Legislature(1995 - 1996)

03/07/1996 09:15 AM FIN

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
txt
                             MINUTES                                           
                    SENATE FINANCE COMMITTEE                                   
                          March 7, 1996                                        
                            9:15 a.m.                                          
                                                                               
  TAPES                                                                        
                                                                               
  SFC-96, #33, Side 1 and 2                                                    
  SFC-96, #34, Side 1 (000-316)                                                
                                                                               
  CALL TO ORDER                                                                
                                                                               
  Senator Rick Halford,  Co-chairman, convened the  meeting at                 
  approximately 9:15 a.m.                                                      
                                                                               
  PRESENT                                                                      
                                                                               
  In  addition  to  Co-chairmen  Halford  and  Frank, Senators                 
  Donley, Phillips, Rieger, and Zharoff were present.  Senator                 
  Sharp arrived as the meeting was in progress.                                
                                                                               
  ALSO ATTENDING:  Senator Torgerson; Representative Ogan; Tom                 
  Garrett,  Director, Division of  Tourism, Dept.  of Commerce                 
  and  Economic  Development;  Wendy Wolf,  Programs  Manager,                 
  Division  of   Tourism,  Dept.  of   Commerce  and  Economic                 
  Development;  Catherine  Reardon,   Director,  Division   of                 
  Occupational  Licensing,  Dept.  of  Commerce  and  Economic                 
  Development; Bob Stalnaker, Director, Division of Retirement                 
  and Benefits,  Dept. of  Administration; Ken Taylor,  Deputy                 
  Director,  Division of Wildlife  Conservation, Dept. of Fish                 
  and Game;  Barbara Gabier, Program Coordinator,  Division of                 
  Occupational  Licensing,  Dept.  of  Commerce  and  Economic                 
  Development; Nancy Weller, Medical Assistance Administrator,                 
  Division of Medical  Assistance, Dept. of Health  and Social                 
  Services; Gordon  Evans, representing  the Health  Insurance                 
  Association  of   America;  Harlan  Knudson,   Alaska  State                 
  Hospital & Nursing Home Association; Mike  Greany, Director,                 
  Legislative  Finance  Division;  Bruce  Richards,  aide   to                 
  Senator  Salo;  and  aides to  committee  members  and other                 
  members of the legislature.                                                  
                                                                               
  ALSO  PARTICIPATING  VIA TELECONFERENCE  FROM  KODIAK:   Joe                 
  D'Amico, Commander,  Commercial Crimes  Bureau, Division  of                 
  Fish and Wildlife  Protection, Dept.  of Public Safety;  and                 
  Dick Rottrer.                                                                
                                                                               
  SUMMARY INFORMATION                                                          
                                                                               
  SB  86 -  COMMEMORATIVE GOLD RUSH LICENSE PLATES                             
                                                                               
            Testimony  was presented by  Tom Garrett and Wendy                 
            Wolf  of  the  Dept.   of  Commerce  and  Economic                 
            Development.  The bill was  then held in committee                 
            for comments by the sponsor  and an updated fiscal                 
                                                                               
                                                                               
            note (showing revenue projections)  from the Dept.                 
            of Public Safety.                                                  
                                                                               
  SB 193 -  MANDATORY INSURANCE FOR COSTS OF BIRTH                             
                                                                               
            Testimony  was presented  by Bob  Stalnaker, Nancy                 
            Weller, Gordon  Evans, Harlan  Knudson, and  Bruce                 
            Richards.   The  bill  was  subsequently  held  in                 
            committee for further discussion.                                  
                                                                               
  SB 241 -  STUDDED TIRES ON STERLING HIGHWAY                                  
                                                                               
            Testimony was  presented by  the sponsor,  Senator                 
            Torgerson.    The bill  was  then REPORTED  OUT of                 
            committee    with    a    unanimous   "do    pass"                 
            recommendation  and  zero  fiscal  notes from  the                 
            Dept.   of  Public   Safety  and   the  Dept.   of                 
            Transportation and Public Facilities.                              
                                                                               
  HB 335 -  BIG GAME COMMERCIAL SERVICES BOARD                                 
                                                                               
            Discussion was had  with Representative Ogan,  Ken                 
            Taylor, and  Catherine  Reardon.    Commander  Joe                 
            D'Amico    and    Dick   Rottrer    listened   via                 
            teleconference  from  Kodiak.   SCSCSHB  335 (Fin)                 
            (version W,  3/7/96) was ADOPTED with  a technical                 
            amendment  on  page 8.    In response  to concerns                 
            cited by the  Director of Occupational  Licensing,                 
            she  was  asked  to  provide  proposed  amendments                 
            relating  to (a)  differentiation of  fees between                 
            resident and non-resident  guides, (b)  definition                 
            of   "biologist,"   and   (c)   revised   language                 
            eliminating  "a written  and oral"  from statutory                 
            language  pertaining  to  the  examination  for  a                 
            registered guide license.  The  bill was then held                 
            in committee for further review.                                   
                                                                               
                                                                               
  SENATE BILL NO. 241                                                          
                                                                               
       An Act relating to the use of studded tires on the                      
       Sterling Highway.                                                       
                                                                               
  Co-chairman  Halford directed that SB  241 be brought on for                 
  discussion.     SENATOR  JOHN  TORGERSON,  sponsor   of  the                 
  legislation, came before  committee.  He explained  that the                 
  bill would cure a problem on  the Sterling Highway.  Because                 
  current law  establishes a different  time frame for  use of                 
  studded  tires  on  the southern  peninsula  portion  of the                 
  highway  between Ninilchik  and  Homer,  those driving  from                 
  Anchorage  to Homer are legally required  to change tires in                 
  Ninilchik in  order to  complete the journey  to Homer,  and                 
                                                                               
                                                                               
  reverse the process when returning to Anchorage.  The law is                 
  presently   being  ignored,  but   the  statutes  should  be                 
  corrected.                                                                   
                                                                               
  Senator Torgerson referenced  an earlier fiscal note  by the                 
  Dept.  of Transportation  and  Public Facilities  indicating                 
  fiscal impact.  The department has  since changed the fiscal                 
  note to zero.                                                                
                                                                               
