Legislature(2005 - 2006)BUTROVICH 205

02/16/2005 01:30 PM HEALTH, EDUCATION & SOCIAL SERVICES


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= SB 82 CHILD PROTECTION INTERVIEW/TRANSPORT TELECONFERENCED
Moved CSSB 82(HES) Out of Committee
*+ SB 78 SENIOR CARE PROGRAM TELECONFERENCED
Heard & Held
*+ SB 79 MEDICAID FOR ADULT DENTAL SERVICES TELECONFERENCED
Moved CSSB 79(HES) Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE                                                               
                       February 16, 2005                                                                                        
                           1:33 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Fred Dyson, Chair                                                                                                       
Senator Gary Wilken, Vice Chair                                                                                                 
Senator Lyda Green                                                                                                              
Senator Kim Elton                                                                                                               
Senator Donny Olson                                                                                                             
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE BILL NO. 82                                                                                                              
"An Act relating to child protection, including forensic                                                                        
interviews and transportation of children; and providing for an                                                                 
effective date."                                                                                                                
                                                                                                                                
     MOVED CSSB 82(HES) OUT OF COMMITTEE                                                                                        
                                                                                                                                
SENATE BILL NO. 78                                                                                                              
"An Act establishing the SeniorCare  program and relating to that                                                               
program;  creating a  fund for  the provision  of the  SeniorCare                                                               
program;  repealing  ch.  3,  SLA  2004;  and  providing  for  an                                                               
effective date."                                                                                                                
                                                                                                                                
     HEARD AND HELD                                                                                                             
                                                                                                                                
SENATE BILL NO. 79                                                                                                              
"An Act relating to coverage for adult dental services under                                                                    
Medicaid; and providing for an effective date."                                                                                 
                                                                                                                                
     MOVED CSSB 79(HES) OUT OF COMMITTEE                                                                                        
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 82                                                                                                                   
SHORT TITLE: CHILD PROTECTION INTERVIEW/TRANSPORT                                                                               
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
                                                                                                                                
01/26/05       (S)       READ THE FIRST TIME - REFERRALS                                                                        
01/26/05       (S)       HES, JUD                                                                                               
02/14/05       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
02/14/05       (S)       Heard & Held                                                                                           
02/14/05       (S)       MINUTE(HES)                                                                                            
02/16/05       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
BILL: SB 78                                                                                                                   
SHORT TITLE: SENIOR CARE PROGRAM                                                                                                
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
                                                                                                                                
01/24/05       (S)       READ THE FIRST TIME - REFERRALS                                                                        
01/24/05       (S)       HES, FIN                                                                                               
02/16/05       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
BILL: SB 79                                                                                                                   
SHORT TITLE: MEDICAID FOR ADULT DENTAL SERVICES                                                                                 
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
                                                                                                                                
01/24/05       (S)       READ THE FIRST TIME - REFERRALS                                                                        
01/24/05       (S)       HES, FIN                                                                                               
02/16/05       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
Stacie Kraly, Senior Assistant Attorney General                                                                                 
Department of Law                                                                                                               
PO Box 110300                                                                                                                   
Juneau, AK  99811-0300                                                                                                          
POSITION STATEMENT:  Supports SB 82.                                                                                          
                                                                                                                                
Marcie Kennai, Deputy Commissioner                                                                                              
Office of Children's Services                                                                                                   
Department of Health &                                                                                                          
Social Services                                                                                                                 
PO Box 110601                                                                                                                   
Juneau, AK  99801-0601                                                                                                          
POSITION STATEMENT:  Supports SB 82.                                                                                          
                                                                                                                                
Linda Wilson, Deputy Director                                                                                                   
Public Defender Agency                                                                                                          
Department of Administration                                                                                                    
PO Box 110200                                                                                                                   
Juneau, AK  99811-0200                                                                                                          
POSITION STATEMENT:  Opposed SB 82 if not amended                                                                             
                                                                                                                                
Joel Gilbertson, Commissioner                                                                                                   
Department of Health & Social Services                                                                                          
PO Box 110601                                                                                                                   
Juneau, AK  99801-0601                                                                                                          
POSITION STATEMENT:  Introduced SB 78                                                                                         
                                                                                                                                
Jon Sherwood, Medicaid Specialist                                                                                               
Department of Health & Social Services                                                                                          
PO Box 110601                                                                                                                   
Juneau, AK  99801-0601                                                                                                          
POSITION STATEMENT:  Answered questions on SB 78                                                                              
                                                                                                                                
Pat Luby                                                                                                                        
AARP Representative                                                                                                             
Anchorage, AK                                                                                                                   
POSITION STATEMENT:  Testified in strong support of SB 79                                                                     
                                                                                                                                
Rosemary Hagevig                                                                                                                
Catholic Community Services                                                                                                     
Juneau, AK 99801                                                                                                                
POSITION STATEMENT:  Testified in support of SB 79                                                                            
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
CHAIR FRED DYSON  called the Senate Health,  Education and Social                                                             
Services  Standing  Committee meeting  to  order  at 1:33:56  PM.                                                             
Present  were Senators  Gary Wilken,  Kim Elton,  and Chair  Fred                                                               
Dyson.                                                                                                                          
                                                                                                                                
           SB 82-CHILD PROTECTION INTERVIEW/TRANSPORT                                                                       
                                                                                                                                
CHAIR FRED DYSON  announced SB 82 to be up  for consideration and                                                               
asked for a motion to adopt proposed Amendment 1.                                                                               
                                                                                                                                
1:35:14 PM                                                                                                                    
SENATOR  WILKEN moved  Amendment  1 and  objected for  discussion                                                               
purposes.                                                                                                                       
                                                                                                                                
STACIE KRALY,  senior assistant  attorney general,  Department of                                                               
Law (DOL),  explained the reason  the DOL proposed  the amendment                                                               
stemmed from the  fact that "forensic interview"  was not defined                                                               
in  the  original  bill.  Amendment  1  provides  that  it  is  a                                                               
specialized  kind  of  interview  that is  employed  by  advocacy                                                               
centers to elicit information for  use in criminal or civil court                                                               
proceedings.                                                                                                                    
                                                                                                                                
                                                            24G-1                                                               
                      A M E N D M E N T 1                                                                                   
                                                                                                                                
                                                                                                                                
HEALTH EDUCATION AND SOCIAL SERVICES COMMITTEE                                                                                  
                                                                                                                                
     TO:  SB 82                                                                                                                 
                                                                                                                                
Page 1, line 8, following "cause":                                                                                              
                                                                                                                                
     Insert ", as documented by the department, "                                                                               
                                                                                                                                
                                                                                                                                
Page 2, following line 14:                                                                                                      
                                                                                                                                
     Insert the following new material:                                                                                         
                                                                                                                                
               "(2)  "forensic interview" means a structured                                                                    
                                                                                                                                
     interview that employs objective and age-appropriate                                                                       
                                                                                                                                
     questioning techniques to elicit accurate and reliable                                                                     
                                                                                                                                
     facts that may be used in court proceedings;"                                                                              
                                                                                                                                
                                                                                                                                
Page 2, line 15:                                                                                                                
                                                                                                                                
     Delete "(2)"                                                                                                               
                                                                                                                                
     Insert "(3)"                                                                                                               
                                                                                                                                
                                                                                                                                
CHAIR  DYSON read  the proposed  change on  page 1,  line 8,  and                                                               
commented that  the wording needed  further clarification  so the                                                               
amendment would be conceptual.                                                                                                  
                                                                                                                                
