Legislature(2003 - 2004)

02/26/2003 01:35 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                    ALASKA STATE LEGISLATURE                                                                                  
          SENATE HEALTH, EDUCATION AND SOCIAL SERVICES                                                                        
                       STANDING COMMITTEE                                                                                     
                       February 26, 2003                                                                                        
                           1:35 p.m.                                                                                            
TAPE(S) 03-6                                                                                                                  
MEMBERS PRESENT                                                                                                               
Senator Fred Dyson, Chair                                                                                                       
Senator Lyda Green, Vice Chair                                                                                                  
Senator Gary Wilken                                                                                                             
Senator Bettye Davis                                                                                                            
Senator Gretchen Guess                                                                                                          
MEMBERS ABSENT                                                                                                                
All members present                                                                                                             
COMMITTEE CALENDAR                                                                                                            
SENATE BILL NO. 25                                                                                                              
"An Act  relating to  the teachers' housing  loan program  in the                                                               
Alaska  Housing   Finance  Corporation;  and  providing   for  an                                                               
effective date."                                                                                                                
     [THIS BILL WAS MOVED OUT OF COMMITTEE ON 2/24/03, BUT                                                                      
     WAS COMMENTED ON AT THIS MEETING.]                                                                                         
SENATE BILL NO. 41                                                                                                              
"An Act relating  to medical care and crimes  relating to medical                                                               
care, including medical  care and crimes relating  to the medical                                                               
assistance program."                                                                                                            
     HEARD AND HELD                                                                                                             
SENATE BILL NO. 78                                                                                                              
"An Act  relating to  an optional group  of persons  eligible for                                                               
medical assistance who require treatment  for breast and cervical                                                               
cancer; relating  to cost sharing  by those recipients  under the                                                               
medical  assistance  program;  and  providing  for  an  effective                                                               
          MOVED SB 78 OUT OF COMMITTEE                                                                                          
^Suicide Prevention Council                                                                                                   
     Ms. Merry Carlson                                                                                                          
     Ms. Jeanine Sparks                                                                                                         
     Senator Georgianna Lincoln                                                                                                 
     Representative Mary Kapsner                                                                                                
     Rt. Reverend Mark MacDonald                                                                                                
     Ms. Susan Soule                                                                                                            
     Ms. Carol Seppilu                                                                                                        
PREVIOUS ACTION                                                                                                               
SB 41 - No previous action to consider.                                                                                         
SB 78 - No previous action to consider.                                                                                         
WITNESS REGISTER                                                                                                              
Mr. Elmer Lindstrom, Special Assistant                                                                                          
Department of Health and Social Services                                                                                        
Box 110601                                                                                                                      
Juneau, AK  99801-0601                                                                                                          
POSITION STATEMENT:  Supported SB 41 and commented on SB 78.                                                                  
Ms. Anne M. Gore, Program Director                                                                                              
Breast and Cervical Health Check                                                                                                
Department of Health &                                                                                                          
  Social Services                                                                                                               
PO Box 110601                                                                                                                   
Juneau, AK  99801-0601                                                                                                          
POSITION STATEMENT: Commented on SB 78.                                                                                       
Mr. Kevin Henderson, Eligibility Program Officer                                                                                
Division of Medical Assistance                                                                                                  
Department of Health &                                                                                                          
  Social Services                                                                                                               
PO Box 110601                                                                                                                   
Juneau, AK  99801-0601                                                                                                          
POSITION STATEMENT: Commented on SB 78.                                                                                       
Ms. Caren Robinson                                                                                                              
Alaska Women's Lobby                                                                                                            
PO Box 33702                                                                                                                    
Juneau AK 99803                                                                                                                 
