Legislature(2011 - 2012)BUTROVICH 205

03/19/2012 01:30 PM HEALTH & SOCIAL SERVICES

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01:36:22 PM Start
01:36:43 PM Presentation: Alaska Brain Injury Network
02:28:43 PM SB5
02:37:27 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Presentation - Alaska Brain Injury Network, TELECONFERENCED
Dr. Heather Macomber, Board Member
Bills Previously Heard/Scheduled
Heard & Held
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         March 19, 2012                                                                                         
                           1:36 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Senator Bettye Davis, Chair                                                                                                     
Senator Dennis Egan                                                                                                             
Senator Kevin Meyer                                                                                                             
MEMBERS ABSENT                                                                                                                
Senator Johnny Ellis                                                                                                            
Senator Fred Dyson                                                                                                              
COMMITTEE CALENDAR                                                                                                            
PRESENTATION: ALASKA BRAIN INJURY NETWORK                                                                                       
     - HEARD                                                                                                                    
SENATE BILL NO. 5                                                                                                               
"An Act relating to eligibility requirements for medical                                                                        
assistance for certain children and pregnant women; and                                                                         
providing for an effective date."                                                                                               
     - HEARD AND HELD                                                                                                           
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: SB  5                                                                                                                   
SHORT TITLE: MEDICAL ASSISTANCE ELIGIBILITY                                                                                     
SPONSOR(s): SENATOR(s) DAVIS, EGAN, ELLIS, FRENCH, 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                                                                                               
03/07/11       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/07/11       (S)       Heard & Held                                                                                           
03/07/11       (S)       MINUTE(HSS)                                                                                            
03/23/11       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/23/11       (S)       Heard & Held                                                                                           
03/23/11       (S)       MINUTE(HSS)                                                                                            
03/28/11       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/28/11       (S)       Moved SB   5 Out of Committee                                                                          
03/28/11       (S)       MINUTE(HSS)                                                                                            
03/30/11       (S)       HSS RPT 3DP 1DNP 1AM                                                                                   
03/30/11       (S)       DP: DAVIS, ELLIS, EGAN                                                                                 
03/30/11       (S)       DNP: DYSON                                                                                             
03/30/11       (S)       AM: MEYER                                                                                              
04/08/11       (S)       FIN AT 9:00 AM SENATE FINANCE 532                                                                      
04/08/11       (S)       Heard & Held                                                                                           
04/08/11       (S)       MINUTE(FIN)                                                                                            
04/11/11       (S)       FIN RPT  4DP 2NR                                                                                       
04/11/11       (S)       DP: HOFFMAN, THOMAS, EGAN, ELLIS                                                                       
04/11/11       (S)       NR: STEDMAN, OLSON                                                                                     
04/11/11       (S)       FIN AT 9:00 AM SENATE FINANCE 532                                                                      
04/11/11       (S)       Moved SB   5 Out of Committee                                                                          
04/11/11       (S)       MINUTE(FIN)                                                                                            
04/14/11       (S)       RETURNED TO RLS COMMITTEE                                                                              
03/16/12       (S)       RETURNED TO HSS COMMITTEE                                                                              
03/19/12       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
WITNESS REGISTER                                                                                                              
Dr. Heather Macomber, Board Member                                                                                              
Alaska Brain Injury Network (ABIN)                                                                                              
Anchorage, Alaska,                                                                                                              
POSITION STATEMENT: Presented information on the Alaska Brain                                                                 
Injury Network.                                                                                                                 
THOMAS OBERMEYER, Staff                                                                                                         
Senator Bettye Davis                                                                                                            
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Explained the changes in version I of SB 5                                                                
on behalf of the sponsor.                                                                                                       
ACTION NARRATIVE                                                                                                              
1:36:22 PM                                                                                                                    
CHAIR BETTYE DAVIS called the Senate Health and Social Services                                                               
Standing Committee meeting to order at 1:36 p.m. Present at the                                                                 
call to order were Senators Egan, Meyer, and Chair Davis.                                                                       
^Presentation: Alaska Brain Injury Network                                                                                      
           Presentation: Alaska Brain Injury Network                                                                        
CHAIR DAVIS announced the first order of business was a                                                                         
presentation by the Alaska Brain Injury Network.                                                                                
