Legislature(1993 - 1994)

03/21/1994 01:45 PM Senate HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                         March 21, 1994                                        
                           1:45 p.m.                                           
  MEMBERS PRESENT                                                              
 Senator Bert Sharp, Vice-Chairman                                             
 Senator Loren Leman                                                           
 Senator Mike Miller                                                           
 Senator Jim Duncan                                                            
 Senator Johnny Ellis                                                          
 Senator Judy Salo                                                             
  MEMBERS ABSENT                                                               
 Senator Steve Rieger, Chairman                                                
  COMMITTEE CALENDAR                                                           
 SENATE BILL NO. 313                                                           
 "An Act relating to the Comprehensive Health Insurance Association            
 and to health insurance provided to residents of the state who are            
 high risks; and providing for an effective date."                             
 CS FOR SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 128(FIN)                         
 "An Act relating to paternity determinations and acknowledgements."           
 CS FOR HOUSE BILL NO. 323(JUD) am                                             
 "An Act relating to requests for anatomical gifts and to the                  
 release of certain information for the purpose of facilitating                
 anatomical gifts."                                                            
 HOUSE BILL NO. 429                                                            
 "An Act relating to the special education service agency."                    
  PREVIOUS SENATE COMMITTEE ACTION                                             
 SB 313 - No previous action to record.                                        
 HB 128 - No previous action to record.                                        
 HB 323 - No previous action to record.                                        
 HB 429 - No previous action to record.                                        
  WITNESS REGISTER                                                             
 Representative Cynthia Toohey                                                 
 Prime Sponsor                                                                 
 State Capitol                                                                 
 Juneau, Alaska 99801-1182                                                     
  POSITION STATEMENT:   Supported HB 323.                                      
 Jens Saakvitne, Director                                                      
 Life Alaska, Inc.                                                             
 P.O. Box 230785                                                               
 Anchorage, Alaska 99523-0785                                                  
  POSITION STATEMENT:   Supported HB 323.                                      
 Al Zangri, Chief                                                              
 Bureau of Vital Statistics                                                    
 Department of Health and Social Services                                      
 P.O. Box 110675                                                               
 Juneau, Alaska 99811-0675                                                     
  POSITION STATEMENT:   Reviewed HB 323, HB 128.                               
 Renee Chatman, Staff                                                          
 Representative Bettye Davis                                                   
 State Capitol                                                                 
 Juneau, Alaska 99801-1182                                                     
  POSITION STATEMENT:  Read the Sponsor Statement for HB 128.                  
 Representative Bettye Davis                                                   
 Prime Sponsor                                                                 
 State Capitol                                                                 
 Juneau, Alaska 99801-1182                                                     
  POSITION STATEMENT:   Supported HB 128.                                      
 John Mallonee, Deputy Director                                                
 Child Support Enforcement Division                                            
 Department of Revenue                                                         
 550 W. 7th, Suite 312                                                         
 Anchorage, Alaska 99501-3556                                                  
  POSITION STATEMENT:   Supported HB 128.                                      
