Legislature(2009 - 2010)BUTROVICH 205

03/15/2010 01:30 PM Senate HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved SB 307 Out of Committee
Heard & Held
Moved CSSCR 13(HSS) Out of Committee
Bills Previously Heard/Scheduled
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         March 15, 2010                                                                                         
                           1:32 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Senator Bettye Davis, Chair                                                                                                     
Senator Joe Paskvan, Vice Chair                                                                                                 
Senator Johnny Ellis                                                                                                            
Senator Joe Thomas                                                                                                              
Senator Fred Dyson                                                                                                              
MEMBERS ABSENT                                                                                                                
All members present                                                                                                             
COMMITTEE CALENDAR                                                                                                            
SENATE BILL NO. 307                                                                                                             
"An Act relating to residential shelters for runaway minors."                                                                   
     - MOVED SB 307 OUT OF COMMITTEE                                                                                            
SENATE CONCURRENT RESOLUTION NO. 13                                                                                             
Supporting senior caregivers and encouraging the Department of                                                                  
Health and Social Services to provide additional education on                                                                   
the effects of aging and the importance of senior caregivers.                                                                   
     - MOVED CSSCR 13(HSS) OUT OF COMMITTEE                                                                                     
SENATE BILL NO. 250                                                                                                             
"An  Act   requiring  insurance  coverage  for   autism  spectrum                                                               
disorders,  describing the  method for  establishing a  treatment                                                               
plan  for those  disorders, and  defining the  treatment required                                                               
for those disorders; and providing for an effective date."                                                                      
     - HEARD AND HELD                                                                                                           
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: SB 307                                                                                                                  
SHORT TITLE: SHELTERS FOR RUNAWAY MINORS                                                                                        
SPONSOR(s): HEALTH & SOCIAL SERVICES                                                                                            
03/10/10       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/10/10       (S)       HSS, JUD                                                                                               
03/15/10       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
BILL: SCR 13                                                                                                                  
SHORT TITLE: SUPPORTING SENIOR CAREGIVERS                                                                                       
SPONSOR(s): BUNDE                                                                                                               
02/24/10       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/24/10       (S)       HSS                                                                                                    
03/15/10       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
BILL: SB 250                                                                                                                  
SHORT TITLE: INS. COVERAGE: AUTISM SPECTRUM DISORDER                                                                            
SPONSOR(s): HEALTH & SOCIAL SERVICES                                                                                            
02/01/10       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/01/10       (S)       HSS, FIN                                                                                               
03/15/10       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
WITNESS REGISTER                                                                                                              
CELESTE HODGE, Staff to Senator Davis                                                                                           
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Introduced SB 307.                                                                                        
KIMBERLEE COLBO, Attorney                                                                                                       
Covenant House                                                                                                                  
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Was available for questions.                                                                              
WILDA LAUGHLIN, Legislative Liaison                                                                                             
Special Assistant to the Commissioner                                                                                           
Department of Health and Social Services (DHSS)                                                                                 
Juneau, AK                                                                                                                      
POSITION STATEMENT: Supported SB 307.                                                                                         
LAUREN RICE, Director of Public Affairs                                                                                         
Covenant House                                                                                                                  
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Supported SB 307.                                                                                         
TREVOR FULTON, Staff for Senator Con Bunde                                                                                      
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Read the sponsor statement for SCR 13.                                                                    
LORNA MILLS, representing herself                                                                                               
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Testified on SCR 13.                                                                                      
KAY BRANCH                                                                                                                      
Elder Health Program Coordinator                                                                                                
Alaska Native Tribal Health Consortium (ANTHC)                                                                                  