1:36:43 PM                                                                                                                  
DR. HEATHER  MACOMBER, Board Member, Alaska  Brain Injury Network                                                               
(ABIN), presented  information related to ABIN.  She related that                                                               
AlaskaNeuro Associates  has been managing the  concussion program                                                               
for the Anchorage  School District since [HB  15] was implemented                                                               
last year. She explained the  definition of sports concussion and                                                               
listed facts related to them.                                                                                                   
She  said  that  sports  concussion   is  defined  as  a  complex                                                               
pathophysiological  process  affecting   the  brain,  induced  by                                                               
traumatic biomechanical forces. They  are self-resolving and most                                                               
that  occur do  not have  a loss  of consciousness.  Athletes who                                                               
have  sustained concussions  are  4  to 6  times  more likely  to                                                               
sustain a second concussion. Most concussions occur in football.                                                                
She related  that concussion awareness  has been  developing over                                                               
the past  ten years.  Similar programs  have been  implemented in                                                               
the  Lower 48.  The Center  for Disease  Control (CDC)  considers                                                               
concussions  at an  epidemic level.  It is  important to  protect                                                               
student athletes  because their  brains are still  developing and                                                               
they are vulnerable to lasting effects of a concussion.                                                                         
DR.  MACOMBER  described the  mechanism  of  concussions and  the                                                               
neurometabolic change of concussions.  She listed a concussion as                                                               
a metabolic injury which does not show up on a MRI.                                                                             
She  addressed  why concussion  management  is  important. It  is                                                               
important to prevent  cumulative effects of the  injury and allow                                                               
players  to   return  quickly  and   safely  to   play.  Sideline                                                               
assessment  helps   identify  when  to  seek   immediate  medical                                                               
attention. Second impact  syndrome happens rarely, but  it can be                                                               
fatal.  Most  often second  impact  syndrome  occurs in  athletes                                                               
younger than 21  years old. There is an increase  in the risks of                                                               
concussions with more  than one; each concussion  is more serious                                                               
and the recovery is longer.                                                                                                     
DR.  MACOMBER  addressed  the  common  immediate  post-concussive                                                               
symptoms;  emotional, cognitive,  physical,  and sleep  problems.                                                               
Most concussions recover in a couple of weeks.                                                                                  
DR. MACOMBER stressed that an  athlete cannot be trusted to self-                                                               
report because they want to continue  to play the sport. She said                                                               
that when the  word "concussion" is removed  from the questioning                                                               
of an  athlete about  his or  her injury,  the rate  of reporting                                                               
increases dramatically.  She showed a  quotation from a  New York                                                               
Times  article: "Anonymous  questionnaires that  ask specifically                                                               
about concussions have reported  rates among high school football                                                               
players  at  about   15  percent  each  season;   when  the  word                                                               
concussion is omitted  and a description of  symptoms is provided                                                               
instead, close  to 50 percent of  players say they had  one, with                                                               
35 percent reporting two or more."                                                                                              
She  described former  neurology  guidelines  and new  concussion                                                               
management  guidelines. Too  much weight  was given  for loss  of                                                               
consciousness in  the past. She  listed five steps  of concussion                                                               
management: remove symptomatic athletes  from play, restrict them                                                               
from  play when  they  are symptomatic,  graduate  the return  to                                                               
play,   provide  neurocognitive   testing,   and  recognize   the                                                               
differences when testing children.                                                                                              
DR. MACOMBER  discussed the neuropsychology role  in working with                                                               
concussion  victims   by  using  the   Immediate  Post-Concussion                                                               
Assessment  and Cognitive  Testing (ImPACT)  method. She  related                                                               
that  ABIN is  the only  entity using  this assessment  tool. She                                                               
explained that ImPact is a 20  to 25 minute test covering a range                                                               
of symptoms.  She listed  the entities that  use ImPACT,  such as                                                               
the   military,  professional   sports,   colleges,  and   school                                                               
districts. She showed a graph  listing the unique contribution of                                                               
neurocognitive  testing to  concussion management.  She concluded                                                               
that the test reveals insight into concussions.                                                                                 
DR.  MACOMBER   talked  about  the  ImPACT   "Bell-Ringer"  study                                                               
consisting  of 64  high school  athletes with  "mild" concussions                                                               
and no loss  of consciousness. Two groups were  compared in terms                                                               