 Margaret Lowe, Commissioner                                                   
 Department of Health and Social Services                                      
 P.O. Box 110601                                                               
 Juneau, Alaska 99811-0601                                                     
  POSITION STATEMENT:   Reviewed HB 429.                                       
 Carol Carrol, Staff                                                           
 Senator Kerttula                                                              
 State Capitol                                                                 
 Juneau, Alaska 99801-1182                                                     
  POSITION STATEMENT:   Reviewed SB 313.                                       
 Bob Niebrugge, Consumer Representative                                        
 Comprehensive Health Insurance Association                                    
 P.O. Box 365                                                                  
 Glennallen, Alaska 99588                                                      
  POSITION STATEMENT:   Reviewed SB 313.                                       
  ACTION NARRATIVE                                                             
 TAPE 94-21, SIDE A                                                            
 Number 008                                                                    
 VICE-CHAIRMAN SHARP called the Senate Health, Education and Social            
 Services (HESS) Committee to order at 1:45 p.m.  He introduced                
 HB 323  (RELEASE OF CERTAIN DEATH CERT. INFO) as the first order of           
 business before the committee.                                                
 REPRESENTATIVE CYNTHIA TOOHEY, Prime Sponsor, stated that HB 323              
 would facilitate organ and tissue donations.  Over 300 tissue and             
 organ transplants are anticipated this year in Alaska.  She                   
 explained that currently there are restrictions on the release of             
 pertinent information collected by the Department of Health and               
 Social Services (DHSS) which cause delays; potential organ and                
 tissue donors could be lost.  HB 323 would permit pertinent                   
 information from DHSS to be given to a bank, storage facility, or             
 person handling procurement of anatomical gifts within a time frame           
 that would allow successful donation of organs and tissue.  The               
 pertinent information consists of the name of the individual who              
 could execute the anatomical gift, the medical suitability of the             
 potential donor, the contact person to obtain permission in a                 
 timely manner to allow successful harvest, and procedures                     
 specifying circumstances when an anatomical request would be                  
 inappropriate.  Representative Toohey noted support from the Alaska           
 Medical Association, DHSS, and the court systems.  HB 323 also has            
 two zero fiscal notes.  She pointed out that HB 323 passed the                
 House unanimously.                                                            
 SENATOR LEMAN supported organ and tissue donation.  He inquired as            
 to the time period for successful donation of an organ or tissue.             
 Number 083                                                                    
 JENS SAAKVITNE, Director of Life Alaska, Inc., informed the                   
 committee that after the heart stops, only tissue can be donated.             
 Tissue donation can be accepted up to twenty-four hours after the             
 heart stops.                                                                  
 SENATOR LEMAN inquired as to the procedures regarding the contact             
 of the next of kin.  He asked who would be asking the department              
 for the pertinent information and how would that information                  
 provide knowledge of medical suitability for donation.                        
 JENS SAAKVITNE stated that the initial medical suitability would be           
 determined by the decedent's age and the suspected cause of death.            
 He explained that in 90 percent of the cases the coroner or a                 
 police officer would have the initial information for screening and           
 they have about an 80 percent accuracy rate.                                  
 SENATOR LEMAN asked what information could be provided by the                 
 department in the immediate turnaround that would be beneficial.              
 JENS SAAKVITNE explained that currently the coroner only releases             
 the decedent's name and time of death.  The other pertinent                   
 information is left for the procurement organization to find.  Mr.            
 Saakvitne stated that they would be interested in the decedent's              
 age, the suspected cause of death, the next of kin, and a way to              
 contact them.  Mr. Saakvitne noted that when calling the next of              
 kin, he identifies himself, his affiliation, and the fact that he             
 is an information and support system resource.                                
 SENATOR LEMAN asked if HB 323 provides any protection against an              
 organ or tissue procurement organization being the first caller to            
 the next of kin.  JENS SAAKVITNE stated that the coroner would not            
 release the name of the decedent until the next of kin had been               
 notified.  The language of HB 323 states that the information "may"           
 be released, which places a lot of responsibility on the organ and            
 tissue procurement organization.  Mr. Saakvitne explained that they           
 never try to talk a family into donation; their responsibility is             
 to let the family know of this option.                                        
 SENATOR LEMAN inquired of the actual procedure to be followed in              
 the case of a possible organ or tissue donation.                              
 Number 190                                                                    
 AL ZANGRI, Chief of the Bureau of Vital Statistics for the                    
 Department of Health and Social Services, explained that Life                 
 Alaska calls the coroner or the medical examiner daily to identify            
 potential donors.  The department in Juneau would never be                    
 involved; it would be done through the medical examiner's office in           
 Anchorage or through the various state coroners.  The medical                 
 examiner and coroner are on call twenty-four hours a day and they             
 are called in every case.                                                     
 REPRESENTATIVE CYNTHIA TOOHEY clarified that Life Alaska or another           
 procurement organization would call the family.                               
 SENATOR LEMAN asked who would involve the department.  He posed an            
 accident situation when asking who would call and involve others.             
