Legislature(2017 - 2018)BUTROVICH 205

03/13/2017 01:30 PM HEALTH & SOCIAL SERVICES

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Heard & Held
-- Public Testimony --
Heard & Held
-- Public Testimony --
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         March 13, 2017                                                                                         
                           1:31 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Senator David Wilson, Chair                                                                                                     
Senator Natasha von Imhof, Vice Chair                                                                                           
Senator Cathy Giessel                                                                                                           
Senator Peter Micciche                                                                                                          
Senator Tom Begich                                                                                                              
MEMBERS ABSENT                                                                                                                
All members present                                                                                                             
COMMITTEE CALENDAR                                                                                                            
SENATE BILL NO. 53                                                                                                              
"An  Act relating  to insurance  coverage for  contraceptives and                                                               
related  services; relating  to medical  assistance coverage  for                                                               
contraceptives  and  related  services;   and  providing  for  an                                                               
effective date."                                                                                                                
     - HEARD & HELD                                                                                                             
SENATE BILL NO. 91                                                                                                              
"An Act extending the governor's declaration of disaster                                                                        
emergency to address the opioid epidemic; and providing for an                                                                  
effective date."                                                                                                                
     - HEARD & HELD                                                                                                             
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: SB 53                                                                                                                   
SHORT TITLE: INSURANCE COVERAGE FOR CONTRACEPTIVES                                                                              
SPONSOR(s): GARDNER                                                                                                             
02/10/17       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/10/17       (S)       HSS, L&C                                                                                               
03/13/17       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
BILL: SB 91                                                                                                                   
SHORT TITLE: EXTEND DISASTER EMERGENCY: OPIOID EPIDEMIC                                                                         
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
03/10/17       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/10/17       (S)       HSS                                                                                                    
03/13/17       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
WITNESS REGISTER                                                                                                              
SENATOR BERTA GARDNER                                                                                                           
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Sponsor of SB 53, provided an overview.                                                                   
JONATHON CHURCH, Staff                                                                                                          
Senator Gardner                                                                                                                 
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Provided a sectional overview of SB 53.                                                                   
MEGAN WALLACE, Attorney                                                                                                         
Legislative Affairs Agency                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Addressed questions regarding SB 53.                                                                      
DR. JAY BUTLER, Chief Medical Officer                                                                                           
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Provided an overview of SB 91.                                                                            
STACY KRALY, Chief Assistant Attorney General                                                                                   
Alaska Department of Law                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Addressed bill-drafting questions regarding                                                               
SB 91.                                                                                                                          
ANDREW JONES, Section Chief, Emergency Programs: Health                                                                         
Emergency Response Operations, EMS and Trauma                                                                                   
Division of Public Health                                                                                                       
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Answered questions regarding SB 91 and the                                                                
administering of overdose kits.                                                                                                 
KARA NELSON, co-founder                                                                                                         
Juneau Recovery Community Organization                                                                                          
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 91.                                                                            
MICHAEL CARSON, Vice President                                                                                                  
MyHouse Mat-Su                                                                                                                  
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT: Testified in support of SB 91.                                                                            
MIKE COONS, representing self                                                                                                   
Palmer, Alaska                                                                                                                  
POSITION STATEMENT: Testified in opposition of SB 91.                                                                         
JOHN GREEN, representing himself                                                                                                
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT: Testified in support of SB 91.                                                                            
ACTION NARRATIVE                                                                                                              
1:31:58 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:31 p.m.  Present at the                                                               
call  to   order  were  Senators  Begich,   von  Imhof,  Giessel,                                                               
Micciche, and Chair Wilson.                                                                                                     
          SB 53-INSURANCE COVERAGE FOR CONTRACEPTIVES                                                                       
1:32:37 PM                                                                                                                    
CHAIR WILSON announced the consideration of SB 53.                                                                              
1:32:43 PM                                                                                                                    
SENATOR BERTA GARDNER, Alaska State Legislature, Juneau, Alaska,                                                                
provided a sponsor's statement on SB 53 as follows:                                                                             
     SB 53 is,  we believe, a cost-saving  measure that will                                                                    
     help improve  the lives of  women in families.  What it                                                                    
     does simply  is it  requires that  health-care insurers                                                                    
     in  the state  of Alaska  allow for  coverage of  a 12-                                                                    
     month   supply  of   contraceptives,  self-administered                                                                    
     hormonal-contraceptive patches at one time.                                                                                
     Some   of   you   may  be   aware   that   prescription                                                                    
     contraceptives  require  that  a woman  return  to  her                                                                    
     provider or to a pharmacy  for refills sometimes in one                                                                    
     month,    sometimes    in    three-month    increments.                                                                    
     Contraceptives have been  used for a long  time and are                                                                    
      known to be safe we think should be available in 12-                                                                      
     month increments.                                                                                                          
     Many  women  in  Alaska  don't   have  the  ability  to                                                                    
     consistently  get to  their providers  for appointments                                                                    
     either because  of work,  location, or  school. One-in-                                                                    
     four women report missing a  pill because they couldn't                                                                    
     get  the  refill  pack  in  time.  Ensuring  consistent                                                                    
     access  to  birth   control  gives  individuals  better                                                                    
     ability  to   control  when   and  whether   they  have                                                                    
     children,  it gives  them more  career and  educational                                                                    
     opportunities and reduces the  likelihood that they end                                                                    
