Legislature(2009 - 2010)BUTROVICH 205
03/15/2010 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB307 | |
| SCR13 | |
| SB250 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 307 | TELECONFERENCED | |
| *+ | SB 250 | TELECONFERENCED | |
| *+ | SCR 13 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 15, 2010
1:32 p.m.
MEMBERS PRESENT
Senator Bettye Davis, Chair
Senator Joe Paskvan, Vice Chair
Senator Johnny Ellis
Senator Joe Thomas
Senator Fred Dyson
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 307
"An Act relating to residential shelters for runaway minors."
- MOVED SB 307 OUT OF COMMITTEE
SENATE CONCURRENT RESOLUTION NO. 13
Supporting senior caregivers and encouraging the Department of
Health and Social Services to provide additional education on
the effects of aging and the importance of senior caregivers.
- MOVED CSSCR 13(HSS) OUT OF COMMITTEE
SENATE BILL NO. 250
"An Act requiring insurance coverage for autism spectrum
disorders, describing the method for establishing a treatment
plan for those disorders, and defining the treatment required
for those disorders; and providing for an effective date."
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 307
SHORT TITLE: SHELTERS FOR RUNAWAY MINORS
SPONSOR(s): HEALTH & SOCIAL SERVICES
03/10/10 (S) READ THE FIRST TIME - REFERRALS
03/10/10 (S) HSS, JUD
03/15/10 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: SCR 13
SHORT TITLE: SUPPORTING SENIOR CAREGIVERS
SPONSOR(s): BUNDE
02/24/10 (S) READ THE FIRST TIME - REFERRALS
02/24/10 (S) HSS
03/15/10 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: SB 250
SHORT TITLE: INS. COVERAGE: AUTISM SPECTRUM DISORDER
SPONSOR(s): HEALTH & SOCIAL SERVICES
02/01/10 (S) READ THE FIRST TIME - REFERRALS
02/01/10 (S) HSS, FIN
03/15/10 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
CELESTE HODGE, Staff to Senator Davis
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Introduced SB 307.
KIMBERLEE COLBO, Attorney
Covenant House
Anchorage, AK
POSITION STATEMENT: Was available for questions.
WILDA LAUGHLIN, Legislative Liaison
Special Assistant to the Commissioner
Department of Health and Social Services (DHSS)
Juneau, AK
POSITION STATEMENT: Supported SB 307.
LAUREN RICE, Director of Public Affairs
Covenant House
Anchorage, AK
POSITION STATEMENT: Supported SB 307.
TREVOR FULTON, Staff for Senator Con Bunde
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Read the sponsor statement for SCR 13.
LORNA MILLS, representing herself
Anchorage, AK
POSITION STATEMENT: Testified on SCR 13.
KAY BRANCH
Elder Health Program Coordinator
Alaska Native Tribal Health Consortium (ANTHC)
Anchorage, AK
POSITION STATEMENT: Supported SCR 13.
JOANNE GIBBENS, Deputy Director
Division of Senior and Disability Services
Department of Health and Social Services (DHSS)
Juneau, AK
POSITION STATEMENT: Testified that the administration supports
HCR 13.
MARIE DARLIN
AARP Capitol City Task Force
Juneau, AK
POSITION STATEMENT: Testified in support of SCR 13.
DENISE DANIELLO, Executive Director
Alaska Commission on Aging
Department of Health and Social Services (DHSS)
Juneau, AK
POSITION STATEMENT: Testified in support of SCR 13.
KEVIN TURKINGTON, Chief Executive Officer
Senior Care of Alaska
President, Board of National Private Duty Association (NPDA)
Anchorage, AK
POSITION STATEMENT: Testified in support of SCR 13.
REPRESENTATIVE PETE PETERSEN
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Sponsor of SB 250
TOM OBERMEYER, Staff to Senator Davis
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Gave an overview of the CS for SB 250.
LORRI UNUMB, Attorney
Autism Speaks
Columbia, SC
POSITION STATEMENT: Testified in support of SB 250.
SHEELA TALLMAN, Legislative Affairs
Premera Blue Cross Blue Shield of Alaska
POSITION STATEMENT: Testified in opposition to SB 250.