1:36:25 PM                                                                                                                    
CHAIR DYSON  noted the objection  was withdrawn  and [conceptual]                                                               
Amendment 1 was adopted.                                                                                                      
                                                                                                                                
CHAIR DYSON  recalled a  question about  the immunity  section on                                                               
page 2, paragraph (e), and asked Ms. Kraly to comment.                                                                          
                                                                                                                                
MS KRALY recapped saying the  discussion on Monday related to the                                                               
scope  of the  immunity provision  stated on  page 2,  lines 5-8.                                                               
After  much  discussion, the  Department  of  Law (DOL)  and  the                                                               
Office  of  Children's Services  (OCS)  decided  that the  entire                                                               
paragraph could be removed.                                                                                                     
                                                                                                                                
CHAIR DYSON  remarked it would  revert to the standards  in Title                                                               
9.                                                                                                                              
                                                                                                                                
MS.  KRALY  agreed  that  it  reverts  to  the  general  immunity                                                               
provisions under Title 9.                                                                                                       
                                                                                                                                
1:38:20 PM                                                                                                                    
CHAIR DYSON  moved to remove  paragraph (e)  from page 2,  line 5                                                               
and subsequently  renumber the paragraphs. Hearing  no objection,                                                               
Amendment 2 was adopted.                                                                                                        
                                                                                                                                
CHAIR  DYSON referenced  the  amendment  concerning findings  and                                                               
noted  Senator Green's  concern is  that the  language implies  a                                                               
duty for  the state to  provide child advocacy center  (CAC) type                                                               
services.  He noted  the last  line in  the first  (a) subsection                                                               
says  that  no  child  shall  be  denied  comprehensive  services                                                               
because of inability to pay.                                                                                                    
                                                                                                                                
CHAIR  DYSON recalled  several years  ago sexual  assault victims                                                               
were required to  pay for their own  investigation. Although that                                                               
issue had been addressed, he  was concerned about the possibility                                                               
of  the state  failing to  gather admissible  evidence because  a                                                               
victim wasn't  able pay for  the investigation. He  asked Senator                                                               
Green whether  she was  concerned that  the implication  was that                                                               
the state would provide CAC type services everywhere.                                                                           
                                                                                                                                
1:40:29 PM                                                                                                                    
SENATOR GREEN said she didn't want to create an entitlement.                                                                    
                                                                                                                                
CHAIR  DYSON said  this section  of  statute isn't  the place  to                                                               
imply the use of remedial services.                                                                                             
                                                                                                                                
MARCIA   KENNAI,  deputy   commissioner,  Office   of  Children's                                                               
Services (OCS), Department of Health  and Social Services (DHSS),                                                               
expressed agreement  and said  if the final  sentence is  read in                                                               
entirety, it appears  the intent is that the issue  be related to                                                               
the ability  to pay in  those circumstances where OCS  engages in                                                               
an investigative circumstance and not remedial services.                                                                        
                                                                                                                                
CHAIR  DYSON  asked whether  the  intent  would be  clarified  if                                                               
"forensic  services" or  "investigative  services" were  inserted                                                               
and "therapeutic" removed from the paragraph.                                                                                   
                                                                                                                                
MS. KRALY  said since forensic  interview is defined,  the phrase                                                               
should say:                                                                                                                     
                                                                                                                                
     No  child  in  Alaska  should be  denied  access  to  a                                                                    
     forensic interview  during a child  abuse investigation                                                                    
     including a medical assessment  because of inability to                                                                    
     pay.                                                                                                                       
                                                                                                                                
1:43:01 PM                                                                                                                    
CHAIR DYSON recapped saying  delete, "comprehensive services" and                                                               
insert, "forensic interview" to the  phrase "during a child abuse                                                               
investigation including medical assessment".                                                                                    
                                                                                                                                
SENATOR  ELTON said  it wouldn't  work  to strike  "comprehensive                                                               
services"  and  insert  "forensic interview"  and  also  include,                                                               
"including   medical  assessment"   because  medical   assessment                                                               
wouldn't be included in a forensic interview.                                                                                   
                                                                                                                                
MS. KRALY  concurred with the  interpretation. If the  purpose of                                                               
the  limitation  is to  create  a  forensic interview,  then  the                                                               
medical  assessment  is  a  separate   issue  from  the  forensic                                                               
interview as it is defined.                                                                                                     
                                                                                                                                
1:44:05 PM                                                                                                                    
CHAIR DYSON asked if it should read:                                                                                            
                                                                                                                                
        No child in Alaska should be denied access to a                                                                         
       forensic interview and medical assessment during a                                                                       
     child abuse investigation because of inability to pay.                                                                     
                                                                                                                                
SENATOR GREEN  asked whether he  intended to  include legislative                                                               
intent in the findings amendment.                                                                                               
                                                                                                                                
CHAIR DYSON responded that was yet to be determined.                                                                            
                                                                                                                                
1:44:52 PM                                                                                                                    
MS.  KRALY said  used as  legislative intent,  she would  suggest                                                               
changing the  medical assessment  language to match  the language                                                               
in AS.47.17.064. Because "medical  assessment" isn't defined, the                                                               
phrase should read:                                                                                                             
                                                                                                                                
     No  child  in  Alaska  should be  denied  access  to  a                                                                    
     forensic  interview   or  a  medical   or  radiological                                                                    
     examination   [during  a   child  abuse   investigation                                                                    
     because of inability to pay.]                                                                                              
                                                                                                                                
1:46:24 PM                                                                                                                    
CHAIR DYSON drew  attention to subsections (b) and  (c) and asked                                                               
Senator Green if a duty or an obligation was still inferred.                                                                    
                                                                                                                                
SENATOR GREEN opined it implies  a huge obligation and emphasized                                                               
the danger in being too specific with entitlements.                                                                             
                                                                                                                                
CHAIR DYSON acknowledged  his history is different  than hers. He                                                               
asked where she sees the entitlement language.                                                                                  
                                                                                                                                
SENATOR  GREEN replied  it's the  "No child  shall be  denied..."                                                               
language.                                                                                                                       
                                                                                                                                
CHAIR  DYSON  said  that  phrase is  qualified  with  the  phrase                                                               
"because of inability to pay for an investigation."                                                                             
                                                                                                                                
SENATOR GREEN pointed out it's subject to the interpretation.                                                                   
                                                                                                                                
1:47:40 PM                                                                                                                    
CHAIR DYSON  said this doesn't refer  to someone with a  need; it                                                               
refers  to  a  victim of  a  crime.  He  intended  this to  be  a                                                               
narrowing to include investigation of  the crime and recording of                                                               
the evidence rather than treatment of the person.                                                                               
                                                                                                                                
SENATOR  ELTON said  he  would  like to  assume  that a  criminal                                                               
investigation  wouldn't be  interrupted because  someone couldn't                                                               
pay  for the  interview.  Rather,  he'd like  to  think that  the                                                               
language is a restatement of  current department practices, which                                                               
is that an investigation wouldn't  stop because a victim couldn't                                                               
pay.                                                                                                                            
                                                                                                                                
MS. KRALY  agreed with  the statement  and reminded  members that                                                               
the  advocacy center  proposed the  amendment. Nevertheless,  she                                                               
didn't believe  that criminal or  child abuse  investigations are                                                               
held at bay to determine who might pay for the service.                                                                         
                                                                                                                                
CHAIR  DYSON  moved,  as  Amendment  3, a  new  Section  1,  with                                                               
subsequent  renumbering.  He  said it's  the  legislative  intent                                                               
findings  and it  changes just  the last  sentence in  subsection                                                               
(a). It would read:                                                                                                             
                                                                                                                                