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Supported SCR 13.                                                                                         
JOANNE GIBBENS, Deputy Director                                                                                                 
Division of Senior and Disability Services                                                                                      
Department of Health and Social Services (DHSS)                                                                                 
Juneau, AK                                                                                                                      
POSITION STATEMENT: Testified that the administration supports                                                                
HCR 13.                                                                                                                         
MARIE DARLIN                                                                                                                    
AARP Capitol City Task Force                                                                                                    
Juneau, AK                                                                                                                      
POSITION STATEMENT: Testified in support of SCR 13.                                                                           
DENISE DANIELLO, Executive Director                                                                                             
Alaska Commission on Aging                                                                                                      
Department of Health and Social Services (DHSS)                                                                                 
Juneau, AK                                                                                                                      
POSITION STATEMENT: Testified in support of SCR 13.                                                                           
KEVIN TURKINGTON, Chief Executive Officer                                                                                       
Senior Care of Alaska                                                                                                           
President, Board of National Private Duty Association (NPDA)                                                                    
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Testified in support of SCR 13.                                                                           
REPRESENTATIVE PETE PETERSEN                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Sponsor of SB 250                                                                                         
TOM OBERMEYER, Staff to Senator Davis                                                                                           
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Gave an overview of the CS for SB 250.                                                                    
LORRI UNUMB, Attorney                                                                                                           
Autism Speaks                                                                                                                   
Columbia, SC                                                                                                                    
POSITION STATEMENT: Testified in support of SB 250.                                                                           
SHEELA TALLMAN, Legislative Affairs                                                                                             
Premera Blue Cross Blue Shield of Alaska                                                                                        
POSITION STATEMENT: Testified in opposition to SB 250.                                                                        
ACTION NARRATIVE                                                                                                              
1:32:29 PM                                                                                                                    
CHAIR BETTYE DAVIS  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:32 p.m.  Present at the                                                               
call to  order were Senators  Paskvan, Ellis, and  Davis. Senator                                                               
Dyson arrived soon thereafter.                                                                                                  
               SB 307-SHELTERS FOR RUNAWAY MINORS                                                                           
1:32:48 PM                                                                                                                    
CHAIR DAVIS announced consideration of SB 307.                                                                                  
SENATOR DYSON joined the meeting.                                                                                               
1:33:39 PM                                                                                                                    
CELESTE HODGE,  Staff to Senator  Davis, sponsor of SB  307, said                                                               
this bill  will allow shelters  like Covenant House  Alaska (CVA)                                                               
to continue to apply for federal  grants. In 2007 CVA was awarded                                                               
the federal  Basic Center Grant (BCG)  through the Administration                                                               
for Children and Families (ACF),  but they were recently notified                                                               
that they  are out of compliance  because they have more  than 20                                                               
beds, which  is what the  grant allows. However, ACF  did concede                                                               
that a state  law requiring more beds would  override the federal                                                               
requirement. SB  307 does  that and therefore  will allow  CVA to                                                               
continue to  compete for  federal grants  by operating  under the                                                               
terms of their license.                                                                                                         
This will not  increase the cost or workload of  the CVA staff so                                                               
there is a zero fiscal note, she concluded.                                                                                     
SENATOR THOMAS joined the meeting.                                                                                              
1:36:45 PM                                                                                                                    
SENATOR DYSON said  this is absolutely common sense  and he can't                                                               
imagine  that there  is  any opposition.  He  suggested that  the                                                               
chair ask  if there is  any negative  testimony and, if  not, the                                                               
committee can move ahead with the bill.                                                                                         
KIMBERLEE  COLBO, Attorney,  Covenant  House, Anchorage,  Alaska,                                                               
said she was available for questions.                                                                                           
1:39:02 PM                                                                                                                    
WILDA  LAUGHLIN, Legislative  Liaison, Department  of Health  and                                                               