 AL ZANGRI said that the police or the investigating officer would             
 call the coroner's office.  If the coroner's office decides to take           
 jurisdiction they would notify the medical examiner.  Mr. Zangri              
 noted that the medical examiner is the first individual in the                
 department who would be notified of a potential death and possible            
 organ or tissue donation.  At this point, the pertinent information           
 has been collected and is present in the coroner and the medical              
 examiner's files.  Generally, a call from a procurement                       
 organization occurs within the next few hours in order to obtain              
 the pertinent information.                                                    
 SENATOR ELLIS asked if the transplant agencies referred to in the             
 sponsor statement are required to be licensed.  JENS SAAKVITNE                
 stated that Alaska does not require licensure.  Life Alaska is                
 licensed as a non profit agency and Northwest Organ Procurement               
 Agency is an independent agency.  In Alaska, Life Alaska is the               
 only agency dealing with transplants after the heart has stopped.             
 SENATOR ELLIS requested that Representative Toohey go over her                
 notion that a decedent's family could find a certain comfort after            
 permitting donation.                                                          
 REPRESENTATIVE CYNTHIA TOOHEY noted the many invaluable donations.            
 She explained that donation often gives the family solace because             
 perhaps, it could help someone else.                                          
 Number 271                                                                    
 SENATOR ELLIS asked if the decedent's family would receive more               
 information under HB 323.  JENS SAAKVITNE said that the information           
 for the decedent's family would stay the same.  Mr. Saakvitne                 
 explained that currently within five weeks of the death and                   
 donation, the family will receive a letter outlining the transplant           
 while maintaining confidentiality.  The decedent's family is                  
 entered into a one year bereavement program which serves as a                 
 support system.  REPRESENTATIVE CYNTHIA TOOHEY felt that                      
 confidentiality was as it should be.                                          
 SENATOR ELLIS requested that the issue of fetal tissue be addressed           
 regarding HB 323.  JENS SAAKVITNE informed the committee that the             
 standard for tissue transplant purposes is from birth to age                  
 seventy or eighty.  There is no use for transplant of fetal tissue.           
 From full-term birth on, there are some donation options.  Mr.                
 Saakvitne noted that they are required to document the infant's               
 SENATOR ELLIS asked if that requirement was due to a law or a moral           
 feeling.  JENS SAAKVITNE said that documenting the infant's heart             
 beat was not due to a law or a moral feeling.  Fetal tissue cannot            
 be used for transplant because the tissue is not large enough or              
 developed enough.  Mr. Saakvitne said that the only research he was           
 involved with was for knee or shoulder joint requests by                      
 physicians.  Mr. Saakvitne emphasized that he would not be involved           
 in a research donation for anything less than a full-term birth.              
 SENATOR SALO moved HB 323 out of committee with individual                    
 recommendations.  Hearing no objections, it was so ordered.                   
 Number 331                                                                    
 VICE-CHAIR SHARP introduced  HB 128  (EARLY ACKNOWLEDGEMENT OF                
 PATERNITY) as the next order of business.                                     
 RENEE CHATMAN, Staff to Representative Bettye Davis, read the                 
 sponsor statement.  She stated that non-support of children is a              
 national epidemic which HB 128 addressed by requiring the state               
 registrar to prepare a paternity acknowledgment form.  She                    
 explained that a paternity acknowledgment form would allow a child            
 to acquire access to support from the father's Social Security,               
 worker's compensation, inheritance, health insurance, etc.  She               
 noted that HB 128 would allow the father legal access to his child,           
 even if he was not married to the mother.  In conclusion, she                 
 stated that HB 128 would guarantee that Alaskan children receive              
 support from both parents.                                                    
 SENATOR LEMAN asked if other states have requirements similar to              
 Alaska regarding establishment of paternity.  He expressed concern            
 with the portion of the sponsor statement requiring "full faith and           
 credit to a determination of paternity by another state, regardless           
 of the method in which paternity was established."                            
 REPRESENTATIVE BETTYE DAVIS, Prime Sponsor, explained that                    
 currently the federal government mandates that other states'                  
 determination of paternity be recognized.  Other states do have               
 comparable procedures to establish paternity.  She informed the               
 committee that HB 128 began as a paternity bill which was already             
 being done voluntarily, but not as mandated.  The other mandates              
 were added to HB 128 in order to be in compliance with federal                
 SENATOR SALO asked what would be voluntary and what would be                  
 required, especially regarding the mother.                                    
