Legislature(2001 - 2002)
04/30/2001 04:55 PM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE SENATE HEALTH, EDUCATION & SOCIAL SERVICES COMMITTEE April 30, 2001 4:55 p.m. MEMBERS PRESENT Senator Lyda Green, Chair Senator Loren Leman, Vice Chair Senator Gary Wilken Senator Bettye Davis Senator Jerry Ward MEMBERS ABSENT All members present COMMITTEE CALENDAR SENATE BILL NO. 38 "An Act relating to a new optional group of persons eligible for medical assistance who require treatment for breast or cervical cancer; and providing for an effective date." Committee Action: See HB 65 CS FOR HOUSE BILL NO. 65(HES) "An Act relating to a new optional group of persons eligible for medical assistance who require treatment for breast or cervical cancer; and providing for an effective date." MOVED SCS CSHB 65(HESS) OUT OF COMMITTEE Confirmation Hearings for the Board of Dental Examiners, Board of Dispensing Opticians, Board of Education and Early Development, Board of Marital and Family Therapy, State Medical Board, Alaska Mental Health Trust Authority Board of Trustees, Board of Certified Direct Entry Midwives, Board of Nursing, Board of Examiners of Optometry, Board of Pharmacy, State Physical Therapy and Occupational Therapy Board, Board of Professional Counselors, Professional Teaching Practices Commission, Board of Psychologists and Psychological Associate Examiners, University of Alaska Board of Regents and Board of Social Work Examiners. SENATE BILL NO. 192 "An Act relating to child care grants; and providing for an effective date." MOVED SB 192 OUT OF COMMITTEE CS FOR HOUSE BILL NO. 142(HES) "An Act relating to the Alaska temporary assistance program; and providing for an effective date." MOVED SCS CSHB 142(HES) OUT OF COMMITTEE SENATE CS FOR CS FOR HOUSE CONCURRENT RESOLUTION NO. 1(STA) Relating to establishing a Task Force on a Statewide Comprehensive Energy Plan. HEARD AND HELD SPONSOR SUBSTITUTE FOR SENATE BILL NO. 94 "An Act relating to the financing of major maintenance of public school facilities; authorizing the commissioner of revenue to sell the right to receive a portion of the anticipated revenue from a certain tobacco litigation settlement to the Northern Tobacco Securitization Corporation; relating to the deposit of certain anticipated revenue from a certain tobacco litigation settlement; authorizing the issuance of bonds by the Northern Tobacco Securitization Corporation with proceeds to finance public school major maintenance; and providing for an effective date." MOVED SSSB 94 OUT OF COMMITTEE PREVIOUS COMMITTEE ACTION SB 38 - See Labor and Commerce minutes date 2/01/01 and 2/15/01 and HESS minutes dated 4/23/01. HCR 1 - See State Affairs minutes dated 4/24/01. SB 94 - See HESS minutes dated 3/16/01, 3/28/01. WITNESS REGISTER Mary Louden Johnson, Coordinator Fairbanks Breast Cancer Support Group Fairbanks, AK 99701 POSITION STATEMENT: Testified on SB 38 Karen Perdue, Commissioner Department of Health & Social Services PO Box 110601 Juneau, AK 99801-0601 POSITION STATEMENT: Testified on HB 65 Victoria Shaver No address provided POSITION STATEMENT: Testified on HB 65 Carla Williams No address provided POSITION STATEMENT: Testified on HB 65 Marsha Hastings No address provided POSITION STATEMENT: Testified on HB 65 Shelly Coolidge No address provided POSITION STATEMENT: Testified on HB 65 Kristy Tibbles Legislative Aide to Senator Drue Pearce Room 119 Alaska State Capitol Juneau, AK 99801-1182 POSITION STATEMENT: Introduced SB 192 YVONNE CHASE, Deputy Commissioner of Early Development Department of Education & Early Development th 801 W 10 St. Juneau, AK 99801-1894 POSITION STATEMENT: Testified on SB 192 JOY LYON, President Alaska Chapter of the National Association of the Education of Young Children (AAEYC) Juneau, AK 99801 POSITION STATEMENT: Supports SB 192 GWENI MAKI, Owner and Director ABC Child Care Center Juneau, AK 99801 POSITION STATEMENT: Supports SB 192 Patrick Flynn, Aide to Representative Ethan Berkowitz Alaska State Capitol, Room 404 Juneau, AK 99801-1182 POSITION STATEMENT: Introduced HCR 1 ACTION NARRATIVE TAPE 01-01-42, SIDE A Number 001 CHAIRMAN LYDA GREEN called the Senate Committee meeting to order at 4:55 p.m. Present were Senators Leman, Wilken, Davis and Green. Senator Ward arrived at 5:50 p.m. The first order of business was SB 38. SB 38-MEDICAL ASSISTANCE:BREAST/CERVICAL CANCER HB 65-MEDICAL ASSISTANCE:BREAST/CERVICAL CANCER CHAIRWOMAN GREEN recapped written testimony that told the story of a college student who was repeatedly dismissed as too young to have cervical abnormalities each time she described the difficulties she was having to various physicians. At no time was she offered free cervical screening even though she qualified for the service. At the age of 26 she was diagnosed with cervical cancer and died at the age of 28. The friends relating the story