Legislature(2017 - 2018)SENATE FINANCE 532

02/27/2018 09:00 AM FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ SB 105 MARITAL & FAMILY THERAPY LIC. & SERVICES TELECONFERENCED
Heard & Held
+ SB 108 MEDICAL CARE/LICENSING/MEDICAL BOARD TELECONFERENCED
Heard & Held
+ SB 165 COMPREHENSIVE HEALTH INSURANCE FUND TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
                 SENATE FINANCE COMMITTEE                                                                                       
                     February 27, 2018                                                                                          
                         9:02 a.m.                                                                                              
                                                                                                                                
                                                                                                                                
9:02:03 AM                                                                                                                    
                                                                                                                                
CALL TO ORDER                                                                                                                 
                                                                                                                                
Co-Chair  MacKinnon  called  the  Senate  Finance  Committee                                                                    
meeting to order at 9:02 a.m.                                                                                                   
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Lyman Hoffman, Co-Chair                                                                                                 
Senator Anna MacKinnon, Co-Chair                                                                                                
Senator Click Bishop, Vice-Chair                                                                                                
Senator Peter Micciche                                                                                                          
Senator Donny Olson                                                                                                             
Senator Gary Stevens                                                                                                            
Senator Natasha von Imhof                                                                                                       
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
None                                                                                                                            
                                                                                                                                
ALSO PRESENT                                                                                                                  
                                                                                                                                
Senator   Cathy  Giessel,   Sponsor;  Fred   Parady,  Deputy                                                                    
Commissioner,   Department  of   Commerce,  Community,   and                                                                    
Economic  Development; Senator  David Wilson,  Sponsor; Gary                                                                    
Zepp,  Staff,  Senator   Wilson;  Randall  Burns,  Director,                                                                    
Division  of Behavioral  Health,  Department  of Health  and                                                                    
Social  Services;  Elizabeth   Ripley,  CEO,  Mat-Su  Health                                                                    
Foundation;  Jon  Zasada,  Policy Director,  Alaska  Primary                                                                    
Care  Association; Brittany  Hartmann,  Staff, Senator  Anna                                                                    
MacKinnon;   Lori   Wing-Heier,    Director,   Division   of                                                                    
Insurance,  Department of  Commerce, Community  and Economic                                                                    
Development.                                                                                                                    
                                                                                                                                
PRESENT VIA TELECONFERENCE                                                                                                    
                                                                                                                                
Debora  Stovern, Executive  Director,  Alaska State  Medical                                                                    
Board,  Anchorage;  Doctor  Danny Robinette,  Chief  Medical                                                                    
Officer,  Foundation   Health  Partners,   Fairbanks;  Karen                                                                    
Cunningham,  Vice  President,  Marriage and  Family  Therapy                                                                    
Board, Anchorage; Ken McCarty, Director, Discovery Cove                                                                         
Recovery and Wellness Center, Eagle River.                                                                                      
                                                                                                                                
SUMMARY                                                                                                                       
                                                                                                                                
SB 105    MARITAL & FAMILY THERAPY LIC. & SERVICES                                                                              
                                                                                                                                
          SB 105 was HEARD and HELD in committee for                                                                            
          further consideration.                                                                                                
                                                                                                                                
SB 108    MEDICAL CARE/LICENSING/MEDICAL BOARD                                                                                  
                                                                                                                                
          SB 108 was HEARD and HELD in committee for                                                                            
          further consideration.                                                                                                
                                                                                                                                
SB 165    COMPREHENSIVE HEALTH INSURANCE FUND                                                                                   
                                                                                                                                
          SB 165 was HEARD and HELD in committee for                                                                            
          further consideration.                                                                                                
                                                                                                                                
SENATE BILL NO. 108                                                                                                           
                                                                                                                                
     "An Act relating to the State Medical Board; relating                                                                      
     to the licensing of physicians, osteopaths, and                                                                            
    podiatrists; and providing for an effective date."                                                                          
                                                                                                                                
9:03:32 AM                                                                                                                    
                                                                                                                                
SENATOR CATHY GIESSEL, SPONSOR, discussed the presentation,                                                                     
"SB 108 State Medical Board" (copy on file).                                                                                    
                                                                                                                                
9:03:51 AM                                                                                                                    
                                                                                                                                
Senator Giessel highlighted Slide 2, "Purpose":                                                                                 
                                                                                                                                
     1. Streamline Physician Licensing                                                                                          
     2. Need for office assistants                                                                                              
                                                                                                                                
9:04:26 AM                                                                                                                    
                                                                                                                                
Senator Giessel discussed Slide 3, "Streamline MD                                                                               
licensing":                                                                                                                     
                                                                                                                                
     Section 1, 2, 8, 9, 10                                                                                                     
          State Medical Board to write regulations to                                                                           
          delegate to EXECUTIVE ADMINISTRATOR:                                                                              
                                                                                                                                
          1. review applications and grant license if                                                                       
          requirements are met                                                                                                  
          2. review applications and issue temporary                                                                        
          license if requirements are met                                                                                   
          3. grant certification if requirements are met                                                                    
          4. spells out prohibitions to this delegated                                                                      
          authority                                                                                                             
                                                                                                                                
9:06:28 AM                                                                                                                    
                                                                                                                                
Senator Giessel discussed Slide 4, "Streamline MD                                                                               
licensing":                                                                                                                     
                                                                                                                                
     Section 10, 11                                                                                                             
          1. Allows another person, designated by the                                                                           
          board, to help the Executive Administrator to                                                                         
          issue temporary license.                                                                                          
                                                                                                                                
          2. Outlines when this could happen                                                                                    
                                                                                                                                
Senator Giessel stated that this change was urgently needed                                                                     
and widely supported.                                                                                                           
                                                                                                                                
9:08:20 AM                                                                                                                    
                                                                                                                                
Senator Giessel highlighted Slide 5, "Medical Assistants -                                                                      
Unlicensed Assistive Personnel":                                                                                                
                                                                                                                                
     Medical Assistants                                                                                                         
          trained in "routine medical tasks"                                                                                
                                                                                                                                
     Section 3                                                                                                                  
          authorizes delegation to unlicensed person                                                                        
                                                                                                                                
          prohibits delegation of pain management or opioid                                                                 
          related activities                                                                                                    
                                                                                                                                
Senator Giessel offered a brief history of the role of                                                                          
medical assistance in practice.                                                                                                 
                                                                                                                                
9:10:31 AM                                                                                                                    
                                                                                                                                
Senator Giessel addressed Slide 6, "Medical Assistants -                                                                        
Unlicensed Assistive Personnel":                                                                                                
                                                                                                                                
     Section 6                                                                                                                  
          adds  unlicensed  assistive personnel,  performing                                                                    
          delegated  routine  medical  duties  to  exception                                                                  
          under "License to  practice medicine, podiatry, or                                                                    
          osteopathy"                                                                                                           
                                                                                                                                
     Section 13                                                                                                                 
          adds   "medical  assistants"   to  definition   of                                                                  
          "medical  professional"  under Title  12  Criminal                                                                  
          Procedure                                                                                                             
                                                                                                                                
Senator Giessel stated that only licensed medical                                                                               
professionals could access the state's pharmaceutical                                                                           
database.                                                                                                                       
                                                                                                                                
9:12:18 AM                                                                                                                    
                                                                                                                                
Senator Giessel looked at Slide 7, "Certified Medical                                                                           
Assistants - NEW entity":                                                                                                       
                                                                                                                                
     Why?                                                                                                                   
     Prescription Drug Monitoring Program (PDMP)                                                                                
                                                                                                                                
         prohibits access by any unlicensed person                                                                              
                                                                                                                                
          envisioned  clinician  delegate "look  up"  before                                                                    
          prescribing                                                                                                           
                                                                                                                                
     Problem                                                                                                                
                                                                                                                                
          No licensed  people in MD  clinic, other  than the                                                                    
          MD                                                                                                                    
                                                                                                                                
          Frequent need to check on PDMP                                                                                        
                                                                                                                                
     Solution                                                                                                               
                                                                                                                                
          Alaska's Community Colleges  training programs for                                                                    
          CMA                                                                                                                   
                                                                                                                                