          No child  in Alaska  should be  denied access                                                                         
          to forensic  interview or  medical assessment                                                                         
          or   radiological   examination  because   of                                                                         
          inability to pay.                                                                                                     
                                                                                                                                
CHAIR DYSON asked whether there was objection to Amendment 3.                                                                   
                                                                                                                                
SENATOR GREEN objected.                                                                                                         
                                                                                                                                
SENATOR  ELTON  asked  whether  he  moved  the  entire  page  and                                                               
suggested  the  findings  component  be  one  amendment  and  the                                                               
language change on community partnership be a second amendment.                                                                 
                                                                                                                                
CHAIR  DYSON acknowledged  the two  paragraphs were  separated on                                                               
his  sheet and  he  announced  the motion  to  adopt Amendment  3                                                               
included just the findings.                                                                                                     
                                                                                                                                
CHAIR DYSON asked for a roll call on proposed Amendment 3.                                                                      
                                                                                                                                
Amendment 3 failed 2-2 with  Senator Elton and Chair Dyson voting                                                               
yea and Senators Green and Wilken voting nay.                                                                                   
                                                                                                                                
1:52:26 PM                                                                                                                    
CHAIR DYSON asked for a motion to adopt the definition language.                                                                
                                                                                                                                
SENATOR ELTON moved  to accept the definition language  on page 2                                                               
lines 10 - 14.                                                                                                                  
                                                                                                                                
                      A M E N D M E N T 4                                                                                   
                                                                                                                                
Page 2, lines 10, delete "-based program"                                                                                       
                                                                                                                                
     Add, "partnership committed to a multidisciplinary team                                                                    
                                                                                                                                
approach".                                                                                                                      
                                                                                                                                
                                                                                                                                
CHAIR  DYSON questioned  whether it  was worthwhile  voting on  a                                                               
definition  since  the  amendment talking  about  child  advocacy                                                               
failed.                                                                                                                         
                                                                                                                                
SENATOR ELTON  suggested it replaces similar  language already in                                                               
the   bill  on   page  2,   subsection  (f)(1)   and  is   purely                                                               
definitional. Instead  of saying "community-based program"  as it                                                               
does  in  the  bill,  it  would  say,  "...community  partnership                                                               
committed to a multi-disciplinary team approach..."                                                                           
                                                                                                                                
CHAIR DYSON asked whether there was objection.                                                                                  
                                                                                                                                
SENATOR  GREEN objected  to discuss  the definition  further. She                                                               
asked  if the  use of  the term  "multi-disciplinary team"  might                                                               
commit the state to certain  standards and expectations regarding                                                               
the function of child advocacy centers.                                                                                         
                                                                                                                                
SENATOR OLSON joined the committee at 1:56 PM.                                                                                  
                                                                                                                                
MS. KENNAI said  the term is also used in  places that don't have                                                               
child  advocacy  centers.  When  child  sexual  abuse  cases  are                                                               
reported the multi-disciplinary team meets.                                                                                     
                                                                                                                                
SENATOR GREEN asked if a  standard and expectation is established                                                               
that may not exist some places in the state.                                                                                    
                                                                                                                                
MS. KENNAI  replied her understanding  is that the fields  of law                                                               
enforcement,  child  protection,   criminal  prosecution,  victim                                                               
advocacy,  and  medical  and mental  health  helped  develop  the                                                               
protocols  and  those fields  are  available  in the  communities                                                               
where child advocacy centers are in place.                                                                                      
                                                                                                                                
SENATOR GREEN  asked whether the  definition of a  child advocacy                                                               
center is in the new language.                                                                                                  
                                                                                                                                
CHAIR DYSON pointed to page 2, line 10.                                                                                         
                                                                                                                                
SENATOR  GREEN  asked  where  the   primary  reference  to  child                                                               
advocacy center resides in statute.                                                                                             
                                                                                                                                
MS. KENNAI pointed to Section 1, lines 10-11.                                                                                   
                                                                                                                                
CHAIR DYSON asked whether there  was objection to Senator Elton's                                                               
motion. Hearing none, Amendment 4 was adopted.                                                                                  
                                                                                                                                
SENATOR WILKEN moved Amendment 5.                                                                                               
      Strike the sentence in Section 1, line 5 that begins: "No                                                                 
     child in Alaska..." and ends in "...because of an ability                                                                  
     to pay." The balance of the section would remain.                                                                          
                                                                                                                                
He explained he  agrees with Senator Green about  not creating an                                                               
entitlement, but he didn't want to lose the entire findings.                                                                    
                                                                                                                                
CHAIR DYSON  clarified the proposed  amendment offers  a modified                                                               
Section 1. He asked whether there was objection to Amendment 5.                                                                 
                                                                                                                                
SENATOR DONNY  OLSON apologized  for his  late arrival  and asked                                                               
what would  happen if a  child was abused physically  or sexually                                                               
and didn't have the ability to pay.                                                                                             
                                                                                                                                
SENATOR WILKEN  replied: "I'm not  in this business, but  I can't                                                               
imagine how we  would turn someone away without saying  it in the                                                               
law."  Furthermore, he  didn't believe  a child  would be  turned                                                               
away because of an inability to pay.                                                                                            
                                                                                                                                
2:01:53 PM                                                                                                                    
SENATOR OLSON said his interpretation  is different. The sentence                                                               
doesn't turn someone away as much as it denies access.                                                                          
                                                                                                                                
CHAIR DYSON asked whether there was objection to Amendment 5.                                                                   
                                                                                                                                
SENATOR OLSON objected.                                                                                                         
                                                                                                                                
SENATOR  ELTON summarized  the  previous  discussion for  Senator                                                               
Olson.                                                                                                                          
                                                                                                                                
2:04:15 PM                                                                                                                    
SENATOR OLSON  asked the  department to  comment on  the proposed                                                               
amendment.                                                                                                                      
                                                                                                                                
MS. KENNAI  clarified the department  would never deny a  child a                                                               
medical exam  or an  investigation because  they weren't  able to                                                               
pay.                                                                                                                            
                                                                                                                                
CHAIR  DYSON  added  there  is  no  impediment  in  law  and  the                                                               
department has  the authorization to  do what is needed  during a                                                               
criminal investigation.  He asked Senator Olson  if he maintained                                                               
his objection.                                                                                                                  
                                                                                                                                
SENATOR OLSON  replied just to  further the discussion.  He asked                                                               
about the  procedure for  getting a  child to  a facility  from a                                                               
remote area.                                                                                                                    
                                                                                                                                
MS. KENNAI replied  if a disclosure happened in  a village school                                                               
and a child needed to fly  to a child advocacy center, DHSS would                                                               
fly  the  child   in  at  department  expense  as   part  of  the                                                               
investigation.                                                                                                                  
                                                                                                                                
SENATOR OLSON withdrew his objection to Amendment 5.                                                                            
                                                                                                                                
2:06:29 PM                                                                                                                    
SENATOR GREEN objected to Amendment  5 and stated, "I'm not going                                                               
to support  this because I  still think this totally  changes the                                                               
focus of what this legislation is.  It's become a definition of a                                                               
child advocacy center in my mind. And for the record, I object."                                                                
                                                                                                                                
CHAIR DYSON asked for a roll call vote.                                                                                         
                                                                                                                                
Amendment 5  passed 4-1  with Senators  Elton, Wilken,  Olson and                                                               
Chair Dyson voting yea and Senator Green voting nay.                                                                            
                                                                                                                                
