Legislature(2011 - 2012)BUTROVICH 205

02/28/2011 01:30 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved CSSB 27(HSS) Out of Committee
Heard & Held
Bills Previously Heard/Scheduled
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                       February 28, 2011                                                                                        
                           1:30 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Senator Bettye Davis, Chair                                                                                                     
Senator Dennis Egan                                                                                                             
Senator Johnny Ellis                                                                                                            
Senator Kevin Meyer                                                                                                             
Senator Fred Dyson                                                                                                              
MEMBERS ABSENT                                                                                                                
All members present                                                                                                             
COMMITTEE CALENDAR                                                                                                            
SENATE BILL NO. 27                                                                                                              
"An  Act relating  to flame  retardants and  to the  manufacture,                                                               
sale, and  distribution of products containing  flame retardants;                                                               
relating to  bioaccumulative toxic  chemicals; and  providing for                                                               
an effective date."                                                                                                             
     - MOVED CSSB 27(HSS) OUT OF COMMITTEE                                                                                      
SENATE BILL NO. 52                                                                                                              
"An Act  requiring health care  insurers to provide  coverage for                                                               
treatment  of  mental  health conditions,  and  requiring  parity                                                               
between  health  care  insurance   coverage  for  mental  health,                                                               
alcoholism, and  substance abuse benefits and  other medical care                                                               
benefits;  eliminating  different  treatment  for  mental  health                                                               
conditions  from  the  minimum   benefits  of  the  state  health                                                               
insurance plan; removing an exclusion  for mental health services                                                               
or alcohol  or drug  abuse from the  definition of  'basic health                                                               
care  services'  in  the  law   relating  to  health  maintenance                                                               
organizations;   repealing  a   definition   of  'mental   health                                                               
benefits' that excludes treatment  of substance abuse or chemical                                                               
dependency; and providing for an effective date."                                                                               
     - HEARD AND HELD                                                                                                           
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: SB  27                                                                                                                  
SHORT TITLE: FLAME RETARDANTS AND TOXIC CHEMICALS                                                                               
SPONSOR(s): SENATOR(s) WIELECHOWSKI                                                                                             
01/19/11       (S)       PREFILE RELEASED 1/7/11                                                                                
01/19/11       (S)       READ THE FIRST TIME - REFERRALS                                                                        
01/19/11       (S)       HSS, FIN                                                                                               
02/21/11       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
02/21/11       (S)       Heard & Held                                                                                           
02/21/11       (S)       MINUTE(HSS)                                                                                            
02/28/11       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
BILL: SB  52                                                                                                                  
SHORT TITLE: MENTAL HEALTH CARE INSURANCE BENEFIT                                                                               
SPONSOR(s): SENATOR(s) DAVIS                                                                                                    
01/19/11       (S)       READ THE FIRST TIME - REFERRALS                                                                        
01/19/11       (S)       HSS, L&C, FIN                                                                                          
02/28/11       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
WITNESS REGISTER                                                                                                              
KARLA HART, Staff to Senator Wielechowski                                                                                       
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Explained changes in CSSB 27.                                                                             
SENATOR WIELECHOWSKI                                                                                                            
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Sponsor of SB 27.                                                                                         
TOM OBERMEYER, Staff to Senator Davis                                                                                           
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Presented SB 52 for the sponsor.                                                                          
DENNIS BAILEY, Attorney                                                                                                         
Legislative Legal Services                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Answered questions regarding SB 52.                                                                       
BRENDA KNAPP, Treatment and Recovery Program Administrator                                                                      
Division of Behavioral Health                                                                                                   
Department of Health and Social Services                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Answered questions regarding fiscal note for                                                              
SB 52.                                                                                                                          
ACTION NARRATIVE                                                                                                              
1:30:00 PM                                                                                                                    
CHAIR BETTYE DAVIS  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:30 p.m.  Present at the                                                               
call to order were Senators Egan, Meyer, and Chair Davis.                                                                       
          SB  27-FLAME RETARDANTS AND TOXIC CHEMICALS                                                                       
1:31:07 PM                                                                                                                    
CHAIR DAVIS  announced the  first order of  business would  be SB                                                               