          National exams for Certification                                                                                      
                                                                                                                                
     Done in most other states. Washington State is one                                                                         
     example                                                                                                                    
                                                                                                                                
9:14:17 AM                                                                                                                    
                                                                                                                                
Senator Giessel discussed Slide 8, "CMA (Certified Medical                                                                      
Assistant) Process defined":                                                                                                    
                                                                                                                                
     Section 4                                                                                                                  
          Certification - process will be defined in                                                                        
          regulation                                                                                                            
                                                                                                                                
     Section 5                                                                                                                  
          Title "CMA" and limits its use                                                                                    
                                                                                                                                
     Section 12                                                                                                                 
          Penalty for practicing without license as CMA                                                                     
                                                                                                                                
Senator Giessel addressed Slide 9, "Urgent need for SB                                                                          
108":                                                                                                                           
                                                                                                                                
     Efficient, expeditious and effective licensing of MDs                                                                  
                                                                                                                                
     Legal clarity for delegation of "routine medical                                                                       
     duties" to unlicensed assistive personnel (medical                                                                     
     assistants)                                                                                                                
                                                                                                                                
     More legally stringent delegated activities to                                                                             
     licensed entity, Certified Medical Assistant                                                                           
                                                                                                                                
9:14:29 AM                                                                                                                    
                                                                                                                                
Senator Giessel discussed Slide 10, "Urgent need for SB                                                                         
108":                                                                                                                           
                                                                                                                                
     These changes needed this session                                                                                      
                                                                                                                                
     Support                                                                                                                
          State Medical Board (requested)                                                                                       
          Department of Commerce                                                                                                
                                                                                                                                
     No opposition                                                                                                          
                                                                                                                              
9:15:10 AM                                                                                                                    
                                                                                                                                
Senator Stevens asked how long the temporary license would                                                                      
last and whether it removed the responsibility to precure a                                                                     
permanent license.                                                                                                              
                                                                                                                                
Senator Giessel replied that the temporary license was                                                                          
time-limited. She deferred to Ms. Stovern.                                                                                      
                                                                                                                                
9:15:50 AM                                                                                                                    
                                                                                                                                
Co-Chair MacKinnon wondered  whether medical assistants were                                                                    
licensed in other states.                                                                                                       
                                                                                                                                
Senator  Giessel   replied  that  other   states  recognized                                                                    
certified  medical assistants,  which was  why the  national                                                                    
exams were available.                                                                                                           
                                                                                                                                
9:16:13 AM                                                                                                                    
                                                                                                                                
Senator  von   Imhof  looked  at  the   fiscal  note,  which                                                                    
reflected that  professional licensing programs  were funded                                                                    
by receipt supported services to  fund the two new full-time                                                                    
positions that the  bill would create, which  meant that the                                                                    
expense would be paid by  the health professionals that were                                                                    
involved with the board.                                                                                                        
                                                                                                                                
Senator Giessel replied in the affirmative.                                                                                     
                                                                                                                                
9:16:51 AM                                                                                                                    
                                                                                                                                
Co-Chair  MacKinnon wondered  whether the  structure of  the                                                                    
bill was understood by the entire committee.                                                                                    
                                                                                                                                
9:16:55 AM                                                                                                                    
                                                                                                                                
Senator  Olson  asked  how  the   bill  would  affect  heath                                                                    
corporations in rural Alaska.                                                                                                   
                                                                                                                                
Senator  Giessel  responded  that  she had  not  heard  from                                                                    
specific    native    corporations    or    native    health                                                                    
organizations.   She   imagined   that  if   Anchorage   was                                                                    
experiencing issues then rural areas must be as well.                                                                           
                                                                                                                                
9:18:06 AM                                                                                                                    
                                                                                                                                
Senator  Olson wondered  about continuing  medical education                                                                    
(CME) requirements for medical assistants.                                                                                      
                                                                                                                                
Senator Giessel deferred to Ms. Stovern.                                                                                        
                                                                                                                                
9:18:31 AM                                                                                                                    
                                                                                                                                
Senator  Olson  asked  whether other  professionals  working                                                                    
under the  per view of  the medical board would  be affected                                                                    
by the bill.                                                                                                                    
Senator  Giessel replied  that  physician's assistants  were                                                                    
affected,  because  they  delegated to  unlicensed  assisted                                                                    
personnel and needed to access the PDMP.                                                                                        
                                                                                                                                
9:19:23 AM                                                                                                                    
                                                                                                                                
Co-Chair  Hoffman  wondered  whether the  legislation  would                                                                    
increase the  number of certified medical  assistants in the                                                                    
state.                                                                                                                          
                                                                                                                                
Senator Giessel replied that it  was hard to predict whether                                                                    
the numbers  would grow but that  it was a growing  field of                                                                    
work.                                                                                                                           
                                                                                                                                
9:20:32 AM                                                                                                                    
                                                                                                                                
Senator von Imhof read from the sponsor statement:                                                                              
                                                                                                                                
     The bill provides for physician delegation of                                                                              
     specific, routine activities to unlicensed personnel                                                                       
     working in physician offices.                                                                                              
                                                                                                                                
Senator  von  Imhof  assumed  that  the  "specific,  routine                                                                    
activities"  would   be  within  the  parameters   of  their                                                                    
training and would be spelled out in regulation.                                                                                
                                                                                                                                
Senator Giessel replied in the affirmative.                                                                                     
                                                                                                                                
9:21:33 AM                                                                                                                    
                                                                                                                                
Senator Micciche spoke  to concerns that had  been voiced by                                                                    
the American Association of  Medical Assistants (AAMA) about                                                                    
confusion surrounding certified medical assistants.                                                                             
                                                                                                                                
Senator  Giessel said  that she  had  been in  communication                                                                    
with  the  association  and  had  clarified  with  them  the                                                                    
importance  of the  bill. She  stated  that the  association                                                                    
could bring other concerns to the Board of Medicine.                                                                            
                                                                                                                                
9:22:13 AM                                                                                                                    
                                                                                                                                
Co-Chair  MacKinnon noted  that there  was a  letter in  the                                                                    
packet  from  the  AAMA that  offered  suggestions  on  what                                                                    
initials  to  give  certified medical  assistants  (copy  on                                                                    
file).                                                                                                                          
                                                                                                                                
Senator Giessel stated that she  was aware of the letter and                                                                    
had instructed  the AAMA  to communicate  with the  Board of                                                                    
Medicine.   She  asserted   that   she   was  carrying   the                                                                    
legislation on behalf of the  board and would not change any                                                                    
aspects of the bill unless the board agreed.                                                                                    
                                                                                                                                
9:22:50 AM                                                                                                                    
                                                                                                                                
Co-Chair   MacKinnon   wondered   how  many   other   states                                                                    
recognized  certified medical  assistants through  licensure                                                                    
programs. She asked whether the  final licensure of a doctor                                                                    
coming into the  state had to be approved by  the board, and                                                                    
after that  happened, would a list  of physicians officially                                                                    
approved to practice in the stat be approved by the board.                                                                      
                                                                                                                                
Senator Giessel deferred the question to Ms. Stovern.                                                                           
                                                                                                                                
9:24:20 AM                                                                                                                    
                                                                                                                                
Co-Chair  MacKinnon understood  that  a "clean"  application                                                                    
would  not   go  before  the   board,  but   a  questionable                                                                    
application would go before the board for further scrutiny.                                                                     
                                                                                                                                
Senator Giessel shared that it would  be up to the board how                                                                    
they  wanted   to  review   applications  approved   by  the                                                                    
executive  administrator. She  said that  the issue  was not                                                                    
discussed in the bill.                                                                                                          
                                                                                                                                