POSITION STATEMENT: Supported SB 78.                                                                                          
Ms. Carla Williams                                                                                                              
Alaska Breast Cancer Advocacy                                                                                                   
13001 Norak Place                                                                                                               
Anchorage AK 99516                                                                                                              
POSITION STATEMENT: Supported SB 78.                                                                                          
Ms. Emily Nenon                                                                                                                 
American Cancer Society                                                                                                         
1635 Northwester Ave.                                                                                                           
Anchorage 99508                                                                                                                 
POSITION STATEMENT: Supported SB 78.                                                                                          
ACTION NARRATIVE                                                                                                              
TAPE 03-6, SIDE A                                                                                                             
                 SB 25-AHFC LOANS TO EDUCATORS                                                                              
CHAIR FRED DYSON  called the Senate Health,  Education and Social                                                             
Services Standing  Committee meeting  to order  at 1:35  p.m. All                                                               
members  were  present. He  said  that  he  wanted to  correct  a                                                               
statement he made regarding SB  25, which passed out of committee                                                               
on February  24. After  a further  look at  state law  he learned                                                               
that the  state might not be  liable for the actions  of children                                                               
who are a  ward of the state.   Instead, the legal  guardian of a                                                               
child would be liable for their activities.                                                                                     
                SB 41-MEDICAID COSTS AND CRIMES                                                                             
CHAIR FRED DYSON announced SB 41 to be up for consideration.                                                                    
SENATOR LYDA GREEN, sponsor, said  that because of concerns about                                                               
the  increasing cost  of Medicaid  and the  increasing number  of                                                               
fraudulent  claims,  the  administration and  the  Department  of                                                               
Health, Education  and Social Services  (DHSS) want to  get input                                                               
on this bill. She said she  would come back to the committee with                                                               
a new committee substitute (CS) to the sponsor substitute.                                                                      
CHAIR DYSON  asked if there  were any objections to  adopting the                                                               
sponsor substitute  to SB 41,  version 23-LS020\A. There  were no                                                               
objections and it was so ordered.                                                                                               
MR. ELMER LINDSTROM, Special Assistant,  Department of Health and                                                               
Social Services, said this issue  was a priority for the governor                                                               
and DHSS.                                                                                                                       
CHAIR DYSON said SSSB 41 would  be set aside for further work and                                                               
a hearing at a later date.                                                                                                      
          SB 78-MEDICAID FOR BREAST & CERVICAL CANCER                                                                       
CHAIR FRED DYSON  announced SB 78 to be up  for consideration and                                                               
noted  that  another  bill  on the  same  subject,  sponsored  by                                                               
Senator Davis,  was referred to  the Senate HESS  Committee. That                                                               
bill is scheduled for a hearing next week.                                                                                      
SENATOR  LYDA  GREEN, sponsor,  said  SB  78 removes  the  sunset                                                               
provision of  the 2001 legislation  to allow women who  have been                                                               
participating the  program to continue  treatment and  to provide                                                               
treatment for  women who  will be diagnosed  in the  future. This                                                               
bill gives  DHSS the authority  to impose allowable  cost sharing                                                               
under  federal  authority  for the  breast  and  cervical  cancer                                                               
category.  The state  would then  be  able to  submit an  amended                                                               
state plan to the federal  government that would also provide for                                                               
the  implementation of  a system  by which  these funds  would be                                                               
collected. The language  in the bill is the same  as the language                                                               
that was used for the original Denali Kid Care program.                                                                         
SENATOR GRETCHEN GUESS  asked her to describe  how other Medicaid                                                               
programs  are dealt  with  and  how many  have  the cost  sharing                                                               
contribution language in section (e).                                                                                           
SENATOR  GREEN  explained  that  the  more  established  Medicaid                                                               
programs  have very  high  standards,  meaning participants  must                                                               
have low  levels of  income and very  limited asset  ownership to                                                               
qualify. The more recent programs  have a general reference to an                                                               
income limit,  but not to an  asset limit. She suggested  that at                                                               
some future time a co-pay  requirement or client participation in                                                               
rates might allow the program to  be extended to other people who                                                               
might qualify  without creating a  great expense to the  state or                                                               
the federal government.                                                                                                         
SENATOR GUESS asked  what co-pays are in effect  and would remain                                                               
in effect if this bill passes.                                                                                                  
MR.   LINDSTROM  said   the  governor   strongly  supports   this                                                               