of outcome.                                                                                                                     
She pointed out that post-traumatic  migraine is a common symptom                                                               
following  sports  concussions.   She  addressed  the  cumulative                                                               
effects of  more than one  concussion. Evidence exists  that more                                                               
than  three  concussions  is   associated  with  ongoing  adverse                                                               
effects in some athletes. She shared additional ImPACT research.                                                                
1:50:56 PM                                                                                                                    
DR. MACOMBER  related the  clinical protocol  with neurocognitive                                                               
testing.   She    described   baseline    pre-testing,   sideline                                                               
assessment, and  principles of sideline assessment,  which are to                                                               
remove the athlete  from distracting activity and  people, try to                                                               
maintain their full  attention, speak in a loud  and clear voice,                                                               
and have the  athlete perform all tasks listed  on the assessment                                                               
card. If  they fail  any questions, they  cannot return  to play.                                                               
Sideline assessment  is completed  by a coach,  athletic trainer,                                                               
EMT, or  someone who  knows the signs  of a  concussion. Athletes                                                               
with severe signs go directly to the ER.                                                                                        
DR.  MACOMBER  showed a  card  containing  the best  approach  to                                                               
concussion management  that can be  used by coaches.  It contains                                                               
on-field cognitive  testing. She  showed an  example of  the pre-                                                               
test protocol. She gave examples of a design memory test.                                                                       
1:56:36 PM                                                                                                                    
DR. MACOMBER reported on the Anchorage School District post-                                                                    
injury  protocol.  She  described  how  the  injured  student  is                                                               
assessed. She  listed steps in  the return-to-play  protocol. She                                                               
gave examples of what injured athletes can and cannot do.                                                                       
DR. MACOMBER stressed  what ImPACT will do when  used properly by                                                               
trained  professionals. It  will  determine the  severity of  the                                                               
concussion,   provide  valuable   information  to   the  athlete,                                                               
parents, athletic  trainers, physicians, and  teachers, determine                                                               
when  it is  safe to  return to  play, and  reduce liability  for                                                               
school districts.                                                                                                               
She  said  the  ImPACT  process is  a  team  collaboration  where                                                               
coordination   between   parents,  coaches,   nurses,   teachers,                                                               
counselors, and the student is critical.                                                                                        
DR. MACOMBER talked about why  schools choose ImPACT; concussions                                                               
are one of  the most serious medical problems at  the high school                                                               
level,  proper management  of  concussions is  the  best form  of                                                               
prevention of serious injury,  litigation for improper management                                                               
of concussions can be avoided, and  it creates a team approach to                                                               
concussion management.                                                                                                          
She  shared current  Anchorage School  District  (ASD) data.  ASD                                                               
middle  and   high  school  students  completed   8,354  baseline                                                               
assessments and there were 30  post-injury tests. She opined that                                                               
there should  be more post-injury  tests: however, it is  a brand                                                               
new  program   and  students  are  reluctant   to  discuss  their                                                               
symptoms. Also,  some parents  and coaches  are unhappy  with the                                                               
DR. MACOMBER spoke of challenges to the program such as under-                                                                  
reporting of concussions and the  poor roll-out of the program by                                                               
schools.   Some   coaches   did  not   cooperate   and   students                                                               
underreported  injuries   due  to  fear   of  prolonged/excessive                                                               
restriction. Teachers and support  staff were sometimes unwilling                                                               
to meet  students' needs or  grant accommodations. A  few coaches                                                               
directed  students  to  re-take  baselines  in  order  to  assess                                                               
concussion  themselves,  despite  having   no  training  in  this                                                               
regard.  Some  students  deliberately  performed  poorly  on  the                                                               
baseline, with the goal of being  returned to play faster after a                                                               
concussion.   Some  baselines   were   conducted  in   suboptimal                                                               
conditions, resulting in low scores  that do not reflex students'                                                               
true abilities.                                                                                                                 
DR. MACOMBER  spoke of financial  and insurance  constraints such                                                               
as  under-insured or  uninsured students,  higher co-pays,  codes                                                               
denied  or   insurance  unwilling  to  pay   for  assessment,  no                                                               
additional resources  available to alleviate  patients' financial                                                               
burdens, and no insurance available.                                                                                            