Social Services  (DHSS), thanked  the committee for  carrying the                                                               
bill and  Covenant House for  working with DHSS. She  stated that                                                               
the administration has no concerns with the bill.                                                                               
LAUREN  RICE,   Director  of  Public  Affairs,   Covenant  House,                                                               
Anchorage,  Alaska, thanked  Chair  Davis and  the committee  for                                                               
bringing the bill forward.                                                                                                      
1:40:29 PM                                                                                                                    
CHAIR DAVIS  closed public  testimony and asked  the will  of the                                                               
SENATOR  PASKVAN  moved to  report  SB  307 from  committee  with                                                               
individual  recommendations and  attached  fiscal note(s).  There                                                               
being  no objection,  SB 307  moved  from the  Senate Health  and                                                               
Social Services Standing Committee.                                                                                             
At ease from 1:40 p.m. to 1:42 p.m.                                                                                             
              SCR 13-SUPPORTING SENIOR CAREGIVERS                                                                           
CHAIR DAVIS announced consideration of SCR 13.                                                                                  
1:42:28 PM                                                                                                                    
TREVOR FULTON,  staff for  Senator Con  Bunde, introduced  SCR 13                                                               
paraphrasing the following sponsor statement:                                                                                   
     Alaska's senior  population is  growing. The  number of                                                                    
     Alaskans  65  years of  age  or  older is  expected  to                                                                    
     increase by nearly 60 percent  in the next 20 years and                                                                    
     the population of those 85  years or older is projected                                                                    
     to double by  2050. Per capita, Alaska  has the fastest                                                                    
     growing 85 and over population in the entire nation.                                                                       
     While  advances in  medicine, technology,  and assisted                                                                    
     living practices  are enabling seniors to  live longer,                                                                    
     more productive,  and more comfortable lives  than ever                                                                    
     before, the fact  remains that many of  our aging loved                                                                    
     ones  will   at  some  point   require  some   form  of                                                                    
     caregiving.  In  fact,  more than  25  percent  of  all                                                                    
     seniors need some level of  assistance with their daily                                                                    
     It is critical that we as  a state are prepared to meet                                                                    
     and manage the needs of our aging population.                                                                              
     By  supporting senior  caregivers  and encouraging  the                                                                    
     Department  of Health  and Social  Services to  provide                                                                    
     additional education  on the  effects of aging  and the                                                                    
     importance   of  senior   caregivers,   SCR  13   draws                                                                    
     attention  to the  changing  demographics  of aging  in                                                                    
     Alaska  and   the  critical   role  played   by  senior                                                                    
1:45:28 PM                                                                                                                    
SENATOR  PASKVAN   moved  to  adopt  the   work  draft  committee                                                               
substitute (CS) for  SCR 13, labeled 26-LS1481\P,  as the working                                                               
document.  There being  no objection,  version P  was before  the                                                               
1:46:30 PM                                                                                                                    
LORNA  MILLS,  representing herself,  said  she  is a  registered                                                               
nurse and  the owner of Care  Net Inc., a private-duty  home care                                                               
provider in Anchorage that employs  caregivers who help people in                                                               
their own homes. Because un-monitored  care opens the possibility                                                               
for  exploitation of  vulnerable older  persons, there  is a  big                                                               
difference between  hiring someone from a  reputable private-duty                                                               
home care  organization and hiring  someone from a  newspaper ad,                                                               
she said.  As a member  of the National  Private-Duty Association                                                               
(NPDA) and the Alaska chapter, she  said she speaks for the group                                                               
in saying  they are dedicated and  have made it their  mission to                                                               
preserve the integrity of the  private-duty home care industry by                                                               
adhering  to certain  standards.  A goal  of  the association  is                                                               
educate  the community  about  the importance  of  using an  NPDA                                                               
She asked  Mr. Fulton what  the sponsor hopes to  accomplish with                                                               
SCR 13, what he will do  to support businesses like hers, and how                                                               
she can help.                                                                                                                   
CHAIR DAVIS  advised Ms.  Mills to contact  either her  office or                                                               
the sponsor's.                                                                                                                  
1:49:43 PM                                                                                                                    