     up  needing government  assistance.  With perfect  use,                                                                    
     hormonal birth control  has a success rate  of about 95                                                                    
     The  data that  we have  that we  are relying  on comes                                                                    
     from  2010 that  says,  "In Alaska  48  percent of  all                                                                    
     pregnancies were  unintended; of those  pregnancies, 60                                                                    
     percent resulted in birth, 26  percent in abortion, and                                                                    
     the    remainder    were    miscarriages.    Unintended                                                                    
     pregnancies have  a drastic impact on  the wellbeing of                                                                    
     Alaskan  women and  families, and  are associated  with                                                                    
     adverse maternal  and child health outcomes,  and along                                                                    
     with health concerns,  unintended pregnancies are major                                                                    
     cost  drivers to  Alaska's  public-health programs.  In                                                                    
     2010, public-funded unintended  pregnancies cost Alaska                                                                    
     almost $43 million.                                                                                                        
     When contraceptives are  more readily available, Alaska                                                                    
     will  see  a  reduction  in the  number  of  unintended                                                                    
     pregnancies and abortions  which will ultimately result                                                                    
     in a cost savings to the state.                                                                                            
1:35:39 PM                                                                                                                    
JONATHON   CHURCH,   Staff,   Senator   Gardner,   Alaska   State                                                               
Legislature, Juneau, Alaska, provided supportive data on SB 53                                                                  
as follows:                                                                                                                     
     One  of  the studies  in  your  packet followed  84,000                                                                    
     women in California who were  given various supplies of                                                                    
     contraceptives:  one-month  supply, three  months,  and                                                                    
     one  year. Researches  of that  study found  that women                                                                    
     given a  one-year supply saw a  30-percent reduction in                                                                    
     the odds of  having conceived a pregnancy as  well as a                                                                    
     46-percent  reduction   in  the   odds  of   having  an                                                                    
     abortion. Had the  remainder of the women  in the study                                                                    
     been  given  a  one-year   supply,  an  estimated  1300                                                                    
     publicly  funded births  and 300  abortions would  have                                                                    
     been avoided.                                                                                                              
     We have  heard some  concerns about  the issue  of pill                                                                    
     waste  due  to  improper storage  or  possible  illegal                                                                    
     selling.  According  to  the CDC,  oral  contraceptives                                                                    
     have a shelf  life of three to five  years depending on                                                                    
     the manufacturer;  this timeline can be  diminished due                                                                    
     to humidity  or temperature, but we  believe that women                                                                    
     that opt  for a  12-month supply  of birth  control and                                                                    
     who are  regular users of oral  contraceptives know how                                                                    
     to store their medications.                                                                                                
     The  study from  California also  found that  women who                                                                    
     were   dispensed   the    one-year   supply   of   oral                                                                    
     contraceptives  wasted on  average  one cycle.  Wasting                                                                    
     one cycle is rather  insignificant compared to the cost                                                                    
     of clinic  and pharmacy visits  as well as the  cost of                                                                    
     unintended  pregnancies.  In  the unlikely  event  that                                                                    
     women  do  start  selling-off hormonal  birth  control,                                                                    
     there are  already criminal statutes  in place  to deal                                                                    
     with  that behavior.  Senate Bill  53  would also  make                                                                    
     birth   control   more  readily   available   therefore                                                                    
     decreasing the need for any sort of black market.                                                                          
MR. CHURCH provided a sectional analysis on SB 53 as follows:                                                                   
Section 1:                                                                                                                  
Amends  AS  21.42 by  adding  a  new  section, AS  21.42.427.  AS                                                               
21.42.427  requires  a  health  care insurer,  in  the  group  or                                                               
individual  market,  that   provides  coverage  for  prescription                                                               
contraceptives   to   provide    reimbursement   for   dispensing                                                               
prescription   contraceptives  for   a  12-   month  period.   AS                                                               
21.42.427(b)-(g) contains other  related compliances and coverage                                                               
provisions. Also provides provision  for allowing for a religious                                                               
organization  that  is  not required  to  provide  contraceptives                                                               
under the  Affordable Care Act  would also be exempt  from having                                                               
to provide contraceptives.                                                                                                      
Section 2:                                                                                                                  
Amends  AS 47.07.065  by adding  new  subsections (b)-(d),  which                                                               
require the Department  of Health and Social Services  to pay for                                                               
prescription  contraceptives  intended  to last  for  a  12-month                                                               
period  for   eligible  recipients  of  medical   assistance,  if                                                               
prescribed to and requested by the  recipient, as well as pay for                                                               
specified related services.                                                                                                     
Section 3:                                                                                                                  
Requires the  Department of Health  and Social Services  to amend                                                               
and  submit  for  federal  approval  a  state  plan  for  medical                                                               
assistance coverage consistent with sec. 2 of this act.                                                                         
Section 4:                                                                                                                  
Provides  that sec.  2  of  this Act  takes  effect  only if  the                                                               
provisions of sec. 2 of this Act receive federal approval.                                                                      
Section 5:                                                                                                                  
Provides that if sec. 2 of  the Act takes effect, it takes effect                                                               
the day  after the commissioner  of the Department of  Health and                                                               
Social  Services makes  certification of  federal approval  under                                                               
secs. 3 and 4 of the act.                                                                                                       
Section 6:                                                                                                                  
Except for  sec. 5 of  this act, provides  for a January  1, 2018                                                               
effective date.                                                                                                                 
1:39:09 PM                                                                                                                    
MR. CHURCH  addressed fiscal  notes and an  issue on  coverage as                                                               
     There are three-fiscal notes  currently attached to the                                                                    
     bill.  Two-fiscal notes  noted from  the Department  of                                                                    
     Health and  Social Services,  and one  zero-fiscal note                                                                    
     from the Division of Insurance.                                                                                            
     One issue  that came  up recently is  that the  bill as                                                                    
     written  would not  cover the  Alaska  Care Plan  which                                                                    
     covers 45  percent of state  employees; this is  due to                                                                    