 REPRESENTATIVE BETTYE DAVIS stated that everything in HB 128 was a            
 mandate.  She clarified that the individual cannot be forced to               
 sign the form, but it is mandatory that the form be offered.  She             
 noted that the fiscal note would be increased and that increase               
 would be picked up by the Division of Child Support in the federal            
 government.  She thought that an amendment would be offered for the           
 fiscal note to increase by $30,000.                                           
 Number 399                                                                    
 JOHN MALLONEE, Deputy Director of Child Enforcement Support                   
 Division of the Department of Revenue, supported HB 128.  The bill            
 would bring Alaska into compliance with federal regulations which             
 continue federal financial participation.  He noted that Alaska has           
 had a voluntary paternity acknowledgment program for quite a while.           
 HB 128 would only put the practice into law; however, HB 128 would            
 not force anyone to voluntarily acknowledge paternity.  He                    
 discussed other states' success with the program; the program is              
 SENATOR ELLIS said that he supported HB 128.                                  
 SENATOR LEMAN asked what would happen in a situation with a married           
 woman having a child fathered by a man other than her husband.                
 JOHN MALLONEE acknowledged that such a situation would create                 
 various problems.  He explained that if a married woman has a                 
 child, the child would be assumed to be fathered by her husband.              
 Such cases have occurred and the true paternity was established               
 later by blood test.  He informed the committee that the courts               
 have ruled differently at various times; therefore, a legal dilemma           
 with much court time is created.                                              
 SENATOR LEMAN clarified that such a dilemma would be created with             
 or without HB 128.  He asked if HB 128 would add to that dilemma.             
 REPRESENTATIVE BETTYE DAVIS asserted that HB 128 does not address             
 or add to that legal dilemma.  JOHN MALLONEE noted that the federal           
 government has not issued final directives on many of the issues in           
 HB 128.                                                                       
 AL ZANGRI clarified that under current state law the husband must             
 be put on the birth certificate and is considered the father under            
 law.  In order to change the father on the birth certificate, one             
 must go to court.  He informed the committee that the Bureau of               
 Vital Statistics and DHSS are working on a new model law that the             
 federal government introduced last year.  This law would allow for            
 three party affidavits for paternity.  He believed that this law              
 reflects reality.                                                             
 Mr. Zangri explained that he had a temporary position that over the           
 past six months was converted to full-time, processing affidavits             
 of paternity, due to the increased volume.  That position would end           
 at the month's end, which would leave them unable to support this             
 paternity program.  He said that they were going to add a Range 8             
 to the fiscal note; approximately $30,000.  He agreed with                    
 Representative Davis that the Department of Revenue would RSA over            
 to the DHSS which would essentially be an increase in their federal           
 authorization.  Currently, the position must be placed in the                 
 fiscal note.                                                                  
 SENATOR SHARP inquired as to when that fiscal note would be coming.           
 AL ZANGRI said that it would be forthcoming in the next few days.             
 SENATOR ELLIS moved HB 128 out of committee with individual                   
 recommendations.  Hearing no objections, it was so ordered.                   
 Number 510                                                                    
 VICE-CHAIR SHARP introduced  HB 429  (SPECIAL EDUCATION SERVICE               
 AGENCY) as the next order of business.                                        
 MARGARET LOWE, Commissioner of DHSS, said that she was representing           
 Representative Jeannette James, the sponsor of HB 429.  She read a            
 brief sponsor statement.                                                      
 SENATOR DUNCAN clarified that HB 429 repeals the section of the               
 statute that requires the Governor's Council on Disabilities and              
 Special Education to govern the state's Special Education Service             
 Agency (SESA).  He asked if the intent of HB 429 was to create a              
 consumer-driven governing board, then why not structure that                  
 governing board in statutes.  Repealing the governing portion                 
 without any provisions does not ensure anything.                              
 MARGARET LOWE noted that she was President of the SESA board for              
 1994.  She explained that SESA intended to repeal the statutes                
 first and then work on legislation to make statutory provisions.              