  Senator Donley MOVED  that SB 241  pass from committee  with                 
  accompanying zero fiscal  notes.   No objection having  been                 
  raised,  SB  241  was  REPORTED  OUT  of  committee  with  a                 
  unanimous "do pass"  recommendation and zero notes  from the                 
  Dept. of Transportation and Public  Facilities and the Dept.                 
  of Public Safety.                                                            
                                                                               
                                                                               
  SENATE BILL NO. 86                                                           
                                                                               
       An  Act  relating to  issuance of  special request                      
       commemorative  gold  rush  motor  vehicle  license                      
       plates.                                                                 
                                                                               
  Co-chairman Halford directed  that SB 86  be brought on  for                 
  discussion.   TOM  GARRETT, Director,  Division of  Tourism,                 
  Dept. of Commerce and Economic  Development; and WENDY WOLF,                 
  Programs Manager, Division of Tourism, Dept. of Commerce and                 
  Economic  Development,   and  Co-chair,  Alaska   Gold  Rush                 
  Centennial  Task  Force; came  before  committee.   Ms. Wolf                 
  attested  to  a  close   working  relationship  between  the                 
  division and the Yukon as a result of the successful highway                 
  anniversary promotion.   She also  advised of a  cooperative                 
  agreement with Yukon  and British Columbia Tourism  North to                 
  build upon  the gold rush  anniversary as  another means  of                 
  creating tourism opportunities,  increasing highway  travel,                 
  and providing Alaskans  an opportunity to learn  about state                 
  history.   The  task force began  to form  in 1992.   It has                 
  involved   over  a   hundred  individuals,   statewide,  via                 
  teleconference.   The  effort is  conducted within  existing                 
  funding   for   the  division's   office   of  history   and                 
  archaeology.    In  1994  the  legislature,  by  resolution,                 
  recognized the gold rush centennial and the role of the task                 
  force to coordinate statewide activities.                                    
                                                                               
  Ms. Wolf referenced distribution of an annual newsletter and                 
  report  and a  series  of community  grants  as evidence  of                 
  ongoing efforts.   She further advised  of design of a  logo                 
  and  development  of a  press  kit in  conjunction  with the                 
  Alaska Tourism Marketing Council and the state library.  She                 
  then  distributed a  press  kit for  members'  review.   The                 
  public relations program grew as communities offered funding                 
  in support of state  efforts.  That enabled the  division to                 
  go  on  line and  share  a  page with  the  Yukon Territory,                 
                                                                               
                                                                               
  establish a  recognition program  for pioneers and  historic                 
  properties, provide for coordination of museum and symposium                 
  planning, etc.                                                               
                                                                               
  Interest in the centennial is high.   The license plate made                 
  available through SB 89 is  a cost effective marketing tool.                 
  After sale of the first 260 plates (at $30 a set), the state                 
  will break even.   Those  purchasing subsequent plates  will                 
  pay for the cost of the program.  Ms. Wolf urged support for                 
  the bill.   Senator  Donley commented  on lack of  estimated                 
  revenue  on   1995  fiscal  notes.     Co-chairman   Halford                 
  concurred.  He  further noted analysis language  saying that                 
  "A revised  fiscal note  will  be submitted  to reflect  new                 
  general fund revenue."  He then observed that since there is                 
  no subsequent note, the status of the Dept. of Public Safety                 
  fiscal note is unknown.  The Co-chairman estimated that sale                 
  of $30  sets of  plates which  cost $2.60  to produce  would                 
  result in  a  positive fiscal  note of  $15.0 to  $18.0.   A                 
  fiscal note must be  provided before the bill can  move from                 
  committee.                                                                   
                                                                               
  Co-chairman Frank referenced previously proposed legislation                 
  requiring  vehicles  to  have  only  one license  plate  and                 
  suggested that perhaps that  provision could be incorporated                 
  within the present bill.  He  expressed need to discuss that                 
  possibility  with  the  sponsor.    As  an  alternative,  he                 
  subsequently  recommended  that  the  centennial  gold  rush                 
  license plate  become standard  issue.   Mr. Garrett  voiced                 
  appreciation for  that approach,  characterizing it as  "our                 
  ultimate marketing dream."                                                   
                                                                               
  In  response to  a question  from Senator Zharoff,  Ms. Wolf                 
  said that the  decade of  gold rush plates  would extend  to                 
  2004.                                                                        
                                                                               
  Discussion  followed between  Ms.  Wolf  and  Senator  Randy                 
  Phillips  regarding  division  efforts   during  the  Alaska                 
  Highway celebration.   She  advised that  perceived problems                 
  stemmed from the  fact that the Yukon  expended considerably                 
  more on the effort than did Alaska.                                          
                                                                               
  Co-chairman Halford directed that SB 86 be held in committee                 
  pending receipt of an updated fiscal  note and attendance by                 
  the sponsor, Senator Sharp.                                                  
                                                                               
                                                                               
  SENATE BILL NO. 193                                                          
                                                                               
       An Act requiring insurance  coverage for certain  costs                 
       of birth; and providing for an effective date.                          
                                                                               
  Co-chairman  Halford directed that SB 193  be brought on for                 
  discussion.  BRUCE RICHARDS, aide to Senator Judy Salo, came                 
                                                                               
                                                                               
  before committee.   He explained that the bill would require                 
  48-hour mandatory coverage of postpartum hospitalization and                 
  medical care  for  a mother  and new-born  baby for  regular                 
  vaginal delivery and 96  hours for a Cesarean section.   The                 
  legislation was  introduced in  response to  a  call from  a                 
  constituent who was not authorized to remain in the hospital                 
  after 24  hours  and did  not believe  she was  ready to  be                 
  discharged.    Review  of the  situation  indicates  this is                 
  becoming a nationwide issue.  Six states have passed similar                 
  legislation, and it is under consideration in 16 others.                     
                                                                               
  Mr. Richards  referenced subsection (c), commencing  at page                 
  1, line  13, and  stressed that  the bill  does not  require                 
  mothers and infants  to remain in the hospital  for 48 or 96                 
  hours.    If the  mother  and  physician are  in  agreement,                 
  discharge may occur prior  to stated time frames.    Senator                 
  Donley  expressed  concern  over   "to  what  great  lengths                 
  insurance  companies go  to  avoid providing  coverage"  and                 
  noted that statutory language has previously been twisted in                 
  dramatic ways.                                                               
                                                                               