9:25:02 AM                                                                                                                    
                                                                                                                                
FRED  PARADY, DEPUTY  COMMISSIONER, DEPARTMENT  OF COMMERCE,                                                                    
COMMUNITY,  AND ECONOMIC  DEVELOPMENT, spoke  in support  of                                                                    
the legislation. He shared that  the workload of the medical                                                                    
board  had dramatically  increased due  to telemedicine.  He                                                                    
stated  that  in  2015,  the backlog  reached  6  months  in                                                                    
application   processing  time   due   to   the  volume   of                                                                    
applications  received.   He  relayed  that  in   FY17,  the                                                                    
division processed  22 percent more medical  licenses and 31                                                                    
percent more nursing licenses than  in FY16. He related that                                                                    
to date  in FY18, more  licenses had been received  than the                                                                    
entirety of  the previous  fiscal year.  He shared  that the                                                                    
department had worked to  streamline the application process                                                                    
for health  care professions. He  said that  a comprehensive                                                                    
examination  of the  application  process had  been done  to                                                                    
identify areas  of friction, or  "rubs." He relayed  that 27                                                                    
rubs  had   been  identified,   which  had   been  evaluated                                                                    
individually to determine whether  the issue served a public                                                                    
safety purpose,  met a  public safety  need, or  whether the                                                                    
process  was  outdated  or obsolete.  He  explained  that  a                                                                    
three-pronged  approach had  been initiated  to implementing                                                                    
solutions to  streamlining the licensure process.  The areas                                                                    
of  friction  were  split  in  three  areas:  small  changes                                                                    
through board  regulations, improvements in  technology, and                                                                    
changes to statute  that would allow the  department to more                                                                    
effectively   administer   programs.   He   concluded   that                                                                    
legislative  support  of the  bill  was  the final  step  in                                                                    
ensuring Alaska's  health care facilities were  able to stay                                                                    
open, while  remining fully  staffed and  able to  serve the                                                                    
public in a timely fashion.                                                                                                     
                                                                                                                                
9:32:10 AM                                                                                                                    
                                                                                                                                
DEBORA  STOVERN, EXECUTIVE  DIRECTOR,  ALASKA STATE  MEDICAL                                                                    
BOARD,  ANCHORAGE (via  teleconference),  stated that  under                                                                    
current  statute  only the  board  was  authorized to  grant                                                                    
licenses, the  board also had  the authority to  delegate to                                                                    
her  the authority  to  approve  applications for  temporary                                                                    
permits, curtesy  licenses, and  resident permits.  She said                                                                    
that  because  the  board  only met  four  times  per  year,                                                                    
temporary permits allowed applicants  with complete files to                                                                    
practice until the  next board meeting, when  files would be                                                                    
considered  by  the  board  for   approval  of  a  permanent                                                                    
license. She  said that a temporary  permit was time-limited                                                                    
to 6 months  and could not be extended. She  related that as                                                                    
part of  the licensing streamlining project  that Mr. Parady                                                                    
spoke   to,  the   board  had   taken  actions   to  improve                                                                    
application processing,  including; in  office efficiencies,                                                                    
changes  to  application   requirements,  the  inclusion  of                                                                    
participation  in  programs  offered by  the  Federation  of                                                                    
State  Medical Boards,  the adoption  of  regulation for  an                                                                    
expedited temporary  permit. She  anticipated that  once the                                                                    
legislation  passed, the  board would  continue to  delegate                                                                    
the approval  authority to the  executive secretary  as well                                                                    
as  the  licensing  supervisor,  for  the  issuance  of  the                                                                    
expedited  temporary   permits.  She   said  that   once  an                                                                    
expedited file  was complete,  it would  be referred  to the                                                                    
executive secretary  for approval  of the  permeant license.                                                                    
Any  application  with  derogatory or  adverse  information,                                                                    
discrepancies,  or questions  and concerns  would require  a                                                                    
board  review   for  approval  of  temporary   or  permanent                                                                    
license,  as   appropriate.  She  related  that   under  the                                                                    
legislation much of the temporary  licensure would be at the                                                                    
discretion  of the  board.  She spoke  to  the CME  question                                                                    
posed  by  Senator Olson.  She  said  the licensing  program                                                                    
required   that    assistants   maintain    their   national                                                                    
certification, which  meant they had to  complete continuing                                                                    
medical  education. She  anticipated  that  the board  would                                                                    
require   something    similar   with    certified   medical                                                                    
assistants.                                                                                                                     
                                                                                                                                
9:37:11 AM                                                                                                                    
                                                                                                                                
Senator  Stevens wanted  a guarantee  that no  one would  be                                                                    
given a  temporary license that  did not have  the necessary                                                                    
medical background.                                                                                                             
                                                                                                                                
Ms. Stovern responded that temporary  permits were issued on                                                                    
a  checklist  that  had  been developed  by  the  board  and                                                                    
delineated all  of the requirements for  licensure. She said                                                                    
that  the process  ensured that  all requirements  were met,                                                                    
and all  credentials were in place  before temporary permits                                                                    
were  issued.  The  board  would   be  tasked  with  further                                                                    
developing that checklist for the enhanced process.                                                                             
                                                                                                                                
9:38:33 AM                                                                                                                    
                                                                                                                                
Senator Stevens  wanted assurances that the  public would be                                                                    
safe.                                                                                                                           
                                                                                                                                
Senator   Olson  commented   that   he  understood   Senator                                                                    
Stevens's  concerns but  that  he had  witnessed  a lack  of                                                                    
service  in rural  areas of  the state  due to  the lack  of                                                                    
streamlining in the permitting process.                                                                                         
                                                                                                                                
9:40:16 AM                                                                                                                    
                                                                                                                                
Co-Chair  MacKinnon  felt  it was  important  to  note  that                                                                    
Senator Olson was a doctor.                                                                                                     
                                                                                                                                
Senator  Olson  said he  was  first  licensed as  a  medical                                                                    
doctor in 1984 and had  practiced in rural Alaska throughout                                                                    
his career. He  added that he had been on  the medical board                                                                    
from 1995, until he was elected to office.                                                                                      
                                                                                                                                
9:41:50 AM                                                                                                                    
                                                                                                                                
Senator Micciche asked  whether the bill would  speed up the                                                                    
permitting   process   without   reducing   the   credential                                                                    
requirements.                                                                                                                   
                                                                                                                                
Ms. Stovern replied yes. She  said that the board considered                                                                    
that the credentials  had been reviewed for  the issuance of                                                                    
a  temporary permit  and took  that into  consideration when                                                                    
granting a permanent license.                                                                                                   
                                                                                                                                
9:43:58 AM                                                                                                                    
                                                                                                                                
Senator Micciche reiterated  concern that requirements would                                                                    
be reduced at the risk of public safety.                                                                                        
                                                                                                                                
9:44:31 AM                                                                                                                    
                                                                                                                                
Co-Chair  MacKinnon  understood  that Senator  Micciche  was                                                                    
requesting  assurances that  there  would be  no changes  in                                                                    
requirements for permanent licensure in the state.                                                                              
                                                                                                                                
Ms.  Stovern  replied that  the  requirements  would not  be                                                                    
changed.                                                                                                                        
                                                                                                                                
9:44:47 AM                                                                                                                    
                                                                                                                                
Senator  Stevens   requested  further  information   on  the                                                                    
backlog of 290 applications.                                                                                                    
                                                                                                                                
Ms.  Stovern  said  that  there was  not  currently  a  huge                                                                    
backlog.  She  related that  there  had  been an  influx  in                                                                    
application  due to  increased telemedicine.  She felt  that                                                                    
once   streamlining   efficiencies  were   implemented   the                                                                    
application processing time  would be significantly reduced.                                                                    
She relayed that there were  some delays in the process that                                                                    
were outside of the boards  control. She stated that once an                                                                    
application   was   received   by   her   office   it   took                                                                    
approximately  one  to  three weeks  to  issue  a  temporary                                                                    
license.  She said  that current  backlogs  were related  to                                                                    
missing documents and credentials in files.                                                                                     
                                                                                                                                
9:47:53 AM                                                                                                                    
                                                                                                                                
Senator  Stevens felt  that a  6-month extension  would take                                                                    
care of the current backlog.                                                                                                    
                                                                                                                                
Ms. Stovern responded in the affirmative.                                                                                       
                                                                                                                                