SENATOR EGAN moved to adopt  the proposed committee substitute to                                                               
SB 27, CSSB 27( ), labeled 27-LS0300\B, as the working document.                                                                
CHAIR DAVIS objected for discussion purposes.                                                                                   
1:31:12 PM                                                                                                                    
SENATOR  BILL  WIELECHOWSKI,  sponsor   of  SB  27,  thanked  the                                                               
committee for  hearing the bill  and said his staff  would review                                                               
the changes in the CS.                                                                                                          
KARLA HART,  staff to Senator  Wielechowski, said the  changes to                                                               
SB 27  from version  M to version  B begin on  page 1.  The first                                                               
change makes enforcement  easier by clarifying that  the limit of                                                               
PBDE by mass applies to each individual component.                                                                              
1:32:04 PM                                                                                                                    
SENATOR ELLIS joined the meeting.                                                                                               
MS. HART further  explained that no component of  any product may                                                               
contain more  than 0.1  percent of  bromines. The  second change,                                                               
page 1, section (c) adds  other external components to electronic                                                               
appliances.  This includes  things like  toasters, blenders,  and                                                               
microwaves, and  ensures that anything that  people have physical                                                               
contact with would be  free of PBDEs.  On page  3, the CS removes                                                               
the  retailer assistance  component, the  review by  departments,                                                               
and  the  list  of  toxic  chemicals.  These  are  replaced  with                                                               
required  participation   by  DEC  in  the   interstate  chemical                                                               
clearinghouse. The clearinghouse  is now up and  running. In this                                                               
way, DEC could  buy a share of a toxicologist  instead of a whole                                                               
department, and share the knowledge of many states.                                                                             
CHAIR DAVIS asked if section 18.31.660 was new.                                                                                 
MS.  HART affirmed  that it  was.  The new  version changed  "may                                                               
participate"  to "shall  participate." The  CS adds  an immediate                                                               
effective date for  interstate clearinghouse participation. Those                                                               
changes were  done to clarify  the bill,  and also to  reduce the                                                               
fiscal notes.                                                                                                                   
CHAIR DAVIS asked if there was a new fiscal note.                                                                               
MS. HART  answered that staff at  DEC was preparing a  new fiscal                                                               
note, but the  CS has to be adopted before  they will release it.                                                               
The  current fiscal  note is  roughly  $159,000. This  recognizes                                                               
that the  toxicologist position will  probably be cut.  The prior                                                               
note was  almost $400,000. The  DSHS fiscal note should  be zero,                                                               
and the public safety note says zero.                                                                                           
SENATOR WIELECHOWSKI, sponsor  of SB 27, said  he doesn't believe                                                               
a toxicologist  is needed, so the  real cost is only  the cost of                                                               
joining the interstate clearinghouse.                                                                                           
CHAIR  DAVIS  said  this  could   be  taken  up  in  the  Finance                                                               
SENATOR  MEYER asked  if the  state associations  of firefighters                                                               
and fire chiefs have taken a position.                                                                                          
SENATOR WIELECHOWSKI said they have  indicated verbally that they                                                               
support the bill.                                                                                                               
MS. HART stated  they should be sending a letter  of support, and                                                               
they did support the bill  last year, and indicated a willingness                                                               
to  pass  a resolution  in  support  this  year. The  State  Fire                                                               
Marshall gave verbal  support but has some  concerns, because his                                                               
job is not to  protect us from toxics, his job  is to fight fires                                                               
and protect the public from fires.                                                                                              
1:39:27 PM                                                                                                                    
SENATOR MEYER said it would  be helpful to have something showing                                                               
their support.  There is one  letter from a retired  fire fighter                                                               
opposing the bill.                                                                                                              
MS. HART  said that  person has testified  against the  bill each                                                               
year. She  noted that their  office has also received  letters of                                                               
support from active  firefighters, and the Alaska  Chapter of the                                                               
American  Fire Fighters  Association is  also in  favor, and  has                                                               
written  letters in  past years.  The State  Association of  Fire                                                               
Chiefs has also supported the  bill in past years. Possibly there                                                               
is some fatigue with repeatedly passing resolutions.                                                                            
1:40:54 PM                                                                                                                    
SENATOR MEYER asked how SB 27 would be enforced.                                                                                
MS.  HART responded  that initial  enforcement  would be  through                                                               
wholesalers  and distributors,  not  retailers. The  law will  be                                                               
published and news will spread  quickly. Many states already have                                                               
these  laws. Wholesalers  and distributors  have  to disclose  if                                                               