legislation. He  explained the current  co-pay is $50 per  day up                                                               
to  a  maximum  of  $200  for  discharge  of  inpatient  hospital                                                               
services,  5%  of  allowable   charges  for  outpatient  hospital                                                               
services, $3 per  day for physicians services and $2  per day for                                                               
each prescription and [indisc.].                                                                                                
SENATOR  GUESS asked  if  the language  on page  1,  line 11,  is                                                               
problematic because  it says, "to  the maximum extent  allowed by                                                               
federal  law,"  but  then  later indicates  a  sliding  scale  by                                                               
household income.                                                                                                               
MR. LINDSTROM  replied that he didn't  think so by virtue  of the                                                               
permissive  language  on  line   10,  which  says,  "may  require                                                               
CHAIR DYSON commented the co-pay  limits are ridiculously low and                                                               
asked if federal law requires them.                                                                                             
MR. LINDSTROM  replied that is  correct and said he  was speaking                                                               
to the  maximum that DHSS would  be allowed to implement  at this                                                               
point according to federal law.                                                                                                 
CHAIR DYSON  said he  understood the  sponsor's comments  to mean                                                               
that to  qualify for  this benefit  a person will  have to  be at                                                               
200% of poverty level, the same as Denali Kid Care.                                                                             
MR. LINDSTROM  replied for this program,  Medicaid eligibility is                                                               
tied directly to  eligibility for the screening  program and that                                                               
is 250 percent of the federal poverty level.                                                                                    
CHAIR DYSON said  he understood this administration  was going to                                                               
recommend altering  some of the  qualifying levels and  asked Mr.                                                               
Lindstrom if he was saying those two will not be altered.                                                                       
MR.  LINDSTROM replied  the administration  supports the  bill as                                                               
drafted and he is unaware of  any suggestion to alter the federal                                                               
poverty  level for  this program.  The point  that Senator  Green                                                               
made is  why it's  important to have  this discussion  about what                                                               
the committee  might want to  consider relative to  cost sharing.                                                               
He pointed out:                                                                                                                 
     It's    been   a    long-standing   desire    of   this                                                                    
     administration that  if and when  we are allowed  to do                                                                    
     so by the federal government,  it is perfectly fair and                                                                    
     very  appropriate  for  individuals who  are  in  these                                                                    
     relatively  higher  income  categories to  support  the                                                                    
     medical costs to  the extent they are able to  do so in                                                                    
     a reasonable manner. This is  language that we are very                                                                    
     comfortable with.                                                                                                          
CHAIR DYSON  asked how much 250  percent of annual income  at the                                                               
federal poverty level amounts to.                                                                                               
AN  UNIDENTIFIED SPEAKER  said he  thought the  poverty level  in                                                               
Alaska is about  $11,000 per year, so 250 percent  would be about                                                               
$25,000 for a single person.                                                                                                    
MS.  ANNE  GORE, Program  Director,  Breast  and Cervical  Health                                                               
Check, said she thought the amount  is about $23,000 per year for                                                               
a single individual.                                                                                                            
CHAIR  DYSON  said   he  understood  that  there   are  no  asset                                                               
limitations to qualify.                                                                                                         
MS.  GORE  responded  that  to  be  eligible  for  the  screening                                                               
program, a woman must have an  income below the poverty level, be                                                               
between the ages of  18 - 64 and she may or  may not have medical                                                               
insurance.  She may  have medical  insurance that  would preclude                                                               
her  from  receiving  those  screening   services  (i.e.  if  the                                                               
insurance wouldn't pay  for preventative health care,  such as an                                                               
annual exam  or a mammogram). If  she is below the  income level,                                                               
has insurance and the physician  submits proof that the insurance                                                               
carrier denied her claim because  those services are not covered,                                                               
she is  eligible to  have her  screening and  diagnostic services                                                               
paid for. Once she undergoes treatment,  even if she has an unmet                                                               
deductible  of  $5,000,  she is  considered  to  have  creditable                                                               
coverage  and   is  not  eligible  to   receive  treatment  under                                                               
CHAIR DYSON asked about the asset requirements.                                                                                 
MS. GORE  replied there is  no asset  test for the  screening and                                                               
diagnostic program or for the treatment program.                                                                                
CHAIR DYSON asked if a person  would qualify who had a home worth                                                               
$1  million that  was paid  for  but had  just lost  his job  and                                                               
medical coverage.                                                                                                               
