Legislature(1993 - 1994)
03/21/1994 01:45 PM Senate HES
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
March 21, 1994
1:45 p.m.
MEMBERS PRESENT
Senator Bert Sharp, Vice-Chairman
Senator Loren Leman
Senator Mike Miller
Senator Jim Duncan
Senator Johnny Ellis
Senator Judy Salo
MEMBERS ABSENT
Senator Steve Rieger, Chairman
COMMITTEE CALENDAR
SENATE BILL NO. 313
"An Act relating to the Comprehensive Health Insurance Association
and to health insurance provided to residents of the state who are
high risks; and providing for an effective date."
CS FOR SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 128(FIN)
"An Act relating to paternity determinations and acknowledgements."
CS FOR HOUSE BILL NO. 323(JUD) am
"An Act relating to requests for anatomical gifts and to the
release of certain information for the purpose of facilitating
anatomical gifts."
HOUSE BILL NO. 429
"An Act relating to the special education service agency."
PREVIOUS SENATE COMMITTEE ACTION
SB 313 - No previous action to record.
HB 128 - No previous action to record.
HB 323 - No previous action to record.
HB 429 - No previous action to record.
WITNESS REGISTER
Representative Cynthia Toohey
Prime Sponsor
State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Supported HB 323.
Jens Saakvitne, Director
Life Alaska, Inc.
P.O. Box 230785
Anchorage, Alaska 99523-0785
POSITION STATEMENT: Supported HB 323.
Al Zangri, Chief
Bureau of Vital Statistics
Department of Health and Social Services
P.O. Box 110675
Juneau, Alaska 99811-0675
POSITION STATEMENT: Reviewed HB 323, HB 128.
Renee Chatman, Staff
Representative Bettye Davis
State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Read the Sponsor Statement for HB 128.
Representative Bettye Davis
Prime Sponsor
State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Supported HB 128.
John Mallonee, Deputy Director
Child Support Enforcement Division
Department of Revenue
550 W. 7th, Suite 312
Anchorage, Alaska 99501-3556
POSITION STATEMENT: Supported HB 128.
Margaret Lowe, Commissioner
Department of Health and Social Services
P.O. Box 110601
Juneau, Alaska 99811-0601
POSITION STATEMENT: Reviewed HB 429.
Carol Carrol, Staff
Senator Kerttula
State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Reviewed SB 313.
Bob Niebrugge, Consumer Representative
Comprehensive Health Insurance Association
P.O. Box 365
Glennallen, Alaska 99588
POSITION STATEMENT: Reviewed SB 313.
ACTION NARRATIVE
TAPE 94-21, SIDE A
Number 008
VICE-CHAIRMAN SHARP called the Senate Health, Education and Social
Services (HESS) Committee to order at 1:45 p.m. He introduced
HB 323 (RELEASE OF CERTAIN DEATH CERT. INFO) as the first order of
business before the committee.
REPRESENTATIVE CYNTHIA TOOHEY, Prime Sponsor, stated that HB 323
would facilitate organ and tissue donations. Over 300 tissue and
organ transplants are anticipated this year in Alaska. She
explained that currently there are restrictions on the release of
pertinent information collected by the Department of Health and
Social Services (DHSS) which cause delays; potential organ and
tissue donors could be lost. HB 323 would permit pertinent
information from DHSS to be given to a bank, storage facility, or
person handling procurement of anatomical gifts within a time frame
that would allow successful donation of organs and tissue. The
pertinent information consists of the name of the individual who
could execute the anatomical gift, the medical suitability of the
potential donor, the contact person to obtain permission in a
timely manner to allow successful harvest, and procedures
specifying circumstances when an anatomical request would be
inappropriate. Representative Toohey noted support from the Alaska
Medical Association, DHSS, and the court systems. HB 323 also has
two zero fiscal notes. She pointed out that HB 323 passed the
House unanimously.
SENATOR LEMAN supported organ and tissue donation. He inquired as
to the time period for successful donation of an organ or tissue.
Number 083
JENS SAAKVITNE, Director of Life Alaska, Inc., informed the
committee that after the heart stops, only tissue can be donated.
Tissue donation can be accepted up to twenty-four hours after the
heart stops.