2:07:17 PM                                                                                                                    
LINDA  WILSON, deputy  director,  Alaska  Public Defender  Agency                                                               
(APDA),  Department of  Administration reported  that the  agency                                                               
handles  the  representation  of   parent  and  child  protective                                                               
proceedings  and children  in  juvenile delinquency  proceedings.                                                               
Furthermore,  APDA has  participated  in  the Children's  Justice                                                               
Task Force  with members of  OCS and  is familiar with  the child                                                               
advocacy centers.                                                                                                               
                                                                                                                                
Although she looks forward to working toward a resolution, APDA                                                                 
wants to put their concerns on the record. The following is                                                                     
verbatim:                                                                                                                       
                                                                                                                                
     I was  able to listen  in to  most of the  testimony on                                                                    
     Monday and  so while I'm  not going to  be specifically                                                                    
     addressing the  amendments that you discussed  today, I                                                                    
     did want to just share  some of our concerns about what                                                                    
     the purpose  of this bill  does and maybe look  to ways                                                                    
     that  we could  possible shore  up some  of it  so that                                                                    
     some of those concerns might go away.                                                                                      
                                                                                                                                
     I  think   what  you   have  to   start  out   with  is                                                                    
     understanding the importance of  parental rights - that                                                                    
     parents have a  right to custody of  their children and                                                                    
     to parent  their children. We  have to  understand that                                                                    
     that's a given. And I  think there was testimony Monday                                                                    
     also about our right  against unreasonable searches and                                                                    
     seizures.                                                                                                                  
                                                                                                                                
     What this bill does is  grant an extraordinary power to                                                                    
     OCS that is not something  that is typically done. What                                                                    
     it's allowing OCS  to do is to seize a  child - to take                                                                    
     physical  control of  a child  and take  them somewhere                                                                    
     without notifying the parent.  And it does this without                                                                    
     any judicial  oversight at all.  The parts of  the bill                                                                    
     that do  that are in Section  1 - again I'm  looking at                                                                    
     the version  without those  recent amendments  done. So                                                                    
     it's  [subsection] (c)  and (d)  that are  going to  be                                                                    
     added to [AS] 47.17.064.                                                                                                   
                                                                                                                                
     Wanting to do this  without officially taking the child                                                                    
     into  emergency -  that was  the goal  - not  requiring                                                                    
     them to  take emergency  custody but yet  to physically                                                                    
     transport children to have  either a forensic interview                                                                    
     that   may  or   may  not   include  a   very  invasive                                                                    
     gynecological exam.  This is very concerning,  I think,                                                                    
     to parents  out there  that they're not  notified about                                                                    
     this type of thing.                                                                                                        
                                                                                                                                
     What we  would like  to see  at least  in here  is some                                                                    
     judicial  oversight.  When   you  don't  take  official                                                                    
     custody  -  and  we  can call  that  emergency  custody                                                                    
     that's provided  for in [AS]  47.10.142 -  in 47.10.142                                                                    
     when you do take  official emergency custody, within 24                                                                    
     hours you have  to file something with  the courts. Let                                                                    
     the court know  if you decided during that  24 hours to                                                                    
     release the  children. You at  least have to  report to                                                                    
     the  court what  you  did, why  and  what your  reasons                                                                    
     were.                                                                                                                      
                                                                                                                                
     In this bill, there's no  requirement to do that. So if                                                                    
     you were to take the children  and go have them do this                                                                    
     forensic interview  - which may  or may not  include an                                                                    
     invasive  genealogical  exam  -   if  they  return  the                                                                    
     children,  there's  no  reporting,  no  accounting,  no                                                                    
     judicial  process,  no  oversight  by  the  courts  and                                                                    
     that's very concerning.                                                                                                    
                                                                                                                                
     In    criminal   cases,    if    somebody   wants    to                                                                    
     [indiscernible] or  do a glass  warrant, all  they have                                                                    
     to is  call the on-duty magistrate,  present their case                                                                    
     to them and the magistrate  gives their blessing to it.                                                                    
     Why  wouldn't  we  want  them to  be  doing  that?  Why                                                                    
     wouldn't  we  want  some  sort  of  judicial  oversight                                                                    
     before they're taking this  drastic measure? If there's                                                                    
     reasonable  cause, why  shouldn't  they  be willing  to                                                                    
     present  that to  an on-duty  magistrate? All  it would                                                                    
     take is a telephone call; it  could be done in a matter                                                                    
     of minutes.  It's not  that onerous of  a hoop  to jump                                                                    
     through.                                                                                                                   
                                                                                                                                
2:13:09 PM                                                                                                                    
     So those are  our concerns. We would  certainly like to                                                                    
     see some  sort of judicial oversight  component in this                                                                    
     bill for this type of drastic action.                                                                                      
                                                                                                                                
SENATOR  OLSON   asked  Ms.  Wilson   whether  she   favored  the                                                               
legislation or not.                                                                                                             
                                                                                                                                
MS.  WILSON replied  she didn't  support the  legislation without                                                               
amendment  because there  is no  judicial oversight.  Referencing                                                               
the end  of subsection (d)  she read: "Transportation of  a child                                                               
under  this section  does not  constitute the  child being  taken                                                               
into emergency custody of the state under AS 47.10.142." Without                                                                
                                                                                                                                
SENATOR GREEN asked whether DOL  might be available to respond to                                                               
Ms. Wilson's  testimony because  in the  previous hearing  it was                                                               
stated that troopers already have this authority.                                                                               
                                                                                                                                
MS.  KRALY   responded  she  and   Ms.  Wilson  had   a  detailed                                                               
conversation  earlier regarding  the fact  that "this  was not  a                                                               
vast  departure  from  current practice."  She  said  Ms.  Wilson                                                               
remained concerned and they agreed  to continue the discussion to                                                               
try and find common ground.                                                                                                     
                                                                                                                                
SENATOR   ELTON  noted   Ms.   Wilson  identified   this  as   an                                                               
extraordinary step  and he  was curious  if other  states require                                                               
some   sort  of   judicial  oversight   before  removing   and/or                                                               
transporting a child.                                                                                                           
                                                                                                                                
2:15:47 PM                                                                                                                    
MS. KENNAI replied some states  do require temporary custody. The                                                               
primary  goal  here  is  to  take children  who  disclose  for  a                                                               
forensic  interview   before  they  go  home   and  get  coached.                                                               
Certainly, the parent  would be notified so that  they could meet                                                               
at  the  child advocacy  center  if  possible. Current  emergency                                                               
custody  statutes  do not  allow  it,  but current  statute  does                                                               
authorize  transport of  children  to a  hospital or  examination                                                               
without parental  permission when  there is evidence  of physical                                                               
abuse. SB 82 adds sexual abuse to statute.                                                                                      
                                                                                                                                
SENATOR  ELTON  mentioned  a  phone  call  could  be  made  to  a                                                               
magistrate or judge  and he questioned whether  that would create                                                               
difficulty for either the child or the department.                                                                              
                                                                                                                                
MS. KENNAI replied  it has caused some  difficulty. Although they                                                               
certainly  have  the  authority  to contact  a  judge  to  obtain                                                               
emergency custody,  on many occasions permission  has been denied                                                               
based  on the  fact that  the  disclosure may  not be  sufficient                                                               
evidence.  "If  you  look  at the  research,  most  children  who                                                               
disclose  sexual abuse  are  telling the  truth.  There's a  very                                                               
small percentage that are false  allegations." If a child is sent                                                               
home  and a  parent  begins  to coach  or  intimidate, the  child                                                               
becomes afraid  to speak up by  the time they reach  the advocacy                                                               
center.                                                                                                                         
                                                                                                                                