2:07:35 PM                                                                                                                    
DR. MACOMBER reviewed the key points from the presentation.                                                                     
DR.  MACOMBER  showed a  video  -  Sports Concussions  Are  Brain                                                               
2:14:10 PM                                                                                                                    
CHAIR DAVIS  pointed out that  some parents agree and  some don't                                                               
agree with the  ImPACT assessment. She wondered  how accurate the                                                               
numbers were that were obtained from the school district.                                                                       
DR. MACOMBER said that all schools differ in their reporting.                                                                   
CHAIR DAVIS asked what happens when neglect has occurred.                                                                       
DR.  MACOMBER replied  that  AlaskaNeuro Associates  communicates                                                               
with the schools  about any reported problem. The  schools try to                                                               
address the problem internally.                                                                                                 
CHAIR DAVIS  suggested legislation  might be  the answer  to this                                                               
dilemma. She  stressed that she  was concerned about  the school-                                                               
age population. She asked where the grant money comes from.                                                                     
DR. MACOMBER  offered to provide  that information.  She recalled                                                               
that  a student  had applied  to  an agency  called LINKS,  which                                                               
turned out to be for those who were older than 18.                                                                              
CHAIR DAVIS asked if students  were required to have insurance in                                                               
order to play sports.                                                                                                           
DR. MACOMBER said no.                                                                                                           
2:17:56 PM                                                                                                                    
SENATOR EGAN asked why a parent would be against this program.                                                                  
DR. MACOMBER  listed various  reasons. Some  of the  parents felt                                                               
they  were  being forced  into  the  program  or that  their  own                                                               
physician should determine the plan  for evaluation and treatment                                                               
of a concussion.                                                                                                                
SENATOR EGAN  pointed out that  this type of assessment  is being                                                               
done in professional and high school sports.                                                                                    
DR. MACOMBER  said Alaska was one  of the last state's  to have a                                                               
program. She described how the program came to be.                                                                              
2:19:55 PM                                                                                                                    
SENATOR MEYER asked for DR. MACOMBER's background.                                                                              
DR. MACOMBER said she was a neuropsychologist.                                                                                  
SENATOR MEYER asked if she specialized in brain injuries.                                                                       
DR. MACOMBER said she did.                                                                                                      
SENATOR MEYER inquired  if concussions are brain  injuries and if                                                               
they can cause permanent damage.                                                                                                
DR. MACOMBER replied that a  concussion is considered the mildest                                                               
form of  a brain injury and  usually resolves itself, but  it can                                                               
cause permanent damage.                                                                                                         
SENATOR MEYER asked if the brain can be surgically fixed.                                                                       
DR. MACOMBER  gave examples of  the instances when  surgery could                                                               
be used;  however, she said  most concussions just  require rest.                                                               
She described the role of glucose in the brain.                                                                                 
SENATOR  MEYER  related  concussions to  Fetal  Alcohol  Spectrum                                                               
2:22:11 PM                                                                                                                    
SENATOR  MEYER   wanted  to  know  if   treatment  protocols  for                                                               
concussions were practiced statewide.                                                                                           
DR. MACOMBER did not know.                                                                                                      
SENATOR MEYER suggested making the  program standard for all high                                                               
DR. MACOMBER said the state standard  now is that an athlete must                                                               
be cleared by a person  certified in concussion management before                                                               
he  or  she  can  play again.  She  described  the  credentialing                                                               
program and who can deliver the program.                                                                                        
SENATOR MEYER  asked if athletic  trainers are qualified  to make                                                               
the assessment.                                                                                                                 
DR.  MACOMBER said  they were  not  because they  don't have  the                                                               
training. She gave an example and discussed the liability issue.                                                                
SENATOR  MEYER  restated  the  question  to  ask  about  sideline                                                               
DR. MACOMBER related  that trainers and coaches  could be trained                                                               
to do  those assessments.  She described  how the  information is                                                               
shared with the school district.                                                                                                
2:25:56 PM                                                                                                                    
CHAIR  DAVIS asked  if  AlaskaNeuro reports  back  to the  school                                                               
