03/10/2010 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearings | |
| SB46 | |
| SB172 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 46 | TELECONFERENCED | |
| += | SB 172 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 10, 2010
1:31 p.m.
MEMBERS PRESENT
Senator Bettye Davis, Chair
Senator Joe Paskvan, Vice Chair
Senator Johnny Ellis
Senator Joe Thomas
Senator Fred Dyson
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
CONFIRMATION HEARINGS
Board of Nursing
Nancy Bienvenue - Fairbanks
CONFIRMATION ADVANCED
Alaska Mental Health Trust Authority Board of Trustees
Laraine Derr - Anchorage
Mary Jane Michael - Anchorage
Carlton Smith - Juneau
CONFIRMATIONS ADVANCED
State Medical Board
Dr. William W. Resinger - Palmer
CONFIRMATION ADVANCED
SENATE BILL NO. 46
"An Act relating to child support awards made by a court; and
repealing Rule 90.3, Alaska Rules of Civil Procedure."
- MOVED CSSB 46(HSS) OUT OF COMMITTEE
SENATE BILL NO. 172
"An Act establishing the Alaska Health Care Commission in the
Department of Health and Social Services; and providing for an
effective date."
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 46
SHORT TITLE: CHILD SUPPORT AWARDS
SPONSOR(s): SENATOR(s) KOOKESH
01/21/09 (S) PREFILE RELEASED 1/9/09
01/21/09 (S) READ THE FIRST TIME - REFERRALS
01/21/09 (S) HSS, JUD, FIN
03/01/10 (S) HSS AT 1:30 PM BUTROVICH 205
03/01/10 (S) Heard & Held
03/01/10 (S) MINUTE(HSS)
03/10/10 (S) HSS AT 1:30 PM BELTZ 105 (TSBldg)
BILL: SB 172
SHORT TITLE: ALASKA HEALTH CARE COMMISSION
SPONSOR(s): SENATOR(s) OLSON
03/27/09 (S) READ THE FIRST TIME - REFERRALS
03/27/09 (S) HSS, FIN
04/17/09 (S) HSS AT 1:30 PM BUTROVICH 205
04/17/09 (S) Scheduled But Not Heard
04/18/09 (S) HSS AT 10:00 AM BUTROVICH 205
04/18/09 (S) -- MEETING CANCELED --
02/03/10 (S) HSS AT 1:30 PM BUTROVICH 205
02/03/10 (S) Heard & Held
02/03/10 (S) MINUTE(HSS)
03/10/10 (S) HSS AT 1:30 PM BELTZ 105 (TSBldg)
WITNESS REGISTER
NANCY BIENVENUE, Appointee
Board of Nursing
POSITION STATEMENT: Testified as appointee to the Board of
Nursing.
LARAINE DERR, Appointee
Alaska Mental Health Trust Authority Board of Trustees
POSITION STATEMENT: Testified as appointee to the Alaska Mental
Health Trust Authority Board of Trustees.
MARY JANE MICHAEL, Appointee
Alaska Mental Health Trust Authority Board of Trustees
POSITION STATEMENT: Testified as appointee to the Alaska Mental
Health Trust Authority Board of Trustees.
CARLTON SMITH, Appointee
Alaska Mental Health Trust Authority Board of Trustees
POSITION STATEMENT: Testified as appointee to the Alaska Mental
Health Trust Authority Board of Trustees.
DR. WILLIAM W. RESINGER, Appointee
State Medical Board
POSITION STATEMENT: Testified as appointee to the State Medical
Board.
SENATOR ALBERT KOOKESH
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Sponsor of SB 46.
DOROTHY SHOCKLEY
Staff to Senator Kookesh
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Explained the changes in the CS for SB 46.
KEN ALPER, representing himself
Juneau, AK
POSITION STATEMENT: Testified in support of SB 46.
SENATOR DONALD OLSON
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Sponsor of SB 172
TOM OBERMEYER
Staff to Senator Davis
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Explained the changes in CS for SB 172.
JAMES J. JORDAN, Executive Director
Alaska State Medical Association
POSITION STATEMENT: Testified in support of SB 172.