CHAIR  DYSON expressed  concern  and  asked if  DHSS  or a  peace                                                               
officer is currently authorized to take custody.                                                                                
                                                                                                                                
MS. KRALY  replied the standard  for taking emergency  custody is                                                               
under AS 47.10.142. She read:                                                                                                   
                                                                                                                                
        (a) The Department of Health and Social Services                                                                        
     may take emergency custody of a child upon discovering                                                                     
     any of the following circumstances:                                                                                        
        (1) the child has been abandoned as abandonment                                                                         
     is described in AS 47.10.013;                                                                                              
        (2) the child has been neglected by the child's                                                                         
      parents or guardian, as "neglect" is described in AS                                                                      
     47.10.014,   and   the   department   determines   that                                                                    
     immediate  removal  from  the child's  surroundings  is                                                                    
     necessary  to  protect  the  child's  life  or  provide                                                                    
     immediate necessary medical attention;                                                                                     
          (3) the child has been subjected to physical harm                                                                     
     by a  person responsible  for the child's  welfare, and                                                                    
     the department  determines that immediate  removal from                                                                    
     the child's  surroundings is  necessary to  protect the                                                                    
     child's  life or  that immediate  medical attention  is                                                                    
     necessary; or                                                                                                              
          (4) the child or a sibling has been sexually                                                                          
     abused under circumstances listed in AS 47.10.011(7).                                                                      
                                                                                                                                
                                                                                                                                
MS.  KRALY  said  the  distinction  is  that  it's  a  heightened                                                               
standard  to take  emergency custody.  As  Ms. Kennai  indicated,                                                               
mere disclosure  isn't always  sufficient to  establish discovery                                                               
to  support   an  emergency  custody.  The   standard  should  be                                                               
heightened to  be able  to remove  a child  from a  parent's home                                                               
without  notifying the  parent  or  without getting  pre-judicial                                                               
approval.  Under  the  emergency  custodies  statutes,  you  must                                                               
either file a petition or release within 24 hours.                                                                              
                                                                                                                                
SENATOR  DYSON  questioned the  reason  a  child's disclosure  of                                                               
sexual abuse wouldn't be enough to take emergency custody.                                                                      
                                                                                                                                
2:21:02 PM                                                                                                                    
MS. KRALY  replied it's certainly  a complicated question,  but a                                                               
disclosure  alone  might  not be  sufficient  depending  on  what                                                               
disclosure  is made,  how it  is made,  and to  whom it  is made.                                                               
"That's when  we want to  get more  information before we  make a                                                               
mistake."                                                                                                                       
                                                                                                                                
CHAIR DYSON said  he was uncomfortable with that  and perhaps the                                                               
issue  ought to  be addressed  in the  Senate Judiciary  Standing                                                               
Committee.                                                                                                                      
                                                                                                                                
2:23:13 PM                                                                                                                    
CHAIR DYSON stated his preference to  send the bill to the Senate                                                               
Judiciary  Standing Committee  then return  it to  this committee                                                               
for review.                                                                                                                     
                                                                                                                                
SENATOR  WILKEN   moved  CSSB  82(HES)  out   of  committee  with                                                               
individual recommendations and attached fiscal notes.                                                                           
                                                                                                                                
SENATOR OLSON said the point  Ms. Wilson brought forward is cause                                                               
for concern, but  he was curious whether those  concerns had ever                                                               
been legitimized.                                                                                                               
                                                                                                                                
MS.  WILSON responded  Ms. Kraly  mentioned  they haven't  always                                                               
gotten a writ of assistance  when requested. "But I can guarantee                                                               
you that  the majority of the  time, if there are  allegations of                                                               
sexual  abuse, the  state takes  emergency custody."  She assured                                                               
members that this happens on a regular basis.                                                                                   
                                                                                                                                
What the bill does not  provide, she said, is judicial oversight.                                                               
Physically taking  control of  a child  is emergency  custody and                                                               
most states don't have that  extraordinary power without judicial                                                               
oversight.  What  about  the instances  of  false  findings,  she                                                               
asked. "Don't  we at least want  there to be some  judicial hoops                                                               
that they  have to jump  through at some  point in the  process -                                                               
especially if it results in no findings?"                                                                                       
                                                                                                                                
SENATOR  OLSON remarked  getting a  48-hour  hold or  a Title  47                                                               
commitment from  a magistrate in the  middle of the night  is one                                                               
of the last  things he wants to  worry about as a  doctor. On the                                                               
other hand, it's  extremely invasive for a young child  to have a                                                               
gynecological examination when it isn't justified.                                                                              
                                                                                                                                
2:26:25 PM                                                                                                                    
SENATOR ELTON  said it would seem  that the fiscal note  would be                                                               
greater than zero to reflect additional transportation expenses.                                                                
                                                                                                                                
MS. KENNAI  said they would  have to do  an analysis on  that but                                                               
DHSS doesn't  see there would be  a large increase in  the number                                                               
of interviews. In  some areas of the state it  is a problem while                                                               
in other areas  they can call a judge and  get permission to take                                                               
the child for an interview.                                                                                                     
                                                                                                                                
She explained once  the child gets to the  child advocacy center,                                                               
the  physical exam  isn't conducted  without parental  consent so                                                               
some checks  and balances already  exist even though  they aren't                                                               
in statute.                                                                                                                     
                                                                                                                                
2:29:14 PM                                                                                                                    
CHAIR  DYSON  asked  whether  there   was  objection  to  Senator                                                               
Wilken's motion  to move CSSB  82(HES) out of  committee. Hearing                                                               
none, the motion carried.                                                                                                       
                                                                                                                                
                   SB  78-SENIOR CARE PROGRAM                                                                               
                                                                                                                              
2:30:06 PM                                                                                                                    
SENATOR DYSON announced SB 78 to be up for consideration.                                                                       
                                                                                                                                
COMMISSIONER  JOEL GILBERTSON,  Department of  Health and  Social                                                               
Services,  advised   he  was  addressing  his   comments  to  the                                                               
committee  substitute   (CS).  The  bill  deals   with  extending                                                               
SeniorCare  benefits  to  Alaska seniors  -  particularly  around                                                               
prescription drug  coverage. The  Legislature passed a  bill last                                                               
session  that established  a $120.00  per  month cash  assistance                                                               
program  for  low-income  seniors  living below  135  percent  of                                                               
poverty  and a  prescription drug  subsidy for  seniors that  are                                                               
between 135 and 150 percent of poverty.                                                                                         
                                                                                                                                
That benefit  program expires  on January 1,  2006 at  which time                                                               
the  new,  Part D,  federal  Medicare  drug benefit  will  become                                                               
effective and  provide seniors  with prescription  drug benefits.                                                               
Parts A and  B are what most Alaska seniors  have. Part A relates                                                               
to in-patient  hospital services for  seniors; Part B  relates to                                                               
out-patient physician  reimbursements; Part C deals  with managed                                                               
care plans  under Medicare but isn't  used in Alaska; and  Part D                                                               
is the new prescription drug benefit.                                                                                           
                                                                                                                                
Each part  has associated costs.  Part A has its  own deductible;                                                               
Part B  has its own  premium and  deductible for seniors  to pay;                                                               
and Part D will have  a premium deductible. Therefore, as seniors                                                               
enroll in  Medicare Part  D, those above  135 percent  of poverty                                                               
will be responsible for some  premium and deductible costs. Those                                                               
are  first dollar  costs,  which means  they  must satisfy  those                                                               
before  they may  receive benefits  under  the prescription  drug                                                               
benefit.                                                                                                                        
                                                                                                                                