MS. GORE said technically that  person could, but she thought one                                                               
would have  enough assets if one  owned a million dollar  home to                                                               
pay for screening.                                                                                                              
CHAIR DYSON  asked Mr. Lindstrom if  the preceding administration                                                               
had moved away from having an asset qualification.                                                                              
MR. LINDSTROM  said this program is  peculiar because eligibility                                                               
is  tied  to  the  screening   program.  Historically,  the  cash                                                               
assistance programs have always had an asset test attached.                                                                     
MR.  KEVIN HENDERSON,  Eligibility Program  Officer, Division  of                                                               
Medical Assistance,  DHSS, said some Medicaid  programs have been                                                               
around for 10-12  years that do not have an  asset test. However,                                                               
most of the traditional categories do have asset tests.                                                                         
CHAIR DYSON said he understood  that asset requirements have been                                                               
on the books, but they have largely been ignored.                                                                               
MR. HENDERSON replied:                                                                                                          
     Medicaid is pretty complicated and  as you get into the                                                                    
     law,  there   are  30  some  different   categories  of                                                                    
     eligibility  -  all  of  those  authorized  under  some                                                                    
     federal   law   -   some  are   mandatory,   some   are                                                                    
He explained that the Denali Kid  Care program and the Breast and                                                               
Cervical  Program don't  have  an asset  test  under the  federal                                                               
provisions.  Many of  the  traditional  Medicaid categories  that                                                               
have  been around  a  long time  have always  had  an asset  test                                                               
CHAIR DYSON asked if federal  law precludes the state from having                                                               
an asset test.                                                                                                                  
MR. HENDERSON replied  it does in the breast  and cervical cancer                                                               
category. He added:                                                                                                             
     It ties eligibility directly to  whether they have been                                                                    
     screened by  the Breast and Cervical  Screening Program                                                                    
     and that  program, I believe  by federal law,  does not                                                                    
     have  an asset  test attached  to it.  Adding an  asset                                                                    
     test to it  is not, to my knowledge, an  option for the                                                                    
SENATOR  BETTYE DAVIS  asked if  the division  had been  denied a                                                               
waiver  once for  Denali Kid  Care and  under what  circumstances                                                               
that happened.                                                                                                                  
MR.  LINDSTROM   explained  that  DHSS  petitioned   the  federal                                                               
government and  asked for the  ability to do  more in the  way of                                                               
co-payments and cost sharing but were told no.                                                                                  
SENATOR DAVIS  said according to  the bill, the state  is already                                                               
drawing the  maximum amount of  money it  can get based  upon the                                                               
MR. LINDSTROM agreed.                                                                                                           
SENATOR DAVIS  thought Section 2  was redundant and asked  why it                                                               
is needed.                                                                                                                      
MR. LINDSTROM replied  the governor and commissioner  think it is                                                               
worthwhile  to reiterate  the notion  that  with these  programs,                                                               
particularly when someone  is above the typical  income level for                                                               
Medicaid, the  state be  allowed to  implement a  reasonable cost                                                               
sharing mechanism.                                                                                                              
SENATOR  DAVIS   said  she  thought   that  language   should  be                                                               
MR. LINDSTROM  responded that he  thought the language  made that                                                               
clear  and  he  didn't  think  it  was  inconsistent  with  other                                                               
SENATOR DAVIS asked if Mr. Lindstrom  was preparing a new plan or                                                               
waiting for the federal government to give out new guidelines.                                                                  
MR. LINDSTROM  said he thought  allowing the state to  go further                                                               
would require a change in federal law.                                                                                          
CHAIR DYSON said  the state could change the 250%  of the federal                                                               
poverty level amount if it wanted to.                                                                                           
MR. LINDSTROM  replied that is  correct, although it  wouldn't be                                                               
in the  context of the Medicaid  program; it would refer  back to                                                               
the screening program.                                                                                                          
2:04 p.m.                                                                                                                     
MS. CAREN ROBINSON, Alaska Women's Lobby, supported SB 78.                                                                      
MS. CARLA  WILLIAMS, President of  Alaska Breast  Cancer Advocacy                                                               
and the  state field coordinator  for the National  Breast Cancer                                                               
Coalition said that both organizations support SB 78.                                                                           
CHAIR  DYSON  thanked  her  for  her efforts  on  behalf  of  all                                                               
Alaskans,  particularly people  suffering from  these devastating                                                               
MS. EMILY NENON,  American Cancer Society, stated  support for SB