ACTION NARRATIVE
1:32:29 PM
CHAIR BETTYE DAVIS called the Senate Health and Social Services
Standing Committee meeting to order at 1:32 p.m. Present at the
call to order were Senators Paskvan, Ellis, and Davis. Senator
Dyson arrived soon thereafter.
SB 307-SHELTERS FOR RUNAWAY MINORS
1:32:48 PM
CHAIR DAVIS announced consideration of SB 307.
SENATOR DYSON joined the meeting.
1:33:39 PM
CELESTE HODGE, Staff to Senator Davis, sponsor of SB 307, said
this bill will allow shelters like Covenant House Alaska (CVA)
to continue to apply for federal grants. In 2007 CVA was awarded
the federal Basic Center Grant (BCG) through the Administration
for Children and Families (ACF), but they were recently notified
that they are out of compliance because they have more than 20
beds, which is what the grant allows. However, ACF did concede
that a state law requiring more beds would override the federal
requirement. SB 307 does that and therefore will allow CVA to
continue to compete for federal grants by operating under the
terms of their license.
This will not increase the cost or workload of the CVA staff so
there is a zero fiscal note, she concluded.
SENATOR THOMAS joined the meeting.
1:36:45 PM
SENATOR DYSON said this is absolutely common sense and he can't
imagine that there is any opposition. He suggested that the
chair ask if there is any negative testimony and, if not, the
committee can move ahead with the bill.
KIMBERLEE COLBO, Attorney, Covenant House, Anchorage, Alaska,
said she was available for questions.
1:39:02 PM
WILDA LAUGHLIN, Legislative Liaison, Department of Health and
Social Services (DHSS), thanked the committee for carrying the
bill and Covenant House for working with DHSS. She stated that
the administration has no concerns with the bill.
LAUREN RICE, Director of Public Affairs, Covenant House,
Anchorage, Alaska, thanked Chair Davis and the committee for
bringing the bill forward.
1:40:29 PM
CHAIR DAVIS closed public testimony and asked the will of the
committee.
SENATOR PASKVAN moved to report SB 307 from committee with
individual recommendations and attached fiscal note(s). There
being no objection, SB 307 moved from the Senate Health and
Social Services Standing Committee.
At ease from 1:40 p.m. to 1:42 p.m.
SCR 13-SUPPORTING SENIOR CAREGIVERS
CHAIR DAVIS announced consideration of SCR 13.
1:42:28 PM
TREVOR FULTON, staff for Senator Con Bunde, introduced SCR 13
paraphrasing the following sponsor statement:
Alaska's senior population is growing. The number of
Alaskans 65 years of age or older is expected to
increase by nearly 60 percent in the next 20 years and
the population of those 85 years or older is projected
to double by 2050. Per capita, Alaska has the fastest
growing 85 and over population in the entire nation.
While advances in medicine, technology, and assisted
living practices are enabling seniors to live longer,
more productive, and more comfortable lives than ever
before, the fact remains that many of our aging loved
ones will at some point require some form of
caregiving. In fact, more than 25 percent of all
seniors need some level of assistance with their daily
activities.
It is critical that we as a state are prepared to meet
and manage the needs of our aging population.
By supporting senior caregivers and encouraging the
Department of Health and Social Services to provide
additional education on the effects of aging and the
importance of senior caregivers, SCR 13 draws
attention to the changing demographics of aging in
Alaska and the critical role played by senior
caregivers.
1:45:28 PM
SENATOR PASKVAN moved to adopt the work draft committee
substitute (CS) for SCR 13, labeled 26-LS1481\P, as the working
document. There being no objection, version P was before the
committee.
1:46:30 PM
LORNA MILLS, representing herself, said she is a registered
nurse and the owner of Care Net Inc., a private-duty home care
provider in Anchorage that employs caregivers who help people in
their own homes. Because un-monitored care opens the possibility
for exploitation of vulnerable older persons, there is a big
difference between hiring someone from a reputable private-duty
home care organization and hiring someone from a newspaper ad,
she said. As a member of the National Private-Duty Association
(NPDA) and the Alaska chapter, she said she speaks for the group
in saying they are dedicated and have made it their mission to
preserve the integrity of the private-duty home care industry by
adhering to certain standards. A goal of the association is
educate the community about the importance of using an NPDA
agency.