9:48:42 AM                                                                                                                    
                                                                                                                                
DOCTOR  DANNY ROBINETTE,  CHIEF MEDICAL  OFFICER, FOUNDATION                                                                    
HEALTH PARTNERS, FAIRBANKS  (via teleconference), understood                                                                    
the  concern about  credentials. He  encouraged keeping  the                                                                    
diligent process  intact and not changing  the standards. He                                                                    
stressed  the  importance  of   a  streamlined  process  for                                                                    
granting privileges  to candidates.  He related that  he had                                                                    
lost  candidates  to  other  states  because  the  licensing                                                                    
process had taken too long.  He expressed strong support for                                                                    
the legislation.                                                                                                                
                                                                                                                                
9:50:49 AM                                                                                                                    
                                                                                                                                
Senator  Stevens  wondered  how  the bill  would  help  with                                                                    
efficiency of licensure.                                                                                                        
                                                                                                                                
Dr.  Robinette  thought  that   granting  authority  to  the                                                                    
director would save  waiting for the next  board meeting for                                                                    
a clean candidate.                                                                                                              
                                                                                                                                
9:51:48 AM                                                                                                                    
                                                                                                                                
Senator  Stevens surmised  that  if an  individual had  been                                                                    
given a  6-month extension, but at  the end of the  6 months                                                                    
the  file  was   not  complete,  he  would   be  denied  the                                                                    
opportunity to continue to work in the state.                                                                                   
                                                                                                                                
Dr. Robinette agreed.                                                                                                           
                                                                                                                                
9:52:23 AM                                                                                                                    
                                                                                                                                
Vice-Chair Bishop asked how much it cost to vet applicants.                                                                     
                                                                                                                                
Dr. Robinette  answered that, including  the cost  of hiring                                                                    
temporary  staff  to  manage  the  workload,  the  cost  was                                                                    
several  hundreds  of  thousands  of dollars.  The  cost  of                                                                    
recruiting an  individual physician was between  $30,000 and                                                                    
$50,000.                                                                                                                        
                                                                                                                                
9:53:41 AM                                                                                                                    
                                                                                                                                
Vice-Chair  Bishop remarked  that the  hospital would  spend                                                                    
time vetting the individual, as would the board.                                                                                
                                                                                                                                
Dr.  Robinette  agreed,  and   believed  that  both  vetting                                                                    
opportunities should  exist, he  thought that  anything that                                                                    
could be done to streamline the vetting would be helpful.                                                                       
                                                                                                                                
9:54:33 AM                                                                                                                    
                                                                                                                                
9:54:55 AM                                                                                                                    
                                                                                                                                
Co-Chair MacKinnon CLOSED public testimony.                                                                                     
                                                                                                                                
9:55:02 AM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
9:55:19 AM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
9:55:22 AM                                                                                                                    
                                                                                                                                
Co-Chair MacKinnon directed attention to the fiscal note.                                                                       
                                                                                                                                
9:55:39 AM                                                                                                                    
                                                                                                                                
Vice-Chair Bishop discussed the fiscal note from the                                                                            
Department of Commerce, Community and Economic Development                                                                      
(DCCED). He read from the analysis:                                                                                             
                                                                                                                                
     One  full-time  Records  and  Licensing  Supervisor  is                                                                    
     needed  to  implement   this  program.  Currently,  one                                                                    
     existing  Records and  Licensing  Supervisor is  spread                                                                    
     among numerous  programs; only part of  that position's                                                                    
     time is dedicated  to medical programs. As  a result of                                                                    
     the   addition  of the   certified  medical   assistant                                                                    
     license type, the workload  related to medical programs                                                                    
     supports a dedicated Records and Licensing Supervisor.                                                                     
                                                                                                                                
     If  the  bill passes  the  following  expenses will  be                                                                    
     incurred:                                                                                                                  
     Personal  Services:   $177.8  (2  full-time  positions)                                                                    
     Travel: $1.5 (1 training session per year)                                                                                 
     Services: $10.0 (annual legal review)                                                                                      
               $5.0 (annual investigations)                                                                                     
               $4.5 (regulations project  in the first year)                                                                    
          $30.0 (annual core services & allocated                                                                               
               costs)                                                                                                           
     Supplies: $20.0 (set up for  new employees in the first                                                                    
                    year)                                                                                                       
           $2.5 (postage in the first year) $1.0                                                                                
               (office supplies)                                                                                                
                                                                                                                                
     Professional licensing programs  within the Division of                                                                    
     Corporations, Business  and Professional  Licensing are                                                                    
     funded by Receipt Supported  Services, fund source 1156                                                                    
     Rcpt  Svcs (DGF).  Licensing fees  for each  occupation                                                                    
     are set per AS 08.01.065 so the total amount of                                                                            
     revenue    collected     approximately    equals    the                                                                    
     occupation's actual regulatory costs.                                                                                      
                                                                                                                                
9:57:42 AM                                                                                                                    
                                                                                                                                
Co-Chair MacKinnon  asked whether  Ms. Stovern  had comments                                                                    
pertaining  to the  AAMA  and their  concerns  with CMAs  in                                                                    
Alaska.                                                                                                                         
                                                                                                                                
Ms. Stovern  replied that the  board had not  considered the                                                                    
concerns.                                                                                                                       
                                                                                                                                
9:58:54 AM                                                                                                                    
                                                                                                                                
Co-Chair MacKinnon spoke again to  the letter from Donald A.                                                                    
Balasa, Ms. Davis, MBA, CEO  and Legal Counsel for the AAMA.                                                                    
She asked Senator Giessel to speak to her credentials.                                                                          
                                                                                                                                
Senator Giessel shared that she  had been a registered nurse                                                                    
in Alaska since 1974,  and Advanced Nurse Practitioner since                                                                    
2000.  She relayed  that  she  had served  on  the Board  of                                                                    
Nursing from  2002 to 2010,  five of those years  she served                                                                    
as chair  of the board.  She said  that the issue  raised by                                                                    
the AAMA was  trivial, as opposed to  the legislation, which                                                                    
would address a critically urgent matter.                                                                                       
                                                                                                                                
10:01:07 AM                                                                                                                   
                                                                                                                                
Senator  Olson asked  whether Senator  Giessel had  received                                                                    
letters of support of opposition from physician groups.                                                                         
                                                                                                                                
Senator Giessel said that she  had not received letters from                                                                    
the Alaska  State Medical Association or  the Association of                                                                    
Physicians  and Surgeons.  She reminded  the committee  that                                                                    
the Board of Medicine had written the bill.                                                                                     
                                                                                                                                
Co-Chair  MacKinnon announced  that amendments  were due  by                                                                    
5pm the following day.                                                                                                          
                                                                                                                                
SB  108  was  HEARD  and   HELD  in  committee  for  further                                                                    
consideration.                                                                                                                  
                                                                                                                                
SENATE BILL NO. 105                                                                                                           
                                                                                                                                
     "An  Act  relating  to the  licensure  of  marital  and                                                                    
     family therapists;  relating to  professional liability                                                                    
     insurance for  marital and family  therapists; relating                                                                    
     to medical  assistance for  marital and  family therapy                                                                    
     services; and providing for an effective date."                                                                            
                                                                                                                                
10:03:46 AM                                                                                                                   
                                                                                                                                
SENATOR  DAVID  WILSON,  SPONSOR,   read  from  the  Sponsor                                                                    
Statement:                                                                                                                      
                                                                                                                                
     If enacted, Senate Bill 105  would add licensed Marital                                                                    
     and  Family  Therapists  to  the  list  of  independent                                                                    
     licensed  practitioners,   in  order  to   address  the                                                                    
     shortage   of   Medicaid-eligible   behavioral   health                                                                    
     providers  in  the  state,   afford  more  options  for                                                                    
     beneficiaries, and increase access to care.                                                                                
                                                                                                                                
He shared  that approximately  20 percent of  Alaska's adult                                                                    
population  needed  mental  or behavioral  health  services;                                                                    
however, 19 percent  of those in need  received funding from                                                                    
Medicaid  or  the  Behavioral  Health  Fund.  He  said  that                                                                    
research had  shown that  Alaska was  in need  of additional                                                                    
psychiatrists to  meet the state's  mental health  needs. He                                                                    
read from the Sponsor Statement:                                                                                                
                                                                                                                                