  GORDON EVANS,  Health Insurance Association of America, came                 
  before committee  voicing opposition to  the bill.   He said                 
  the  association  opposes  all  legislation  which  mandates                 
  coverage since it  tends to raise  costs.  The instant  bill                 
  would merely add another law to cure a  non-existent problem                 
  in Alaska.                                                                   
                                                                               
  Mr. Evans pointed to  great strides made by the  health care                 
  industry in providing and delivering quality care at reduced                 
  costs.  One  means of achieving  the reduction was to  lower                 
  the  number of  in-patient hospital  stays for a  variety of                 
  illnesses,  including  the length  of  maternity stay.   The                 
  average stay for maternity is not the  result of a change in                 
  policy by insurance companies but the result of a long trend                 
  of  steady decline.   The average stay  for vaginal delivery                 
  was 4 days in  1970, 2.2 days in 1988,  and 2 days in  1993.                 
  That  decline  is  consistent  with  the decline  for  other                 
  services, due to increased medical knowledge and advances in                 
  patient care.                                                                
                                                                               
  Mr. Evans acknowledged that the health care industry has not                 
  gotten  across  some key  points  in "this  mostly emotional                 
  issue."   The issue does not  involve debate about "covering                 
  medically necessary care."   If hospital care  is necessary,                 
  insurers will  cover it for  as long  as needed.   The  real                 
  issue  is  whether,  and how,  insurers  and  policy holders                 
  should cover care that is  not medically necessary or  which                 
  does not need to be provided  in an unduly expensive setting                 
  such as a hospital versus a home or hotel.  Critics of early                 
  discharge fail to understand that not paying for unnecessary                 
  care  or  care  in  unnecessary  settings  is  what  enables                 
  insurers  to  offer  numerous  other  services  managed care                 
  programs provide.  Mr. Evans  cited "well-baby," dental, and                 
                                                                               
                                                                               
  vision coverage as examples.  He stressed that "nobody wants                 
  a discharge program that jeopardizes  the health of a mother                 
  or  child."    The  industry would  not  be  utilizing early                 
  discharge programs  if they were not medically  safe.  There                 
  is a lack of data indicating  that early discharge before 48                 
  hours after vaginal  and before 96 after  a Cesarean section                 
  is harmful or unsafe for  the mother or baby.  Advocates  of                 
  proposed new mandates within CSSB 193 (L&C) have provided no                 
  evidence  that insurance companies  doing business in Alaska                 
  are  systematically  requiring  mothers and  infants  to  be                 
  discharged before  they are  medically ready.   There  is no                 
  empirical evidence to suggest how  long a hospital maternity                 
  stay should  be.  The American College  of Obstetricians and                 
  Gynecologists suggests that:                                                 
                                                                               
       There is relatively little scientific data  on the                      
       ideal length of hospital stay for delivery.                             
                                                                               
  The  American  Medical  Association   has  taken  a  similar                 
  position.   The  Health  Insurance  Association  of  America                 
  believes  that  services  and length  of  hospital  stay for                 
  mothers and infants  should be determined on  a case-by-case                 
  basis and on medical necessity for  both mother and child as                 
  determined jointly by a mother and her doctor.                               
                                                                               
  Co-chairman Frank voiced his understanding  that if a doctor                 
  now determines that  a woman should remain  hospitalized for                 
  longer than 48 hours following a regular birth, no insurance                 
  company now doing  business in Alaska would  refuse to cover                 
  that care.  Mr. Evans concurred in that understanding.                       
                                                                               
  Discussion followed concerning the situation which gave rise                 
  to introduction of the legislation.   Mr. Evans advised that                 
  one of Senator Salo's constituents  indicated she was forced                 
  to leave the hospital before 24 hours.  He acknowledged that                 
  an isolated case of early discharge might have occurred, but                 
  he said he  had no knowledge of  such a case.   No complaint                 
  was filed with the Division of Insurance.                                    
                                                                               
  NANCY WELLER, Medical Assistance  Administrator, Division of                 
  Medical Assistance,  Dept. of  Health  and Social  Services,                 
  came before committee in response to a question from Senator                 
  Rieger asking if  the proposed  bill would impact  Medicaid.                 
  She explained that while it is  unclear whether or not there                 
  will  be  impact, and  the  sponsor  has  requested a  legal                 
  opinion, impact  is not anticipated  because the legislation                 
  does  not  require  hospitalization.    The bill  speaks  to                 
  hospitalization  or  medical care  for  a certain  number of                 
  hours following delivery.  The  Medicaid program provides 24                 
  hours of in-patient care  for vaginal delivery and 72  hours                 
  for  a  Cesarean   section  without  a  request   for  prior                 
  authorization for extended stay.  If the physician feels the                 
  mother needs to remain hospitalized for a longer period, the                 
  professional   review   organization   is  called,   medical                 
                                                                               
                                                                               
  information is  shared, approval  is obtained, and  Medicaid                 
  pays  for  the  care.    Medicaid  also  provides  for  "any                 
  medically necessary services for the  pregnant woman and the                 
  child following  delivery."  If the mother  is only Medicaid                 
  eligible because  she is pregnant,  she "gets two  months of                 
  all health care  services covered  by the program  following                 
  discharge from the hospital."                                                
                                                                               
  Senator Rieger voiced his understanding that should Medicaid                 
  be impacted by the proposed bill, current program procedures                 
  would remain unchanged.  Mrs.  Weller concurred, advising of                 
  her understanding that the bill does not require 48 hours of                 
  hospitalization.    In  response  to  a  question  from  the                 
  Senator,  Mrs. Weller  said that  children born to  women on                 
  Medicaid receive "an automatic one-year coverage of Medicaid                 
  without reapplying for coverage."                                            
                                                                               