DEBORAH ERICKSON, Executive Director
Alaska Health Care Commission (AHCC)
POSITION STATEMENT: Testified in support of SB 172 on behalf of
DHSS and AHCC.
JEFF JESSEE, CEO
Alaska Mental Health Trust Authority (AMHTA)
said
POSITION STATEMENT: Testified that AMHTA wants a seat on the
Alaska Health Care Commission.
WAYNE STEVENS, President and CEO
Alaska State Chamber of Commerce (ASCC)
POSITION STATEMENT: Testified in support of SB 172
SHELLY HUGHES
Alaska Primary Care Association (APCA)
POSITION STATEMENT: Thanked the committee for adding a primary
care position to SB 172.
DENISE LICCIOLI
Staff to Senator Olson
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Provided clarifying information related to
SB 172.
ACTION NARRATIVE
1:31:05 PM
CHAIR BETTYE DAVIS 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 Dyson, Paskvan and Davis.
^CONFIRMATION HEARINGS
Board of Nursing
Alaska Mental Health Trust Authority Board of Trustees
State Medical Board
CHAIR DAVIS announced committee would hear from the governor's
appointees to the foregoing boards and commissions who were up
for confirmation.
1:33:47 PM
NANCY BIENVENUE, appointee, Board of Nursing, said she is an RN
and is honored to be appointed and looks forward to serving.
SENATOR PASKVAN noted that she is CEO of Care Net Pregnancy
Center and asked if women visit the center for medical guidance.
MS. BIENVENUE answered no; the clinic provides pregnancy testing
and confirmation of pregnancy by ultrasound exam, but they also
provide a lot of other services in terms of material assistance,
referral and information for women facing an unplanned
pregnancy.
SENATOR PASKVAN observed that a woman who suspects she might be
pregnant could go to Care Net seeking guidance on how best to
proceed on a medical basis.
MS. BIENVENUE clarified that they would confirm her pregnancy,
but they don't offer other medical services or advice. They help
a woman explore her options for her pregnancy and give her any
information she is seeking.
SENATOR PASKVAN asked if she has used her qualifications as a
nurse since she started working at Care Net in 2004.
MS. BIENVENUE replied that as a registered nurse she oversees
the nursing staff; a medical director oversees all the nurses.
SENATOR PASKVAN asked if her duties are primarily nursing
related or administrative and therefore non nursing.
MS. BIENVENUE replied they're primarily administrative, but she
oversees the nurses and has an extensive background in women's
health nursing.
SENATOR PASKVAN asked about Care Net's mission statement.
MS. BIENVENUE said it is "serving women, upholding life." This
is a faith-based organization that offers life-affirming
assistance to women facing unplanned pregnancies. They also help
men and families facing this issue. They don't deny services to
anybody; all services are free and confidential. Care Net became
a clinic two years ago; prior to that they offered self-test
pregnancy testing.
SENATOR PASKVAN observed that the term "clinic" infers that it's
a medical-related facility, but she's indicating that isn't the
case.
MS. BIENVENUE replied they are licensed as a clinic and they
offer the limited medical service of ultrasound, overseen by the
medical director.
SENATOR PASKVAN asked what Care Net's goals or objectives are.
MS. BIENVENUE replied the goals are to assist women with the
utmost standard of care and truth and compassion; the objectives
are to offer compassionate care for women who are facing an
unplanned pregnancy.
SENATOR PASKVAN asked what she means by "truth."
MS. BIENVENUE said it means medically accurate and truthful
information. She said her perspective is that a woman facing an
unplanned pregnancy needs to be fully informed of every issue
related to her pregnancy and this includes the visual
information of seeing an ultrasound of the unborn baby. She
continued:
When she sees her child she often is, it helps her
make an informed decision and that decision we of
course hope will be for life, but regardless of what a
woman chooses when she comes to our center we support
her and help her. I mean we don't support necessarily
an abortion decision, but the woman is supported in
what she does in terms of receiving compassionate
care. And if a woman does choose abortion she's
welcome to come back to our center for assistance with
post-abortion healing if that's something she's
needing later on.
SENATOR PASKVAN asked if the clinic's employment requirements
are faith-based.
MS. BIENVENUE answered yes, according to law.