She asked Mr. Fulton what the sponsor hopes to accomplish with
SCR 13, what he will do to support businesses like hers, and how
she can help.
CHAIR DAVIS advised Ms. Mills to contact either her office or
the sponsor's.
1:49:43 PM
KAY BRANCH, Elder Health Program Coordinator, Alaska Native
Tribal Health Consortium (ANTHC), said ANTHC supports SCR 13 on
behalf of their tribal health partners, the 16,000 Alaska Native
elders in the state, and caregivers. And they encourage DHSS to
ensure that caregiving resources and education embraces the
cultural and linguistic traditions of Alaska Native people. As
part of the Medicaid reform initiative, Alaska tribal health
organizations collaborated to design a tribal long term care
service development plan that would increase access to both home
and community-based and facility services for Alaska Native
elders and people with disabilities. This includes components
like SCR 13 that encourages family caregivers to provide care
and supplement with formal services only when necessary. This
maintains the family structure and honors the long-standing
tradition of caring for elders, she said.
Tribal health system partners continue to work with DHSS to
increase home and community-based services at all levels. This
includes traveling to rural regions to better understand the
challenges of rural service delivery and tribal health
organizations thereby ensuring equal access to services
statewide. Culturally appropriate nursing and assisted living
homes are also needed to provide the full range of long term
care services to Alaska Native elders and people with
disabilities. ANTHC therefore also seeks support for the tribal
facility capital projects in Anchorage, Kotzebue, and Bethel,
she concluded.
1:52:56 PM
JOANNE GIBBENS, Deputy Director, Division of Senior and
Disability Services, Department of Health and Social Services
(DHSS), stated that the administration supports SCR 13.
SENATOR DYSON said the implication of the resolution is that
DHSS needs a kick in the pants, but it appears that DHSS doesn't
look at it that way. He asked what the resolution really
accomplishes and why the department supports it.
MS. GIBBENS replied the department supports the resolution
because it recognizes the need and is committed to doing what it
can with existing and future resources to meet that needs of
caregivers. Through a combination of federal and state funds
they currently provide funding for eight agencies statewide to
provide caregiver support services. That's probably not
sufficient to meet the statewide need, but they are committed to
do what they can and to continue working with the Alaska
Commission on Aging to identify strategies to improve service
delivery statewide.
1:55:57 PM
SENATOR DYSON referenced the resolve on page 2 and asked what
the impact is for the Legislature to say it recognizes senior
caregiving as a profession.
MS. GIBBENS said she believes that recognizing something as a
profession recognizes it as a calling and a life's task and
work. Also, family caregivers can sometimes get paid for
providing services and in that respect it's a profession for
them.
SENATOR DYSON asked if she sees this as a precursor to formal
training and/or licensing.
MS. GIBBENS replied DHSS already provides training to
caregivers, counseling and support groups to families, and
respite services for family members.
SENATOR DYSON observed that she's saying "no."
MS. GIBBENS agreed.
SENATOR DYSON asked Mr. Fulton if he and the sponsor believe
that the resolution commits the Legislature provide funding to
do everything outlined in the resolve section on page 2.
CHAIR DAVIS suggested he take the resolution at face value. She
believes it's appropriate for the department to express support
and doesn't feel that it will bind the Legislature.
SENATOR DYSON said it could be argued differently but he won't
push it.
2:01:09 PM
MARIE DARLIN, AARP Capitol City Task Force, expressed support
for SCR 13. It's important to educate people about the growing
need for caregiver services because that need for those services
is growing rapidly. She suggested that a little more emphasis
might be given to letting people know what services are
available through the state or community organizations.
2:03:12 PM
DENISE DANIELLO, Executive Director, Alaska Commission on Aging,
Department of Health and Social Services (DHSS), said Alaska's
senior population is growing faster than any state in the
nation, but not because seniors are moving here. It's that the
people who moved here in the '70s and '80s are aging and
choosing to remain in Alaska. This is an important population in
terms of their investment in Alaska. According to a study done
by the University of Alaska, seniors contribute more than $1.5
billion to the state economy each year and this doesn't include
the seniors who continue to work and volunteer. SJR 13 calls
attention to the changing demographics and the need to look at
the types of services that are provided and whether they are
sufficient to keep seniors living here.