there  are any  PBDEs  in the  products they  sell.  There is  no                                                               
enforcement component in the budget.  Major retailers are already                                                               
complying in  many other states,  and enforcement has not  been a                                                               
big issue.                                                                                                                      
SENATOR  WIELECHOWSKI   said  his  understanding  is   that  many                                                               
manufacturers  are  complying.  Those   not  complying  are  from                                                               
CHAIR DAVIS noted the CS was adopted, and would go to Finance.                                                                  
SENATOR EGAN  moved to report  CS for  SB 27 from  committee with                                                               
individual recommendations and soon  to be attached fiscal notes.                                                               
There being no  objection, CSSB 27(HSS) moved  from Senate Health                                                               
and Social Services Standing Committee.                                                                                         
1:44:26 PM                                                                                                                    
Brief at-ease from 1:44 - 1:45                                                                                                  
          SB  52-MENTAL HEALTH CARE INSURANCE BENEFIT                                                                       
1:45:29 PM                                                                                                                    
CHAIR DAVIS announced the next order of business would be SB 52.                                                                
TOM OBERMEYER,  Staff to  Senator Davis, said  that SB  52 amends                                                               
several  sections of  Alaska's health  insurance code  to require                                                               
that  health care  insurers provide  full  "parity," i.e.,  equal                                                               
insurance coverage, or the same  financial and treatment coverage                                                               
for  mental health  conditions, including  alcohol and  substance                                                               
abuse, as  other physical illnesses.  This bill expands  on state                                                               
compliance  under  HB 222  in  2009  with newly  enacted  federal                                                               
parity law, the "Paul Wellstone  and Peter Domenici Mental Health                                                               
Parity and Addiction  Equity Act" of 2008. That  Act also applies                                                               
to all children's health insurance  programs and became effective                                                               
April 1, 2009.                                                                                                                  
1:49:30 PM                                                                                                                    
MR. OBERMEYER  said that historically, health  insurers have been                                                               
reluctant to cover mental health  and substance abuse services on                                                               
the same basis  as general medical and  surgical services. During                                                               
the 1980s many  states required insurers to  provide coverage for                                                               
mental  health services  and  to offer  freedom  of choice  among                                                               
providers. However, concerns about  the adequacy of this coverage                                                               
persisted  because insurers  imposed  increased  cost sharing  or                                                               
restrictive benefit  limits. This led  to more federal  and state                                                               
intervention on  behalf of consumers.  While current  federal law                                                               
does  not mandate  that group  plans must  provide mental  health                                                               
coverage, if  they do, they  must provide the same  financial and                                                               
treatment  coverage offered  for other  physical illnesses.  This                                                               
bill differs  from federal law  in that  it does mandate  that "a                                                               
health care insurer which offers,  issues for delivery, delivers,                                                               
or  renews  a  health  care  insurance plan  to  an  employer  or                                                               
individual on a group or  individual basis shall provide coverage                                                               
for treatment of a mental health condition."                                                                                    
CHAIR DAVIS asked if he could provide a sectional analysis.                                                                     
MR.  OBERMEYER  said  that  Section 1  prohibits  a  health  care                                                               
insurer from  placing a  greater financial  burden on  an insured                                                               
for  the treatment  of alcoholism  or drug  abuse than  for other                                                               
medical   care,  including   limits   on  payment,   deductibles,                                                               
copayment,   or  other   cost   sharing  requirements,   methods,                                                               
prenotification requirements,  limiting or excluding  coverage or                                                               
services, or  denying coverage because treatment  was interrupted                                                               
or not completed.  It defines a "health care  insurance plan" and                                                               
"health care insurance."                                                                                                        
Section 2 requires  health care insurers to  provide coverage for                                                               
treatment of  mental health conditions.  It requires  that health                                                               
care insurance provisions are applied  to the treatment of mental                                                               
health conditions in the same  way as those health care insurance                                                               
conditions are applied to other medical care.                                                                                   
Section  3   is  an  editorial   amendment.  Section   4  removes                                                               
limitations  on  mental  health benefits  from  ACHIA  high  risk                                                               
plans. Section 5  removes a 50 percent  copayment requirement for                                                               
mental health services  under an ACHIA plan. Section  6 removes a                                                               
provision under an ACHIA plan  that requires certain expenses for                                                               
the treatment  of mental  and nervous conditions  be paid  at the                                                               
rate of  50 percent. Section  7 removes the exclusion  for mental                                                               
health services  or services for  alcohol or drug abuse  from the                                                               