SENATOR PASKVAN asked if her personal faith-based beliefs
influence or limit the guidance or advice she gives.
MS. BIENVENUE replied they operate from a faith-based
perspective in terms of their operations and hiring practices.
It's allowed in the law and is a part of what they do at the
clinic, but that doesn't affect the service they provide.
1:42:51 PM
SENATOR ELLIS joined the meeting.
SENATOR PASKVAN asked if first-time visitors to Care Net
understand that it's a faith-based clinic.
MS. BIENVENUE answered yes; they don't hide this information.
SENATOR PASKVAN asked if she sees any conflict between the Care
Net objectives and the Board of Nursing objectives.
MS. BIENVENUE replied she doesn't see a conflict.
SENATOR PASKVAN asked if she understands that the objectives of
the Board of Nursing may be more comprehensive than those of her
personal faith-based value system.
MS. BIENVENUE answered yes.
SENATOR PASKVAN asked how she relates to nurses working in
settings other than Care Net.
MS. BIENVENUE said she relates on a collegial basis. She added
that she hasn't always worked in a faith-based setting.
SENATOR PASKVAN asked if she is active in any local nursing
organizations.
MS. BIENVENUE answered no.
1:45:26 PM
CHAIR DAVIS informed Ms. Bienvenue that her name will go forward
and that voting will take place at a later date. The action of
the committee today in no way obligates a member to vote either
for or against the appointee.
MS. BIENVENUE asked if her appointment to the Alaska Mental
Health Trust Authority is on the agenda today.
CHAIR DAVIS suggested she contact Boards and Commissions because
she doesn't have that information.
1:47:07 PM
CHAIR DAVIS announced the next appointment is Lorraine Derr to
the Mental Health Trust Authority Board of Trustees
LARAINE DERR, appointee, Alaska Mental Health Trust Authority
Board of Trustees, said she is up for reappointment; she
currently serves as chair of the finance committee and vice-
chair of the trust. She said she enjoys serving although it's a
heady responsibility to be one of just seven members with
responsibility over 964,000 acres of land and $324 million.
CHAIR DAVIS asked how many years she has served on the trust.
MS. DERR replied four years.
1:48:35 PM
SENATOR ELLIS asked what she hopes to accomplish in this next
term.
MS. DERR replied there are several projects under way and
they're also trying to develop policies for the trust land
office. One project she's interested in is to exchange forestry
lands around communities for logged land on Prince of Wales
Island. Because the trust mission is to provide for mental
health programs in perpetuity, banking logged land now will
yield forested land in 40 or 50 years. The proposed building on
trust land on the Juneau waterfront is part of another project
that entails putting trust resources to use in order to provide
money for mental health programs in years to come. As the
longest tenured member of the trust, she said she looks forward
to continuing to help build a team of trustees.
1:51:35 PM
SENATOR ELLIS asked if the trust considers matters such as being
a good neighbor when it makes decisions about how to use its
land resources to produce revenue in perpetuity. Noting that
legislators' phones start to ring when the trust is in conflict
with conservation groups or a community, he asked how the trust
modulates those conflicts for the long-term health and
reputation of the trust.
MS. DERR replied the trust has been a good neighbor; they have
worked with affected communities to reduce the impacts when they
sold or developed land. Going forward they need to look at new
ventures and different revenue opportunities. This year the
trust has about $24.7 million in the budget in direct grants to
the various trust beneficiaries.
SENATOR ELLIS said he appreciates that the trust mission is to
produce revenue for the core beneficiaries of the trust, but he
wonders if the board has a set of core values that guide the
decisions to develop trust lands.
1:54:33 PM
MS. DERR replied they do have guiding principles. The chair
reads them at each meeting and they're followed closely.
Certainly there are struggles within the board because they all
come from different backgrounds, but they keep the needs of
their beneficiaries before them at all times.
CHAIR DAVIS thanked Ms. Derr for her service.