SENATOR LEMAN inquired as to the procedures regarding the contact
of the next of kin. He asked who would be asking the department
for the pertinent information and how would that information
provide knowledge of medical suitability for donation.
JENS SAAKVITNE stated that the initial medical suitability would be
determined by the decedent's age and the suspected cause of death.
He explained that in 90 percent of the cases the coroner or a
police officer would have the initial information for screening and
they have about an 80 percent accuracy rate.
SENATOR LEMAN asked what information could be provided by the
department in the immediate turnaround that would be beneficial.
JENS SAAKVITNE explained that currently the coroner only releases
the decedent's name and time of death. The other pertinent
information is left for the procurement organization to find. Mr.
Saakvitne stated that they would be interested in the decedent's
age, the suspected cause of death, the next of kin, and a way to
contact them. Mr. Saakvitne noted that when calling the next of
kin, he identifies himself, his affiliation, and the fact that he
is an information and support system resource.
SENATOR LEMAN asked if HB 323 provides any protection against an
organ or tissue procurement organization being the first caller to
the next of kin. JENS SAAKVITNE stated that the coroner would not
release the name of the decedent until the next of kin had been
notified. The language of HB 323 states that the information "may"
be released, which places a lot of responsibility on the organ and
tissue procurement organization. Mr. Saakvitne explained that they
never try to talk a family into donation; their responsibility is
to let the family know of this option.
SENATOR LEMAN inquired of the actual procedure to be followed in
the case of a possible organ or tissue donation.
Number 190
AL ZANGRI, Chief of the Bureau of Vital Statistics for the
Department of Health and Social Services, explained that Life
Alaska calls the coroner or the medical examiner daily to identify
potential donors. The department in Juneau would never be
involved; it would be done through the medical examiner's office in
Anchorage or through the various state coroners. The medical
examiner and coroner are on call twenty-four hours a day and they
are called in every case.
REPRESENTATIVE CYNTHIA TOOHEY clarified that Life Alaska or another
procurement organization would call the family.
SENATOR LEMAN asked who would involve the department. He posed an
accident situation when asking who would call and involve others.
AL ZANGRI said that the police or the investigating officer would
call the coroner's office. If the coroner's office decides to take
jurisdiction they would notify the medical examiner. Mr. Zangri
noted that the medical examiner is the first individual in the
department who would be notified of a potential death and possible
organ or tissue donation. At this point, the pertinent information
has been collected and is present in the coroner and the medical
examiner's files. Generally, a call from a procurement
organization occurs within the next few hours in order to obtain
the pertinent information.
SENATOR ELLIS asked if the transplant agencies referred to in the
sponsor statement are required to be licensed. JENS SAAKVITNE
stated that Alaska does not require licensure. Life Alaska is
licensed as a non profit agency and Northwest Organ Procurement
Agency is an independent agency. In Alaska, Life Alaska is the
only agency dealing with transplants after the heart has stopped.
SENATOR ELLIS requested that Representative Toohey go over her
notion that a decedent's family could find a certain comfort after
permitting donation.
REPRESENTATIVE CYNTHIA TOOHEY noted the many invaluable donations.
She explained that donation often gives the family solace because
perhaps, it could help someone else.
Number 271
SENATOR ELLIS asked if the decedent's family would receive more
information under HB 323. JENS SAAKVITNE said that the information
for the decedent's family would stay the same. Mr. Saakvitne
explained that currently within five weeks of the death and
donation, the family will receive a letter outlining the transplant
while maintaining confidentiality. The decedent's family is
entered into a one year bereavement program which serves as a
support system. REPRESENTATIVE CYNTHIA TOOHEY felt that
confidentiality was as it should be.
SENATOR ELLIS requested that the issue of fetal tissue be addressed
regarding HB 323. JENS SAAKVITNE informed the committee that the
standard for tissue transplant purposes is from birth to age
seventy or eighty. There is no use for transplant of fetal tissue.
From full-term birth on, there are some donation options. Mr.
Saakvitne noted that they are required to document the infant's
heartbeat.