  In response to questions from Co-chairman Frank, Mrs. Weller                 
  explained that  Medicaid policies  are similar  to those  of                 
  insurance companies  in terms  of provision  of 24  hours of                 
  care for  vaginal delivery  in a  hospital.   If the  mother                 
  requires additional care, the  physician calls and  requests                 
  permission for an extended stay.  The Co-chairman advised of                 
  his understanding  that the  legislation would  require that                 
  the mother remain  in the hospital  for 48 hours unless  she                 
  and the  physician agree on  earlier discharge.   Since that                 
  appears to differ  from present Medicaid policy in  terms of                 
  length of stay and pre-approval for  an extended stay, it is                 
  difficult to understand why no cost would be involved.  Mrs.                 
  Weller reiterated  that  the bill  does not  mandate an  in-                 
  patient setting.  It is thus questionable whether there will                 
  be impact  on the program.  Co-chairman Frank referenced the                 
  sponsor's intent  that the  patient remain  in the  hospital                 
  rather than merely under a doctor's care.                                    
                                                                               
  Bruce Richards returned before committee to explain that the                 
  term  "medical  care"  would cover  home  visits  and return                 
  visits to the  doctor.   Co-chairman Frank again  questioned                 
  the fact that  the bill  appears to mandate  48 hours  while                 
  Medicaid  specifies  24  hours,   with  prior  approval  for                 
  exceptional cases.   He suggested  that should the  proposed                 
  bill  pass,  there would  be  an inconsistency  between what                 
  private health care providers are required to cover and what                 
  Medicaid provides.   At the present time,  private insurance                 
  and Medicaid appear  to be comparable.  Should  the proposed                 
  bill pass, Medicaid would become substandard relative to the                 
  new  mandate.   Mr.  Richards  voiced  his belief  that  the                 
  proposed  bill  would cover  Medicaid.   He  suggested there                 
  would be no increase in costs  because Medicaid is living up                 
  to the spirit of the law at the present time.  Authorization                 
  after 24 hours is forthcoming under Medicaid.  Medicaid also                 
  pays for medical care once the patient is discharged.                        
                                                                               
  In response to additional  questions from Co-chairman Frank,                 
                                                                               
                                                                               
  Mr.  Richards  explained   that  the  proposed   legislation                 
  responds  to  "a  small problem  in  Alaska."    It is  more                 
  prevalent  in   the  "Lower   Forty-eight"  due   to  health                 
  maintenance organizations.   The intention  is to "nip  this                 
  problem  in  the  bud."    Some  places  in  California  are                 
  discussing discharge as  soon as  six hours after  delivery.                 
  While no evidence indicates 48 hours  is the "magic number,"                 
  there is also no evidence to suggest that early discharge is                 
  safe.  The  American Academy of  Pediatrics has asked for  a                 
  moratorium on the issue.                                                     
                                                                               
  Co-chairman  Frank  advised   of  difficulty  envisioning  a                 
  situation   in   which   a   doctor   recommends   continued                 
  hospitalization but the hospital nevertheless discharges the                 
  patient.  Mr. Richards said that the question is not whether                 
  the individual will be  discharged but "Who is going  to pay                 
  for the coverage  if they  stayed longer."   People pay  for                 
  medical  insurance   to  cover  situations   such  as  that.                 
  Amendments contained within the proposed  bill relate to the                 
  insurance title rather than health codes.                                    
                                                                               
  Senator Rieger asked  if reference to "insurer"  would cover                 
  HMOs.  Mr. Richards responded affirmatively.                                 
                                                                               
  In response to a  further question from Senator  Rieger, Mr.                 
  Richards stressed that the proposed bill does not  require a                 
  patient to remain in  the hospital for 48 hours.  Under bill                 
  language, the decision to leave earlier would be made by the                 
  patient and her doctor.  Language commencing at page 1, line                 
  14, and carrying over to page 2, lines 1 and 2, reflects the                 
  sponsor's  intent  that the  decision  be made  by  both the                 
  patient and doctor in consultation with one another.                         
                                                                               
  Senator Rieger referenced correspondence from a pediatrician                 
  who indicated that the best way to ensure a baby gets off to                 
  a healthy start is follow-up visits, especially in the first                 
  week.    That  is  what  is  most commonly  not  covered  by                 
  insurance.    Mr.  Richards  explained  that  lack  of  bill                 
  provisions  relating  to  follow-up care  reflects  Alaska's                 
  geography and the  manner in which  health care is  provided                 
  across the state.                                                            
                                                                               
  Co-chairman Frank  voiced reluctance to place arbitrary time                 
  periods in statute.  He then  questioned why the decision on                 
  length of stay should not be left to the doctor to decide.                   
                                                                               
  END:      SFC-96, #33, Side 1                                                
  BEGIN:    SFC-96, #33, Side 2                                                
                                                                               
  The Co-chairman next asked how a  stay beyond 48 hours would                 
  be  covered.   Mr.  Richards  responded that  most insurance                 
  companies would cover medically necessary costs.                             
                                                                               
  Co-chairman  Frank suggested that  the focus of  the bill is                 
                                                                               
                                                                               
  "this feeling that  the mother  may not be  ready to  leave"                 
  rather  than reliance on  a medical  professional's opinion.                 
  Mr. Richards explained that the physician would consult with                 
  the patient  prior to making a  decision.  That  is why bill                 
  language relates to a decision by the mother and the "health                 
  care provider" rather  than the  doctor alone.   Co-chairman                 
  Frank  suggested  that a  specific time  frame might  not be                 
  necessary  if  the decision  is left  to  the doctor.   That                 
  appears to be  more logical than placing an  arbitrary limit                 
  in statute.   Mr.  Richards reiterated  that the bill  deals                 
  only with who is going to pay for the initial 48 hours.  Co-                 
  chairman Frank again voiced concern over legislative mandate                 
  of a specific time frame, saying that it moves away from the                 
  professional   judgment   aspect   of    individual   cases.                 
  Individuals want insurance to cover  costs, and costs should                 
  be medically reasonable and necessary.                                       
                                                                               
  Senator   Sharp  inquired   regarding   the  frequently   of                 
  incidences  in  which  a physician  has  recommended  a stay                 
  longer  than 24  hours for  which an  insurance company  has                 
  refused to pay.  Mr.  Richards described that occurrence  in                 
  Alaska as "very small."   The problem is growing  outside of                 
  Alaska and only starting to show here.                                       
                                                                               