1:55:53 PM
MARY JANE MICHAEL, appointee, Alaska Mental Health Trust
Authority Board of Trustees, said she has served almost a year
to fill a vacancy. She serves on the resource committee so she's
been focused on learning about trust lands and other available
resources, but she's also interested in looking at ways to help
the beneficiaries in ways other than by funding programs. For
example, she's interested in looking at using trust lands for
affordable housing developments. She related that she's also
been somewhat involved in the Redroof Inn project. In conclusion
she said she has been proud to serve on the board and looks
forward to continuing.
1:58:50 PM
SENATOR ELLIS asked what she hopes to accomplish in the next
term.
MS. MICHAEL said she believes that there is a lot of untapped
opportunity and she hopes to help the trust focus on resource
development from their lands.
SENATOR ELLIS noted that Ms. Derr indicated that the easy
opportunities to generate funds for the trust have been taken
and observed that this implies that the trust will have to push
projects that have more inherent conflict. He asked what core
principles will guide her and the board generally in managing
these conflicts as they develop the trust lands to produce
revenue.
2:00:56 PM
MS. MICHAEL said she believes there are untapped investment
opportunities to produce revenue, including using trust
resources to invest in other lands that produce revenue.
Certainly the primary goal is to generate revenue to benefit the
beneficiaries, but the board agrees that it has to listen to the
public and collaborate with the affected communities.
CHAIR DAVIS thanked Ms. Michael for her service and said her
name will be forwarded.
2:03:49 PM
CARLTON SMITH, appointee, Alaska Mental Health Trust Authority
Board of Trustees, said he has a 25 year career in commercial
real estate mostly in Anchorage; his Juneau firm advises clients
nationwide with balance sheet values of at least $5 million. He
provided a brief professional resume and said he believes he can
bring value to the board particularly in the area of real estate
policy development. He related that a member of his family was a
beneficiary of the trust for many years and that drives his
interest in the issues facing the trust. But what really appeals
is that the trust is a young organization and thus a dynamic
management model. He understands the complexities of the mission
and is very interested in working with the trust.
2:07:01 PM
SENATOR THOMAS joined the meeting.
CHAIR DAVIS thanked Mr. Smith for his interest in the position
and said his name would be forwarded.
2:07:30 PM
DR. WILLIAM W. RESINGER, appointee, State Medical Board, said he
has been a board member since 2007. He considers it an honor to
serve and is happy to serve a second term. He informed the
committee that he has been a physician in Alaska since moving to
the state in 1984; in 2001 he began practicing part time.
2:09:54 PM
CHAIR DAVIS thanked Dr. Resinger for his service and said his
name would be forwarded for a vote by the full body.
At ease from 2:10 p.m. to 2:11 p.m.
SB 46-CHILD SUPPORT AWARDS
CHAIR DAVIS announced consideration of SB 46. It was heard
previously.
2:11:08 PM
SENATOR ALBERT KOOKESH, sponsor of SB 46, said the changes that
he agreed to during the previous hearing were placed in the
proposed committee substitute (CS) and copies have been
distributed to the members.
SENATOR PASKVAN moved to adopt the work draft committee CS for
SB 46, labeled 26-LS0279\P, as the working document. There being
no objection, version P was before the committee.
2:13:11 PM
DOROTHY SHOCKLEY, staff to Senator Kookesh, explained the
following changes: [Unless otherwise stipulated, the page and
line references relate to version S.]
· Page 5, line 13: Delete $100,000 and insert $105,000.
· Page 6, line 21: Following "or other means." insert the
sentence "A court shall find that health insurance is
available only if a dependent child has reasonable
geographic access to the covered services or the insurance
includes the coverage of transportation needed for the
services."
· Page 6, lines 21-25: Following "or other means." delete the
language from subsection (a) and insert on line 29 in
subsection (b).
· Page 6, lines 28-31 and page 7, lines 1-8: delete from
subsection (b) and insert in new subsection (c).
· Page 7, line 9: Subsection (c) is renumbered to become
subsection (d) in version P.
· Page 7, lines 20-25 in version P: Insert new subsection (e)
containing the following language:
A court shall find that the cost of cash
medical support or private health insurance
is reasonable under this section if the cost
to the responsible parent does not exceed
five percent of the responsible parent's
gross income. In calculating the percentage
for purposes of health insurance coverage,
the cost is the cost of adding the dependent
child to the existing insurance coverage or
the difference between self-only and family
coverage.