     the location  of the definition of  health-care insurer                                                                    
     in Title 21.  Since the Division of  Insurance does not                                                                    
     regulate self-insured  employers such as the  state, we                                                                    
     would need to place the  definition outside of Title 21                                                                    
     and at  that time  the Division of  Administration will                                                                    
     have a fiscal note associated  with the bill, but we do                                                                    
     not know what the fiscal impact will be at this time.                                                                      
SENATOR BEGICH asked  him to verify that the  bill simply extends                                                               
the time period for contraceptives.                                                                                             
MR. CHURCH answered  correct, 12 months instead of  monthly or 3-                                                               
month visits.                                                                                                                   
SENATOR BEGICH assumed that the  negative-fiscal notes are due to                                                               
data in the bill's report that the  bill should lead to a drop in                                                               
unintended pregnancies and unintended abortions.                                                                                
MR. CHURCH concurred with Senator Begich.                                                                                       
SENATOR  GIESSEL   noted  that  the  bill   contained  more  than                                                               
contraceptives and asked for an elaboration.                                                                                    
MR. CHURCH replied  that the first portion of  the bill addresses                                                               
the  coverage   for  contraceptives  that  is   required  by  the                                                               
Affordable Care Act and puts  the requirements in statute, so the                                                               
coverage continues if changes occur.                                                                                            
SENATOR  GIESSEL  stated  that  she  thought  the  bill  strictly                                                               
addressed prescriptive contraceptives.                                                                                          
MR. CHURCH replied as follows:                                                                                                  
     Ultimately  with  the  current requirements  these  are                                                                    
     already  required by  the federal  government so  there                                                                    
     would be  no, I would  say, practical change  minus the                                                                    
     ability  to  prescribe   the  hormonal  birth  controls                                                                    
     beyond the one or three months.                                                                                            
1:42:26 PM                                                                                                                    
SENATOR  VON IMHOF  quoted section  1 in  SB 53,  lines 12-14  as                                                               
     Provide   coverage  for   prescription  contraceptives;                                                                    
     voluntary sterilization  procedures; and consultations,                                                                    
     examinations,  procedures,  and medical  services  that                                                                    
     are necessary to  prescribe, dispense, insert, deliver,                                                                    
     distribute, administer,  or remove the  drugs, devices,                                                                    
     and  other products  or  services  provided under  this                                                                    
She asked  if voluntary sterilization procedures  were already in                                                               
the bill or being added in a new section.                                                                                       
MR.  CHURCH  explained  that voluntary  sterilization  procedures                                                               
would be  added to state  statute. He assumed that  the procedure                                                               
was  covered by  the Affordable  Care  Act. He  noted that  Megan                                                               
Wallace  with  Legislative  Legal  was available  to  speak  more                                                               
accurately to the bill.                                                                                                         
SENATOR  VON  IMHOF  asked  to  confirm  that  the  bill  is  not                                                               
necessarily about  just adding 12  months of  contraceptives. She                                                               
opined  that voluntary  sterilization  gets into  surgery and  is                                                               
very expensive.                                                                                                                 
SENATOR  GARDNER  noted  that  the bill's  intention  is  not  to                                                               
increase   coverage,  but   to  simply   say  for   the  hormonal                                                               
contraceptives that people should be able to get them in a 12-                                                                  
month supply.                                                                                                                   
SENATOR VON  IMHOF asked  to confirm  that SB  53 is  saying that                                                               
voluntary sterilization is included.                                                                                            
SENATOR  GARDNER reiterated  that her  intention is  for the  12-                                                               
month  supply  and asked  that  the  bill's drafter  address  the                                                               
1:44:42 PM                                                                                                                    
At ease.                                                                                                                        
1:45:40 PM                                                                                                                    
CHAIR WILSON called the committee back to order.                                                                                
SENATOR  VON  IMHOF  repeated  her  inquiry  regarding  voluntary                                                               
sterilization  procedures versus  the  sponsor's  intent of  just                                                               
covering 12 months of oral contraceptives.                                                                                      
1:46:15 PM                                                                                                                    
MEGAN  WALLACE,  Attorney,  Legislative  Affairs  Agency,  Alaska                                                               
State  Legislature,   Juneau,  Alaska,   addressed  bill-drafting                                                               
questions regarding SB 53 as follows:                                                                                           
     Section 1  starting on  page 1,  line 9,  requires that                                                                    
     any  insurance  plan  offered  in  the  state  have  to                                                                    
     provide coverage for a, b  and c, which is prescription                                                                    
     contraceptives,     the     voluntary     sterilization                                                                    
     procedures,   and    the   consultation,   examination,                                                                    
     procedures,  and medical  services  that are  necessary                                                                    
     for  those  services; in  addition  to  that, the  bill                                                                    
     requires that  a health-care  insurer reimburse  for 12                                                                    
     months of birth control.                                                                                                   
     Yes,  the  bill  does  two   things:  it  requires  the                                                                    
     sterilization  and  consultation   and  procedures  and                                                                    
     other  services  necessary  to have  birth  control  or                                                                    
     other  contraceptives prescribed  and those  procedures                                                                    
     necessary to carry out  those prescriptions covered and                                                                    
     then  in  addition   requires  essentially  a  12-month                                                                    
     supply of contraceptives where requested.                                                                                  
SENATOR VON  IMHOF asked to  clarify if the verbiage  being added                                                               
is new or is already covered by the Alaska Care Plan.                                                                           
MS. WALLACE replied as follows:                                                                                                 
     I  cannot speak  to  what the  plan  already covers,  I                                                                    
     don't  possess that  information,  so that  would be  a                                                                    
     question  for the  administration in  terms of  whether                                                                    
     they  can  confirm  that these  coverages  are  already                                                                    
     available under  this specific plan.  All I  can advise                                                                    
     is  that the  bill requires  that all  health-insurance                                                                    
     plans provide  the coverage in  both item-1 on  page 1,                                                                    
     [lines  10-14], and  then item-2  which is  on page  2,                                                                    
     line 2-6;  it requires both  1 and 2 being  included in                                                                    
