to make                                                               
the  effective date  tomorrow because  someone who  cannot afford                                                               
the  copay  will  have  to   go  somewhere  for  treatment.    He                                                               
acknowledged  that  the  insurance companies  have  to  establish                                                               
paperwork, but sooner is better for patients.                                                                                   
                                                                                                                                
                                                                                                                                
REPRESENTATIVE  COLVER   described  Mr.  Hansen's   testimony  as                                                               
compelling, and inquired about the cost for Mr. Hansen's copay.                                                                 
                                                                                                                                
MR. HANSEN  replied that he  qualifies for Medicare;  however, if                                                               
he were  younger, his copay would  be $2,000 per month.   He said                                                               
he  would have  had to  go  back to  the hospital  and the  chemo                                                               
fluids, although now  all cancer medications cost  about the same                                                               
because they are all unique and targeted.                                                                                       
                                                                                                                                
4:54:33 PM                                                                                                                    
                                                                                                                                
KIMBERLY THEIS,  Advocacy Manager,  Leukemia &  Lymphoma Society,                                                               
echoed the  sentiments that have  been shared, and said  that the                                                               
Leukemia &  Lymphoma Society  believes this  is a  vital solution                                                               
intended to  ensure that patients  can reliably  and consistently                                                               
expect  fair  coverage  for  cancer   treatments  even  when  the                                                               
treatments come in the  form of a pill.  She  said the society is                                                               
hopeful  that the  lawmakers  in Alaska  will  embrace this  bill                                                               
because it  helps to offer  meaningful improvements in  access to                                                               
care.                                                                                                                           
                                                                                                                                
CHAIR OLSON announced public testimony would remain open.                                                                       
                                                                                                                                
[SB 142 was held over.]                                                                                                         
                                                                                                                                
4:55:32 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Labor and  Commerce Standing Committee  meeting was  adjourned at                                                               
4:55 p.m.                                                                                                                       

Document Name Date/Time Subjects
SB142 ver W am.pdf HL&C 4/6/2016 3:15:00 PM
SB 142
SB142 Sponsor Statement ver W.pdf HL&C 4/6/2016 3:15:00 PM
SB 142
SB142 Sectional Analysis ver W.pdf HL&C 4/6/2016 3:15:00 PM
SB 142
SB142 Fiscal Note-DCCED-DOL-01-29-16.pdf HL&C 4/6/2016 3:15:00 PM
SB 142
SB142 Summary of Changes ver A to ver W.A.pdf HL&C 4/6/2016 3:15:00 PM
SB 142
SB142 Supporting Document-Letter LLS.pdf HL&C 4/6/2016 3:15:00 PM
SB 142
SB142 Supporting Document-National Map JULY 2015.pdf HL&C 4/6/2016 3:15:00 PM
SB 142
SB142 Supporting Document-Letter NPAF.pdf HL&C 4/6/2016 3:15:00 PM
SB 142
SB142 Supporting Document-SPEAC Response to Opposition Memo.pdf HL&C 4/6/2016 3:15:00 PM
SB 142
SB142 Supporting Document-State Fiscal Impact Studies SUMMARY 12-2016.pdf HL&C 4/6/2016 3:15:00 PM
SB 142
SB142 Supporting Document-Benefits of Oral Anti-Cancer Therapies Corp Comm 12-03-13.pdf HL&C 4/6/2016 3:15:00 PM
SB 142
SB142 Supporting Document-Journal of Health Economics Oral Therapy Cost Study Summary.pdf HL&C 4/6/2016 3:15:00 PM
SB 142
SB142 Supporting Document-Letter AIM.pdf HL&C 4/6/2016 3:15:00 PM
SB 142
SB142 Supporting Document-Letter ASCO and DOG.pdf HL&C 4/6/2016 3:15:00 PM
SB 142
SB142 Supporting Document-Letter Denali Oncology.pdf HL&C 4/6/2016 3:15:00 PM
SB 142
SB142 Supporting Document-Letter IMF.pdf HL&C 4/6/2016 3:15:00 PM
SB 142
SB142 Draft Proposed Amendment ver W.A.1.pdf HL&C 4/6/2016 3:15:00 PM
SB 142
SB148 ver W.pdf HL&C 4/6/2016 3:15:00 PM
SB 148
SB148 Sectional Analysis.pdf HL&C 4/6/2016 3:15:00 PM
SB 148
SB148 Fiscal Note-DOLWD-OSH-11-17-15.php.pdf HL&C 4/6/2016 3:15:00 PM
SB 148
SB148 Supporting Documents-Letter-US Dept. of Labor.pdf HL&C 4/6/2016 3:15:00 PM
SB 148
HB372 Draft Proposed Amendment H.1.pdf HL&C 4/6/2016 3:15:00 PM
HB 372
HB234 ver A.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Sponsor Statement.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Fiscal Note-DCCED-DOI-03-11-16.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Email Anne Norton 1-18-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Email Bobbi 1-19-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Email Bryan Thomas 2-1-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Email Diane Ingle 3-15-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Email Dr. Arom Evans undated-received 3-18-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Email Dr. John DeReyter 3-21-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Email Lise Kirsis 3-14-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Email Lita White 1-23-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Email Lynn Edwards 1-22-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Email Maureen Lawlor 1-26-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Email Maureen Lawlor 3-8-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Email Pamela Lund 2-1-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Email Sheila Gallagher 1-27-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Letter Alaska Mental Health Board-Advisory Board on Alcholism and Drug Abuse 3-15-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Letter Alaska Mental Health Trust 3-16-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Letter Alaska Psychological Association 3-6-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Letter American Osteopathic Association 3-15-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Letter Anne Henry 1-19-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Letter JAMHI 1-18-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Psycho-Oncology Randomized Cancer Trial from Dr. Freeman 2014.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Telehealth Policy Trends and Considerations-NCSL 2015.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-American Telemedicine Assoc-Telemedicine Gap Aanalysis 3-2015.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Supporting Documents-Article My Statesman from Austin American 2-29-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Opposing Documents-Email John DeRuyter 1-14-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234
HB234 Opposing Documents-Email Joel Wieman 1-16-2016.pdf HL&C 4/6/2016 3:15:00 PM
HB 234