· Page 7, lines 17-18: Subsection (d) in version \S is
rewritten and becomes subsection (f) on page 7, lines 26-31
of version P. It is rewritten as follows:
(f) In this section,
(1) "cash medical support" means
an amount ordered to be paid toward the cost
of health insurance provided by a public
entity or by another parent through
employment or otherwise, or for other
medical costs not covered by insurance;
(2) "health care expenses"
includes medical, dental, vision, and mental
health counseling expenses.
· Page 7, line 24: Following "party's initial pleading"
insert "in superior court".
· Page 8, line 20: Delete "tribunal" and insert "court".
· Page 8, line 27: Following "outstanding support order."
insert "An award may be modified to require cash medical
support regardless of whether insurance is available to
either parent if neither parent has purchased health
insurance."
· Page 8, line 28: Following "insurance payments" insert "or
cash medical support".
· Page 8, line 29: Delete "tribunal" and insert "court".
· Page 10, line 5: Delete "tribunal" and insert "court".
· Page 11, line 18: Delete "NON-APPLICABILITY" and insert
"NONAPPLICABILITY".
2:17:43 PM
SENATOR OLSON joined the committee.
SENATOR KOOKESH said he agrees with the changes that were made
and he'd be grateful if the committee would move the bill.
2:18:51 PM
KEN ALPER, representing himself, said he is a local business
owner testifying in support of SB 46. He and his wife employ 20-
25 employees and they receive on average five to ten child-
support garnishment orders per year. A $1,000 to $1,500 order is
not unusual for an employee who grosses about $1,500 per month,
but it is unusual for an employee to stay on the payroll once
the child support garnishment goes into effect. They typically
move on to stay ahead of the order and that's part of the
problem that the sponsor is trying to reconcile. He said he
respects the need to care for these children, but when the state
takes so much from low-wage employees it reduces their stability
and opportunity to advance themselves.
2:21:16 PM
SENATOR PASKVAN asked what the statute would do that the court
rule isn't currently doing.
MR. ALPER replied it's his understanding that the 40 percent
number would be reduced to a smaller maximum percentage. It
would vary depending on the number of children.
SENATOR PASKVAN said he'd like the administration to answer that
question because that's not his understanding.
STACEY STEINBERG, Chief Assistant Attorney General, Collections
and Support Section, Civil Division, Department of Law (DOL),
stated that as currently proposed, SB 46 will not address how
much is taken out of an employee's paycheck when he/she owes
child support.
MS. SCHOCKLEY added that once the court rule is in statute, it
will be easier to make changes and the people who are affected
will have better access.
CHAIR DAVIS closed public testimony.
2:25:40 PM
SENATOR PASKVAN moved to report CS for SB 46, labeled 26-
LS0279\P, from committee with individual recommendations and
accompanying zero fiscal note(s). There being no objection CSSB
46(HSS) moved from the Senate Health and Social Services
Standing Committee.
SB 172-ALASKA HEALTH CARE COMMISSION
2:26:28 PM
CHAIR DAVIS announced consideration of SB 172. It was heard
previously.
SENATOR DONALD OLSON, sponsor of SB 172 said the bill relates to
the authorization of the Alaska Health Care Commission. This
will be a permanent commission to address health care issues and
rising health care costs. He noted that a proposed committee
substitute (CS) was distributed to members.
CHAIR DAVIS asked Mr. Obermeyer to review the changes
represented in the proposed CS.
2:28:17 PM
TOM OBERMEYER, staff to Senator Davis, said the only substantive
difference between the proposed CS and the original bill is on
page 3, line 6, relating to the composition and membership of
the commission under Sec. 18.09.020. Version S designates that
there will be 12 commission members; nine voting members will be
appointed by the governor, including the state medical director
as chair, and three nonvoting members will be ex officio members
from the House, the Senate, and Office of the Governor. The
original bill designated a 10 member commission.
2:30:51 PM
SENATOR PASKVAN moved to adopt the work draft CS for SB 172,
labeled 26-LS0790\S, as the working document. There being no
objection, version S was before the committee.