SENATOR ELLIS asked if that requirement was due to a law or a moral
feeling. JENS SAAKVITNE said that documenting the infant's heart
beat was not due to a law or a moral feeling. Fetal tissue cannot
be used for transplant because the tissue is not large enough or
developed enough. Mr. Saakvitne said that the only research he was
involved with was for knee or shoulder joint requests by
physicians. Mr. Saakvitne emphasized that he would not be involved
in a research donation for anything less than a full-term birth.
SENATOR SALO moved HB 323 out of committee with individual
recommendations. Hearing no objections, it was so ordered.
Number 331
VICE-CHAIR SHARP introduced HB 128 (EARLY ACKNOWLEDGEMENT OF
PATERNITY) as the next order of business.
RENEE CHATMAN, Staff to Representative Bettye Davis, read the
sponsor statement. She stated that non-support of children is a
national epidemic which HB 128 addressed by requiring the state
registrar to prepare a paternity acknowledgment form. She
explained that a paternity acknowledgment form would allow a child
to acquire access to support from the father's Social Security,
worker's compensation, inheritance, health insurance, etc. She
noted that HB 128 would allow the father legal access to his child,
even if he was not married to the mother. In conclusion, she
stated that HB 128 would guarantee that Alaskan children receive
support from both parents.
SENATOR LEMAN asked if other states have requirements similar to
Alaska regarding establishment of paternity. He expressed concern
with the portion of the sponsor statement requiring "full faith and
credit to a determination of paternity by another state, regardless
of the method in which paternity was established."
REPRESENTATIVE BETTYE DAVIS, Prime Sponsor, explained that
currently the federal government mandates that other states'
determination of paternity be recognized. Other states do have
comparable procedures to establish paternity. She informed the
committee that HB 128 began as a paternity bill which was already
being done voluntarily, but not as mandated. The other mandates
were added to HB 128 in order to be in compliance with federal
regulations.
SENATOR SALO asked what would be voluntary and what would be
required, especially regarding the mother.
REPRESENTATIVE BETTYE DAVIS stated that everything in HB 128 was a
mandate. She clarified that the individual cannot be forced to
sign the form, but it is mandatory that the form be offered. She
noted that the fiscal note would be increased and that increase
would be picked up by the Division of Child Support in the federal
government. She thought that an amendment would be offered for the
fiscal note to increase by $30,000.
Number 399
JOHN MALLONEE, Deputy Director of Child Enforcement Support
Division of the Department of Revenue, supported HB 128. The bill
would bring Alaska into compliance with federal regulations which
continue federal financial participation. He noted that Alaska has
had a voluntary paternity acknowledgment program for quite a while.
HB 128 would only put the practice into law; however, HB 128 would
not force anyone to voluntarily acknowledge paternity. He
discussed other states' success with the program; the program is
worthwhile.
SENATOR ELLIS said that he supported HB 128.
SENATOR LEMAN asked what would happen in a situation with a married
woman having a child fathered by a man other than her husband.
JOHN MALLONEE acknowledged that such a situation would create
various problems. He explained that if a married woman has a
child, the child would be assumed to be fathered by her husband.
Such cases have occurred and the true paternity was established
later by blood test. He informed the committee that the courts
have ruled differently at various times; therefore, a legal dilemma
with much court time is created.
SENATOR LEMAN clarified that such a dilemma would be created with
or without HB 128. He asked if HB 128 would add to that dilemma.
REPRESENTATIVE BETTYE DAVIS asserted that HB 128 does not address
or add to that legal dilemma. JOHN MALLONEE noted that the federal
government has not issued final directives on many of the issues in
HB 128.
AL ZANGRI clarified that under current state law the husband must
be put on the birth certificate and is considered the father under
law. In order to change the father on the birth certificate, one
must go to court. He informed the committee that the Bureau of
Vital Statistics and DHSS are working on a new model law that the
federal government introduced last year. This law would allow for
three party affidavits for paternity. He believed that this law
reflects reality.
Mr. Zangri explained that he had a temporary position that over the
past six months was converted to full-time, processing affidavits
of paternity, due to the increased volume. That position would end
at the month's end, which would leave them unable to support this
paternity program. He said that they were going to add a Range 8
to the fiscal note; approximately $30,000. He agreed with
Representative Davis that the Department of Revenue would RSA over
to the DHSS which would essentially be an increase in their federal
authorization. Currently, the position must be placed in the
fiscal note.