     all plans  offered in  the state  if this  bill becomes                                                                    
1:48:58 PM                                                                                                                    
SENATOR  MICCICHE  noted  that  AS  21.42.420  has  coverage  for                                                               
prescription  drugs and  asked why  a separate  section under  AS                                                               
21.42.420  was not  considered that  simply says,  "Birth control                                                               
pills  and hormonal  contraceptive patches  will be  extended for                                                               
360 days versus  the 90 days that is currently  allowed under the                                                               
section."  He asked  why an  entire subsection  was created  that                                                               
included other services.                                                                                                        
MS. WALLACE replied as follows:                                                                                                 
     The  bill  does  more than  provide  prescription  drug                                                                    
     coverage, so it was  essentially a drafting decision to                                                                    
     set  this  requirement  out  in  their  own  subsection                                                                    
     because as  I was  just articulating the  bill requires                                                                    
     coverage   for   certain   procedures,   consultations,                                                                    
     examinations,  and then  in  addition  to that  there's                                                                    
     restrictions  on  the   coverage  provided  under  this                                                                    
     section  that  don't  apply to  the  prescription  drug                                                                    
     coverage under AS 21.42.420.                                                                                               
SENATOR GARDNER specified as follows:                                                                                           
     Our intent  is not to  add any  new coverage as  not to                                                                    
     change  co-pays,  but   simply  to  have  prescription,                                                                    
     hormonal,   self-administered   contraceptives  to   be                                                                    
      available at a 12-month plan and why it was drafted                                                                       
     differently I don't know. I should know, but I don't.                                                                      
SENATOR BEGICH  asked Ms. Wallace why  the bill was drafted  in a                                                               
way that was not what the sponsor of the legislation requested.                                                                 
1:51:44 PM                                                                                                                    
MS. WALLACE replied as follows:                                                                                                 
     I was  directed to draft the  bill that is in  front of                                                                    
     us and  if there was  a miss communication  between our                                                                    
     office and  Senator Gardner, the sponsor,  I'd be happy                                                                    
     to provide her  with a new version  that clarified that                                                                    
     intent, but  essentially it  was my  understanding that                                                                    
     we provided the bill that was requested.                                                                                   
SENATOR BEGICH  asked Senator Gardner  if the bill does  what she                                                               
intended it to do.                                                                                                              
SENATOR  GARDNER replied  apparently  not and  conceded that  the                                                               
bill goes further.                                                                                                              
1:52:40 PM                                                                                                                    
CHAIR  WILSON  announced  that the  committee  will  hear  public                                                               
1:52:57 PM                                                                                                                    
At ease.                                                                                                                        
1:54:52 PM                                                                                                                    
CHAIR WILSON  called the  committee back  to order.  He announced                                                               
that SB 53 will be held awaiting a committee substitute (CS).                                                                   
1:55:50 PM                                                                                                                    
At ease.                                                                                                                        
        SB 91-EXTEND DISASTER EMERGENCY: OPIOID EPIDEMIC                                                                    
1:56:58 PM                                                                                                                    
CHAIR WILSON announced the consideration of SB 91.                                                                              
1:57:17 PM                                                                                                                    
DR. JAY BUTLER,  Chief Medical Officer, Department  of Health and                                                               
Social Services  (DHSS), Juneau, Alaska, provided  an overview of                                                               
SB 91 as follows:                                                                                                               
     In  late 2016,  DHSS  competed for  and  was awarded  a                                                                    
     five-year  grant by  the  Federal  Substance Abuse  and                                                                    
     Mental  Health Services  Administration  to support  an                                                                    
     opioid  overdose prevention  program that  included the                                                                    
     distribution   of  Naloxone,   a  drug   that  can   be                                                                    
     lifesaving  when   administered  to  someone   who  has                                                                    
     stopped breathing due to an opioid overdose.                                                                               
     The grant  funds have  been used  to acquire  the nasal                                                                    
     spray form  of the drug  that is  part of a  rescue kit                                                                    
     distributed   through  Alaska   Project  HOPE,   "HOPE"                                                                    
     standing for,  "harm reduction overdose  prevention and                                                                    
     education." We worked with law  enforcement in terms of                                                                    
     how they might  be able to best carry the  kits to best                                                                    
     administer   them  if   needed   during  an   emergency                                                                    
     Project  HOPE has  prioritized partnerships  with staff                                                                    
     of organizations  that do  not have  medical direction,                                                                    
     meaning that they would have  someone who could issue a                                                                    
     prescription  for  the  drug and  those  who  are  most                                                                    
     likely to  be present when  an overdose occurs  such as                                                                    
     for certain  first responders  and persons  involved in                                                                    
     recovery support.                                                                                                          
     To  provide the  kits under  a standing-medical  order,                                                                    
     the department  explored a number  of options.  We were                                                                    
     advised by the attorney  general's office that the best                                                                    
     option would be for  the state-medical officer to issue                                                                    
     a  standing order  and the  authority for  the standing                                                                    
     order  would require  a disaster  declaration. Governor                                                                    
     Walker issued  the declaration on  February 14  with an                                                                    
     anticipated  legislative   concurrent  resolution  that                                                                    
     would extend  the declaration for  longer than  the 30-                                                                    
     day deration defined by Alaska statute.                                                                                    
     No state  funds are  required to support  Project HOPE.                                                                    
     Since  the declaration,  12 organizations  have already                                                                    
     received   the  training   including  some   that  have                                                                    
     received training-the-trainer training  and are able to                                                                    
     provide  the  kits  and  nearly   800  kits  have  been                                                                    
     dispensed so  far. This past Thursday  we returned that                                                                    
     the  opinion of  Legislative Legal  is that  a bill  is                                                                    
     required to extend the declaration  and to continue the                                                                    
     distribution of the kits under the standing order.                                                                         
2:00:15 PM                                                                                                                    