KAY  BRANCH,  Elder  Health Program  Coordinator,  Alaska  Native                                                               
Tribal Health Consortium  (ANTHC), said ANTHC supports  SCR 13 on                                                               
behalf of their tribal health  partners, the 16,000 Alaska Native                                                               
elders in the  state, and caregivers. And they  encourage DHSS to                                                               
ensure  that  caregiving  resources and  education  embraces  the                                                               
cultural and  linguistic traditions  of Alaska Native  people. As                                                               
part  of the  Medicaid  reform initiative,  Alaska tribal  health                                                               
organizations  collaborated to  design  a tribal  long term  care                                                               
service development plan that would  increase access to both home                                                               
and  community-based  and  facility services  for  Alaska  Native                                                               
elders  and people  with disabilities.  This includes  components                                                               
like SCR  13 that  encourages family  caregivers to  provide care                                                               
and  supplement with  formal services  only when  necessary. This                                                               
maintains  the  family  structure and  honors  the  long-standing                                                               
tradition of caring for elders, she said.                                                                                       
Tribal  health system  partners  continue to  work  with DHSS  to                                                               
increase home  and community-based  services at all  levels. This                                                               
includes  traveling to  rural regions  to  better understand  the                                                               
challenges   of  rural   service  delivery   and  tribal   health                                                               
organizations   thereby  ensuring   equal   access  to   services                                                               
statewide.  Culturally appropriate  nursing  and assisted  living                                                               
homes are  also needed  to provide  the full  range of  long term                                                               
care   services  to   Alaska  Native   elders  and   people  with                                                               
disabilities. ANTHC  therefore also seeks support  for the tribal                                                               
facility  capital projects  in Anchorage,  Kotzebue, and  Bethel,                                                               
she concluded.                                                                                                                  
1:52:56 PM                                                                                                                    
JOANNE  GIBBENS,   Deputy  Director,   Division  of   Senior  and                                                               
Disability  Services, Department  of Health  and Social  Services                                                               
(DHSS), stated that the administration supports SCR 13.                                                                         
SENATOR  DYSON said  the implication  of the  resolution is  that                                                               
DHSS needs a kick in the  pants, but it appears that DHSS doesn't                                                               
look  at  it  that  way.  He asked  what  the  resolution  really                                                               
accomplishes and why the department supports it.                                                                                
MS.  GIBBENS  replied  the  department  supports  the  resolution                                                               
because it recognizes the need and  is committed to doing what it                                                               
can  with existing  and future  resources to  meet that  needs of                                                               
caregivers.  Through a  combination  of federal  and state  funds                                                               
they currently  provide funding for  eight agencies  statewide to                                                               
provide   caregiver  support   services.   That's  probably   not                                                               
sufficient to meet the statewide  need, but they are committed to                                                               
do  what  they  can  and  to continue  working  with  the  Alaska                                                               
Commission  on Aging  to identify  strategies to  improve service                                                               
delivery statewide.                                                                                                             
1:55:57 PM                                                                                                                    
SENATOR DYSON  referenced the  resolve on page  2 and  asked what                                                               
the impact  is for  the Legislature to  say it  recognizes senior                                                               
caregiving as a profession.                                                                                                     
MS. GIBBENS  said she  believes that  recognizing something  as a                                                               
profession  recognizes it  as a  calling  and a  life's task  and                                                               
work.  Also,  family  caregivers   can  sometimes  get  paid  for                                                               
providing  services and  in that  respect it's  a profession  for                                                               
SENATOR DYSON  asked if she  sees this  as a precursor  to formal                                                               
training and/or licensing.                                                                                                      
MS.   GIBBENS  replied   DHSS   already   provides  training   to                                                               
caregivers,  counseling  and  support  groups  to  families,  and                                                               
respite services for family members.                                                                                            
SENATOR DYSON observed that she's saying "no."                                                                                  
MS. GIBBENS agreed.                                                                                                             
SENATOR  DYSON asked  Mr. Fulton  if he  and the  sponsor believe                                                               
that the  resolution commits the  Legislature provide  funding to                                                               
do everything outlined in the resolve section on page 2.                                                                        
CHAIR DAVIS suggested  he take the resolution at  face value. She                                                               
believes it's  appropriate for the department  to express support                                                               