CHAIR DAVIS pointed out that the CS designates the medical
examiner as chair but it doesn't identify who will fill the
other seats. A separate handout proposes the organizations or
groups they might represent, but the designations will be made
following committee discussion and public testimony. She noted
that the commissioner of the Department of Health and Social
Services (DHSS) wrote to ask that the commission remain small
and to suggest that if the membership is increased that the new
members should represent [primary care physicians and the
behavioral health provider community.] It was the sponsor who
recommended adding two members for a total of 12, she said.
SENATOR DYSON observed that this seems to be a good way to
handle it.
2:34:28 PM
JAMES J. JORDAN, Executive Director, Alaska State Medical
Association, said ASMA represents physicians statewide and they
support creating the Alaska Health Care Commission in statute.
However, they would like the committee to consider physician
representation on this commission, both general practitioners
and general surgeons. He opined that physicians need to be at
the table helping develop Alaska's comprehensive statewide
health care policy and helping the commission fulfill its duties
in developing the strategies necessary to improve the health of
all Alaskans.
SENATOR DYSON asked if one of the voting members should have
significant experience in rural Alaska or does he believe that
the physician representation he suggested would adequately
represent the medical delivery teams in rural Alaska.
MR. JORDAN said he believes that the general practitioner could
represent the health care professionals that are part of the
healthcare delivery team, particularly with telemedicine.
2:38:02 PM
SENATOR PASKVAN observed that the proposed position number 8
designates a primary care physician who is licensed to practice
in the state and is board certified. He asked if board
certification is a meaningful requirement and if ASMA has a
position on that.
MR. JORDAN replied it's becoming uncommon to find primary care
physicians who are not board certified in Alaska. He described
the requirement as forward looking in light of the movement to
require board certification and continuing renewals in
licensures and certifications of competence.
CHAIR DAVIS said she'd like the administration to speak to that
because it was their recommendation.
2:40:10 PM
DEBORAH ERICKSON, Executive Director, Alaska Health Care
Commission (AHCC), said she works within the Department of
Health and Social Services (DHSS) and she is speaking today on
behalf of both DHSS and AHCC. She confirmed that DHSS suggested
the language related to the additional seat for a primary care
physician who practices family medicine, primary care internal
medicine, or pediatric medicine in the state. Because it's very
rare now for somebody to be practicing and licensed without
having board certification in any of these fields, DHSS would
have no objection to adding clarifying language that the
individual practicing would also be required to have board
certification in that particular field.
2:42:02 PM
SENATOR PASKVAN asked if she said the department wouldn't mind
if the board certification requirement were removed.
MS. ERICKSON replied DHSS doesn't have a concern with either
adding or leaving out the provision requiring board
certification.
CHAIR DAVIS said the committee needs to discuss and make a
decision on that matter. She asked if she's seen the list the
committee is considering.
MS. ERICKSON answered no.
CHAIR DAVIS said it was her intention to take testimony on the
proposed list of commission members before making a decision
about what to put in the final CS.
MS. ERICKSON said she'd like to first speak to the AHCC
recommendation about the size of the commission. The AHCC
January report included a recommendation for a permanent
commission established in statute and responsible for
comprehensive, sustained, accountable, and transparent health
system improvement planning for the state. They specifically
recommended that the commission remain the same size as the
existing commission, which is seven voting and three ex officio
members. AHCC made that recommendation with the specific
understanding that there was some support for a larger body. The
concern is that a larger commission would not facilitate
communication and decision making and that it might in fact
function more as an advocacy body. Thus, for reasons of
efficiency and the function of the group, AHCC wanted to state
on the record that the existing body worked well.
2:45:30 PM
MS. ERICKSON said the Department of Health and Social Services
also believes that the commission should maintain a relatively
small size, but the two additional seats would be acceptable. If
these are added, DHSS recommends that they be designated for a
primary care physician and a representative from the behavioral
health provider community. Although they're somewhat different
than DHSS suggested, she believes that the department would find
the descriptions for the primary care physician and the
behavioral health provider acceptable.