expressed support for SB 38. MARY LOUDEN JOHNSON, coordinator for the Fairbanks Breast Cancer Support Group, testified via teleconference in support of SB 38. The group represents about 150 women and has some members that have been recently diagnosed with breast cancer and others who are 15 year survivors. She noted that, on average, one woman per week is diagnosed with breast cancer. Although most members are working women with insurance, they want to support those women who are not fortunate enough to have coverage. CHAIRWOMAN GREEN announced HB 65 was moved to the Senate after the hearing for SB 38 was scheduled. Because they are mirror bills, permission was received to waive the 24-hour rule so HB 65 could be heard instead of SB 38. SENATOR LEMAN moved adoption of CSHB 65, version F as the working document. There were no objections. CHAIRWOMAN GREEN noted that the language in section 1, subsection (b) requires that not more than $175,800.00 of general fund money be spent in fiscal year 2002, and not more than $189,500 be spent in 2003. She asked Senator Leman to address page 2, line 3. SENATOR LEMAN explained that the Department of Health and Social Services would provide information on environmental, behavioral and genetic factors contributing to breast and cervical cancer. From this, recommendations would be made to reduce the incidences in Alaska. SENATOR LEMAN moved adoption of amendment 1. CHAIRWOMAN GREEN explained amendment 1 requires that information concerning the total medical cost per person for the fiscal year preceding the date of the report, whether paid for by the state or not, shall be provided separately for each person who receives assistance under section 1 of the bill. The information would be presented in a way that would not allow the identification of individuals. SENATOR DAVIS objected to the amendment. CHAIRWOMAN GREEN responded she wants to know what the charges are and what the state is actually paying because she believes the measure is under funded for the predicted number of individuals. She wants to ensure that Medicaid is not requiring Alaskan doctors, vendors, oncologists and others to settle for an agreed upon sum over which there is no control. SENATOR GREEN asked that a representative from the Department of Health and Social Services speak to the amendment. Number 319 KAREN PERDUE, Commissioner of the Department of Health and Social Services, said she saw some implementation problems with the amendment because the total medical cost per person for the fiscal year preceding the date of the report may include time when the person is not on medical assistance and is therefore no business of the state. Additionally, there is no method for collecting that private information. CHAIRWOMAN GREEN said her reason for gathering that information is that the measure is under funded and not because she wants individuals to be identified. She wanted to know what the total billing would be and what amount Medicaid would pay. COMMISSIONER PERDUE replied the fiscal note was developed using actual yearly Medicaid payments for breast and cervical cancer diagnoses. From this data, they averaged the cost per experience. CHAIRWOMAN GREEN asked whether the data was collected on the State's fiscal year. COMMISSIONER PERDUE said the fiscal note was written to collect the information that way. CHAIRWOMAN GREEN said the way the accounting is done is the department's decision but it is important to know how much is being paid for the service. She then asked whether the treatment expenses were those coming just from the State of Alaska. COMMISSIONER PERDUE responded that although some treatment is not done in state they do have a policy that favors using in-state providers. CHAIRWOMAN GREEN commented that if they have enough information to make the payment, that's the information she's talking about. She wants to know what the impact is on the system. SENATOR DAVIS asked why the funding is limited to $175,800 and $189,500 if she feels these amounts are not adequate. CHAIRWOMAN GREEN responded, "We may have a bigger issue coming back next year and we need to have the information when we get ready for another review. If we don't have the information we don't know." They based their figures on the department's numbers. COMMISSIONER PERDUE pointed out the fiscal note represents the most accurate numbers currently available and are based on their experience of the average cost. She assumes it is not the intention of the legislature to cut women off if the funding estimate is inaccurate. Statute language allows eligible women to be served. SENATOR DAVIS asked whether women would continue to receive treatment if the funds were exhausted. She pointed out that there is a monetary limitation in the bill but statute says that once a woman is identified, treatment will continue. COMMISSIONER PERDUE replied