and doesn't feel that it will bind the Legislature.                                                                             
SENATOR DYSON  said it could  be argued differently but  he won't                                                               
push it.                                                                                                                        
2:01:09 PM                                                                                                                    
MARIE  DARLIN, AARP  Capitol City  Task Force,  expressed support                                                               
for SCR  13. It's important  to educate people about  the growing                                                               
need for caregiver services because  that need for those services                                                               
is growing  rapidly. She  suggested that  a little  more emphasis                                                               
might  be  given  to  letting   people  know  what  services  are                                                               
available through the state or community organizations.                                                                         
2:03:12 PM                                                                                                                    
DENISE DANIELLO, Executive Director,  Alaska Commission on Aging,                                                               
Department of  Health and Social  Services (DHSS),  said Alaska's                                                               
senior  population  is  growing  faster than  any  state  in  the                                                               
nation, but  not because seniors  are moving here. It's  that the                                                               
people  who  moved here  in  the  '70s  and  '80s are  aging  and                                                               
choosing to remain in Alaska.  This is an important population in                                                               
terms of  their investment in  Alaska. According to a  study done                                                               
by the  University of Alaska,  seniors contribute more  than $1.5                                                               
billion to the  state economy each year and  this doesn't include                                                               
the  seniors who  continue to  work and  volunteer. SJR  13 calls                                                               
attention to  the changing demographics  and the need to  look at                                                               
the  types of  services that  are provided  and whether  they are                                                               
sufficient to keep seniors living here.                                                                                         
2:06:09 PM                                                                                                                    
KEVIN TURKINGTON,  CEO, Senior Care  of Alaska;  President, Older                                                               
Persons Action Group  and Alaska chapter of  the National Private                                                               
Duty Association (NPDA), said he  is testifying in support of SCR
13.  It can  bring  a  better balance  to  supporting the  entire                                                               
senior population.  Many resources are focused  to the low-income                                                               
seniors  and,  while  that  is important,  about  75  percent  of                                                               
seniors don't qualify  for these services. The best  way to serve                                                               
seniors and  lower the costs  of doing  so is to  empower seniors                                                               
and family and professional caregivers.  This can be accomplished                                                               
by filtering  all current regulations and  subsequent legislation                                                               
through SCR 13  and the powerful statement if makes  on behalf of                                                               
seniors and their families.                                                                                                     
2:09:54 PM                                                                                                                    
CHAIR  DAVIS called  an at  ease due  to a  teleconference system                                                               
2:17:16 PM                                                                                                                    
CHAIR DAVIS reconvened the meeting and closed public testimony.                                                                 
2:17:57 PM                                                                                                                    
SENATOR PASKVAN  moved to report  CSSCR 13,  labeled 26-LS1481\P,                                                               
from  committee  with  individual  recommendations  and  attached                                                               
fiscal  note(s). There  being no  objection, CSSCR  13(HSS) moved                                                               
from the Senate Health and Social Services Standing Committee.                                                                  
At ease from 2:18 p.m. to 2:20 p.m.                                                                                             
         SB 250-INS. COVERAGE: AUTISM SPECTRUM DISORDER                                                                     
2:20:05 PM                                                                                                                    
CHAIR  DAVIS  announced  consideration   of  SB  250.  She  asked                                                               
Representative  Peterson   if  he  would  like   to  present  the                                                               
companion to SB 250, which he introduced in the House.                                                                          
REPRESENTATIVE PETE  PETERSEN, sponsor of HB  187, encouraged the                                                               
committee  to  ask questions  of  the  autism experts  that  were                                                               
CHAIR DAVIS  said it was not  her intent to move  the bill today.                                                               
She asked Mr. Obermeyer to present the bill.                                                                                    
2:22:13 PM                                                                                                                    
TOM OBERMEYER,  staff to Senator  Davis, said he was  speaking to                                                               
the committee  substitute (CS) for  SB 250,  labeled 26-LS1400\R.                                                               
He read the sponsor statement into  the record. [A copy is in the                                                               
bill file.]                                                                                                                     
He  related  that SB  250  mandates  coverage for  diagnosis  and                                                               
treatment of autism spectrum disorders  (ASD) in any plan offered                                                               
by the  health care  insurer. Early treatment  has been  shown to                                                               