2:46:57 PM
JEFF JESSEE, CEO, Alaska Mental Health Trust Authority (AMHTA),
said AMHTA wants a seat at the table too. He is familiar with
the struggle to keep a group small enough to be functional and
still represent all of the necessary aspects adequately so
decisions are fully informed and representative of the issues
that need to be considered. While he's pleased that there is
interest in adding behavioral health representation to the
commission, he believes that it's critical to have someone who
has a system wide perspective. He confirmed this with
Commissioner Hogan and he expected the DHSS representative to
convey that the department would support the behavioral health
representative being a representative of AMHTA. That
representative might be a provider or an administrator of an
organization but they would be able to represent the interests
of the behavioral health system and have a systemic view of this
issue. This would bring the type of expertise and information
that would be most helpful to the commission, he concluded.
SENATOR DYSON asked if the mental health community would include
people who deal with substance abuse.
MR. JESSEE answered yes; the term behavioral health is
universally used to denote both mental health and substance
abuse.
2:51:01 PM
WAYNE STEVENS, President and CEO, Alaska State Chamber of
Commerce (ASCC), related that he has served as a member of the
Health Care Commission for the past year. This temporary
commission expires this year and while it began to address many
relevant issues, it doesn't have time to address them to the
degree required. Alaska's health care system needs adjustment in
order to provide cost effective, quality access to residents and
the best first step to address these issues is to establish in
statute the Alaska Health Care Commission. Experts and
representatives of key stakeholders appointed to this body will
form a plan to realign the system. The Alaska State Chamber of
Commerce supports a permanent commission that will provide
recommendations to the governor and Legislature that will result
in a health care system that provides quality and affordable
access to all Alaskans. The ASCC also supports including seats
on the commission for the state chamber and for primary care.
2:53:29 PM
SENATOR DYSON asked if he has a specific member to recommend.
MR. STEVENS replied he isn't seeking a seat for himself and he
doesn't have a specific recommendation, but he does believe that
the business community needs representation because it is a
significant contributor to the health care system. He added that
he has an interest in the health care community and served on
the Kodiak hospital board for about 14 years. And as a
representative of the business community he has an interest and
understanding of how to control and contain costs. According to
testimony the commission received, there are four basic parts to
the cost equation in the drivers of health care: 50 percent is
personal responsibility; 20 percent is the environment in which
you live; 20 percent is genetics; and 10 percent is the cost of
access to health care. When you're not addressing the largest
part of the problem it's not productive to argue about the
smallest part of the problem, he concluded.
2:56:51 PM
SHELLY HUGHES, Alaska Primary Care Association (APCA), thanked
the committee for adding a primary care position to the bill.
She echoed Mr. Jessee's statement that a representative with a
system perspective would benefit the commission more than say a
solo practice physician who is focused on patient care. APCA
could provide this perspective for medical, basic dental,
behavior health, and the many primary care provider type
positions. While the position could be filled by a physician,
administrators sometimes have a better overall sense of what
works in the overall system, she said. Because primary care is
so key to costs and prevention, it's important to have someone
with this system approach, she concluded.
CHAIR DAVIS said she would take direction from the members and
the sponsor with respect to the proposed list of representatives
before she had a new CS drafted.
2:59:05 PM
SENATOR OLSON said he agrees that a large commission could be
unwieldy, but busy schedules can make it difficult to get enough
people to a meeting to get a fair cross section, particularly
with health care providers. Referencing the earlier discussion
about board certification, he said he doesn't support that idea.
Another concern relates to the governor making the appointments
because it vests too much power in that office. He asked the
committee to consider the alternatives.
CHAIR DAVIS said she and the committee would take that into
consideration, but the governor wouldn't have full control
because people would submit their application and the governor
would have to select from the list.
3:03:12 PM
DENISE LICCIOLI, Staff to Senator Olson, referenced an earlier
statement that the sponsor asked for the commission
representatives listed on the handout and said that's correct
for the first seven positions but not eight and nine. The
sponsor clarified that he doesn't support the requirement for
board certification for position eight and for position nine the
sponsor requested a member from the Alaska Mental Health Trust
Authority.
CHAIR DAVIS held SB 172 in committee.
3:04:50 PM
There being no further business to come before the committee,
Chair Davis adjourned the Senate Health and Social Services
Standing Committee hearing at 3:04 p.m.
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