she would be concerned about that and didn't really know its effect but her reading is that treatment would continue. VICTORIA SHAVER, Diana Craig Cervical Cancer Awareness Foundation member, testified via teleconference and asked for clarification on the amendment. CHAIRWOMAN GREEN said it was a temporary law that requires mandatory review in two years. MS. SHAVER thought it might be better if the amendment did not pass. A five year review period might be better because the appropriation Senator Frank Murkowski secured for Alaska will help the Alaska Medicaid program for five years. Number 491 CARLA WILLIAMS, Coordinator for the Alaska State Breast Cancer Coalition, testified via teleconference. She particularly wanted to address the comment made earlier about behavioral changes to prevent cancer. Scientists do not know what causes breast cancer and as an 11-year survivor of breast cancer she has heard many explanations. She asked whether the 250 percent above poverty level measurement was addressed in the amendment. CHAIRWOMAN GREEN replied that it has not been changed. MS. WILLIAMS was pleased to hear that. She said it was a bipartisan bill because it is a bipartisan disease. She agreed with Senator Murkowski's call for an additional $200 million federal dollars to expand the state's Medicaid program over the next five years. MARSHA HASTINGS, YWCA Encore Plus Program and member of the Alaska Breast Cancer Advocacy Partners, testified via teleconference in support of the legislation. She has been implementing early screening for both breast and cervical cancer since 1995. Accessing early screening is a positive behavioral change but additional screenings bring more detections of cancer. The women being diagnosed are without financial resources and are uninsured. Because they have been diagnosed with cancer they have a preexisting condition and are consequently uninsurable. They would be on the Medicaid program for the duration of their treatment. She would like to see the bill move forward without any amendments. SHELLY COOLIDGE, member of the Alaska Breast Cancer Advocacy Partners, testified via teleconference. She helps women who have been diagnosed with breast cancer move along the care continuum. In her experience, it is not unusual for the discussion about a woman's medical bills to be as emotional as the discussion about her cancer. Unfortunately, many women are making treatment decisions based on cost of treatment rather than what is medically beneficial to them. She would like to see the bill passed from committee without the amendment because the potential of running out of treatment funds is unacceptable. CHAIRWOMAN GREEN stated that the public policy side of the issue is not whether or not women with financial need should be offered treatment but to make certain that fairness is demonstrated throughout the system. She called for a roll call on amendment 1. The measure passed 3 to 1 with Senators Leman, Wilken and Green voting yes and Senator Davis voting no. She said the figures provided by the Department of Health and Social Services as well as information received from Washington were used to arrive at the dollar amounts in amendment 1. SENATOR DAVIS asked whether or not the $189,500 amount came from the department. CHAIRWOMAN GREEN responded the figures came from the fiscal note prepared by the department. She called for additional testimony and received no response. SENATOR LEMAN moved SCS CSHB 65(HESS) and corrected fiscal notes from committee with individual recommendations. There being no objection, the bill moved from committee. Number 630 CHAIRWOMAN GREEN announced legislative confirmation hearings would be the next order of business. Earlier in the week she notified committee members that unless they specifically requested a confirmation hearing, the list of nominees would be forwarded to the full Senate and House for consideration. SENATOR LEMAN moved the Senate HESS Committee report a letter to the full Senate stating they have reviewed the qualifications of the referrals but are giving no indication whether they intend to vote for or against those nominees. CHAIRWOMAN GREEN wanted it on record that each committee member had an extensive packet of background information on each of the nominees and many of them have been approved in previous legislatures. The list of confirmation nominees reported out to the full Senate for action in a joint Senate & House session. SB 192-INCREASE CHILD CARE GRANTS KRISTY TIBBLES, legislative assistant to Senator Drue Pearce, testified that SB 192 would increase the monthly base rate for child care from $33.00 to $50.00 per child and remove the $50.00 cap that currently exists in the Child Care Grant Program. This is a state funded program that provides grants to licensed child care centers and homes for the benefit of the facility and the