improve the symptoms of ASD  and sometimes eliminate the need for                                                               
special education  for a child with  ASD. This is the  proper way                                                               
to deal  with this problem  and it saves  a great deal  of money,                                                               
Mr. Obermeyer said.                                                                                                             
MR.  OBERMEYER   pointed  out  that  self-funded   health  plans,                                                               
including the  "Alaska Care"  plan, would  likely be  exempt from                                                               
the bill  because they  are preempted by  the federal  ERISA law.                                                               
However,  the   state  historically   has  complied   with  state                                                               
insurance laws.                                                                                                                 
The Center for Disease Control (CDC)  reports that about 1 in 110                                                               
children  are affected  by ASDs,  but it  is much  more prevalent                                                               
among  boys. This  is an  increase from  10 years  ago, but  it's                                                               
unclear if this increase is due  to a broader definition of ASDs,                                                               
better diagnoses, or  a combination. Many children  who have been                                                               
diagnosed  go  untreated because  ASD  often  is not  covered  by                                                               
insurance plans. The cost to families is overwhelming.                                                                          
MR.  OBERMEYER   related  that   the  federal   Autism  Treatment                                                               
Acceleration Act of 2009 is  pending legislation and implementing                                                               
SB 250 now  would allow insurers and the state  time to adjust to                                                               
the  requirements of  this law.  Also,  he said,  it would  bring                                                               
health care  professional and jobs  to the state. Since  March of                                                               
2009, 11 states have passed legislation  similar to SB 250 and 19                                                               
states  have introduced  legislation. SB  250 will  significantly                                                               
help the hundreds of Alaskans  suffering from these disorders, he                                                               
2:29:19 PM                                                                                                                    
SENATOR PASKVAN moved to adopt  the proposed committee substitute                                                               
(CS) for  SB 250, labeled  26-LS1400\R, as the  working document.                                                               
There being no objection, version R was before the committee.                                                                   
2:29:44 PM                                                                                                                    
LORRI UNUMB,  Senior Policy Advisor  and Counsel,  Autism Speaks,                                                               
Columbia,  South  Carolina,  said   this  is  a  national  autism                                                               
science, research,  and advocacy  organization. She  informed the                                                               
committee that she is a former  law professor and the parent of a                                                               
child with autism; she now  advocates full time for children with                                                               
autism and work nationwide on  autism insurance reform. She noted                                                               
that she  would speak  to the PowerPoint  handout in  the packets                                                               
focusing  on the  experience  in other  states  that have  passed                                                               
autism insurance reform.                                                                                                        
Slide 6 depicts a  map of the U. S. showing  the states that have                                                               
passed autism  insurance reform.  At Autism Speaks  they consider                                                               
that  15 states  have  enacted meaningful  reform,  she said.  In                                                               
these states  kids can get  the kind and  close to the  amount of                                                               
therapy that's  been prescribed for  them. Indiana  and Minnesota                                                               
passed legislation  in 2001 so  cost data is available,  but it's                                                               
nearly  ten years  old. South  Carolina and  Texas were  the next                                                               
states to pass legislation in  2007; more states followed suit in                                                               
2008 and  2009. As previously  mentioned, legislation  is pending                                                               
in 19 states.                                                                                                                   
MS. UNUMB directed  attention to slide 7  that contains excerpted                                                               
data  from  an  insurance   advocacy  association  report  titled                                                               
"Health  Insurance Mandates  in  the States."  It indicates  that                                                               
covering autism  has impacted  premiums by  less than  1 percent.                                                               
This is  compared to other  mandated treatments  like alcoholism,                                                               
contraceptives, in vitro fertilization,  and prescriptions all of                                                               
which are higher.                                                                                                               
Slide 8 contains  actual cost data from South  Carolina after the                                                               
autism insurance statute became  applicable to the state employee                                                               
health plan  in January 2009. The  state has a population  of 4.5                                                               
million and the  state employee health plan  has 350,000 members.                                                               
When  the  legislation was  introduced  the  state budget  office                                                               
initially  estimated  that this  coverage  would  cost the  state                                                               
$18.9 million and that was later  revised down to $9 million. The                                                               
actual claims date  for all of 2009 shows that  it cost the state                                                               
$856,371.  This translates  to  a 20  cent  premium increase  per                                                               