SB 78 is a proposal under SeniorCare. He emphasized that:                                                                       
                                                                                                                                
     First  and foremost  this legislation  states that  for                                                                    
     seniors  above 135  percent of  poverty  and below  300                                                                    
     percent of poverty, the State  of Alaska will cover the                                                                    
     premium  and  deductible  costs for  those  seniors  to                                                                    
     ensure that there  is no senior in this  state ... that                                                                    
     will  not   be  able  to  enroll   in  a  comprehensive                                                                    
     prescription benefit plan beginning next year.                                                                             
                                                                                                                                
Prescription drugs represent  a sizeable part of  health care and                                                               
many  seniors in  the state  are forced  to choose  between food,                                                               
rent or prescription  drugs. By itself the  Medicare drug benefit                                                               
won't ease  that decision  for many  low-income seniors,  but the                                                               
extension of  the $120 per  month cash assistance  for low-income                                                               
seniors below 135 percent of poverty will help some.                                                                            
                                                                                                                                
He referenced a  chart that looks at what  the qualifications and                                                               
benefits  mean in  real  dollars, and  said  it's important  when                                                               
talking  about   income  levels.  The  cash   assistance  benefit                                                               
continues at $120  per month or for seniors below  135 percent of                                                               
poverty.   Those   individuals   won't  get   state   help   with                                                               
prescription drug  expenses because  the federal  government will                                                               
cover the  costs for  them. Instead  the state  acknowledges they                                                               
have other costs and recognizes that cash is much more flexible.                                                                
                                                                                                                                
Therefore, seniors  below 135 percent  of poverty, which  is just                                                               
under $16,000 per  individual and about $21,000  per couple, will                                                               
continue  to receive  the $120  per month  cash assistance.  They                                                               
will receive  the Medicare  drug benefit with  no premium  and no                                                               
deductible.  The  state expects  to  serve  about 7,000  seniors,                                                               
which  is about  the same  as the  cash assistance  program under                                                               
SeniorCare.                                                                                                                     
                                                                                                                                
The  new  benefit  under  SB  78  deals  with  prescription  drug                                                               
assistance for  seniors above  135 percent of  poverty and  up to                                                               
300 percent  of poverty. That  amounts to just less  than $35,000                                                               
for an individual and just  under $47,000 for a couple. Following                                                               
an asset test,  the state will step in and  cover monthly premium                                                               
and  deductible costs,  but individuals  will still  have out  of                                                               
pocket  expenses for  coinsurance and  prescription drugs.  Under                                                               
this proposal, DHSS expects to serve about 10,000 seniors.                                                                      
                                                                                                                                
2:36:31 PM                                                                                                                    
Comparing old  and new SeniorCare prescription  drug benefits, he                                                               
pointed  out the  considerable savings  that seniors  would enjoy                                                               
under the new proposal.                                                                                                         
                                                                                                                                
2:38:20 PM                                                                                                                    
As previously  stated, DHSS expects  to serve about  7,000 people                                                               
with cash  assistance. For the  original SeniorCare  program, the                                                               
estimates were  accurate for the  cash assistance benefit  in the                                                               
135  percent of  poverty  bracket, but  were somewhat  inaccurate                                                               
between 135  and 150 percent of  poverty, which means there  is a                                                               
surplus in  the SeniorCare Trust  Fund. The surplus will  be used                                                               
to pay for start up and a portion of the first year costs.                                                                      
                                                                                                                                
The fiscal notes  indicate increased expenses for  the first year                                                               
because the Medicare drug benefit  doesn't begin until the second                                                               
half of the next state fiscal year.                                                                                             
                                                                                                                                
2:40:00 PM                                                                                                                    
SENATOR  KIM  ELTON  asked  the reason  the  old  program  didn't                                                               
eliminate residents  in the Pioneer/Veteran  Homes while  the new                                                               
proposal does.                                                                                                                  
                                                                                                                                
JON  SHERWOOD,  Medicaid  specialist, Department  of  Health  and                                                               
Social Services, said both the  current program and SB 78 contain                                                               
provisions for  temporary stay  in the  home. Since  the original                                                               
bill, other statutes have defined  public institutions to exclude                                                               
Pioneer/Veteran Homes.  Prior to last session  they were included                                                               
in some  definitions so that's  why they decided to  specify them                                                               
separately.                                                                                                                     
                                                                                                                                
COMMISSIONER  GILBERTSON  said  the justification  for  excluding                                                               
those residents is  that this would be a  redundant benefit since                                                               
there is already a Pioneer Home Assistance Program.                                                                             
                                                                                                                                
2:41:44 PM                                                                                                                    
SENATOR ELTON  said he  was working from  Version \A  even though                                                               
Version  \G was  under  consideration so  some  of his  questions                                                               
might have already been answered.                                                                                               
                                                                                                                                
He noted  seniors are limited to  30-day out of state  trips with                                                               
exceptions for out  of state medical treatment or  to accompany a                                                               
family  member who  is receiving  medical  treatment outside  the                                                               
state. However, it isn't an exception  to leave the state to care                                                               
for an  ill family  member that  lives out  of state  because the                                                               
senior isn't accompanying the family member outside.                                                                            
                                                                                                                                
COMMISSIONER GILBERTSON  agreed with the interpretation  and said                                                               
the point  is legitimate. He  recalled working on the  issue last                                                               
year  and  acknowledged  it  would be  advantageous  to  use  the                                                               
language they  settled on at  that time.  He thought there  was a                                                               
waiver process  that was established  for the department  to have                                                               
discretion on a case-by-case basis.                                                                                             
                                                                                                                                
2:44:38 PM                                                                                                                    
SENATOR  ELTON  suggested the  committee  look  at the  exception                                                               
language  for Permanent  Fund  dividends  to accommodate  medical                                                               
treatment for an immediate family  member. He then questioned the                                                               
effective date.                                                                                                                 
                                                                                                                                
MR. SHERWOOD  explained the committee substitute  (CS) simplifies                                                               
the language  to have the bill  take effect when Medicare  Part D                                                               
becomes available in Alaska.                                                                                                    
                                                                                                                                
SENATOR ELTON  remarked in five  years the program would  be more                                                               
expensive than the Longevity Bonus Program.                                                                                     
                                                                                                                                
MR. SHERWOOD  replied he didn't  have five-year numbers,  but the                                                               
projection is  to serve  about 17,000 seniors  in the  first year                                                               
for  about $17  million and  the Longevity  Bonus Program  was to                                                               
serve 15,000 seniors for $38 million.                                                                                           
                                                                                                                                
2:47:43 PM                                                                                                                    
SENATOR ELTON acknowledged that because  of the phase out, no one                                                               
would have been served without this program.                                                                                    
                                                                                                                                
CHAIR DYSON asked  for an explanation of  the differences between                                                               
Versions \A and \G.                                                                                                             
                                                                                                                                
MR.   SHERWOOD  described   four  changes:   conforming  language                                                               
changes; clarifying reference to  the Medicare Modernization Act;                                                               
adding SeniorCare  Benefit to  the statutory  list of  items that                                                               
can not  be garnished; and  changing effective date  to eliminate                                                               
reference to January 1.                                                                                                         
                                                                                                                                
2:49:52 PM                                                                                                                    
SENATOR ELTON moved to adopt  Version \G as the working document.                                                               
There being no objection, the motion carried.                                                                                   
                                                                                                                                