 SENATOR DUNCAN did not believe that a two-step process was                    
 necessary.  He suggested repealing and organizing a governing board           
 at the same time.  MARGARET LOWE stated that she had all of that              
 material prepared and ready.                                                  
 SENATOR SALO inquired as to the current composition of the board              
 and the recommended changes.                                                  
 MARGARET LOWE explained that currently the majority of the board              
 members are also members of the Governor's Council on Disabilities            
 and Special Education.  The current board also includes one school            
 superintendent from the Superintendent's Association, and a                   
 representative of the National Education Association (NEA).  She              
 said that the current representation had not worked very well, due            
 to the lack of regional or parental member requirements.  She                 
 asserted that the major reason for the legislation was the conflict           
 of interest with the Governor's Council.  She did not believe that            
 proper surveillance could occur when the Governor's Council, who              
 should be reviewing the quality of services in special education,             
 owns a special education school.                                              
 Ms. Lowe noted that the by-law's change had been voted upon and               
 only waits for this bill or another to pass in order for them to be           
 in effect.  The by-laws specify that two rural area parents with              
 children in those programs would be present on the board.  She                
 noted that direct NEA affiliation would be eliminated, special                
 education teachers would fill those positions.  The superintendent            
 would still be on the board.                                                  
 SENATOR ELLIS pointed out that Governor Hickel had posed a major              
 effort to consolidate and eliminate various boards and commissions.           
 He asked how this board was allowed to be introduced.  MARGARET               
 LOWE did not believe a board was eliminated for this board to be              
 organized.  Ms. Lowe stated that the Governor's office had given              
 approval to proceed with this legislation, primarily due to the               
 conflict of interest issue.                                                   
 TAPE 94-21, SIDE B                                                            
 Number 576                                                                    
 SENATOR ELLIS asked if this board would be a net gain to the number           
 of boards or commissions.  MARGARET LOWE said yes, but noted that             
 this board has never had any staff and would not, under HB 429,               
 because the executive director of SESA would be the staff.                    
 SENATOR ELLIS inquired as to the financial aspect of HB 429.                  
 MARGARET LOWE said that SESA has had a budget for the board for               
 many years.  The funds are under the Department of Education's                
 Special Education funding.  SENATOR ELLIS asked for the amount of             
 the total budget.  MARGARET LOWE did not know, but offered to find            
 out for Senator Ellis.                                                        
 SENATOR ELLIS asked if the number of members for this new                     
 organization would be the same as the previous board.  MARGARET               
 LOWE believed that the new board contained one less person than the           
 original board.  Ms. Lowe noted that the board was still a                    
 statewide representation.                                                     
 SENATOR ELLIS reiterated Senator Duncan's suggestion to specify the           
 board's seats in statutes.  He did not want to leave a gap; why not           
 put in statutes now.                                                          
 SENATOR DUNCAN did not feel there would be any title problems due             
 to the broad title of the legislation.                                        
 SENATOR SALO asked how many staff, other than the executive                   
 director, are currently under SESA.  MARGARET LOWE said that                  
 approximately twenty-eight people are teaching with a support staff           
 of six to eight people.                                                       
 SENATOR SALO noted that the function of SESA was to offer low                 
 volume special education services throughout Alaska.  She asked if            
 they concentrated on any specific areas.  MARGARET LOWE stated that           
 they have instructors for all the major areas of special education.           
 There are no psychologists.                                                   
 SENATOR DUNCAN requested that Ms. Lowe present the information on             
 the composition of the board to add to the bill.                              
 VICE-CHAIRMAN SHARP held SB 429 so that Ms. Lowe could provide                
 information regarding the composition of the board for the                    
 committee to consider.                                                        
 Number 527                                                                    
 VICE CHAIRMAN SHARP introduced  SB 313  (HEALTH INS. FOR HIGH RISK            
 RESIDENTS) as the final order of business before the committee.               