78 and  told members, "It  is unconscionable  to look a  woman in                                                               
the face and tell them they  have cancer when you know they don't                                                               
have the  means to get  treatment." She said  Congress recognized                                                               
this and  created the 70  percent federal match to  state dollars                                                               
spent on this program. This  month President Bush requested a $10                                                               
million line-item increase for the  screening and diagnostic side                                                               
of the program.                                                                                                                 
She also has  questions about the future  implications of setting                                                               
up cost  sharing provisions and  expressed concern  about placing                                                               
an undue  burden on  cancer patients  now or  in the  future. The                                                               
American  Cancer  Society  is  flatly  opposed  to  changing  the                                                               
current eligibility  requirements for  the treatment  program. It                                                               
has to match the eligibility  for the screening program otherwise                                                               
they haven't gotten around the  issue of screening uninsured low-                                                               
income women, knowing that they have no means to get treatment.                                                                 
SENATOR GREEN moved to pass  SB 78 from committee with individual                                                               
recommendations and  the accompanying fiscal note.  There were no                                                               
objections and it was so ordered.                                                                                               
              SUICIDE PREVENTION COUNCIL OVERVIEW                                                                           
CHAIR  FRED  DYSON  announced   the  Suicide  Prevention  Council                                                               
Overview to be the next item on the agenda.                                                                                     
MS.  MERRY  CARLSON began  the  presentation  by introducing  the                                                               
council  members  present. She  then  reported  on the  council's                                                               
accomplishments during FY02. Last year, the council:                                                                            
   (1) Attempted to establish a comprehensive description of the                                                                
        problem of suicide in Alaska and plans to release a                                                                     
        "follow-back" study in March 2003.                                                                                      
   (2) Held "listening sessions" in six Alaskan cities in which                                                                 
        the public, professionals, and other interested parties                                                                 
        informed the council about suicide-related issues,                                                                      
       histories, and treatment programs in those areas.                                                                        
   (3) Drafted a council Work Plan and by-laws.                                                                                 
   (4) Drafted a Statewide Suicide Prevention Plan scheduled for                                                                
        release and public comment in March 2003.                                                                               
   (5) Conducted over 20 presentations across the state designed                                                                
        to inform the public about suicide.                                                                                     
   (6) Established an accessible council office and website.                                                                    
Ms. Carlson continued and said the council aims to:                                                                             
   (1) Continue to review the draft of the Alaska Statewide                                                                     
      Suicide Prevention Plan and receive public comment.                                                                       
   (2) Create an Advisory Group to review the draft.                                                                            
   (3) Finalize and distribute the Plan.                                                                                        
   (4)  Develop a specific five-year  "action plan" based  on the                                                               
   (5)  Support three regions of the state in developing regional                                                               
        suicide prevention plans.                                                                                               
   (6) Create a Youth Advisory Group.                                                                                           
   (7) Create and begin a suicide prevention awareness campaign.                                                                
   (8) Begin a follow-back study.                                                                                               
MS. CARLSON went  on to provide the Committee  with statistics of                                                               
the suicide  problem in Alaska.  For the years  1991-2000, Alaska                                                               
recorded  1,264 suicides,  the  highest rate  of  suicide in  the                                                               
nation. For every completed suicide,  there is an average of over                                                               
four attempts  that require  hospitalization. In  Alaska, suicide                                                               
rates are highest in Alaskans  aged 15-44, while suicide attempts                                                               
are  most  frequent  in  those age  20-39.  Alaska  Natives  have                                                               
suicide rates four times greater  than the national average rate,                                                               
and Native  males, in particular,  have rates over six  times the                                                               
national  average. The  majority  of  completed suicides  involve                                                               
firearms.  In  response  to  a question  from  Chair  Dyson,  Ms.                                                               
Carlson added that  suicide is a symptom; we need  to examine the                                                               
underlying causes.                                                                                                              
Ms.  Carlson  noted  the  themes  of  the  draft  Alaska  Suicide                                                               
Prevention Plan are:                                                                                                            
   (1) Suicide prevention is everyone's responsibility.                                                                         
   (2)  Successful suicide  prevention requires  local plans  and                                                               
        actions, supported by, and integrated with, regional,                                                                   
        state, and national resources.                                                                                          
   (3)  Suicide is related to many other problems facing Alaska's                                                               