  BOB  STALNAKER,   Director,  Division   of  Retirement   and                 
  Benefits,  Dept.   of  Administration,   next  came   before                 
  committee.    Co-chairman  Halford  referenced  fiscal  note                 
  information  estimating  a  monthly  per-employee charge  of                 
  $1.78.  Mr. Stalnaker explained that the $104.0                              
  note (dated  2/21/96)  stemmed from  analysis  of  potential                 
  impact of increased hospital stays.  Numbers were predicated                 
  on  what the  department thinks  experience will be.   State                 
  plans  are experience  rated.   In  such  situations, it  is                 
  common  for  the department  to show  costs in  the analysis                 
  section.   Mr. Stalnaker  directed attention  to an  updated                 
  zero fiscal  note and  referenced amounts  set forth  within                 
  analysis language.                                                           
                                                                               
  The current plan  pre-certifies pregnant  women for one  day                 
  for a vaginal delivery.  If complications arise, coverage is                 
  not denied, regardless  of the length  of stay, if there  is                 
  medical necessity.  Experience shows  that most women who go                 
  to the hospital  for delivery  want to leave  as quickly  as                 
  possible.  Mr. Stalnaker said he was unaware  of individuals                 
  or physicians  disagreeing with  the present  approach.   He                 
  subsequently noted  that  he  knew of  one  case  where  the                 
  individual was upset  because she was not  pre-certified for                 
  two days.  Mr. Stalnaker acknowledged attempts in California                 
  to bring the time down to six hours.  With increased managed                 
  care there is  a "tendency to try  to squeeze it as  much as                 
  possible."   What is happening  nationally is a  reaction to                 
  that.   There is a reasonable point  somewhere.  That is why                 
  the  department  is  neutral  on  the  proposed  bill.   Mr.                 
  Stalnaker advised that he  was not aware of any  cases where                 
                                                                               
                                                                               
  the state disagreed with a doctor on what was prescribed for                 
  a particular patient.                                                        
                                                                               
  Co-chairman Frank said  he was more comfortable  leaving the                 
  decision on length of stay to the doctor's discretion rather                 
  than mandating a minimum.                                                    
                                                                               
  Senator  Rieger inquired  concerning the  co-payment  for an                 
  extended stay.   Mr. Stalnaker advised of an  80% co-payment                 
  per the state health plan.  A state employee can purchase an                 
  addition  10%  coverage.    The  co-payment applies  to  any                 
  services, including delivery.  Senator Rieger suggested that                 
  at a market cost of $600  a day for hospitalization, mothers                 
  would not frivolously remain if the extended stay would cost                 
  them  $120.    Mr.  Stalnaker  concurred,  saying  that  the                 
  foregoing  was considered when  the department  analyzed the                 
  bill.  While  experience might  raise costs, the  department                 
  does  not  know  what  those costs  might  be.    It  is not                 
  reasonable  to  assume that  a  mother would  want  to incur                 
  additional, unnecessary  costs.   He  acknowledged that  the                 
  legislation might not measurably impact  the plan.  However,                 
  it could increase  stays.  That will not be  known until the                 
  department has some experience with the issue.                               
                                                                               
  Senator  Rieger  voiced  his  understanding  that  under the                 
  status quo,  which is policy rather than law, the stay is 24                 
  hours.  It is then up to the discretion of the doctor, only,                 
  for the  patient to  remain beyond  that time.   Should  the                 
  proposed bill  become law, remaining  for the next  24 hours                 
  would be up to the discretion of the doctor and the patient.                 
  Hospitalization beyond  48 hours would, again, be  up to the                 
  discretion of the doctor.  Mr. Stalnaker concurred.  Senator                 
  Rieger then  voiced his  belief that,  in light  of the  co-                 
  payment, it is unlikely there will  be great impact from the                 
  bill.                                                                        
                                                                               
  Brief discussion of co-payments for insurance plans followed                 
  between Co-chairman Frank and Mr. Stalnaker.                                 
                                                                               
  HARLAN   KNUDSON,   Alaska   Hospital   and   Nursing   Home                 
  Association, next came before committee, voicing support for                 
  the bill.   He  acknowledged pressure  on both  insurers and                 
  health care providers  to lower  costs.   He questioned  the                 
  qualifications of both himself and committee members to deal                 
  with an  issue  involving women  and  infants.   He  further                 
  attested to a  lack of understanding of conditions in Alaska                 
  by out-of-state  insurance companies when a  physician calls                 
  to request authorization  for extended hospitalization.   He                 
  urged that members discuss the legislation with their wives,                 
  mothers, and sisters prior to a vote.                                        
                                                                               
  When Senator Rieger asked about the  actual cost of an extra                 
  hospital  day, Mr. Knudson noted that,  in delivery of care,                 
  hospitals  tend  to  bunch  charges   into  the  first  day.                 
                                                                               
                                                                               
  Subsequent days are generally less costly.                                   
                                                                               
  Co-chairman  Halford  referenced  the  updated  fiscal  note                 
  reflecting  impact  of  $125.0  to  $250.0 in  the  analysis                 
  portion and  questioned whether figures should  be presented                 
  in that fashion  or spread across cost columns.   He said he                 
  was  not  convinced that  notation  in the  analysis portion                 
  meets the  letter of  fiscal note  law.    He  acknowledged,                 
  however, that  that  policy  issue  is  not  unique  to  the                 
  proposed bill.                                                               
                                                                               
  Discussion  followed  between   Co-chairman  Frank  and  Mr.                 
  Stalnaker regarding the impact of health care cost increases                 
  on  the state  plan.   In  the course  of his  comments, Mr.                 
  Stalnaker described deductibles and caps  as methods of cost                 
  control.                                                                     
                                                                               
  Further discussion followed concerning  insurance provisions                 
  of state agreements  with five employee labor unions and the                 
  commissioner's plan which  covers non-union employees.   Mr.                 
  Stalnaker noted that  the state has experienced  three years                 
  of no  cost increases.    The dynamics  of health  insurance                 
  increases  "are starting  to  hit  the  plan  again."    The                 
  proposed bill will not "matter in the big scheme of things."                 
  It will not have material impact on the plan as a whole.                     
                                                                               
  Co-chairman  Halford  directed  that the  bill  be  held for                 
  further review.                                                              
                                                                               
                                                                               
  CS FOR HOUSE BILL NO. 335(RES)(title am)                                     
                                                                               