     Currently,  licensed  marital   and  family  therapists                                                                    
     (MFTs)  are   only  allowed  to  provide   services  in                                                                    
     community  health clinics  of  physician mental  health                                                                    
     clinics, which  limits the number of  willing providers                                                                    
     in  the  mental  health  care  arena.  SB  105  expands                                                                    
     medical  assistance  reimbursement  services  to  cover                                                                    
     those services provided by MFTs.                                                                                           
                                                                                                                                
     Specifically, SB 105                                                                                                       
        • Designated LMFTs as providers eligible to render                                                                      
          and   bill   for   Medicaid-funded   services   as                                                                    
          independent practitioners under Alaska Statute                                                                        
          47.07.030(b)                                                                                                          
        • Clarifies supervisory requirements for Marital                                                                        
          Family Therapist Licensees                                                                                            
        • Requires Marital Family Therapist Licensees to                                                                        
          carry    Liability   Insurance    for   Regulatory                                                                    
          Investigation  Fees of at least $30,000                                                                               
                                                                                                                                
     In  2016,  the  Alaska  Board  of  Marital  and  Family                                                                    
     Therapy  unanimously  recommended the  statute  changes                                                                    
     contained in SB 105.                                                                                                       
                                                                                                                                
10:09:44 AM                                                                                                                   
                                                                                                                                
GARY ZEPP, STAFF, SENATOR WILSON, discussed the Sectional                                                                       
Analysis (copy on file):                                                                                                        
                                                                                                                                
     Sections 1 &  2 of the bill impact AS  08.63 "Marital &                                                                    
     Family   Therapy"   and   the   subsections   08.63.100                                                                    
     "Qualifications for license  to practice" and 08.63.120                                                                    
     "Authorized Supervisors."                                                                                                  
                                                                                                                                
     Section 1:  "Qualifications for license to  practice" -                                                                    
     AS 08.63.100                                                                                                               
     PAGE  2, LINES  17-25: adds  a supervision  requirement                                                                    
     for martial & family  therapists and clarifies that the                                                                    
     required 1,500  hours of clinical contact  must include                                                                    
     100 hours  of individual  supervision and 100  hours of                                                                    
     group supervision and  that may be conducted  by one or                                                                    
     more supervisors.  The intent is  to allow doctor  A to                                                                    
     supervise and  if Doctor A becomes  unavailable, doctor                                                                    
     B  can  continue the  supervision  a  Martial &  Family                                                                    
     Therapist associate.                                                                                                       
                                                                                                                                
     Section 1 continues on:                                                                                                    
     PAGE 2, LINES 29-31: It  requires not less than $30,000                                                                    
     in professional liability  coverage for the applicant's                                                                    
     regulatory investigation fees in the state.                                                                                
                                                                                                                                
     Section 2: impacts "Authorized Supervisors"                                                                                
     PAGE 3,  LINES 2-18:  expands the group  supervision to                                                                    
     include  professional  counselors,   marital  &  family                                                                    
     therapists,   physicians   who   are  licensed   as   a                                                                    
     psychiatrist,  an  advanced practice  registered  nurse                                                                    
     who is authorized  by the Board of  Nursing to practice                                                                    
     as an  adult or family psychiatric  mental health nurse                                                                    
    practitioner, a psychologist, and a social worker.                                                                          
                                                                                                                                
     Sections 3, 4, & 5  impact AS 47.07 "Medical Assistance                                                                    
     for  Needy Persons"  and  the  subsection AS  47.07.030                                                                    
     "Medical Services to be Provided."                                                                                         
                                                                                                                                
   Section 3: impacts "Medical Services to be Provided"                                                                         
     PAGE  3,  LINE  31:  adds marital  and  family  therapy                                                                    
     services  to the  list of  optional services  available                                                                    
     through  the Dept.  of Health  & Social  Services under                                                                    
     this subsection.                                                                                                           
                                                                                                                                
     Section 4: impacts "Medical Services to be Provided"                                                                       
     PAGE  4, LINES  8-16: adds  a new  paragraph (g)  to AS                                                                    
     47.70.030   to   clarify    that   the   term   "direct                                                                    
     supervision"   may  be   performed  by   one  or   more                                                                    
     psychiatrists, as long as  that supervision takes place                                                                    
     on the  premises of the  clinic 30  % of the  time that                                                                    
     the clinic is open.                                                                                                        
                                                                                                                                
     The  so-called 30%  Rule is  found  in regulation  7AAC                                                                    
     135.030 "Provider enrollment and organization."                                                                            
                                                                                                                                
     Section 5: impacts "Medical Services to be Provided"                                                                       
     PAGE  4, LINES  17-31  & PAGE  5, LINE  1:  adds a  new                                                                    
     subsection  (h)   to  AS  47.70.030  that   allows  the                                                                    
     department  to  reimburse  a  mental  health  physician                                                                    
     clinic for  services provided by a  psychiatrist, or an                                                                    
     individual  who  works  under  a  psychiatrist  and  is                                                                    
     licensed  to practice  as a  professional counselor,  a                                                                    
     martial &  family therapist, a physician  assistant, an                                                                    
     advanced  practice registered  nurse who  is authorized                                                                    
     by  the Board  of Nursing  to practice  as an  adult or                                                                    
     family psychiatric mental  health nurse practitioner, a                                                                    
     psychologist, a psychologist  associate, and a clinical                                                                    
     social worker.                                                                                                             
                                                                                                                                
     Section  6: PAGE  5, LINES  2-7: amends  the uncodified                                                                    
     law to  authorize the Department  of Health  and Social                                                                    
     Services and  the Board of  Marital and  Family Therapy                                                                    
     to adopt  regulations to implement the  changes of this                                                                    
     act.                                                                                                                       
                                                                                                                                
     Section  7:  PAGE 5,  LINE  8:  contains the  immediate                                                                    
     effective  date  for  Section 6  which  refers  to  the                                                                    
     regulation development.                                                                                                    
                                                                                                                                
     Section [8]: PAGE 5, LINE  9: provides for a January 1,                                                                    
     2019  effective  date  for   all  sections  other  than                                                                    
     Section 6.                                                                                                                 
                                                                                                                                
10:13:29 AM                                                                                                                   
                                                                                                                                
Senator Stevens asked for the licensing timeframe to be                                                                         
licensed as a marital and family therapist, and whether                                                                         
temporary licenses could be issued.                                                                                             
Senator Wilson deferred to the invited testimony.                                                                               
                                                                                                                                
10:14:26 AM                                                                                                                   
                                                                                                                                
Senator   Stevens  hoped   that  the   marital  and   family                                                                    
therapists would not  face the same problems  as the medical                                                                    
practitioners of the previously discussed bill.                                                                                 
                                                                                                                                
Co-Chair MacKinnon OPENED public testimony.                                                                                     
                                                                                                                                
10:15:08 AM                                                                                                                   
                                                                                                                                
Senator  von Imhof  assumed that  the insurance  required in                                                                    
Section 1 could be obtained after training was complete.                                                                        
                                                                                                                                
Senator  Wilson  replied  that the  insurance  language  was                                                                    
intended  to  cover  investigative regulatory  issues  after                                                                    
licensure.                                                                                                                      
                                                                                                                                
10:16:08 AM                                                                                                                   
                                                                                                                                
RANDALL  BURNS,  DIRECTOR,  DIVISION OF  BEHAVIORAL  HEALTH,                                                                    
DEPARTMENT OF  HEALTH AND SOCIAL  SERVICES, (DHSS)  spoke in                                                                    
support of the bill.                                                                                                            
                                                                                                                                
10:16:34 AM                                                                                                                   
                                                                                                                                
Senator von Imhof read form the Sectional Analysis:                                                                             
                                                                                                                                