CHAIR  DYSON  suggested  the  committee  entertain  a  conceptual                                                               
amendment to make eligibility the  same as for the Permanent Fund                                                               
Dividend as far as traveling out of state.                                                                                      
                                                                                                                                
SENATOR ELTON  said he  would like to  review that  before moving                                                               
the bill since he didn't remember the language precisely.                                                                       
                                                                                                                                
CHAIR  DYSON expressed  agreement  and said  he is  uncomfortable                                                               
that seniors must  go through a waiver process to  go outside for                                                               
medical  reasons.   He  added  the   department  would   have  an                                                               
opportunity to  speak against the  change here and in  the Senate                                                               
Finance Standing Committee.                                                                                                     
                                                                                                                                
COMMISSIONER  GILBERTSON  said   the  department  really  doesn't                                                               
monitor senior travel patterns and  that particular change in the                                                               
program  management might  be minimal.  Acknowledging that  it is                                                               
within  Legislature's  purview to  change,  he  said the  current                                                               
language has  proved to be adequate  to address the issue  in the                                                               
last year.                                                                                                                      
                                                                                                                                
SENATOR WILKEN  suggested it  is important  for the  committee to                                                               
know how  many other  states have  this type  of program  and how                                                               
other states are treating the  federal drug prescription program.                                                               
He suggested that western states were of particular interest.                                                                   
                                                                                                                                
COMMISSIONER  GILBERTSON  said  he  would  make  the  information                                                               
available at the next hearing,  but other states haven't begun to                                                               
respond to  the integration between  the state  pharmacy assisted                                                               
plan  and Medicare  drug  benefits. The  Medicare,  Part D,  drug                                                               
benefit would be delivered in  a different way than Medicare Part                                                               
A  and Part  B. Part  D  would essentially  be delivered  through                                                               
private insurance  - pharmacy benefit management  firms. At least                                                               
two firms  would bid  on each  region after  which the  region is                                                               
assigned an  actuarial value per  life of individuals  that would                                                               
be  served.  Then the  actuarial/cash  value  is converted  to  a                                                               
benefit for the consumers.                                                                                                      
                                                                                                                                
He  suggested  many  states are  digesting  the  information  and                                                               
deciding how to  convert what used to be a  Medicaid benefit to a                                                               
supplement to Medicare.                                                                                                         
                                                                                                                                
2:56:05 PM                                                                                                                    
SENATOR WILKEN  said he would  prefer not  to move the  bill from                                                               
committee in order to provide time for further clarification.                                                                   
                                                                                                                                
CHAIR DYSON asked the process used  to decide that 300 percent of                                                               
the federal poverty level was the right number to use.                                                                          
                                                                                                                                
COMMISSIONER  GILBERTSON  replied  he would  provide  information                                                               
regarding  what the  various income  threshold  options mean.  To                                                               
some  extent, he  said, the  line is  discretionary and  there is                                                               
nothing  to peg  it  to  in the  private  market place.  Governor                                                               
Murkowski has  taken the  position that  the threshold  should be                                                               
low enough  so that seniors in  need are served. He  doesn't want                                                               
any senior  in the  state not  to be  enrolled in  a prescription                                                               
drug benefit  next year  because they aren't  able to  afford the                                                               
premium  or deductible,  which  is sizeable.  The  out of  pocket                                                               
expense before the first benefit is received is around $700.                                                                    
                                                                                                                                
After reviewing the income levels,  the governor decided that for                                                               
a senior who  makes less than $35,000 per year  a $670 deductible                                                               
is high so that's where he drew the line.                                                                                       
                                                                                                                                
CHAIR DYSON asked  whether the poverty level is  $10,000 per year                                                               
for a single person.                                                                                                            
                                                                                                                                
COMMISSIONER  GILBERTSON  replied  the Alaska  poverty  level  is                                                               
higher than  the national  average by 25  percent and  in Alaska,                                                               
100 percent of  poverty is between $11,000 and  $12,000 per year.                                                               
Where  you draw  the poverty  line  is the  discretion of  policy                                                               
makers, he emphasized.                                                                                                          
                                                                                                                                
2:59:56 PM                                                                                                                    
CHAIR DYSON asked whether there is an asset test.                                                                               
                                                                                                                                
COMMISSIONER  GILBERTSON said  yes, for  the seniors  who receive                                                               
the  $120 cash  assistance benefit,  the liquid  asset limit  per                                                               
individual  is $6,000.  The secondary  benefit, the  prescription                                                               
drug subsidy liquid asset level is $50,000.                                                                                     
                                                                                                                                
CHAIR DYSON asked about non-liquid assets.                                                                                      
                                                                                                                                
COMMISSIONER GILBERTSON replied there is none.                                                                                  
                                                                                                                                
CHAIR DYSON  noted the in state  advertisements for restructuring                                                               
assets to qualify  for different programs and  remarked that some                                                               
of it looks like scam.                                                                                                          
                                                                                                                                
COMMISSIONER GILBERTSON  agreed and said  it has been  a constant                                                               
struggle for  states and the  federal government to keep  up with                                                               
lawyers that  work to reduce  senior's assets. The  fiscal crisis                                                               
in  Medicaid is  largely  associated with  senior and  disability                                                               
services. Middle  and upper middle income  Americans are spending                                                               
down  parents and  transferring assets  when they  need long-term                                                               
care.  Although both  federal and  state  look-backs have  become                                                               
stricter, a  great number  of lawyers  are still  helping seniors                                                               
become eligible for programs such as this.                                                                                      
                                                                                                                                
3:02:39 PM                                                                                                                    
CHAIR DYSON  said if  40 percent of  the senior  population would                                                               
qualify that  means that  that 40 percent  of seniors  are living                                                               
under the 300 percent of federal poverty level.                                                                                 
                                                                                                                                
COMMISSIONER  GILBERTSON replied  it's a  rough estimate,  but if                                                               
17,000 seniors are served it's about 40 percent.                                                                                
                                                                                                                                
CHAIR  DYSON  announced he  would  hold  the  bill and  would  be                                                               
interested in the department looking  into the qualifications for                                                               
being  out of  state and  whether the  permanent fund  is a  good                                                               
model.                                                                                                                          
                                                                                                                                
SENATOR WILKEN said  he would like to know what  other states are                                                               
doing with regard to the federal program.                                                                                       
                                                                                                                                
3:04:33 PM                                                                                                                    
CHAIR  DYSON said  he  would be  interested  in comparisons  with                                                               
Colorado and Idaho.                                                                                                             
                                                                                                                                
SENATOR DONNY OLSON asked for  information on the distribution of                                                               
rural participants.                                                                                                             
                                                                                                                                
COMMISSIONER GILBERTSON agreed to do so.                                                                                        
                                                                                                                                
CHAIR DYSON asked for information  about what additional benefits                                                               
people might qualify for.                                                                                                       
                                                                                                                                
COMMISSIONER  GILBERTSON said  he would  get the  information and                                                               
clarified there  would be  some dual  eligibility so  the program                                                               
would be available to Alaska  Natives who are eligible for Indian                                                               
Health Service  (IHS) benefits. He  would provide  information on                                                               
the  number of  dual  eligibilities and  the  benefits they  have                                                               
access to, but  it is well established in law  that benefits will                                                               
be provided to all individuals  regardless of whether or not they                                                               
are eligible under IHS or a Native health corporation.                                                                          
                                                                                                                                
3:07:00 PM                                                                                                                    
CHAIR  DYSON said  he  could appreciate  that,  but doesn't  want                                                               
someone to receive payment twice for the same drug.                                                                             
                                                                                                                                