children. The grants are used for staff salaries, benefits, substitute staff, goods or services relating to the health nutrition and safety of children in care, age appropriate equipment and supplies and activities for the children. CHAIRWOMAN GREEN reported she had heard from many child care providers in her community particularly as other state and federally funded programs receive substantial grants and training. Side B She's always encouraged to hear of increased opportunities for people to make a choice on child care. YVONNE CHASE, Deputy Commissioner of Early Development for the Department of Education and Early Development, agreed that it is essential for small child care providers in particular to get the necessities to continue in business. Because this is a flexible pot of money, it allows for a wide variety of uses, which is of particular value to small providers. Clearly, as the number of providers increases, the base rate decreases if the current level of appropriation stays the same. Because the department doesn't know how the final bill will be configured, they have submitted a fiscal note that reflects a range of costs depending upon whether just current licensed providers in the child care grant program receive a base increase or whether current and new program members are included. She emphasized that this is not an entitlement. CHAIRWOMAN GREEN asked whether there is a possibility that child care providers will simply drop out of the business altogether causing a shortage of care givers. DEPUTY COMMISSIONER CHASE said that all states are finding that because this is such a low pay industry, it is difficult to attract and retain quality people. Small providers feel this may be the only money that may allow them to increase salaries, provide training and perhaps offer some health insurance. CHAIRWOMAN GREEN asked whether the language in this legislation could change a grant to an entitlement program. DEPUTY COMMISSIONER CHASE was not certain whether the language would make it an entitlement but this is why they gave a range on the fiscal note. CHAIRWOMAN GREEN responded this might be an optional grant program, which would keep it from being an entitlement. She then read the following: "A grant under (a) of this section shall be $50.00 per month for each child the child care facility cares for, or for each full time equivalent as determined by the department." She then asked whether that was an entitlement. DEPUTY COMMISSIONER CHASE replied that currently and in the past, a child care grant is not an entitlement. They have increased the rate and limited the number of providers who may participate depending on the amount of funds available. CHAIRWOMAN GREEN then asked Ms. Tibbles whether she could clear up the confusion since she did not want to "change a may to a shall if that's not the intention." MS. TIBBLES replied that Senator Pearce's intention was to make the base level $50.00 and then apply geographic adjustments. She was not sure about what she meant by entitlement. CHAIRWOMAN GREEN said a comparable entitlement would be Medicaid. If seven people came in for service then seven people receive the service. Anyone who meets the qualifications automatically qualifies, so it is not possible to determine how many people will qualify ahead of time. If this is the case, she wanted to make sure that the fiscal note reflects that adequately. She pointed out they could pass the measure along and let the Finance Committee make the decision. DEPUTY COMMISSIONER CHASE closed by saying that the department is supportive of the Child Care Grant and also of the increase of the base rate. She wanted to make sure it was understood that as the number of providers increases, those same funds are spread across more providers and the base rate goes down. CHAIRWOMAN GREEN said, "That's the difference in [an] entitlement program. Nothing goes down; just the total amount goes up every time someone else walks through the door." JOY LYON, President of Alaska Chapter of the National Association of the Education of Young Children (AAEYC) represents individuals and groups across the state that are concerned about young children. She testified in strong support of SB 192. Grant funds are typically used for staff salaries that average just $8.14 per hour. An increase in the base rate is needed to help attract and hold quality staff and reduce the current 40 percent turnover rate. Additionally, the Child Care Grant is the only incentive for family child care providers to become licensed. Number 507 GWENI MAKI, owner and director of the ABC Child Care Center, testified in support of SB 192. The increase in the base rate would allow her to improve salaries for her staff to decrease staff turnover. SENATOR WILKEN wanted to cover several finance issues that would be developed further when the bill is heard in the Finance