DR. BUTLER addressed the sectional analysis of SB 91 as follows:                                                                
Section 1:                                                                                                                  
Includes the findings of the  extent of the public-health threat.                                                               
Acknowledges and  describes the governor's  disaster declaration,                                                               
and the need for legislation to extend the declaration.                                                                         
Section 2:                                                                                                                  
Extends the February 14, 2017  disaster declaration for 1 year to                                                               
February 14, 2018.                                                                                                              
Section 3:                                                                                                                  
Makes the effective  date retroactive to March 15,  2017 when the                                                               
current disaster declaration expires.                                                                                           
SENATOR  MICCICHE asserted  that  he is  an  active supporter  of                                                               
dealing the  state's opioid crisis.  He asked for  an explanation                                                               
of  the emergency  declaration's criteria  under federal  law. He                                                               
inquired if the emergency declaration was actually appropriate.                                                                 
2:01:36 PM                                                                                                                    
STACY KRALY, Chief Assistant  Attorney General, Alaska Department                                                               
of Law, Juneau, Alaska, addressed  the emergency declaration from                                                               
SB 91 as follows:                                                                                                               
     This is  a state  emergency declaration, not  a federal                                                                    
     declaration.  Under current  state statute  there is  a                                                                    
     mechanism under the  public-health authorizations under                                                                    
     Title  18  and also  under  the  Military and  Veterans                                                                    
     Affair  statutory authorizations  under  Title 26  that                                                                    
     provides  for  the  issuance of  a  declaration  of  an                                                                    
     If you look in particular  under AS 18.15.390 which are                                                                    
     the  powers  of  the   department  in  a  public-health                                                                    
     disaster, the  department can work with  the Department                                                                    
     of Military and Veterans  Affairs to initiate a public-                                                                    
     health  emergency under  the  auspices and  authorities                                                                    
     that  Military   and  Veterans  Affairs  as   under  AS                                                                    
     26.23.020;  so they  kind of  work in  conjunction with                                                                    
     each  other generally  and under  emergency declaration                                                                    
     are done for flooding, that's  the most recent one that                                                                    
     happened, ice jams and flooding  and that sort of thing                                                                    
     so there would be  an emergency declaration through the                                                                    
     Department of Veterans and  Military Affairs that would                                                                    
     provide   the  department   authorization  to   provide                                                                    
     certain services  and funding in many  cases to address                                                                    
     this emergency, an earthquake or something like that.                                                                      
     What has  also happened though is  that the Legislature                                                                    
     through the  public health statutes, like  I said under                                                                    
     Title  18, has  given the  department the  authority to                                                                    
     use  the  mechanisms  of  a  disaster  declaration  for                                                                    
     purposes of a public-health  emergency and that is what                                                                    
     we have done under this  context; so they work together                                                                    
     a little bit  different. We use the  same framework and                                                                    
     format   under  the   emergency  declaration   for  the                                                                    
     Veterans and  Military Affairs,  but it  is used  for a                                                                    
     public  health emergency  which is  what we've  done in                                                                    
     this context.                                                                                                              
SENATOR MICCICHE asked if the federal grants that are funding                                                                   
the program requires a disaster declaration.                                                                                    
2:04:19 PM                                                                                                                    
MS. KRALY answered no. She continued as follows:                                                                                
     What we  were very  clear in the  emergency declaration                                                                    
     when we  crafted it for  the governor's office  is that                                                                    
     there were  going to be  no additional funds  that were                                                                    
     going to  be administered  generally when  an emergency                                                                    
     happens  like  I  was explaining  previously;  say  the                                                                    
     flood,  there's   a  need  for  an   expenditure,  some                                                                    
     financial  outlay by  the Legislature  to help  address                                                                    
     the  emergency.  This grant  was  applied  for and  was                                                                    
     received long before this  declaration was received, so                                                                    
     there's  no addition  fiscal  outlay  or request  being                                                                    
     made as a result of this declaration.                                                                                      
CHAIR WILSON stated the following:                                                                                              
     Our offices looked  into this a little  bit and working                                                                    
     with the department and the  state as well and first we                                                                    
     want  to thank  the governor  for raising  awareness to                                                                    
     this  issue. We  all want  here  to save  lives and  we                                                                    
     understand, but I  do want to put  this in perspective,                                                                    
     if we  will have  a conversation to  make sure  we have                                                                    
     clearness upon what  is needed and what  is being asked                                                                    
CHAIR WILSON asked if Alaska has already received the $4                                                                        
DR. BUTLER answered yes.                                                                                                        
CHAIR  WILSON asked  him to  verify that  the declaration  is not                                                               
needed for the expenditure of the $4 million.                                                                                   
DR. BUTLER answered correct.                                                                                                    
CHAIR WILSON summarized as follows:                                                                                             
     Really  what is  being asked  for is  that the  medical                                                                    
     director could  have these  special privileges  to help                                                                    
     dispense  Naloxone  throughout the  Alaska  communities                                                                    
     and this  would allow  him to do  that both  allow this                                                                    
     position  to do  that for  the one  year until  the end                                                                    
     date of this declaration.                                                                                                  
2:06:11 PM                                                                                                                    
DR. BUTLER answered correct.                                                                                                    
CHAIR WILSON  asked if  a bill  could be  drafted rather  than an                                                               
emergency declaration.                                                                                                          
DR. BUTLER  answered that  he supported  any means  in addressing                                                               
opioid overdose prevention.                                                                                                     
CHAIR WILSON noted that Dr.  Butler had the emergency declaration                                                               
privilege  within the  30 days.  He asked  if SB  91 extends  the                                                               
privilege for  30 days  or would  the bill be  a stop-gap  if the                                                               
Legislature does not act within the 30-day timeframe.                                                                           