definition  of  "basic health  care  services"  which applies  to                                                               
health   maintenance  organizations.   Section   8  changes   the                                                               
definition of  medical care and  includes mental health  care and                                                               
care  for alcoholism  and substance  abuse in  the definition  of                                                               
"medical  care" for  insurance purposes.  Section  9 repeals  the                                                               
definition  of  "medical  and surgical  benefits"  applicable  to                                                               
health insurance, which excludes  mental health benefits. It also                                                               
repeals the definition of "mental  health benefits," which allows                                                               
the  term to  be defined  in a  health care  insurance plan,  and                                                               
which  excludes   treatment  of   substance  abuse   or  chemical                                                               
dependency. Section 10  states that the act  applies to insurance                                                               
issued after  the effective  date of the  act. Section  11 states                                                               
that  the act  applies to  insurance issued  after the  effective                                                               
date of the act. Section 11 states an effective date.                                                                           
1:55:00 PM                                                                                                                    
MR.  OBERMEYER  explained that  SB  52  tries to  recognize  that                                                               
mental health conditions  must be defined in the  DSM manual, and                                                               
he asked DSHS to confirm  that those disorders are defined there.                                                               
From a policy standpoint, SB  52 recognizes that these conditions                                                               
should be  treated under health  plans the same as  other medical                                                               
conditions. He  noted that DUI  wellness court clients  have been                                                               
found to be medically (chemically)  dependent. It is only fair to                                                               
treat  these conditions  the same  as other  conditions. Treating                                                               
them otherwise is discriminatory.                                                                                               
SENATOR  MEYER asked  if he  had any  idea what  this would  cost                                                               
small business.                                                                                                                 
MR.  OBERMEYER  answered  that the  fiscal  note  indicates  some                                                               
anticipated costs. He  assumes that if law were  put into effect,                                                               
fewer employers  might offer insurance  or fewer  employees might                                                               
enroll. They don't have good  numbers, but other states have done                                                               
this.  There  must be  some  ability  to justify  the  additional                                                               
costs,  because  46  states  have   some  type  of  parity  laws,                                                               
including  28   that  require  full  parity   for  mental  health                                                               
CHAIR  DAVIS said  we  don't know  how much  it  will cost  small                                                               
business. But  we do know  that parity  is possible. In  the long                                                               
run it  may end  up saving  money. We  should provide  parity for                                                               
people with  mental illness simply  because it's the  right thing                                                               
to do.                                                                                                                          
SENATOR MEYER said he did not disagree with that.                                                                               
CHAIR  DAVIS said  there  is no  way of  knowing  the cost.  Many                                                               
employers who  don't have  to provide  this coverage  are already                                                               
doing it.                                                                                                                       
SENATOR  EGAN  noted  that  if   a  small  business  participates                                                               
already, the bill would not affect them.                                                                                        
MR. OBERMEYER  said if  a private  company has  a plan  in effect                                                               
now, the bill  says they would have to have  full parity. If they                                                               
don't have a plan  now and they elect not to  have one, then they                                                               
are not  required to  have mental health  parity. This  bill says                                                               
you must have full parity for  mental health coverage if you have                                                               
a plan.                                                                                                                         
2:03:09 PM                                                                                                                    
SENATOR  MEYER said  the federal  Mental Health  Parity Addiction                                                               
Act says any employer with fewer  than 50 employees is exempt. SB                                                               
52 says  any employer with more  than 5 must participate,  and he                                                               
wondered why that number was chosen.                                                                                            
MR. OBERMEYR said he was not sure.                                                                                              
DENNIS  BAILEY, Attorney,  Legislative  Legal  Services, said  he                                                               
doesn't  know where  the number  came from  or why  it is  in the                                                               
CHAIR  DAVIS stated,  "We can  see  we have  work to  do on  this                                                               
bill." She said  she was not sure what the  number should be, but                                                               
the issue needs to be addressed.                                                                                                
SENATOR  MEYER asked  if substance  abuse and  mental health  are                                                               
typically lumped together.                                                                                                      
MR. OBERMEYER  said that DSHS  has experts on this  question, and                                                               
the  DSM   manual  defines   these  conditions.   Alcoholism  and                                                               
substance abuse are now considered mental health disorders.                                                                     
SENATOR MEYER  asked if  this bill would  be able  to distinguish                                                               
between mental health claims and substance abuse claims.                                                                        
MR. OBERMEYER  said they  would both be  included under  the same                                                               