   Section 4: impacts "Medical Services to be Provided"                                                                         
     PAGE  4, LINES  8-16: adds  a new  paragraph (g)  to AS                                                                    
     47.70.030   to   clarify    that   the   term   "direct                                                                    
     supervision"   may  be   performed  by   one  or   more                                                                    
     psychiatrists, as long as  that supervision takes place                                                                    
     on the  premises of the  clinic 30  % of the  time that                                                                    
     the clinic is open.                                                                                                        
                                                                                                                                
Senator von  Imhof whether  the population  of psychiatrists                                                                    
in  rural  Alaska  could support  the  requirement  in  this                                                                    
section.                                                                                                                        
                                                                                                                                
Mr.  Burns   replied  that  the  language   was  in  current                                                                    
regulation. He said  that he was in support  of changing the                                                                    
language at the  direction of the committee.  He stated that                                                                    
the division  was currently crafting language  that was less                                                                    
burdensome to rural clinics.                                                                                                    
                                                                                                                                
10:21:31 AM                                                                                                                   
AT EASE                                                                                                                         
                                                                                                                                
10:21:54 AM                                                                                                                   
RECONVENED                                                                                                                      
                                                                                                                                
10:21:58 AM                                                                                                                   
                                                                                                                                
Senator  Stevens  repeated   his  question  about  temporary                                                                    
licensing and licensing timelines.                                                                                              
                                                                                                                                
Mr. Burns replied that he could not speak to the question.                                                                      
                                                                                                                                
10:22:54 AM                                                                                                                   
                                                                                                                                
KAREN  CUNNINGHAM,  VICE   PRESIDENT,  MARRIAGE  AND  FAMILY                                                                    
THERAPY BOARD, ANCHORAGE  (via teleconference), testified in                                                                    
support  of  the  legislation.  She  stated  that  associate                                                                    
licensure was available; board  approval was required before                                                                    
the  license  could  be  issued   and  there  was  a  2-year                                                                    
supervision period.  She said that  the bill would  make the                                                                    
supervision period more accessible for applicants.                                                                              
                                                                                                                                
10:24:04 AM                                                                                                                   
                                                                                                                                
Senator Stevens directed his question to Ms. Cunningham.                                                                        
                                                                                                                                
Ms.  Cunningham  replied  that  applications  for  associate                                                                    
licensure  were submitted  to, and  approved by,  the board.                                                                    
Before  the application  could  be  submitted the  applicant                                                                    
needed to have a supervision plan  laid out for the board to                                                                    
approve. She  relayed that there were  currently 18 approved                                                                    
supervisors in the state.                                                                                                       
                                                                                                                                
10:25:41 AM                                                                                                                   
                                                                                                                                
KEN MCCARTY, DIRECTOR, DISCOVERY  COVE RECOVERY AND WELLNESS                                                                    
CENTER,  EAGLE  RIVER  (via  teleconference),  testified  in                                                                    
support of  the legislation. He  shared that the  bill would                                                                    
serve a large need in  the state. He expressed concern about                                                                    
the Section 4  language referenced by Senator  von Imhof. He                                                                    
felt that  the language could isolate  telemedicine in rural                                                                    
areas.                                                                                                                          
                                                                                                                                
10:32:08 AM                                                                                                                   
                                                                                                                                
ELIZABETH RIPLEY,  CEO, MAT-SU HEALTH  FOUNDATION, testified                                                                    
in support  of the bill.  She said that there  were critical                                                                    
pieces  missing  for  Alaska's  continued  care  for  mental                                                                    
health  and substance  use disorders;  sadly, main  paths to                                                                    
treatment are  jails and emergency departments.  She relayed                                                                    
that  the  Mat-Su  Regional  Emergency  Department  was  the                                                                    
number  one  portal  in Mat-Su  for  people  experiencing  a                                                                    
behavioral health crisis, in terms  of both volume and cost,                                                                    
even  though  the  department does  not  provide  behavioral                                                                    
health  services. She  shared that  in 2016,  3,443 patients                                                                    
with  behavioral   health  diagnosis  went  to   the  Mat-Su                                                                    
Regional  Emergency  Department,  which  resulted  in  total                                                                    
charges of $43.8 million, not  counting the additional costs                                                                    
for   estimated   law   enforcement,   911   dispatch,   and                                                                    
transportation. She  believed that  the state  could improve                                                                    
the situation by providing care  in lower cost settings. She                                                                    
relayed that  the average annual  growth rate for  visits to                                                                    
the Mat-Su Regional Emergency Department  by patients with a                                                                    
behavioral  health diagnosis  grew 20  percent between  2015                                                                    
and 2017, due  to the opioid epidemic and  lack of treatment                                                                    
access.  She offered  further statistics  to illustrate  the                                                                    
statewide needs that the bill would address.                                                                                    
                                                                                                                                
10:35:52 AM                                                                                                                   
                                                                                                                                
Senator  Micciche  expressed  concern with  the  assumptions                                                                    
made in the fiscal note.  He opined the Medicaid utilization                                                                    
rate in  the state. He  voiced concern that the  state would                                                                    
be exposed to increased overutilization.                                                                                        
                                                                                                                                
Ms.  Ripley replied  spoke of  a project  called The  Alaska                                                                    
Healthcare Blueprint,  which hoped  to take  a bold  look at                                                                    
the   state's   health   objectives.   She   asserted   that                                                                    
collaborative  work  was  being done  with  state  partners,                                                                    
providers,  and local  delegations to  take a  comprehensive                                                                    
view. She contended that significant  research had been done                                                                    
to ensure  that health  care was being  provided efficiently                                                                    
and  effectively. She  stressed the  need for  "whole person                                                                    
care."  She admitted  that there  would  be additional  cost                                                                    
brought on  by the  bill but that  the legislation  would be                                                                    
more cost effective in the long-run.                                                                                            
                                                                                                                                
10:38:47 AM                                                                                                                   
AT EASE                                                                                                                         
                                                                                                                                
10:39:10 AM                                                                                                                   
RECONVENED                                                                                                                      
Senator von Imhof understood that  the cost would be shifted                                                                    
from expensive emergency room visits  to more clinic visits,                                                                    
where  the same  population would  be served,  for the  same                                                                    
ailments but in a different cost environment.                                                                                   
                                                                                                                                
Ms. Ripley agreed.                                                                                                              
                                                                                                                                
10:40:19 AM                                                                                                                   
                                                                                                                                
JON   ZASADA,   POLICY   DIRECTOR,   ALASKA   PRIMARY   CARE                                                                    
ASSOCIATION,  testified in  support of  the legislation.  He                                                                    
stated  that health  centers had  made major  investments in                                                                    
behavioral  health integration  and  whole  person care.  He                                                                    
said that in the last two  years there had been a 25 percent                                                                    
increase  in  the  number of  behavioral  health  providers,                                                                    
encounters,  and  patients;  over 11,000  Alaskans  received                                                                    
routine behavioral  healthcare in Alaska's  community health                                                                    
centers. He lamented  that there was a  shortage of billable                                                                    
providers in the  state; a study completed  in December 2017                                                                    
revealed that  Alaska community heath centers  were short 12                                                                    
to  18 FTE  equivalents,  which translated  into service  to                                                                    
6,000  to   9,000  patients.  He  stressed   that  federally                                                                    
qualified health  centers saved the state  money by allowing                                                                    
same-day appointments  at a single  rate. He stated  that if                                                                    
LMFTs  were  included in  FQHC  Medicaid  billing a  patient                                                                    
could   see  a   medical  provider   and  a   mental  health                                                                    
professional in the  same day, for a  single charge, instead                                                                    
of  a  referral to  two  sperate  charges. He  detailed  the                                                                    
various ways in which the  bill would serve more patients in                                                                    
comprehensive, whole-patient settings.                                                                                          
                                                                                                                                
10:43:53 AM                                                                                                                   
                                                                                                                                
Senator  Stevens  asked  which medical  professionals  could                                                                    
currently bill Medicaid.                                                                                                        
                                                                                                                                
Mr.  Zasada replied  that licensed  clinical social  workers                                                                    
and psychologists could bill Medicaid.                                                                                          
                                                                                                                                
Co-Chair MacKinnon CLOSED public testimony.                                                                                     
                                                                                                                                