       An Act extending the  termination date of the  Big Game                 
       Commercial Services Board; eliminating  the requirement                 
       for  a  commercial  use  permit   and  for  payment  of                 
       commercial use permit fees; amending the  membership of                 
       the Big Game Commercial Services Board; relating to the                 
       qualifications   for   an   assistant   guide-outfitter                 
       license;  eliminating  the requirement  for  testing of                 
       assistant  guide-outfitters;  providing  for additional                 
       licensing  requirements  for  transporters; eliminating                 
       the requirement for  prior approval to enter  or remain                 
       on state and federal land; eliminating  the requirement                 
       to register base camps; amending the definition of 'big                 
       game  commercial  services';   and  providing  for   an                 
       effective date.                                                         
                                                                               
  Co-chairman Halford directed  that CSHB 335 (Res)(title  am)                 
  be brought on for discussion and referenced a draft SCS CSHB                 
  335 (Fin)  (9-LS1156\W, Utermohle, 3/7/96).   REPRESENTATIVE                 
  SCOTT  OGAN,   sponsor  of  the  legislation,   came  before                 
  committee and explained that under the proposed draft:                       
                                                                               
                                                                               
       1.   Authority to license guides is  given to the Dept.                 
  of        Commerce and Economic Development.                                 
                                                                               
       2.   Basic  statutory  definitions  for guides  remain.                 
  New            language  says that  a  person  who has  been                 
                 convicted of a  felony in the last  ten years                 
                 cannot qualify for a guide license.                           
                                                                               
       3.   Assistant guides may be hired without a test, upon                 
            recommendation of a guide.  That is a significant,                 
            positive change.                                                   
                                                                               
       4.   Provisions for class-A guides will encourage rural                 
            employment.  A  class-A guide  is someone who  has                 
            lived  or hunted  in the  area for  ten years  and                 
            lives in the local area.                                           
                                                                               
       5.   Game  biologists  are  precluded from  becoming  a                 
  guide for           twelve  months  after employment  by the                 
                      Dept. of Fish and Game in areas in which                 
                      they worked and  studied.  An individual                 
                      employed by the  state to study  animals                 
                      in  an area has  an unfair  advantage to                 
                      subsequently   exploit   the   wildlife.                 
                      Existing  law  prohibiting  a  fish  and                 
                      wildlife   enforcement    officer   from                 
                      becoming a  guide prior to  three months                 
                      after concluding employment is retained.                 
                                                                               
       6.   The level  of accountability for  transporters, in                 
  terms                                                                        
            of  violations,  is raised  to  the same  level as                 
            guides.                                                            
                                                                               
       7.   Language within insurance provisions is changed to                 
            require proof of financial responsibility.                         
                                                                               
       8.   The  time  that  an   individual  may  operate  an                 
  airplane       incidental to guide  activities is  increased                 
                 from 250 to 500 hours.                                        
                                                                               
       9.   Authority is given  to the  Dept. of Commerce  and                 
  Economic       Development to discipline guides convicted of                 
                 violations.                                                   
                                                                               
      10.   Guide-use  areas  are retained.    However, guides                 
  will not       have to  report to  the department  or get  a                 
                 permit  from the  department for  a guide-use                 
                 area.  Guides  will have to  be in three  use                 
                 areas.   They  will  simply  have  to  notify                 
                 protection when they wish to change, and they                 
                 may change once every calendar year.                          
                                                                               
      11.   Statutory  language regarding what a guide  may do                 
                                                                               
                                                                               
  and what       a transporter may not do  is expanded so that                 
                 there is no cross-over between the two.                       
                                                                               
      12.   Retroactive  authority  is provided  to  those who                 
  were           licensed since the old board was sunset.                      
                                                                               
      13.   Wage and hour  provisions exempt assistant  guides                 
  from           overtime--similar    to     provisions    for                 
                 fishermen,  agriculture,  and  various  other                 
                 occupations.                                                  
                                                                               
      14.   The commercial-use permit is eliminated.                           
                                                                               
  The  industry  has  complained for  many  years  that  it is                 
  difficult  to   get  assistant  guides  because  of  testing                 
  requirements.  A guide is legally  responsible for action in                 
  the field as  if he were committing each act himself.  He is                 
  thus responsible for  not only the actions of  his assistant                 
  guides  but  those  of his  clients.    With  that level  of                 
  responsibility, guides should be able  to hire whomever they                 
  wish.                                                                        
                                                                               
  Representative Ogan directed attention to a needed change at                 
  page 8, line 11, and recommended  removal of "at all times."                 
  He  explained  that it  is impractical  for a  registered or                 
  class-A assistant guide  to be  physically present with  the                 
  assistant guide "at all times."  Supervision by a registered                 
  guide  or  class-A  assistant  is acceptable.    Co-chairman                 
  Halford noted that after  the recommended deletion  language                 
  would remain as it is in current law.                                        
                                                                               
  Senator  Sharp   voiced  his  understanding   that  mandated                 
  insurance  requirements  had  expired.    He then  asked  if                 
  current provisions  for  insurance  or  proof  of  financial                 
  responsibility   were   the   only   insurance   provisions.                 
  Representative Ogan responded  affirmatively.  Senator Sharp                 
  attested to several  guides who conducted two or three hunts                 
  a year who  had to go out of business because they could not                 
  afford the mandated insurance.                                               
                                                                               
  Senator  Randy  Phillips  MOVED  for  adoption of  SCS  CSHB                 
  335(Fin) (Version W, dated 3/7/96) with the technical change                 
  recommended by Representative Ogan  at page 8, line 11.   No                 
  objection  having  been  raised,  SCS  CSHB  335  (Fin)  was                 
  ADOPTED.                                                                     
                                                                               
  In response to  a question from Senator  Zharoff, asking why                 
  deleted  language  was included  in  the draft,  Co-chairman                 
  Halford  explained  that the  intent  is that  the  level of                 
  supervision for  assistant guides be higher than supervision                 
  required  for class-A assistant  guides.   Original language                 
  adopting class-A assistant guide  provisions was intended to                 
  encourage the hire of long-time residents in game management                 
  units.    The attempt  was  to  keep local  people  in local                 
                                                                               
                                                                               
  hunting areas involved.  The Co-chairman reiterated that the                 
  level of supervision for a class-A assistant guide should be                 
  less than supervision required for an assistant guide.  That                 
  provides  an   advantage  to  hiring   and  keeping  class-A                 
  assistant guides.                                                            
                                                                               