SENATOR ELTON expressed interest  in whether the previous program                                                               
had pro rata language and  also in departmental discussions about                                                               
inserting pro rata language in this bill.                                                                                       
                                                                                                                                
3:08:24 PM                                                                                                                    
CHAIR DYSON held SB 78 in committee.                                                                                            
                                                                                                                                
            SB 79-MEDICAID FOR ADULT DENTAL SERVICES                                                                        
                                                                                                                                
CHAIR FRED DYSON announced SB 79 to be up for consideration.                                                                    
                                                                                                                                
3:08:43 PM                                                                                                                    
BRAD WHISTLER,  dental officer, Department  of Health  and Social                                                               
Services (DHSS), introduced himself.                                                                                            
                                                                                                                                
COMMISSIONER  JOEL GILBERTSON,  Department of  Health and  Social                                                               
Services  (DHSS), explained  this  is a  Governor proposal  under                                                               
Medicaid. It would provide  capped preventative dental healthcare                                                               
benefit to all low-income adults in Alaska.                                                                                     
                                                                                                                                
Currently, Medicaid  dental coverage  for people  over age  21 is                                                               
restricted to  emergency dental  services, which  basically means                                                               
pulling a  tooth if a problem  arises. SB 79 proposes  to enhance                                                               
the  emergency dental  Medicaid  services for  adults to  include                                                               
preventative  and/or restorative  care.  Because of  the lack  of                                                               
preventative Medicaid  dental services  in years past,  a backlog                                                               
exists,  which  justifies the  proposed  annual  benefit cap  for                                                               
preventative  services to  $1,150  per client.  The annual  limit                                                               
amounts  to what  it  would cost  to replace  an  upper or  lower                                                               
denture so  that a  senior could  replace a  full denture  over a                                                               
two-year period.                                                                                                                
                                                                                                                                
He noted currently there are  about 41,000 Medicaid beneficiaries                                                               
in Alaska.                                                                                                                      
                                                                                                                                
3:11:09 PM                                                                                                                    
COMMISSIONER GILBERTSON said the  Mendenhall Trust Authority is a                                                               
partner in  the proposal and has  allocated some of its  money to                                                               
pay part  of the state  match. Recent  studies have shown  a link                                                               
between  oral   health  and  chronic   diseases  and   the  trust                                                               
recognizes  the trustees  have a  pressing need  for oral  health                                                               
care. "This  transition will  allow us  to position  the Medicaid                                                               
program around preventative services,  which is a good investment                                                               
for the state."                                                                                                                 
                                                                                                                                
He noted  the associated  fiscal note  and explained  the general                                                               
fund match  is augmented with  Mental Health Trust money  for the                                                               
next six  years. There  are a number  of optional  services under                                                               
Medicaid  and this  proposal is  to  include preventative  dental                                                               
services.                                                                                                                       
                                                                                                                                
3:13:06 PM                                                                                                                    
SENATOR KIM  ELTON asked  the number of  Alaska dentists  that do                                                               
Medicaid services.                                                                                                              
                                                                                                                                
COMMISSIONER GILBERTSON acknowledged access has been an issue.                                                                  
                                                                                                                                
MR. WHISTLER  said access  varies across  the state  but overall,                                                               
about 85 percent of Alaska  dentists are enrolled in the Medicaid                                                               
program. Although he didn't know  how many dentists are accepting                                                               
new Medicaid clients he did  acknowledge the real access issue is                                                               
when new clients  who are enrolled in Medicaid go  for care. With                                                               
regard  to the  adult  program, the  proposal  would augment  the                                                               
tribal dental programs that are already serving adults.                                                                         
                                                                                                                                
3:15:32 PM                                                                                                                    
SENATOR ELTON referenced  the fee information in  the fiscal note                                                               
and  said it  would  be helpful  to  have a  list  of the  Juneau                                                               
dentists that  provide two cleanings  a year for $250  because he                                                               
pays considerably more.                                                                                                         
                                                                                                                                
MR.  WHISTLER  replied  the  fiscal note  is  based  on  Medicaid                                                               
reimbursement rates and private rates would be higher.                                                                          
                                                                                                                                
CHAIR  DYSON commented  most medical  practitioners aren't  happy                                                               
with the Medicaid  reimbursement rates. He was  curious about the                                                               
view dentists might have.                                                                                                       
                                                                                                                                
MR.  WHISTLER replied  most dental  practices wouldn't  have more                                                               
than 5  to 10 percent of  its clients in the  Medicaid program so                                                               
dentists  don't  typically rely  on  those  clients for  practice                                                               
income.  He suggested  it might  make dentists  more vocal  about                                                               
reimbursement   rates.  The   program  has   tried  to   maintain                                                               
reimbursement at  between 70  and 80  percent of  usual customary                                                               
reasonable fees.                                                                                                                
                                                                                                                                
COMMISSIONER  GILBERTSON added  the  department  has always  been                                                               
concerned about  provider participation in the  Medicaid program.                                                               
Across  the board,  between 55  and  60 percent  of the  licensed                                                               
providers  in the  state  accept  Medicaid as  a  portion of  the                                                               
insurance they accept.                                                                                                          
                                                                                                                                
3:18:04 PM                                                                                                                    
SENATOR DONNY  OLSON noted chronic  diseases were  addressed, but                                                               
he  saw no  mention  of  acute diseases  such  as gingivitis  and                                                               
resultant septicemia. He  was curious how the  bill would address                                                               
those issues.                                                                                                                   
                                                                                                                                
MR.  WHISTLER said  that  sort  of case  would  fit an  emergency                                                               
dental service,  which would be  covered in the  current program.                                                               
This  bill proposes  to cover  preventive and  restorative dental                                                               
services in  addition to the  emergency services.  Hopefully this                                                               
would augment  existing services so  fewer people would  get into                                                               
an acute condition.                                                                                                             
                                                                                                                                
COMMISSIONER GILBERTSON restated Mr. Whistler's response.                                                                       
                                                                                                                                
3:19:22 PM                                                                                                                    
CHAIR  DYSON  recognized Mr.  Jessie  and  asked whether  he  was                                                               
testifying that the Mental Health  Board agrees with the bill and                                                               
the funding provided by the Mental Health Trust.                                                                                
                                                                                                                                
JEFF JESSIE said  that is correct. He informed  members the trust                                                               
issues over $1  million per year in mini grants  paid directly to                                                               
beneficiaries  and nearly  70  percent of  the  requests are  for                                                               
dental needs  that aren't covered  by Medicaid. It's  clear there                                                               
is need in this area.                                                                                                           
                                                                                                                                
PAT LUBY, AARP representative, testified in of SB 79.                                                                           
                                                                                                                                
ROSEMARY   HAGEVIG,   executive  director,   Catholic   Community                                                               
Services, testified in  strong support of SB 79.  She pointed out                                                               
that providing dental  care would help many people  get back into                                                               
the workforce so they see this as a workplace issue.                                                                            
                                                                                                                                
3:23:26 PM                                                                                                                    
CHAIR DYSON asked for the will of the committee.                                                                                
                                                                                                                                
SENATOR ELTON moved CSSB 79(HES)  \G version, and attached fiscal                                                               
note from committee with  individual recommendations. There being                                                               
no objection, it was so ordered.                                                                                                
There being  no further  business to  come before  the committee,                                                               
Chair Dyson adjourned the meeting at 3:23:56 PM.                                                                              
                                                                                                                                
                                                                                                                                

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