member per  month to provide  all the  kids with autism  in South                                                               
Carolina with the coverage they  need. The South Carolina statute                                                               
is  a little  different  than  what SB  250  proposes because  it                                                               
provides  coverage  only  through  age 16  and  it  caps  applied                                                               
behavior analysis (ABA) therapy at  $50,000 per year. The Harvard                                                               
study  indicates  that the  lifetime  cost  for each  child  with                                                               
autism who does not get treated  is $3.2 million so if you're not                                                               
motivated by  the human  aspect, think about  if from  the fiscal                                                               
perspective, she said.  Fully 50 percent of the  kids who receive                                                               
treatment will go right into  a mainstream first grade classroom,                                                               
saving the state an awful lot of money, she concluded.                                                                          
2:38:42 PM                                                                                                                    
SENATOR PASKVAN asked what policy  issues caused [South] Carolina                                                               
to cap coverage at age 16 and $50,000.                                                                                          
MS. UNUMB replied  she selected age 16  somewhat randomly without                                                               
any  scientific  basis.  Most  of the  states  that  have  reform                                                               
selected  age  18-22.  The original  legislation  didn't  have  a                                                               
therapy cap,  but the insurance  industry argued in favor  of one                                                               
on  the ABA  therapy because  they couldn't  estimate that  cost.                                                               
When the  legislature asked  her to  write in a  cap, she  put in                                                               
$75,000 because  that's the  cost of  her son's  therapy. Shortly                                                               
before the bill passed the cap was negotiated down to $50,000.                                                                  
Slide 10  has a chart comparing  the age and ABA  therapy caps in                                                               
six states with  reform statutes. She offered to  provide a chart                                                               
that compares all 15 states in some detail.                                                                                     
CHAIR DAVIS said that would be helpful.                                                                                         
2:42:18 PM                                                                                                                    
SENATOR DYSON questioned why treatment  for this disability isn't                                                               
paid for  out of the  tax base as  opposed to insurance.  Here in                                                               
particular  it would  be a  very  selective and  disproportionate                                                               
sharing of the burden.                                                                                                          
MS. UNUMB replied some states  have attempted to provide coverage                                                               
through the Medicaid  waiver program, but it  isn't sufficient to                                                               
treat  all  the kids.  Even  with  a  very favorable  70  percent                                                               
federal  match, South  Carolina  has two  to  three year  waiting                                                               
lists of several  hundred children. That doesn't do  a child with                                                               
autism  any  good  because  the   early  intervention  window  is                                                               
critical  for rewiring  the brain.  She added  that autism  is at                                                               
core  a  medical  issue  and  for the  people  who  have  private                                                               
insurance it seems only fair that private insurance play a part.                                                                
SENATOR DYSON thanked her for a thoughtful response.                                                                            
2:46:24 PM                                                                                                                    
SENATOR THOMAS referenced the actual  2009 cost data she provided                                                               
for  the  South  Carolina  state   employee  plan  and  expressed                                                               
disbelief  that treatment  per  child could  cost  so little.  He                                                               
asked how she arrived at $856,000.                                                                                              
MS. UNUMB  said she believes that  cost will rise as  more people                                                               
take  advantage of  the coverage,  but she  doesn't it  will ever                                                               
approximate the state's $9 million estimate.                                                                                    
She referenced  slide 2 showing the  five pervasive developmental                                                               
disorders  (PPD). Within  the five  PDDs there  are three  autism                                                               
spectrum   disorders   (ASDs):  autistic   disorder,   Asperger's                                                               
syndrome, and  pervasive developmental  disorder -  not otherwise                                                               
specified (PDD-NOS).  Autistic disorder  accounts for 1/3  of all                                                               
ASDs,  Asperger's syndrome  accounts  for less  than  1/6 of  all                                                               
ASDs,  and the  milder PDD-NOS  accounts  for 1/2  of all  autism                                                               
spectrum disorders.  The kids  in the  first category  are severe                                                               
and they  are prescribed the intensive  behavioral therapy. While                                                               
the  prevalence of  PDD  is 1  in  110, only  1/3  have a  severe                                                               
diagnosis and  only some of  those will  be prescribed a  full 40                                                               
hour per  week ADA therapy program.  And not all of  the ones who                                                               
are prescribed  the intensive program  will take advantage  of it                                                               
because it takes place in  your home and is incredibly intrusive.                                                               
Not every  family is  willing to  make the  lifestyle adjustments                                                               