Committee. First he pointed out this is a $34.528 million program. The legislature and administration can take pride in the fact that by midyear 2001 there is no longer a wait list for day care. In 2000, the grant program was $1.7 million and in 2001 it was $2.25 million and in 2002 it is $3.7 million which means a base rate of $23.00 in the first year, $33.00 in the second and with the monies appropriated in 2002 it will rise to about $40.00. This reflects extraordinary growth in the grant program and really shows you the impact of this bill. When you multiply the area cost differential by $33.00 you get about $48.00 per day for those areas with high costs. When you use $40.00 and use the same area cost differential you get $58.00. Therefore, the $50.00 cap locks in people with higher costs at $50.00. Raising the base rate to $50.00 would mean those same people would get somewhere around $78.00 per day making this a very expensive bill. With the increase from $23.00 to $33.00, he wanted to receive information on how that money was used. He sent a letter to 50 child care providers in Fairbanks asking them how they used the extra money and he received a response from just three providers. He said he would try again and expected to receive an answer. Next, he expressed disappointment in the fiscal note. He thought it was possible to take the existing day care population and multiply it by the higher number, which would give the fiscal impact today. DEPUTY COMMISSIONER CHASE replied that was the reason for the range in the fiscal note. The lower end represents moving the individuals currently on the program up to the $50.00 base rate that is adjusted for their area of operation. SENATOR WILKEN asked whether that was the $1.5 million. DEPUTY COMMISSIONER CHASE said it was the additional funds bringing the total up to $3.7 million. Next she showed the total estimated population that is available to apply for the grant if it were open to all licensed providers and they opted to apply. In years past, she thought many did not apply because the small amount of money available was not worth the additional paperwork. As the rates increased, more providers returned to the program. SENATOR WILKEN cautioned her to have a better fiscal note when the bill was heard in the Finance Committee. DEPUTY COMMISSIONER CHASE agreed to do so. SENATOR WILKEN then pointed out that several years ago, with HB 40, daycare moved to the Department of Education providing a starting point in government. The legislature wants to be able to look back ten years from now to evaluate the costs. During the interim they will be working with the department so that next year there will be more information about what providers are doing or plan to do with the money. Since this is an expensive but necessary program there needs to be accountability. With that, he reiterated his support for the program. CHAIRWOMAN GREEN said one of her concerns is that there tends to be a disincentive for private daycare providers. She does not want all providers to be government directed programs. She wants to equalize the gift to Head Start and Boys and Girls Club but does not want to put others out of business. It is her preference to allow individuals a choice of child care options. SENATOR WARD moved SB 192 and accompanying fiscal note from committee with individual recommendations. There being no objection, the bill moved from committee. HB 142-AK TEMP. ASSISTANCE PROGRAM AMENDMENTS CHAIRWOMAN GREEN announced that members had a committee substitute in their bill packet that returns the bill to the original language in the Senate version. SENATOR WILKEN moved version O as a working document. There was no objection. SENATOR WARD moved SCS CSHB 142(HES) from committee with individual recommendations. There being no objection, the bill moved from committee. HCR 1-STATEWIDE COMP ENERGY PLAN TASK FORCE PATRICK FLYNN, aide to Representative Berkowitz, explained that a reliable energy system in Alaska is, among other things, a public health issue. Late last year when the development of North Slope natural gas was being discussed, it was brought to light that a statewide comprehensive energy plan had never been produced. This legislation establishes a task force that will examine the condition of Alaska's energy resources, identify areas needing improvement and recommend action. SENATOR WARD asked for the sunset date. MR. FLYNN said it sunsets on March 1, 2002. SENATOR WILKEN referred to page 1, line 10 and asked whether the words "and tribal governments" adds to the bill. MR. FLYNN responded it recognizes there are tribal organizations providing energy programs and to the extent they can aid in ensuring reliable, affordable energy in Alaska, their support is welcome. SENATOR WILKEN asked whether deleting "tribal governments" would exclude anyone because it seemed