DR. BUTLER answered as follows:                                                                                                 
     The current  disaster declaration will expire  on March                                                                    
     15, so if there is a  gap period it means we would stop                                                                    
     the  dispensing  of   the  kit  until  we   can  get  a                                                                    
     resolution for this issue.                                                                                                 
SENATOR VON  IMHOF asked  him to verify  that the  state received                                                               
the   federal  Substance   Abuse  and   Mental  Health   Services                                                               
Administration (SAMHSA) grant of $4.1 million.                                                                                  
DR. BUTLER answered correct.                                                                                                    
SENATOR VON IMHOF assumed that  the program's success required as                                                               
many caregivers as  possible to have access to the  kits in order                                                               
to deliver Naloxone.                                                                                                            
DR. BUTLER  specified that the  persons who may  be administering                                                               
Naloxone did not have to be a health-care provider.                                                                             
2:08:21 PM                                                                                                                    
SENATOR  VON IMHOF  asked  to confirm  that  Naloxone requires  a                                                               
doctor's approval of some sort  in order to administer, something                                                               
that  is not  always time  efficient and  not always  possible in                                                               
emergency situations.                                                                                                           
DR. BUTLER answered correct.                                                                                                    
SENATOR VON IMHOF stated that  one way to circumvent the doctor's                                                               
approval  is by  claiming  an emergency  disaster.  She asked  if                                                               
circumventing  approval  by  a  doctor  was  the  intent  of  the                                                               
emergency disaster declaration.                                                                                                 
DR.  BUTLER specified  that the  disaster declaration  allows the                                                               
standing order  to be  created to  be able  to provide  that pre-                                                               
existing  prescriptive  authority  so  that  the  kits  could  be                                                               
available to people who are most likely to be present.                                                                          
SENATOR VON  IMHOF asked him  to verify that a  blanket authority                                                               
would  be extended  to  the  on-the-ground health-care  providers                                                               
that are in the emergency situation                                                                                             
DR. BUTLER answered correct.                                                                                                    
SENATOR  VON  IMHOF replied  that  she  understood the  reasoning                                                               
behind  getting  800  kits  out and  distributed  as  quickly  as                                                               
possible  without  having  the cumbersome  aspect  of  having  an                                                               
individual  doctor's  approval each  time.  She  stated that  the                                                               
question remained if an emergency  declaration is required versus                                                               
the statute  process. She  asked Dr. Butler  if he  would support                                                               
extending the declaration  30 days to buy time  for the committee                                                               
to write up a statute for a 1-year authority period.                                                                            
2:10:08 PM                                                                                                                    
DR.  BUTLER reiterated  that he  supported however  the authority                                                               
can be  established to distribute  the kits. He pointed  out that                                                               
the  funding is  for five  years  and asked  if the  prescriptive                                                               
authority can be considered for a longer period.                                                                                
SENATOR GIESSEL quoted the statute  that cited the declaration of                                                               
disaster under AS 26.23.020 and commented as follows:                                                                           
      "This emergency declaration allows the allocation of                                                                      
     medicine or supplies to address the emergency;" it is                                                                      
     only for 30 days, it is  a standing order as Dr. Butler                                                                    
     has pointed out. The medication  in the overdose kit is                                                                    
     a  prescription  medication,  consequently he,  as  the                                                                    
     state's   medical   officer,   can  write   a   blanket                                                                    
     prescription  allowing the  training  of personnel,  of                                                                    
     citizens  in the  proper  use of  these,  it's a  nasal                                                                    
     spray, but it does  require the prescription. To extend                                                                    
     this  only for  30  days does  not  really address  the                                                                    
     problem and the state  medical director has provided us                                                                    
     with some  information about the  size of  this problem                                                                    
     and  it will  take more  than just  another 30  days to                                                                    
     address it properly.                                                                                                       
SENATOR BEGICH  asked to  confirm that  the legislation  would do                                                               
what Senator Giessel referenced in statute.                                                                                     
SENATOR GIESSEL answered yes.                                                                                                   
2:12:54 PM                                                                                                                    
CHAIR WILSON  asked Dr.  Butler to explain  the numbers  that are                                                               
referenced in the bill on page 1, lines 9-13.                                                                                   
DR.  BUTLER confirmed  that  heroin-associated  deaths more  than                                                               
quadrupled  from 2009  to 2015,  from 7  deaths to  38 deaths  in                                                               
CHAIR  WILSON  noted that  in  2014  approximately 500  doses  of                                                               
Naloxone was given  out. He asked Dr. Butler if  he knew how many                                                               
kits are planned to be administered for the first year.                                                                         
DR. BUTLER replied that the goal is to distribute 5,000 kits.                                                                   
2:16:32 PM                                                                                                                    
CHAIR WILSON  noted constituency concerns that  wide availability                                                               
of Naloxone may  have a negative impact on society  as a "Get out                                                               
of death  for free card." He  asked if there is  concern that the                                                               
$4 million  will just  be used for  Naloxone rather  than putting                                                               
funds further upstream to get to people before they use opioids.                                                                
DR. BUTLER specified that Naloxone can  save a life, but does not                                                               
cure the  addiction. He concurred  that Naloxone is not  the only                                                               
approach  to  address the  opioid  epidemic.  He set  forth  that                                                               
access  to  treatment  and  the   stigma  often  associated  with                                                               
addiction  must also  be addressed.  He  added that  how pain  is                                                               
being  managed  with  opioids  is   another  area  that  must  be                                                               
2:20:51 PM                                                                                                                    
SENATOR  MICCICHE asked  how other  states are  dealing with  the                                                               
opioid epidemic.                                                                                                                
DR.  BUTLER  replied that  like  Alaska,  other states  are  also                                                               
taking a multi-faceted approach  that includes allowing the state                                                               
medical  officer   to  issue  a  standing   order,  address  drug                                                               
monitoring programs, continued medical  education to providers on                                                               
pain management and addiction, and  limiting the number of opioid                                                               
pills that can be dispensed.                                                                                                    
SENATOR MICCICHE  asked if there  is a "good samaritan"  law that                                                               
covers someone administering Naloxone.                                                                                          