SENATOR SHARP inquired as to when that fiscal note would be coming.
AL ZANGRI said that it would be forthcoming in the next few days.
SENATOR ELLIS moved HB 128 out of committee with individual
recommendations. Hearing no objections, it was so ordered.
Number 510
VICE-CHAIR SHARP introduced HB 429 (SPECIAL EDUCATION SERVICE
AGENCY) as the next order of business.
MARGARET LOWE, Commissioner of DHSS, said that she was representing
Representative Jeannette James, the sponsor of HB 429. She read a
brief sponsor statement.
SENATOR DUNCAN clarified that HB 429 repeals the section of the
statute that requires the Governor's Council on Disabilities and
Special Education to govern the state's Special Education Service
Agency (SESA). He asked if the intent of HB 429 was to create a
consumer-driven governing board, then why not structure that
governing board in statutes. Repealing the governing portion
without any provisions does not ensure anything.
MARGARET LOWE noted that she was President of the SESA board for
1994. She explained that SESA intended to repeal the statutes
first and then work on legislation to make statutory provisions.
SENATOR DUNCAN did not believe that a two-step process was
necessary. He suggested repealing and organizing a governing board
at the same time. MARGARET LOWE stated that she had all of that
material prepared and ready.
SENATOR SALO inquired as to the current composition of the board
and the recommended changes.
MARGARET LOWE explained that currently the majority of the board
members are also members of the Governor's Council on Disabilities
and Special Education. The current board also includes one school
superintendent from the Superintendent's Association, and a
representative of the National Education Association (NEA). She
said that the current representation had not worked very well, due
to the lack of regional or parental member requirements. She
asserted that the major reason for the legislation was the conflict
of interest with the Governor's Council. She did not believe that
proper surveillance could occur when the Governor's Council, who
should be reviewing the quality of services in special education,
owns a special education school.
Ms. Lowe noted that the by-law's change had been voted upon and
only waits for this bill or another to pass in order for them to be
in effect. The by-laws specify that two rural area parents with
children in those programs would be present on the board. She
noted that direct NEA affiliation would be eliminated, special
education teachers would fill those positions. The superintendent
would still be on the board.
SENATOR ELLIS pointed out that Governor Hickel had posed a major
effort to consolidate and eliminate various boards and commissions.
He asked how this board was allowed to be introduced. MARGARET
LOWE did not believe a board was eliminated for this board to be
organized. Ms. Lowe stated that the Governor's office had given
approval to proceed with this legislation, primarily due to the
conflict of interest issue.
TAPE 94-21, SIDE B
Number 576
SENATOR ELLIS asked if this board would be a net gain to the number
of boards or commissions. MARGARET LOWE said yes, but noted that
this board has never had any staff and would not, under HB 429,
because the executive director of SESA would be the staff.
SENATOR ELLIS inquired as to the financial aspect of HB 429.
MARGARET LOWE said that SESA has had a budget for the board for
many years. The funds are under the Department of Education's
Special Education funding. SENATOR ELLIS asked for the amount of
the total budget. MARGARET LOWE did not know, but offered to find
out for Senator Ellis.
SENATOR ELLIS asked if the number of members for this new
organization would be the same as the previous board. MARGARET
LOWE believed that the new board contained one less person than the
original board. Ms. Lowe noted that the board was still a
statewide representation.
SENATOR ELLIS reiterated Senator Duncan's suggestion to specify the
board's seats in statutes. He did not want to leave a gap; why not
put in statutes now.
SENATOR DUNCAN did not feel there would be any title problems due
to the broad title of the legislation.
SENATOR SALO asked how many staff, other than the executive
director, are currently under SESA. MARGARET LOWE said that
approximately twenty-eight people are teaching with a support staff
of six to eight people.
SENATOR SALO noted that the function of SESA was to offer low
volume special education services throughout Alaska. She asked if
they concentrated on any specific areas. MARGARET LOWE stated that
they have instructors for all the major areas of special education.
There are no psychologists.
SENATOR DUNCAN requested that Ms. Lowe present the information on
the composition of the board to add to the bill.