  Senator Zharoff asked if the forgoing would allow a guide to                 
  supervise from "a penthouse in  San Francisco."  Co-chairman                 
  Halford acknowledged that  the board discussed the  issue of                 
  supervision for many  years.  The rule in the old system was                 
  that a class-A  assistant guide could  be running a camp  as                 
  long as  the contracting,  registered, or  master guide  had                 
  contracted the hunt and was actively involved in the hunt at                 
  some  point.  An  assistant guide had  to have contact  on a                 
  regular  basis  with  the  contracting  guide or  a  class-A                 
  assistant guide.  Representative Ogan  noted that during his                 
  term as a public member on the guide board, the standard was                 
  that  the registered guide  had to be  in the  camp at least                 
  once during each hunt.   Under the proposed bill,  a class-A                 
  assistant  guide  may supervise  an  assistant guide  in the                 
  field.                                                                       
                                                                               
  Senator Rieger asked if others associated with the camp (the                 
  cook and packers) would have to be licensed.  Representative                 
  Ogan  responded  negatively.   Only  those who  help pursue,                 
  stalk, take or actively engage in hunting must  be licensed.                 
                                                                               
                                                                               
  Referencing  language at  page 17,  subsections  (A) through                 
  (G),  Representative Ogan explained  that he lifted language                 
  from  existing   regulations  and  placed  it   in  statute.                 
  Established practices needed statutory classification.                       
                                                                               
  KEN   TAYLOR,   Deputy   Director,   Division  of   Wildlife                 
  Conservation, Dept. of Fish and Game, came before committee.                 
  He said that  while he had only recently  received a copy of                 
  the  draft  committee substitute,  initial  review indicates                 
  that it is "a lot cleaner  than existing law."  Requirements                 
  removed from existing  law (the  operations plan was  cited)                 
  will  not  significantly impact  management.   The  Dept. of                 
  Public Safety and division of  fish and wildlife enforcement                 
  would have to address impact as well.                                        
                                                                               
  Senator Zharoff referenced the license fee structure on page                 
  16 and asked if it differentiates between residents and non-                 
  residents.   Co-chairman  Halford  answered negatively.   He                 
  acknowledged discussion of a differential.   For many years,                 
  a  registered  guide or  master guide  had  to be  an Alaska                 
  resident.    That  was  lost  in a  constitutional  question                 
  because guiding is a commercial activity.  He then suggested                 
  that there could  be a  ratio of fees  between resident  and                 
  non-resident guides and transporters.                                        
                                                                               
  END:      SFC-96, #33, Side 2                                                
                                                                               
                                                                               
  BEGIN:    SFC-96, #34, Side 1                                                
                                                                               
  The  Co-chairman advised  that language  could specify  that                 
  non-resident fees in  each category are  four times the  fee                 
  for  a  resident.    Senator   Zharoff  suggested  that  the                 
  committee  review  that   possibility  and  make  provisions                 
  consistent  with  other areas  where  non-resident  fees are                 
  different from those paid by residents.                                      
                                                                               
  CATHERINE  REARDON,  Director,   Division  of   Occupational                 
  Licensing, Dept. of Commerce and Economic Development,  next                 
  came before committee.  She said  the department had not yet                 
  had an opportunity to examine the details of the draft bill,                 
  take  an official  position, or  prepare fiscal notes.   She                 
  acknowledged that the legislation  would have fiscal  impact                 
  on the Dept. of Commerce and Economic Development as well as                 
  the Dept. of Public Safety (due to elimination of commercial                 
  use permits that previously generated enforcement funds).                    
                                                                               
  Ms. Reardon next noted areas within the draft giving rise to                 
  questions and cited provisions requiring "fine tuning:"                      
                                                                               
  Page  3, Line  4,  language relating  to  "written or  oral"                 
  examinations would be more manageable  if it simply said "an                 
  examination."   Oral exams  are difficult  to administer  to                 
  larger groups or in rural areas.  Co-chairman  Halford asked                 
  that  the  department prepare  an  amendment reflecting  the                 
  change.  He  acknowledged that  cited language was  designed                 
  for  administration by  a  peer review  board  and was  more                 
  cumbersome than it needed to be.                                             
                                                                               
  Page  8,  Line  10,  language  relating  to  supervision  of                 
  assistant  guides  is  of  concern.     There  is  need  for                 
  clarification.    The department  would  prepare regulations                 
  defining  what  supervision  means.   At  the  present time,                 
  class-A and assistant guides both  have the same supervision                 
  requirements.   The guide  has to  show up  once during  the                 
  hunt.  Ms. Reardon advised of her understanding of foregoing                 
  discussion to  be that  class-A guides  should require  less                 
  supervision than assistant guides.  Language at Page 7, Line                 
  22, says  that class-A guides may take  charge of a camp and                 
  conduct guide activities without the  registered guide being                 
  present in  the area,  as long  as the  registered guide  is                 
  supervising.   If it is the  intention that assistant guides                 
  not be  able to do so, it would  be helpful if bill language                 
  at page 8 says that an assistant guide cannot take charge of                 
  a  camp.    Otherwise,  supervision  could be  construed  as                 
  supervision from a distance.  If the goal is to make class-A                 
  guides more  appealing to the employer, it  would be helpful                 
  if lack  of independent authority for an assistant guide was                 
  clarified.                                                                   
                                                                               
  Page  7  licensing  requirements for  class-A  guides.   Ms.                 
  Reardon noted  two methods  of attaining  a class-A  license                 
                                                                               
                                                                               
  under current law:                                                           
                                                                               
       1.   Employment one  season as an assistant  guide plus                 
  ten       years of hunting experience in the game management                 
            unit, or                                                           
                                                                               
       2.   Physical residency in the game management unit and                 
            fifteen years of hunting experience in the unit.                   
                                                                               
  If the legislature  wishes to place  a premium on those  who                 
  reside in the game management unit, option number two should                 
  be the only method of attaining that license.                                
                                                                               
  Page  8  language  relating  to   game  biologists  needs  a                 
  definition of "game biologist."   Co-chairman Halford  asked                 
  that Ms. Reardon provide appropriate language.  He explained                 
  that  the  provision  is  simply  intended  to  prohibit  an                 
  individual employed by the state  to gather information from                 
  immediately  using that  information in  a private  business                 
  venture.                                                                     
                                                                               