 CAROL CARROL, staff to Senator Kerttula, explained that SB 313                
 would amend the Health Insurance Association set up 1992 for high-            
 risk health insurance.  She reviewed the amendments to SB 313 which           
 are present in the committee's packets.                                       
 SENATOR LEMAN asked for a description of the " other managed care            
 arrangements " which can be found on page 1, line 10.  CAROL CARROL     L    
 said that a provider type arrangement, a preferred provider                   
 arrangement would be an example.                                              
 BOB NIEBRUGGE, Consumer Representative of the Comprehensive Health            
 Insurance Association, agreed with the preferred provider                     
 arrangement example which Providence Hospital may be able to                  
 fulfill.  He said that HMO's may be able to offer care at a cheaper           
 rate in the future.  SB 313 provides language to offer health care            
 insurance at a cheaper rate to the insurers and make it as                    
 accessible as possible.                                                       
 SENATOR ELLIS asked why Senator Kerttula's original legislation had           
 five insurance representatives and two consumer representatives on            
 the board.                                                                    
 BOB NIEBRUGGE stated that the five insurance representatives were             
 beneficial with the technical tasks to create the legislation.  The           
 composition of the board has been successful.                                 
 SENATOR ELLIS inquired as to Mr. Niebrugge's background.  BOB                 
 NIEBRUGGE explained that he was a self-employed diabetic, a pre-              
 existing condition.  Eventually, he did discover Communicating for            
 Agriculture, which had created a high risk pool.  Under                       
 Communicating for Agriculture, insurance was available at an                  
 elevated premium without any subsidies.                                       
 SENATOR ELLIS asked if Mr. Niebrugge had any suggestions for those            
 individuals who cannot afford the elevated premium.  BOB NIEBRUGGE            
 said not in the context of this legislation.  SENATOR ELLIS said              
 that was the point.                                                           
 SENATOR ELLIS noted that SB 313 references HMO's and previous                 
 legislation from Senator Kerttula attempting to help HMO's to do              
 business in Alaska.  Still, HMO's are not coming to Alaska.  He               
 asked if there was hope for HMO's in Alaska.  BOB NIEBRUGGE said              
 no, this is an attempt to clean up the language in this                       
 SENATOR ELLIS inquired of the background of the other consumer                
 representative on the Association.  BOB NIEBRUGGE explained that              
 Elaine Hurley was the other consumer representative who has a                 
 daughter with a pre-existing health condition.                                
 Number 416                                                                    
 SENATOR DUNCAN asked Mr. Niebrugge if he had insurance through the            
 high risk pool.  BOB NIEBRUGGE said no, he has a group plan.  In              
 response to Senator Duncan, Mr. Niebrugge stated that they had                
 approximately seventy-some applications for the high risk pool.               
 SENATOR DUNCAN asked Mr. Niebrugge to clarify the number of                   
 individuals who actually received insurance.  BOB NIEBRUGGE said              
 that seventy-two individuals were actually insured.  Mr. Niebrugge            
 suspected that very few individuals would be declined, due to their           
 initial information when applying.                                            
 SENATOR DUNCAN stated that these changes seemed to make sense, but            
 would SB 313 change the number of individuals joining the high-risk           
 pool.  BOB NIEBRUGGE explained that the original legislation only             
 provided three levels of deductibles; most individuals opt for the            
 higher deductible because it has the lowest premium.  Mr. Niebrugge           
 indicated that if these changes occur in SB 313, a higher                     
 deductible similar to a catastrophic plan would be offered.  This             
 type plan would substantially decrease premiums which would help              
 SENATOR DUNCAN inquired as to other states' deductible under a                
 high-risk pool.  BOB NIEBRUGGE noted that there are a variety of              
 programs, but they generally lean toward the higher deductible.               
 Mr. Niebrugge offered to provide the committee with a publication             
 of other states' programs.                                                    
 SENATOR DUNCAN asked Mr. Niebrugge about his group policy.  BOB               
 NIEBRUGGE explained that his group policy was with a company that             
 had opened their enrollment to high-risk individuals for a short              
 time.  SENATOR DUNCAN inquired as to the status of his premium.               
 BOB NIEBRUGGE stated that his premiums have gradually increased.              
 SENATOR MILLER moved SB 313 out of committee with individual                  
 recommendations.  Hearing no objections, it was so ordered.                   
 There being no further business before the committee, the meeting             
 was adjourned at 2:55 p.m.                                                    

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