DENNIS BAILEY said that he did  not have a definitive answer, but                                                               
looking  at information  on  DSM standards  he  thinks there  are                                                               
separate  designations of  a disorder  that  are alcohol  related                                                               
versus other disorders  that are non-alcohol related.  They are a                                                               
sub-category of mental illness.                                                                                                 
2:09:29 PM                                                                                                                    
CHAIR DAVIS said  there was someone present from  the Division of                                                               
Behavioral Health.                                                                                                              
2:10:32 PM                                                                                                                    
BRENDA  KNAPP,  Treatment  and  Recovery  Program  Administrator,                                                               
Division  of Behavioral  Health (DBH),  Department of  Health and                                                               
Social Services (DSHS)  said her purpose was  to answer questions                                                               
on the  fiscal note. DSHS submitted  a zero fiscal note.  The DBH                                                               
recognizes  the value  of having  insurance  coverage for  mental                                                               
health and substance abuse issues.  Looking at the impact of this                                                               
parity  bill with  regard  to  a fiscal  note,  research did  not                                                               
indicate a significant cost increase or savings.                                                                                
2:11:51 PM                                                                                                                    
SENATOR DYSON joined the meeting.                                                                                               
SENATOR  MEYER asked  if  SB 52  would have  much  impact to  the                                                               
state,  and  noted   that  impacts  would  be   mostly  to  small                                                               
businesses, whether anything under 50 or over 5 employees.                                                                      
MS. KNAPP answered that DSHS would  not track that. They would be                                                               
tracking Medicaid  expenditures, reduced need for  treatment paid                                                               
by DSHS,  increased need for treatment  facilities and oversight.                                                               
The bill would not impact them directly at this time.                                                                           
SENATOR MEYER said you might actually see a decrease.                                                                           
MS. KNAPP answered that she was not an insurance expert.                                                                        
SENATOR  MEYER asked  if the  Division of  Insurance has  taken a                                                               
MS. KNAPP answered she was not aware that they had.                                                                             
CHAIR  DAVIS said  they usually  remain neutral,  but we  can ask                                                               
that they come forward.                                                                                                         
SENATOR MEYER said he was referring to Linda Hall.                                                                              
CHAIR DAVIS said the committee could  ask her to come to the next                                                               
2:15:55 PM                                                                                                                    
SENATOR  EGAN asked  if a  small  business does  not have  health                                                               
insurance for  their employees, would  this bill require  them to                                                               
provide insurance.                                                                                                              
CHAIR DAVIS said  if you have a  plan you have to  do things, but                                                               
the bill is not saying you have to get a plan.                                                                                  
SENATOR DYSON  noted on page 2,  line 19, there would  seem to be                                                               
one factor that makes employers  reluctant to have parity because                                                               
a diagnosis of  mental illness is more subjective.  The bill says                                                               
an  insurer may  not  use  or require  notification  or a  second                                                               
opinion. He  stated he would  enjoy knowing why a  second opinion                                                               
was excluded.                                                                                                                   
CHAIR DAVIS said they could list  this as an area of concern. She                                                               
said they would look into this area.                                                                                            
SENATOR  DYSON  asked  about the  meaning  of  fraternal  benefit                                                               
society as used in SB 52.                                                                                                       
DENNIS BAILEY  said that a  fraternal benefit society is  a group                                                               
that provides benefits  for its members, such as  the Moose Lodge                                                               
or  the Elks  Lodge,  where  they may  give  some insurance  type                                                               
benefits to their members. These  are categorized separately from                                                               
a normal health insurer.                                                                                                        
SENATOR  DYSON said  some  unions,  including those  representing                                                               
public employees, have their own  health benefit plans, and asked                                                               
if they would be required to comply.                                                                                            
MR. BAILEY  said he had some  ideas on the question,  but felt it                                                               
should be directed to the Division of Insurance.                                                                                
CHAIR DAVIS announced  that SB 52 would be held  in committee for                                                               
further consideration.                                                                                                          
2:22:11 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair Davis adjourned the meeting at 2:22 p.m.                                                                                  

Document Name Date/Time Subjects
SB 52 Sectional Summary 2-21-2011.pdf SHSS 2/28/2011 1:30:00 PM
SB 52
SB 52 Sponsor Statement Rev 2-12-2011 docx.pdf SHSS 2/28/2011 1:30:00 PM
SB 52
SB 52 Suport Docs - Legal Svcs Memo 091010.pdf SHSS 2/28/2011 1:30:00 PM
SB 52
SB 52 Support Docs - NCSL State Comparisons 2010.pdf SHSS 2/28/2011 1:30:00 PM
SB 52
SB 52 Support Docs-DSM-IV-TR - Diag Man Mental Disorders.pdf SHSS 2/28/2011 1:30:00 PM
SB 52
SB 52 Support Docs-MH Parity -42 USCS 300gg-23 preemption.pdf SHSS 2/28/2011 1:30:00 PM
SB 52
SB 52 Support Docs-MH Parity-42 USCS 300gg-26-subst abus (3).pdf SHSS 2/28/2011 1:30:00 PM
SB 52
SB 52 Bill.pdf SHSS 2/28/2011 1:30:00 PM
SB 52