  Page 10, Line  25-26, insurance requirements speak  to proof                 
  of   financial  responsibility  of   $100.0.    Ms.  Reardon                 
  questioned what type  of proof the individual  would have to                 
  submit to the department  (a list of assets,  something from                 
  an  accountant,  etc.).    Should  the department  check  to                 
  determine  if  the  assets are  available  every  two years?                 
  There  are  some administrative  logistics  that need  to be                 
  worked out.                                                                  
                                                                               
  Page 12, Line  10, subsection (e)  relating to inability  of                 
  the department  to discipline a  transporter for  violations                 
  committed  by  his  or her  employee.    Co-chairman Halford                 
  subsequently voiced intent  that both registered  guides and                 
  transporters be treated  equally in terms of  responsibility                 
  for their employees.  In response to a question from Senator                 
  Zharoff,  the  Co-chairman  advised  that  transporters  are                 
  responsible  for  reporting  violations of  which  they  are                 
  aware.   They  are, however,  not actively  involved in  the                 
  field.   A transporter  would be in  violation if  he or she                 
  knowingly transports an  illegal animal and does  not report                 
  the violation.   Language pinpointed by Ms.  Reardon appears                 
  to  be  a  drafting  error.     It  was  intended  that  the                 
  responsibility levels  be comparable  and commensurate  with                 
  ability to both  report violations and "know what  was going                 
  on."                                                                         
                                                                               
  Page  14,  Line   30,  language   says  that  "guides"   are                 
  responsible for assistant guides.                                            
                                                                               
  Page 19 reference to  wage and hour law should  be discussed                 
  with staff from  the Dept.  of Labor.   Co-chairman  Halford                 
  noted that the industry  has had problems with the  issue in                 
  the past.   The proposed  bill includes a  limitation of  60                 
                                                                               
                                                                               
  days a year.   The existing exemption for fishery processing                 
  workers and other exemptions are  "wide open."  The language                 
  applies  only  to  licensed  personnel,  in  the  employ  of                 
  licensed personnel, and "only for a maximum of 60 days . . .                 
  ."  It thus relates to limited, seasonal employees in a very                 
  specific area.   Cooks and other unlicensed  personnel would                 
  not be covered by the exemption.                                             
                                                                               
  Ms.  Reardon referenced earlier  discussion of  resident and                 
  non-resident fees and  advised that it  would be helpful  if                 
  the differential was  placed in  statute, or the  department                 
  will establish  one, across-the-board, consistent fee.   Ms.                 
  Reardon referenced a program with  language saying that out-                 
  of-state collection  agency fees  are twice  as  high as  in                 
  state.  Co-chairman Halford again  asked that the department                 
  prepare  amending language and  a position  paper concerning                 
  whether  the  department  would  support  the   differential                 
  between residents and non-residents.                                         
                                                                               
  Senator  Sharp suggested  that definition of  a non-resident                 
  track with one-year residency requirements  for purchasing a                 
  hunting  license.   Co-chairman Halford  responded  that the                 
  effort  could  be   tried.    He  acknowledged   a  possible                 
  constitutional  question  because  a hunting  license  is  a                 
  privilege, not a  right.  A  commercial activity is  usually                 
  more  suspect   when  residents  are  preferred   over  non-                 
  residents.                                                                   
                                                                               
  Senator Rieger  referenced old  law relating  to guides  and                 
  guide-outfitters and asked what changes  are proposed in the                 
  instant bill.   Co-chairman  Halford explained  that in  the                 
  late  1980s,  the  law  was  changed  to  include  the  term                 
  "outfitter"  with   the  term   "guide"  because   the  term                 
  "outfitter"  is  used outside  of Alaska  to denote  one who                 
  provides both outfitting and guiding services.  The proposed                 
  bill reverts  to original definitions and original language.                 
  He  suggested,  however,  that  the  members might  wish  to                 
  include  a prohibition  on use  of the  term "outfitter"  by                 
  someone  who  is not  a registered  or  master guide,  as it                 
  applies to big game hunting.                                                 
                                                                               
  Senator Rieger  cited an example  of an individual  who does                 
  not actually guide the  hunt (stalk the animal) but  flies a                 
  hunter to  a location and provides  a camp and asked  if the                 
  provider  would be regulated  as a guide  under the proposed                 
  bill.  Co-chairman  Halford voiced intent that  the provider                 
  be treated the same.  If the transporter is operating in air                 
  commerce,  the transporter would  have to  have an  air taxi                 
  license.  If  one provides services  in the field in  actual                 
  pursuit  of game,  a  guide license  is  required.   Senator                 
  Rieger asked  if that  includes setting  up the  camp.   Co-                 
  chairman  Halford  responded  negatively,  advising  that  a                 
  section within  the proposed legislation  deals specifically                 
  with that activity.                                                          
                                                                               
                                                                               
  Senator Rieger directed  attention to Page 17,  Line 18, and                 
  referenced the definition  of "outfit."  He  also referenced                 
  language at Page 5,  Line 27, which says a  registered guide                 
  may  contract to guide or outfit hunts.   He then noted that                 
  language appears to indicate that  outfitting is guiding and                 
  asked if that is a change from the  status quo.  Co-chairman                 
  Halford advised that it is the intent to maintain the status                 
  quo in those three  areas.  He said he  would further review                 
  the draft to  ensure that  is the case.   Catherine  Reardon                 
  remarked that brief  review of the draft  indicates that the                 
  current situation is  unchanged.   She clarified that  under                 
  current law, one  who flies  hunters in and  drops them  off                 
  must have a transporter license.  One who flies hunters into                 
  a camp set up  and established by the transporter  must also                 
  have a guide  license.  That  would continue to be  required                 
  under the proposed draft.                                                    
                                                                               
  Co-chairman Halford  acknowledged the  participation of  JOE                 
  D'AMICO, Commander,  Commercial Crimes  Bureau, Division  of                 
  Fish and Wildlife  Protection, Dept.  of Public Safety,  via                 
  teleconference from  Kodiak.   The Co-chairman then  advised                 
  that the bill would be held for further review.                              
                                                                               
  ADJOURNMENT                                                                  
                                                                               
  The meeting was adjourned at approximately                                   
                                                                               

Document Name Date/Time Subjects