Legislature(1993 - 1994)
03/21/1994 01:45 PM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE 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 heartbeat. 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 regulations. 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 worthwhile. 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 legislation. 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 enrollment. 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.