2:06:09 PM
KEVIN TURKINGTON, CEO, Senior Care of Alaska; President, Older
Persons Action Group and Alaska chapter of the National Private
Duty Association (NPDA), said he is testifying in support of SCR
13. It can bring a better balance to supporting the entire
senior population. Many resources are focused to the low-income
seniors and, while that is important, about 75 percent of
seniors don't qualify for these services. The best way to serve
seniors and lower the costs of doing so is to empower seniors
and family and professional caregivers. This can be accomplished
by filtering all current regulations and subsequent legislation
through SCR 13 and the powerful statement if makes on behalf of
seniors and their families.
2:09:54 PM
CHAIR DAVIS called an at ease due to a teleconference system
malfunction.
2:17:16 PM
CHAIR DAVIS reconvened the meeting and closed public testimony.
2:17:57 PM
SENATOR PASKVAN moved to report CSSCR 13, labeled 26-LS1481\P,
from committee with individual recommendations and attached
fiscal note(s). There being no objection, CSSCR 13(HSS) moved
from the Senate Health and Social Services Standing Committee.
At ease from 2:18 p.m. to 2:20 p.m.
SB 250-INS. COVERAGE: AUTISM SPECTRUM DISORDER
2:20:05 PM
CHAIR DAVIS announced consideration of SB 250. She asked
Representative Peterson if he would like to present the
companion to SB 250, which he introduced in the House.
REPRESENTATIVE PETE PETERSEN, sponsor of HB 187, encouraged the
committee to ask questions of the autism experts that were
online.
CHAIR DAVIS said it was not her intent to move the bill today.
She asked Mr. Obermeyer to present the bill.
2:22:13 PM
TOM OBERMEYER, staff to Senator Davis, said he was speaking to
the committee substitute (CS) for SB 250, labeled 26-LS1400\R.
He read the sponsor statement into the record. [A copy is in the
bill file.]
He related that SB 250 mandates coverage for diagnosis and
treatment of autism spectrum disorders (ASD) in any plan offered
by the health care insurer. Early treatment has been shown to
improve the symptoms of ASD and sometimes eliminate the need for
special education for a child with ASD. This is the proper way
to deal with this problem and it saves a great deal of money,
Mr. Obermeyer said.
MR. OBERMEYER pointed out that self-funded health plans,
including the "Alaska Care" plan, would likely be exempt from
the bill because they are preempted by the federal ERISA law.
However, the state historically has complied with state
insurance laws.
The Center for Disease Control (CDC) reports that about 1 in 110
children are affected by ASDs, but it is much more prevalent
among boys. This is an increase from 10 years ago, but it's
unclear if this increase is due to a broader definition of ASDs,
better diagnoses, or a combination. Many children who have been
diagnosed go untreated because ASD often is not covered by
insurance plans. The cost to families is overwhelming.
MR. OBERMEYER related that the federal Autism Treatment
Acceleration Act of 2009 is pending legislation and implementing
SB 250 now would allow insurers and the state time to adjust to
the requirements of this law. Also, he said, it would bring
health care professional and jobs to the state. Since March of
2009, 11 states have passed legislation similar to SB 250 and 19
states have introduced legislation. SB 250 will significantly
help the hundreds of Alaskans suffering from these disorders, he
concluded.
2:29:19 PM
SENATOR PASKVAN moved to adopt the proposed committee substitute
(CS) for SB 250, labeled 26-LS1400\R, as the working document.
There being no objection, version R was before the committee.
2:29:44 PM
LORRI UNUMB, Senior Policy Advisor and Counsel, Autism Speaks,
Columbia, South Carolina, said this is a national autism
science, research, and advocacy organization. She informed the
committee that she is a former law professor and the parent of a
child with autism; she now advocates full time for children with
autism and work nationwide on autism insurance reform. She noted
that she would speak to the PowerPoint handout in the packets
focusing on the experience in other states that have passed
autism insurance reform.