Co-Chair MacKinnon  stated that a  new fiscal note  would be                                                                    
crafted for consideration during the next bill hearing.                                                                         
                                                                                                                                
10:45:15 AM                                                                                                                   
                                                                                                                                
Co-Chair MacKinnon solicited further discussion on the                                                                          
current fiscal note.                                                                                                            
                                                                                                                                
Senator Wilson reiterated that the intent of the bill was                                                                       
not to create a new expanded care of treatment but to give                                                                      
patients access to care as primary prevention.                                                                                  
                                                                                                                                
Co-Chair MacKinnon announced that amendments were due the                                                                       
following day by 5pm.                                                                                                           
                                                                                                                                
SB 105 was HEARD and HELD in committee for further                                                                              
consideration.                                                                                                                  
                                                                                                                                
SENATE BILL NO. 165                                                                                                           
                                                                                                                                
     "An  Act relating  to the  Alaska comprehensive  health                                                                    
     insurance fund; and providing for an effective date."                                                                      
                                                                                                                                
10:47:23 AM                                                                                                                   
                                                                                                                                
BRITTANY HARTMANN, STAFF, SENATOR ANNA MACKINNON, offered a                                                                     
Sponsor Statement:                                                                                                              
                                                                                                                                
     In 2015,  the individual  health care market  in Alaska                                                                    
     was  in  a  precarious   state.  There  were  only  two                                                                    
     insurers   with   current   enrollees   in   individual                                                                    
     healthcare  plans  in  Alaska,  and  each  insurer  was                                                                    
     experiencing significant  losses. Average  premium rate                                                                    
     increases in 2015 were 38.7%  for one insurer and 39.9%                                                                    
     for  the  other. In  2016,  one  of Alaska's  only  two                                                                    
     remaining  insurers  gave  notice that  they  would  be                                                                    
     withdrawing   from   the   Alaska   individual   market                                                                    
     effective January 2017.                                                                                                    
                                                                                                                                
     The  29th  Legislature passed  HB  374  in 2016,  which                                                                    
     created  the Alaska  Reinsurance  Program, and  allowed                                                                    
     the  Division  of  Insurance to  apply  for  a  federal                                                                    
     Section   1332  state   innovation  waiver   under  the                                                                    
     Affordable Care Act (ACA).  That legislation included a                                                                    
     sunset  date  of  June  30, 2018  to  ensure  that  the                                                                    
     diversion of  insurance premium taxes from  the general                                                                    
     fund  was  not  relied  upon  as  a  long-term  funding                                                                    
     mechanism.  In July  2017, the  waiver was  approved by                                                                    
     both the  Department of Health and  Social Services and                                                                    
     the  Department of  Treasury based  on the  application                                                                    
     submitted  by  the   division,  which  requested  pass-                                                                    
     through funding for the Alaska Reinsurance Program.                                                                        
                                                                                                                                
     The  federal award  for this  waiver was  approximately                                                                    
     $322 million over five years.  The award is to be used,                                                                    
     in conjunction with the  Alaska Reinsurance Program, to                                                                    
     continue to stabilize  the individual healthcare market                                                                    
     in Alaska.                                                                                                                 
                                                                                                                                
     This legislation  extends the  sunset provision  on the                                                                    
     Alaska  comprehensive  health  insurance  fund  by  six                                                                    
     years, from  June 30,  2018 to June  30, 2024  to allow                                                                    
     for the continuation of  the Alaska Reinsurance Program                                                                    
     and receipt of the federal funding.                                                                                        
                                                                                                                                
     The  bill  also  removes  the  requirement  that  funds                                                                    
     collected  under AS  21.09.210  (tax  on insurers),  AS                                                                    
     21.33.055  (unauthorized  insurance  premium  tax),  AS                                                                    
     21.34.180 (surplus lines tax)  and AS 21.66.110 (annual                                                                    
     tax on  title insurance  premiums) are to  be deposited                                                                    
     into  the Alaska  comprehensive  health insurance  fund                                                                    
     within the general fund.                                                                                                   
                                                                                                                                
     Passage of  HB374 by the 29th  Legislature has resulted                                                                    
     in  stabilization of  the individual  insurance market.                                                                    
     The  Section  1332  state  innovation  waiver  provides                                                                    
     funding  for the  Alaska  Reinsurance Program,  through                                                                    
     the  Alaska comprehensive  health  insurance fund.  Now                                                                    
     this legislation  is necessary to ensure  the continued                                                                    
     effectiveness of  the Alaska Reinsurance  Program, meet                                                                    
     the  intent  of the  waiver,  and  receive the  federal                                                                    
     funding.                                                                                                                   
                                                                                                                                
                                                                                                                                
10:48:20 AM                                                                                                                   
                                                                                                                                
Co-Chair  MacKinnon relayed  that  versions the  legislation                                                                    
had appeared before the committee  before. She said that the                                                                    
bill would  create a  stable market and  that the  state had                                                                    
experienced  a   reduction  in   premiums  because   of  the                                                                    
reinsurance program.  She shared that the  legislation would                                                                    
rededicate the revenue stream out  of the insurance fund and                                                                    
into the general  fund, resulting in a  positive fiscal note                                                                    
of approximately  $50 million,  annually. She  commended the                                                                    
work of  Lori Wing-Heier,  Director, Division  of Insurance,                                                                    
Department of  Commerce, Community and  Economic Development                                                                    
on the issue of insurance management in the state.                                                                              
10:51:01 AM                                                                                                                   
                                                                                                                                
LORI   WING-HEIER,   DIRECTOR,    DIVISION   OF   INSURANCE,                                                                    
DEPARTMENT OF COMMERCE,  COMMUNITY AND ECONOMIC DEVELOPMENT,                                                                    
said that SB 165 would  allow the department to continue the                                                                    
reinsurance   program  with   significant  federal   funding                                                                    
because of the 1332 waiver for  a period of five years, with                                                                    
a possible  additional one-year extension. She  said that in                                                                    
2016 the  legislature had been instrumental  in creating the                                                                    
program, which  had proved successful. She  stressed that to                                                                    
collect  on  anticipated  federal  funds,  the  sunset  date                                                                    
needed  to  be  either   removed  or  extended.  The  sunset                                                                    
extension would  also allow  that the  premium tax  that the                                                                    
division collected  would go  back to  the general  fund, as                                                                    
was the original intention.                                                                                                     
                                                                                                                                
10:53:34 AM                                                                                                                   
                                                                                                                                
Co-Chair    MacKinnon    solicited   the    definition    of                                                                    
"reinsurance."                                                                                                                  
                                                                                                                                
10:54:16 AM                                                                                                                   
                                                                                                                                
Vice-Chair  Bishop  expressed  appreciation  for  Ms.  Wing-                                                                    
Heier's  ability to  discuss complicated  issues in  a clear                                                                    
and simple manner.                                                                                                              
                                                                                                                                
Ms.  Wing-Heier shared  that  in the  context  of the  bill,                                                                    
"reinsurance"  meant  that  if  you were  an  individual  in                                                                    
Alaska  that  purchased  insurance  through  the  individual                                                                    
market  but  was  then  diagnosed   with  a  condition  that                                                                    
generated high  cost claims, you  would still  buy insurance                                                                    
from Premera  (because that is  the only carrier  in Alaska)                                                                    
and would never  know that your claim had been  ceded to the                                                                    
reinsurance program. The  claim is then not  paid by Premera                                                                    
but by the  state, which reduced the  overall claims expense                                                                    
for the insurer.                                                                                                                
                                                                                                                                
10:56:25 AM                                                                                                                   
                                                                                                                                
Co-Chair MacKinnon  asked why  the federal  government would                                                                    
be interested in paying the claims.                                                                                             
                                                                                                                                
Ms. Wing-Heier  responded that many Alaskan's  premiums were                                                                    
subsidized  by the  federal government,  without a  cap. She                                                                    
said that  when the large  claims could be removed  from the                                                                    
calculation, and premiums  decreased, the federal government                                                                    
would  save money.  That savings  returned to  the state  to                                                                    
fund the  reinsurance program.  Had the  reinsurance program                                                                    
not been enacted, the federal  government's premiums for low                                                                    
and  moderate-income  individuals  would have  continued  to                                                                    
increase, as would those that did not receive subsidies.                                                                        
                                                                                                                                