2:24:06 PM                                                                                                                    
MS.  KRALY replied  that she  would take  a look  at the  general                                                               
"good  samaritan"  laws  of  the  statutes  and  provide  a  more                                                               
thorough answer of how those would apply.                                                                                       
CHAIR WILSON asked  if training certificates will  be provided to                                                               
show that a  person was well trained  for administering Naloxone.                                                               
He  opined that  certification  would apply  to "good  samaritan"                                                               
laws that a person was trained  within the authority of what they                                                               
DR.  BUTLER explained  that the  kits have  pre-packaged Naloxone                                                               
nasal spray to simplify administering  the drug. He detailed that                                                               
training  is fairly  simple and  provided a  step-by-step process                                                               
for administering Naloxone.                                                                                                     
SENATOR  MICCICHE asked  if  the  state was  in  the right  place                                                               
"mechanically" in training for administering Naloxone.                                                                          
2:28:05 PM                                                                                                                    
ANDREW   JONES,  Section   Chief,   Emergency  Programs:   Health                                                               
Emergency  Response  Operations,  EMS  and  Trauma,  Division  of                                                               
Public  Health,   Department  of  Health  and   Social  Services,                                                               
Anchorage, Alaska, announced his  availability to address how the                                                               
overdose kits are administered.                                                                                                 
CHAIR  WILSON  asked  Mr. Jones  to  address  Senator  Micciche's                                                               
inquiry on Naloxone.                                                                                                            
MR. JONES  explained that  Health Emergency  Response Operations,                                                               
Emergency Medical  Services (EMS)  and the  Trauma System  have a                                                               
comprehensive and  customized training program to  meet the needs                                                               
of Alaskans.  He detailed that  training is  hands-on, one-on-one                                                               
that is similar  to CPR training. He noted  that individuals that                                                               
receive training  get a card to  show that they were  trained. He                                                               
revealed  that training-on-training  has  an application  process                                                               
and the thorough training takes a few hours to complete.                                                                        
He explained that the intent of  the program was to compliment SB
23  and one  of  the parts  of  the bill  says,  "An employer  or                                                               
volunteer of  the overdose program  with training  can administer                                                               
the lifesaving  drug." He said  the intent  was for the  state to                                                               
create an umbrella-program  with a goal to get the  kits into the                                                               
hands of  the non-profits, the  peer-recovery groups,  the people                                                               
who  are in  connection  with individuals  who  are either  going                                                               
through recovery or may actually be using on a day-to-day basis.                                                                
He addressed  Senator Micciche  regarding a  disaster declaration                                                               
and specified  that the two  things that are always  analyzed and                                                               
asked is:  loss of  life, and  loss of property.  He said  the $4                                                               
million  federal grant  will assist  with getting  the medication                                                               
out in an efficient and quick manner to save lives.                                                                             
2:30:36 PM                                                                                                                    
CHAIR WILSON  asked if  DHSS would  come back  in 2018  after the                                                               
declaration is done and ask  the Legislature to issue the medical                                                               
director's position  the same clearance to  authorize dispensing.                                                               
He asked if responding to the  request would be best done through                                                               
a bill process or continue a year-to-year process.                                                                              
DR. BUTLER opined  that the most efficient response  would be the                                                               
bill process.                                                                                                                   
SENATOR VON IMHOF said she was  pleased the state received the $4                                                               
million   SAMHSA  grant;   however,  she   posed  that   using  a                                                               
declaration of disaster emergency  to implement the program opens                                                               
the door to  potential risk of open-ended funding  in the future.                                                               
She  noted that  legal opinion  was sought  and pointed  out that                                                               
there  is a  risk. She  said as  a person  sitting on  the Senate                                                               
Finance Committee,  she acknowledged  the risk and  asserted that                                                               
she  would like  to explore  an  alternative option  if the  same                                                               
thing can be accomplished.                                                                                                      
2:33:27 PM                                                                                                                    
DR.  BUTLER reiterated  that  his objective  is  to maintain  the                                                               
program and save lives in whatever way that is optimal.                                                                         
MS.  KRALY  explained that  the  emergency  declaration that  was                                                               
signed  by   Governor  Walker  was   very  narrowly   crafted  to                                                               
specifically address the concerns  that Senator von Imhof raised.                                                               
She revealed that  an emergency declaration was  the quickest way                                                               
to get the kits into Alaska's communities.                                                                                      
2:36:42 PM                                                                                                                    
SENATOR  GIESSEL noted  that the  Mat-Su has  an opioid  response                                                               
team, a  community group  that has come  together to  address the                                                               
issue  in the  Mat-Su  Valley. She  disclosed  that Anchorage  is                                                               
forming a  similar group. She  asked Mr. Jones  if he knows  if a                                                               
response team is formulating in Fairbanks.                                                                                      
MR. JONES  answered that a Fairbanks  has a collation as  well as                                                               
numerous collations throughout  the state. He said  the intent is                                                               
to provide  tools and capabilities  to empower communities  for a                                                               
long-term response.                                                                                                             
SENATOR GIESSEL asked Mr. Jones  what Naloxone's side effects are                                                               
and the result if the  drug is mistakenly administered to someone                                                               
that is not having an opioid overdose.                                                                                          
MR. JONES answered that the  side effects are minimal, unless the                                                               
person  is allergic  specifically to  Naloxone, a  situation that                                                               
has very few cases of occurrence in  the U.S. He said most of the                                                               
times what ends  up happening if an individual  is overdosing and                                                               
it is  not an  opioid, the  person probably  will not  wakeup and                                                               
that's when CPR is administered.                                                                                                
SENATOR  GIESSEL  asked Mr.  Jones  if  he  knew much  about  the                                                               
state's  "good  samaritan" laws  in  reference  to liability  for                                                               
2:39:21 PM                                                                                                                    
MR. JONES revealed  that one of the statutes as  a result of last                                                               
year's  legislation  from SB  23  addressed  liability and  gross                                                               
negligence. He explained  that gross negligence would  occur if a                                                               
person had  an overdose kit  but did not administer  Naloxone. He                                                               
added  that   administering  CPR  is  covered   under  the  "good                                                               
samaritan" law, as long as gross negligence is not applied.                                                                     