district and the Department of Education.                                                                                       
DR. MACOMBER  explained they report  to the school  district, but                                                               
not the Department of Education.                                                                                                
CHAIR DAVIS stated  that the issue of  concussion treatment needs                                                               
more work in the state.                                                                                                         
DR.  MACOMBER  opined that  the  bill  was  a start.  Over  8,000                                                               
students have baseline data.                                                                                                    
SENATOR MEYER asked who makes up AlaskaNeuro Associates.                                                                        
DR. MACOMBER  replied that  it was just  herself and  Dr. Cherry.                                                               
She said  Alaska is underserved  by neuropsychologists  with only                                                               
six  in  the  state.  It  is challenging  if  Medicaid  does  not                                                               
reimburse  for   services  or   TriCare  does   not  preauthorize                                                               
CHAIR DAVIS asked if TriCare is military insurance.                                                                             
DR. MACOMBER  said it  was. She  reported that  private insurance                                                               
does reimburse.                                                                                                                 
              SB 5-MEDICAL ASSISTANCE ELIGIBILITY                                                                           
2:28:43 PM                                                                                                                    
CHAIR DAVIS announced that SB 5 was before the committee.                                                                       
SENATOR EGAN  moved to adopt  the proposed  CS for SB  5, labeled                                                               
27-LS0057\I, as the work draft before the committee.                                                                            
CHAIR DAVIS objected for discussion purposes.                                                                                   
THOMAS OBERMEYER,  staff to Senator  Bettye Davis, sponsor  of SB                                                               
5, explained the  changes in version I. The changes  were made in                                                               
response to requests from the  Senate to increase the 200 percent                                                               
federal poverty  guideline only for  children [12 and  under], so                                                               
that there would  be less opposition to  including pregnant women                                                               
and children 13 through 19 in the increase.                                                                                     
He  addressed changes  in  the bill.  The title  of  the bill  no                                                               
longer includes  pregnant women. Women  and children 13  and over                                                               
are  covered  at  175  percent   of  the  federal  poverty  line.                                                               
Subsection 16  on page 4 of  the bill is entirely  new. It reads,                                                               
"persons under 13  years of age who are not  covered under (a) of                                                               
this  section and  whose  household income  does  not exceed  200                                                               
percent  of the  federal poverty  line as  defined by  the United                                                               
Sates Department of  Health and Human Services  and revised under                                                               
42 U.S.C. 9902(2)."                                                                                                             
MR. OBERMEYER  said these changes  were made to  address concerns                                                               
by  the  department,  the governor,  and  others,  regarding  the                                                               
possibility of  abortions. The bill  would add 968  more children                                                               
to the Denali KidCare Program who otherwise would be uninsured.                                                                 
2:33:11 PM                                                                                                                    
SENATOR MEYER  assumed there  had been  no pregnancies  under the                                                               
age of 13.                                                                                                                      
MR. OBERMAYER opined that it would be extremely rare.                                                                           
CHAIR DAVIS  said it was a  possibility, but she did  not know of                                                               
any. She offered  to provide that information;  however, she said                                                               
the numbers would be difficult to attain.                                                                                       
MR. OBERMEYER corrected a previous statement to say "under 13."                                                                 
CHAIR DAVIS clarified that the changes  in the bill are small and                                                               
it  now covers  ages zero  to 12  only. She  understood that  the                                                               
federal government will now pay the full 70 percent match.                                                                      
MR. OBERMEYER pointed out that  the fiscal notes were drafted for                                                               
the previous  version of  the bill. He  explained that  after the                                                               
committee adopts version  I, the Department of  Health and Social                                                               
Services will draft new fiscal notes.                                                                                           
MR. OBERMEYER emphasized that only children would be counted in                                                                 
the new fiscal notes.                                                                                                           
CHAIR DAVIS noted that the committee had adopted version I of SB                                                                
5. She requested new fiscal notes by Wednesday. [SB 5 was held                                                                  
in committee.]                                                                                                                  
2:37:27 PM                                                                                                                    
There being no further business to come before the committee,                                                                   
Chair Davis adjourned the Senate Health and Social Services                                                                     
Standing Committee at 2:37 p.m.                                                                                                 

Document Name Date/Time Subjects
Alaska Brain Injury Network.pptx SHSS 3/19/2012 1:30:00 PM