VICE-CHAIRMAN SHARP held SB 429 so that Ms. Lowe could provide
information regarding the composition of the board for the
committee to consider.
Number 527
VICE CHAIRMAN SHARP introduced SB 313 (HEALTH INS. FOR HIGH RISK
RESIDENTS) as the final order of business before the committee.
CAROL CARROL, staff to Senator Kerttula, explained that SB 313
would amend the Health Insurance Association set up 1992 for high-
risk health insurance. She reviewed the amendments to SB 313 which
are present in the committee's packets.
SENATOR LEMAN asked for a description of the " other managed care
arrangements " which can be found on page 1, line 10. CAROL CARROL L
said that a provider type arrangement, a preferred provider
arrangement would be an example.
BOB NIEBRUGGE, Consumer Representative of the Comprehensive Health
Insurance Association, agreed with the preferred provider
arrangement example which Providence Hospital may be able to
fulfill. He said that HMO's may be able to offer care at a cheaper
rate in the future. SB 313 provides language to offer health care
insurance at a cheaper rate to the insurers and make it as
accessible as possible.
SENATOR ELLIS asked why Senator Kerttula's original legislation had
five insurance representatives and two consumer representatives on
the board.
BOB NIEBRUGGE stated that the five insurance representatives were
beneficial with the technical tasks to create the legislation. The
composition of the board has been successful.
SENATOR ELLIS inquired as to Mr. Niebrugge's background. BOB
NIEBRUGGE explained that he was a self-employed diabetic, a pre-
existing condition. Eventually, he did discover Communicating for
Agriculture, which had created a high risk pool. Under
Communicating for Agriculture, insurance was available at an
elevated premium without any subsidies.
SENATOR ELLIS asked if Mr. Niebrugge had any suggestions for those
individuals who cannot afford the elevated premium. BOB NIEBRUGGE
said not in the context of this legislation. SENATOR ELLIS said
that was the point.
SENATOR ELLIS noted that SB 313 references HMO's and previous
legislation from Senator Kerttula attempting to help HMO's to do
business in Alaska. Still, HMO's are not coming to Alaska. He
asked if there was hope for HMO's in Alaska. BOB NIEBRUGGE said
no, this is an attempt to clean up the language in this
legislation.
SENATOR ELLIS inquired of the background of the other consumer
representative on the Association. BOB NIEBRUGGE explained that
Elaine Hurley was the other consumer representative who has a
daughter with a pre-existing health condition.
Number 416
SENATOR DUNCAN asked Mr. Niebrugge if he had insurance through the
high risk pool. BOB NIEBRUGGE said no, he has a group plan. In
response to Senator Duncan, Mr. Niebrugge stated that they had
approximately seventy-some applications for the high risk pool.
SENATOR DUNCAN asked Mr. Niebrugge to clarify the number of
individuals who actually received insurance. BOB NIEBRUGGE said
that seventy-two individuals were actually insured. Mr. Niebrugge
suspected that very few individuals would be declined, due to their
initial information when applying.
SENATOR DUNCAN stated that these changes seemed to make sense, but
would SB 313 change the number of individuals joining the high-risk
pool. BOB NIEBRUGGE explained that the original legislation only
provided three levels of deductibles; most individuals opt for the
higher deductible because it has the lowest premium. Mr. Niebrugge
indicated that if these changes occur in SB 313, a higher
deductible similar to a catastrophic plan would be offered. This
type plan would substantially decrease premiums which would help
enrollment.
SENATOR DUNCAN inquired as to other states' deductible under a
high-risk pool. BOB NIEBRUGGE noted that there are a variety of
programs, but they generally lean toward the higher deductible.
Mr. Niebrugge offered to provide the committee with a publication
of other states' programs.
SENATOR DUNCAN asked Mr. Niebrugge about his group policy. BOB
NIEBRUGGE explained that his group policy was with a company that
had opened their enrollment to high-risk individuals for a short
time. SENATOR DUNCAN inquired as to the status of his premium.
BOB NIEBRUGGE stated that his premiums have gradually increased.
SENATOR MILLER moved SB 313 out of committee with individual
recommendations. Hearing no objections, it was so ordered.
There being no further business before the committee, the meeting
was adjourned at 2:55 p.m.
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