SENATOR  GIESSEL  asked  Dr.  Butler if  he  could  elaborate  on                                                               
Naloxone's  side  effects  and  liability related  to  the  "good                                                               
samaritan" law.                                                                                                                 
DR. BUTLER concurred  with Mr. Jones that nothing  will happen to                                                               
a person that  is administered Naloxone if the  individual is not                                                               
experiencing  an opioid  overdose.  He detailed  that the  person                                                               
will  not   wake  up,  but   9-1-1  should  be  called   and  CPR                                                               
administered by someone that is trained.                                                                                        
2:41:17 PM                                                                                                                    
CHAIR WILSON opened public testimony.                                                                                           
2:41:47 PM                                                                                                                    
KARA  NELSON,   representing  self,  Juneau   Recovery  Community                                                               
Organization, Juneau, Alaska, testified in  support of SB 91. She                                                               
said the  opioid epidemic is  an emergency and people  are dying.                                                               
She asserted that  Naloxone is needed. She revealed  that she has                                                               
been  trained  in  administering  Naloxone and  has  done  so  in                                                               
overdose situations.                                                                                                            
2:44:55 PM                                                                                                                    
MICHAEL CARSON, Vice President,  MyHouse Mat-Su, Wasilla, Alaska,                                                               
testified  in support  of SB  91. He  noted that  he is  also the                                                               
chairman  of  the Mat-Su  Opioid  Task  Force. He  detailed  that                                                               
MyHouse is  one of  the non-profits that  would benefit  from the                                                               
wide  distribution  of  Naloxone  kits.  He  concurred  that  the                                                               
state's heroine increase has, "Gone up through the roof."                                                                       
2:48:27 PM                                                                                                                    
MIKE  COONS,  representing  self, Palmer,  Alaska,  testified  in                                                               
opposition of SB  91. He revealed that he was  a paramedic for 22                                                               
years. He  opined that  distributing Naloxone  will be  a failure                                                               
and  may even  add to  increased  deaths of  opioids by  enabling                                                               
addicts. He said  he objected to the use of  federal funds to pay                                                               
for the $4.1 million grant to the state for disaster relief.                                                                    
CHAIR WILSON clarified that the  $4.1 million comes from a SAMHSA                                                               
MR.  COONS  replied that  the  grant  still comes  from  taxpayer                                                               
2:51:27 PM                                                                                                                    
JOHN GREEN,  representing himself, Wasilla, Alaska,  testified in                                                               
support  of SB  91. He  revealed that  his daughter  died from  a                                                               
heroin addiction. He set forth  that recovery resources should be                                                               
made available in order to save lives.                                                                                          
2:54:12 PM                                                                                                                    
CHAIR WILSON closed public testimony.                                                                                           
He asked  Dr. Butler about  the "after effect." He  remarked that                                                               
the   possible  side   effects   from   receiving  Naloxone   was                                                               
overlooked. He asked Dr. Butler  if an individual's state of mind                                                               
and behavior is affected from Naloxone.                                                                                         
DR.  BUTLER replied  that Naloxone  does not  cure addiction.  He                                                               
emphasized  that addiction  is  a chronic  health condition  that                                                               
requires management. He noted that  the community coalitions play                                                               
an important role in addiction recovery.                                                                                        
CHAIR  WILSON asked  Dr. Butler  to address  the effects  of what                                                               
happens to a person right after receiving Naloxone.                                                                             
2:56:55 PM                                                                                                                    
DR.  BUTLER  replied  that  the  effects  are  dependent  on  the                                                               
CHAIR WILSON  inquired if  there is  a risk  of the  person being                                                               
aggressive  after being  administered Naloxone.  He asked  if the                                                               
effects  from  Naloxone  and  the  risks  are  being  covered  in                                                               
DR. BUTLER explained that the  acute effects that are experienced                                                               
by the  person who receives  the Naloxone  is going to  be driven                                                               
somewhat by  the dose and strength  of the opioid. He  added that                                                               
the amount of  Naloxone administered is important  to get someone                                                               
to  start  breathing  again,  but   to  avoid  going  into  acute                                                               
withdrawal.  He  pointed  out   that  acute  withdrawal  is  very                                                               
unpleasant with the possibility for vomiting.                                                                                   
SENATOR BEGICH noted  that typically a "findings  section" is not                                                               
included  in  legislation and  recommended  that  the section  be                                                               
eliminated from the bill.                                                                                                       
2:59:59 PM                                                                                                                    
CHAIR  WILSON  detailed  that  his   intent  is  to  introduce  a                                                               
committee substitute  at the next  committee meeting. He  said he                                                               
hoped to  get the bill  out of committee  as soon as  possible so                                                               
that the work  of DHSS is not hindered. He  commented on the bill                                                               
as follows:                                                                                                                     
     I  don't think  anyone  here in  the committee  doesn't                                                                    
     think that  every life is  valuable to be saved  and we                                                                    
     thank  the administration  for putting  this forth  and                                                                    
     this plan together. I think  that we've all had our own                                                                    
     experiences with this issue one  way or another, but we                                                                    
     just want to  make sure that we are looking  at this as                                                                    
     a whole. It is my  viewpoint that we are addressing not                                                                    
     just down-the-river, but we can  go further upstream as                                                                    
CHAIR WILSON held SB 91 in committee for future consideration.                                                                  
3:01:15 PM                                                                                                                    
There being no further business to come before the committee,                                                                   
Chair Wilson adjourned the Senate Health and Social Services                                                                    
Committee at 3:01 p.m.                                                                                                          

Document Name Date/Time Subjects
SB053 verA.PDF SHSS 3/13/2017 1:30:00 PM
SB 53
SB053 Sponsor Statement.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB053 Supporting Document - Guttmacher Institute Alaska Specific.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB053 Supporting Document - Guttmacher Institute Cost of Unintended Pregnacies.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB053 Supporting Document - Contraceptives Dispensed and Unintended Pregnancies.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB053 Letter of Opposition - NFIB.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB053 Letter of Support - AK Pharmacists Association.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB053 Letter of Support - Alaska Nurses Association.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB053 Letter of Support - Planned Parenthood.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB 53 Public 1.PDF SHSS 3/13/2017 1:30:00 PM
SB 53
SB053 Sectional Analysis.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB 91 Version A.pdf SHSS 3/13/2017 1:30:00 PM
SB 91
SB 91 Transmittal Letter and Declaration.PDF SHSS 3/13/2017 1:30:00 PM
SB 91
SB 91 Fiscal Note.PDF SHSS 3/13/2017 1:30:00 PM
SB 91
SB 91 Sectional Analysis Version A.pdf SHSS 3/13/2017 1:30:00 PM
SB 91
SB 53 FNs.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB 53 Public 2.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB 53 Public 3.pdf SHSS 3/13/2017 1:30:00 PM
SB 53
SB 91 Public 1.pdf SHSS 3/13/2017 1:30:00 PM
SB 91