10:58:15 AM                                                                                                                   
                                                                                                                                
Co-Chair  MacKinnon   asked  about  the  managed   care  for                                                                    
individuals that were high cost drivers in the system.                                                                          
                                                                                                                                
Ms.  Wing-Heier   replied  that   there  were   very  strict                                                                    
guidelines for  managed care of those  particular consumers.                                                                    
She said  that the division  worked to provide  managed care                                                                    
on every claimant that went through the program.                                                                                
                                                                                                                                
10:59:20 AM                                                                                                                   
                                                                                                                                
Senator  Stevens asked  about  the $25  million return  from                                                                    
Premera, and  whether similar returns  could be  expected in                                                                    
the future.                                                                                                                     
                                                                                                                                
Ms. Wing-Heier  did not expect  similar future  returns. She                                                                    
said that  claims had dropped  significantly in  2017, which                                                                    
had prompted Premera to contact  the division. She said that                                                                    
the  drop in  claims  had been  considered  an anomaly.  She                                                                    
explained that  when an insurance  company filed  rates with                                                                    
the  state, a  contingency  of  3 to  5  percent profit  was                                                                    
included in  the rate  filing. She  stated that  Premera had                                                                    
known  that   they  were  in  excess   of  that  contingency                                                                    
percentage.   She  furthered   that  Premera   involuntarily                                                                    
approached the  state and asked  that the money for  2017 be                                                                    
put back  into the reinsurance  program. She relayed  that a                                                                    
memorandum of  understanding was crafted, without  any fault                                                                    
on the part of Premera, that  the money would be returned to                                                                    
the state.                                                                                                                      
                                                                                                                                
11:00:55 AM                                                                                                                   
                                                                                                                                
Senator  Stevens  asked  whether  additional  insurers  were                                                                    
interested in working with Alaska.                                                                                              
                                                                                                                                
Ms. Wing-Heier replied  that she was hopeful.  She felt that                                                                    
any  reluctance was  not  because of  the  situation in  the                                                                    
state but what was happing on the federal level.                                                                                
                                                                                                                                
11:01:27 AM                                                                                                                   
Senator Stevens expressed appreciation for the information.                                                                     
                                                                                                                                
11:01:40 AM                                                                                                                   
                                                                                                                                
Senator von  Imhof asked  whether there was  a way  that the                                                                    
state could  save as much  money as possible in  the program                                                                    
just in case the waiver was not extended a second time.                                                                         
                                                                                                                                
Ms. Wing-Heier responded that the  idea had been considered.                                                                    
She thought that what was  currently being received from the                                                                    
federal  government could  carry  the program  into the  6th                                                                    
year.                                                                                                                           
                                                                                                                                
Co-Chair MacKinnon CLOSED public testimony.                                                                                     
                                                                                                                                
11:04:50 AM                                                                                                                   
                                                                                                                                
Co-Chair  Hoffman addressed  the  zero fiscal  note for  the                                                                    
Department  of  Administration  (DOA).   He  read  from  the                                                                    
analysis:                                                                                                                       
                                                                                                                                
     This bill  would extend the  repeal date of  the Alaska                                                                    
     comprehensive health  insurance fund statute  from June                                                                    
     30, 2018 to June 30,  2024 and, effective July 1, 2018,                                                                    
     would deposit  insurance premium tax revenues  into the                                                                    
     general  fund  instead   of  the  Alaska  comprehensive                                                                    
     health insurance fund. The general  fund and the Alaska                                                                    
     comprehensive  health  insurance   funds  are  existing                                                                    
     funds and  the change should require  minimal work with                                                                    
     no  significant  fiscal  impact   to  the  Division  of                                                                    
     Finance. Therefore,  the Division of Finance  submits a                                                                    
     zero fiscal note.                                                                                                          
                                                                                                                                
He spoke to the second  zero fiscal note from the Department                                                                    
of Commerce, Community and Economic Development:                                                                                
                                                                                                                                
     This legislation  extends the  sunset provision  on the                                                                    
     Alaska  Comprehensive  Health  Insurance  Fund  by  six                                                                    
     years,  from  June 30,  2018  to  June 30,  2024.  This                                                                    
     legislation  also removes  the  requirement that  funds                                                                    
     collected  under AS  21.09.210  (tax  on insurers),  AS                                                                    
     21.33.055  (unauthorized  insurance  premium  tax),  AS                                                                    
     21.34.180 (surplus lines tax)  and AS 21.66.110 (annual                                                                    
     tax on  title insurance  premiums) are to  be deposited                                                                    
     into  the Alaska  Comprehensive  Health Insurance  Fund                                                                    
     within the general fund.                                                                                                   
                                                                                                                                
11:07:11 AM                                                                                                                   
                                                                                                                                
Co-Chair  MacKinnon understood  that  the current  insurance                                                                    
receipts  that were  designated  general fund  would be  re-                                                                    
routed  into   the  general  fund.  She   wondered  about  a                                                                    
projection on the new general fund contribution.                                                                                
                                                                                                                                
Ms.  Wing-Heier relayed  that  there  was approximately  $63                                                                    
million that  would be  re-routed back  to the  general fund                                                                    
and, going  forward, all  the taxes would  go back  into the                                                                    
general fund.                                                                                                                   
                                                                                                                                
11:08:04 AM                                                                                                                   
                                                                                                                                
Co-Chair MacKinnon  wondered why  this was not  reflected on                                                                    
the fiscal note as revenue coming into the general fund.                                                                        
                                                                                                                                
Ms. Wing-Heier  said that she would  provide the information                                                                    
to the committee later.                                                                                                         
                                                                                                                                
Co-Chair MacKinnon  announced that  amendments were  due the                                                                    
following day by 5pm.                                                                                                           
                                                                                                                                
SB  165  was  HEARD  and   HELD  in  committee  for  further                                                                    
consideration.                                                                                                                  
ADJOURNMENT                                                                                                                   
11:09:37 AM                                                                                                                   
                                                                                                                                
The meeting was adjourned at 11:09 a.m.                                                                                         
                                                                                                                                

Document Name Date/Time Subjects
SB 105 - Legislative Research - Medicaid Expansion & Behavorial Health Grants.pdf SFIN 2/27/2018 9:00:00 AM
SB 105
SB 105 - Summary of Changes, ver D to ver J.pdf SFIN 2/27/2018 9:00:00 AM
SB 105
SB 105 Sponsor Statement.pdf SFIN 2/27/2018 9:00:00 AM
SB 105
SB108 Letter of Support - Foundation Health Partners 2-7-18.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SB108 Letter of Support Cmmsr Navarre 2-2-16.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SB108 Letter of Support ASMB 2-9-18.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SB108 Power Point Presentation 2-12-18.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SSSB108 Sectional Analysis 2-13-18.cg.jmc.2.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SSSB 108 Sponsor Statment 1-22-18.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SB165 Sponsor Statement.pdf SFIN 2/27/2018 9:00:00 AM
SB 165
SB 165 CMS Letter Approving Alaska's State Innovation Waiver.pdf SFIN 2/27/2018 9:00:00 AM
SB 165
SB 165 ACHI Fund.pdf SFIN 2/27/2018 9:00:00 AM
SB 165
SB165 Sectional Analysis.pdf SFIN 2/27/2018 9:00:00 AM
SB 165
SB 105 - HSS FY18 Behavorial Health Treatment Recovery Grant Reductions.pdf SFIN 2/27/2018 9:00:00 AM
SB 105
SB 105 - Sectional Analysis.pdf SFIN 2/27/2018 9:00:00 AM
SB 105
SB 105 AAMFT Testimony 02232018 Finance.pdf SFIN 2/27/2018 9:00:00 AM
SB 105
SB 108 letter to Senator Giessel.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SB108 SS Letter of Support ASMA 2-27-18.pdf SFIN 2/27/2018 9:00:00 AM
SB 108