        communities and cannot be addressed alone.                                                                              
   (4)  Suicide   prevention  efforts   should   target   at-risk                                                               
   (5)  To  prevent   suicide,   we  need   to  develop   healthy                                                               
        communities across Alaska.                                                                                              
   (6)  Successful  suicide prevention  will  require  sufficient                                                               
MS. CARLSON concluded by making  the following recommendations to                                                               
the Governor and the Legislature:                                                                                               
   1. Educate the public  about suicide,  its warning  signs, and                                                               
     specific risk and protective factors.                                                                                      
   2. Fund local suicide prevention plans and  actions, supported                                                               
     by, and integrated with, regional, state, and national                                                                     
   3. Continue funding research for follow-back and other studies                                                               
     to   determine   effective   prevention   and   intervention                                                               
     strategies in Alaska.                                                                                                      
   4. We cannot delay or suspend prevention efforts.                                                                            
   5. Fund ongoing prevention programs and research at current                                                                  
     levels. Where possible, provide increased funding for                                                                      
     existing and new programs.                                                                                                 
MS.  JEANINE SPARKS  read  the testimony  of  CAROL SEPPILU.  Ms.                                                               
Seppilu is  a 20-year  old resident of  Savoonga, Alaska  who has                                                               
lost  many  friends to  suicide.  She  attempted suicide  several                                                               
years ago  while under the  influence of alcohol. Her  miracle of                                                               
survival  has led  her  to become  actively  involved in  suicide                                                               
prevention. She is a member  of the council who attends workshops                                                               
and assists  with program development,  her main  focus remaining                                                               
on  youth. She  reported that  in her  opinion, education  is the                                                               
most  effective method  of suicide  prevention. Developing  self-                                                               
confidence and  other positive  personality traits  are important                                                               
in this education.  Her previous lack of these skills  led her to                                                               
depression and a  suicide attempt. She thanked  the committee for                                                               
its support of the council.                                                                                                     
In response to  a question from Chair Dyson,  Ms. Sparks reported                                                               
that  "follow-backs" involve  investigating unsuccessful  suicide                                                               
attempts  to learn  what  factors and  signs  contributed to  the                                                               
SENATOR GEORGIANNA  LINCOLN reported that the  council began with                                                               
the goals of  former Senator Rick Halford. She  noted the average                                                               
hospital  cost  of an  unsuccessful  suicide  attempt is  $7,200,                                                               
which  is twice  the  amount  of funding  required  to operate  a                                                               
community-based prevention program for  one year. In other words,                                                               
to  recoup costs,  a program  needs only  to prevent  two suicide                                                               
attempts.  Further, the  cost for  prevention  programs would  be                                                               
$2.40 per resident, while  hospitalization costs for unsuccessful                                                               
attempts are $6.22 per resident.                                                                                                
REPRESENTATIVE    MARY   KAPSNER    reiterated   the    council's                                                               
recommendations   to   the   Legislature.  She   emphasized   the                                                               
importance of  educating the public  about suicide  warning signs                                                               
and  specific   risk  and  protective  factors   associated  with                                                               
suicide. She stressed  the need to fund  local suicide prevention                                                               
plans  and actions,  supported by  and integrated  with regional,                                                               
state, and national resources. She  concluded with the request to                                                               
continue funding  research for follow-back  and other  studies to                                                               
determine  effective prevention  and  intervention strategies  in                                                               
RT. REVEREND MARK MACDONALD reported  that the problem of suicide                                                               
is  so  deep   and  intense  in  our  communities   that  we  are                                                               
uncomfortable examining  and studying it. He  is currently hoping                                                               
and working  for the creation  of a common community  around this                                                               
issue that can respond with all available resources.                                                                            
MS.   SUSAN  SOULE   commented   on  community-based   prevention                                                               
programs. She reiterated that the  cost of prevention is far less                                                               
than the cost of response and hospitalization.                                                                                  
In response to a question  from Chair Dyson, Mr. MacDonald agreed                                                               
to  the essential  religious and  spiritual component  in dealing                                                               
with and preventing the problem of suicide.                                                                                     
MS.  CARLSON  concluded  by   reminding  committee  members  that                                                               
suicide has  many causes, which  allows us many  opportunities to                                                               
intervene, and points to the need for significant resources.                                                                    
CHAIR DYSON thanked all participants  for their presentations and                                                               
adjourned the meeting at 3:00 p.m.                                                                                              

Document Name Date/Time Subjects