redundant since federal, state and municipal governments are already included. MR. FLYNN said it would be exclusionary because some tribal governments are not municipal governments. SENATOR WILKEN thought he would look into that because it seemed out of place to him. CHAIRWOMAN GREEN looked at the list of proposed task force members and asked for an explanation of Alaska Village Electric Cooperative (AVEC). MR. FLYNN said AVEC is an organization that provides power to 52 small villages throughout rural Alaska. Their prospective is valuable because they understand some of the difficulties of providing power in low population areas. CHAIRWOMAN GREEN asked if they are a part of the Alaska Rural Electric Cooperative Association (ARECA). MR. FLYNN said they are members of ARECA. From their conversations, it is presumed that their task force member would be from the rail belt region, along the intertie area. CHAIRWOMAN GREEN then asked about the Alaska Coal Administration. MR. FLYNN explained that the Alaska Coal Administration felt they should be represented because interior Alaska power comes almost exclusively from coal. CHAIRWOMAN GREEN then asked about the Alaska Audubon Society. MR. FLYNN said they recognize the efforts to provide interties and additional power production in Alaska have caused difficulties with conservation groups. A frequent complaint is that they are not invited to the table. Therefore, when several conservation organizations asked to be included they decided this was a reasonable request. Initially they asked the Alaska Conservation Alliance to join the task force but received complaints from other members. CHAIRWOMAN GREEN said she did not intend to move the bill from committee that day. SENATOR WARD asked about the possibility that the Alaska Audubon Society member be replace by a member from the Alaska Federation of Natives (AFN). MR. FLYNN said AFN was contacted and that although they are not opposed to the idea, neither are they overly enthusiastic. CHAIRWOMAN GREEN held SCS CSHCR 1 (STA) in committee. SB 94-EDUCATION FUNDING CHAIRWOMAN GREEN announced the final order of business was SSSB 94. SENATOR TAYLOR, bill sponsor, said the dollar amount in the substitute is very similar to the original bill. They wanted to raise the formula by $210.00, which would have generated $57 to $60 million but because the bill was misread and therefore misunderstood, it was not successful. Therefore, he decided the $58 million could be used to repair every school in the state according to the list provided by the Department of Education. This does not include any new school construction. Forty-six schools are listed that would benefit from its passage. The tobacco settlement is part of the funding base and he knows there is controversy concerning the funding mechanism. There are at least two mechanisms coming from the House. CHAIRWOMAN GREEN commented she has no letters either in support or against the bill. SENATOR TAYLOR said that is because the bill is fairly new. Anyone having read SB 94 would be familiar with the intent. He has received enthusiastic support from educators and administrators. CHAIRWOMAN GREEN asked for the general response to using the tobacco settlement money. SENATOR TAYLOR said there could be better ways to finance this, he's not necessarily tied to that method. SENATOR WARD reported he asked for a printout from the settlement and the tax and learned there is a little over $75 million. Of that, almost $2 million has been spent on campaigns to stop smoking and $73 million on government. Therefore, this is "in stride with that effort of those people that wanted children to stop smoking." CHAIRWOMAN GREEN asked if the money was from the tobacco litigation. SENATOR TAYLOR said it was. CHAIRWOMAN GREEN commented that the money is headed to the general fund. SENATOR WARD said, "We and the Governor have certainly spent it like general fund money… We've spent $73 of the $75 on government and from one that voted against the cigarette tax for this very reason, I hope we keep this in mind when the next sin tax rolls around." SENATOR WILKEN thanked Senator Taylor then pointed out that the deferred maintenance list includes about 98 projects totaling about $108.8 million, so the money would address about one-half the list. He then expressed frustration with those Rural Education Attendance Areas (REAA) that are unwilling to help fund their own educational needs but are more than willing to accept "free government". He said he would continue to vocalize his views in this area. CHAIRWOMAN GREEN asked for other testimony and received no response. She asked for the will of the committee. SENATOR WILKEN moved SSSB 94 and fiscal note from committee with individual recommendations. There being no objection, the bill moved from committee. CHAIRWOMAN GREEN adjourned the meeting at 6:40 p.m.