and in rural areas there may be provider issues.                                                                                
One reason  that South Carolina's fiscal  note was so far  off is                                                               
that  the   budget  analyst  took   the  prevalence   number  and                                                               
multiplied it by the cap. They  assumed that every child would be                                                               
prescribed and  get the  maximum treatment,  but it  doesn't work                                                               
that way. In South Carolina 62,000  kids were within the age 2-16                                                               
target  range  and just  64  were  actually prescribed  and  took                                                               
advantage of the therapy in 2009.                                                                                               
SENATOR THOMAS asked  if she has examples from  other states that                                                               
have had  legislation in place  for a  longer period of  time and                                                               
why she  included a slide  that lists businesses that  have self-                                                               
funded ERISA plans.                                                                                                             
2:53:07 PM                                                                                                                    
MS.  UNUMB  said it's  difficult  to  get detailed  data  because                                                               
private insurers  are less  forthcoming, but  she does  have data                                                               
from Minnesota. That benefit has neither  an age nor a dollar cap                                                               
and it's  been in effect  for nine years. Blue  Cross/Blue Shield                                                               
said that the  average utilization on an ABA  program was $30,000                                                               
per year  and the premium increase  has been $.83 per  member per                                                               
month. She noted that Autism  Speaks hired an independent actuary                                                               
to conduct  an analysis on  the companion bill  to SB 250  and he                                                               
projected a cost of $1.34 per member per month.                                                                                 
She  explained that  she included  the information  on the  ERISA                                                               
plans because  she likes to point  out that when a  state chooses                                                               
to  mandate  a benefit  many  ERISA  regulated plans  voluntarily                                                               
follow  suit. The  slide offers  a small  list of  companies that                                                               
have elected to provide an  autism benefit. She believes that the                                                               
Microsoft  administrator is  Premera Blue  Cross Blue  Shield and                                                               
she understands they are a predominant insurer in Alaska.                                                                       
SENATOR PASKVAN asked if there's  a rational explanation for some                                                               
states placing a different dollar cap on therapy based on age.                                                                  
MS.  UNUMB replied  they're the  result of  a political  process.                                                               
Some states have  decided that kids don't need  as much treatment                                                               
once  they enter  school  and  that might  be  true depending  on                                                               
2:57:28 PM                                                                                                                    
SHEELA  TALLMAN, Legislative  Affairs,  Premera  Blue Cross  Blue                                                               
Shield  of  Alaska,  confirmed that  this  legislation  will  not                                                               
impact self-funded  plans, which  are subject  to ERISA  and it's                                                               
not subject to state mandates.  However, the bill will impact the                                                               
40 percent  of the market  that represents individuals  and small                                                               
employers in Alaska  that are already price  stressed. It imposes                                                               
a mandate  on health  insurers like Blue  Cross by  requiring all                                                               
policies to include coverage for ASDs including social skills-                                                                  
based therapies  that generally considered  outside the  realm of                                                               
health  care.  They estimate  that  this  mandate could  increase                                                               
health insurance premiums up to 3 percent so it's not cost free.                                                                
2:59:15 PM                                                                                                                    
SENATOR PASKVAN  asked if  she disputes  the estimated  $1.34 per                                                               
person per month premium increase.                                                                                              
MS. TALLMAN replied  they believe it will be  slightly higher but                                                               
she doesn't have the exact number.                                                                                              
SENATOR PASKVAN asked if the premium  would likely be lower if it                                                               
were spread over a larger population base.                                                                                      
MS. TALLMAN replied their calculations  already include the small                                                               
and large groups of insured.                                                                                                    
CHAIR DAVIS asked if she could  meet with the committee again and                                                               
provide the additional information.                                                                                             
MS. TALLMAN agreed to do so.                                                                                                    
CHAIR DAVIS held SB 250 in committee.                                                                                           
3:00:50 PM                                                                                                                    
There being no further business to come before the committee,                                                                   
Chair Davis adjourned the Senate Health and Social Services                                                                     
Standing Committee hearing at 3:00 p.m.                                                                                         

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