Slide 6 depicts a map of the U. S. showing the states that have
passed autism insurance reform. At Autism Speaks they consider
that 15 states have enacted meaningful reform, she said. In
these states kids can get the kind and close to the amount of
therapy that's been prescribed for them. Indiana and Minnesota
passed legislation in 2001 so cost data is available, but it's
nearly ten years old. South Carolina and Texas were the next
states to pass legislation in 2007; more states followed suit in
2008 and 2009. As previously mentioned, legislation is pending
in 19 states.
MS. UNUMB directed attention to slide 7 that contains excerpted
data from an insurance advocacy association report titled
"Health Insurance Mandates in the States." It indicates that
covering autism has impacted premiums by less than 1 percent.
This is compared to other mandated treatments like alcoholism,
contraceptives, in vitro fertilization, and prescriptions all of
which are higher.
Slide 8 contains actual cost data from South Carolina after the
autism insurance statute became applicable to the state employee
health plan in January 2009. The state has a population of 4.5
million and the state employee health plan has 350,000 members.
When the legislation was introduced the state budget office
initially estimated that this coverage would cost the state
$18.9 million and that was later revised down to $9 million. The
actual claims date for all of 2009 shows that it cost the state
$856,371. This translates to a 20 cent premium increase per
member per month to provide all the kids with autism in South
Carolina with the coverage they need. The South Carolina statute
is a little different than what SB 250 proposes because it
provides coverage only through age 16 and it caps applied
behavior analysis (ABA) therapy at $50,000 per year. The Harvard
study indicates that the lifetime cost for each child with
autism who does not get treated is $3.2 million so if you're not
motivated by the human aspect, think about if from the fiscal
perspective, she said. Fully 50 percent of the kids who receive
treatment will go right into a mainstream first grade classroom,
saving the state an awful lot of money, she concluded.
2:38:42 PM
SENATOR PASKVAN asked what policy issues caused [South] Carolina
to cap coverage at age 16 and $50,000.
MS. UNUMB replied she selected age 16 somewhat randomly without
any scientific basis. Most of the states that have reform
selected age 18-22. The original legislation didn't have a
therapy cap, but the insurance industry argued in favor of one
on the ABA therapy because they couldn't estimate that cost.
When the legislature asked her to write in a cap, she put in
$75,000 because that's the cost of her son's therapy. Shortly
before the bill passed the cap was negotiated down to $50,000.
Slide 10 has a chart comparing the age and ABA therapy caps in
six states with reform statutes. She offered to provide a chart
that compares all 15 states in some detail.
CHAIR DAVIS said that would be helpful.
2:42:18 PM
SENATOR DYSON questioned why treatment for this disability isn't
paid for out of the tax base as opposed to insurance. Here in
particular it would be a very selective and disproportionate
sharing of the burden.
MS. UNUMB replied some states have attempted to provide coverage
through the Medicaid waiver program, but it isn't sufficient to
treat all the kids. Even with a very favorable 70 percent
federal match, South Carolina has two to three year waiting
lists of several hundred children. That doesn't do a child with
autism any good because the early intervention window is
critical for rewiring the brain. She added that autism is at
core a medical issue and for the people who have private
insurance it seems only fair that private insurance play a part.
SENATOR DYSON thanked her for a thoughtful response.
2:46:24 PM
SENATOR THOMAS referenced the actual 2009 cost data she provided
for the South Carolina state employee plan and expressed
disbelief that treatment per child could cost so little. He
asked how she arrived at $856,000.
MS. UNUMB said she believes that cost will rise as more people
take advantage of the coverage, but she doesn't it will ever
approximate the state's $9 million estimate.
She referenced slide 2 showing the five pervasive developmental
disorders (PPD). Within the five PDDs there are three autism
spectrum disorders (ASDs): autistic disorder, Asperger's
syndrome, and pervasive developmental disorder - not otherwise
specified (PDD-NOS). Autistic disorder accounts for 1/3 of all
ASDs, Asperger's syndrome accounts for less than 1/6 of all
ASDs, and the milder PDD-NOS accounts for 1/2 of all autism
spectrum disorders. The kids in the first category are severe
and they are prescribed the intensive behavioral therapy. While
the prevalence of PDD is 1 in 110, only 1/3 have a severe
diagnosis and only some of those will be prescribed a full 40
hour per week ADA therapy program. And not all of the ones who
are prescribed the intensive program will take advantage of it
because it takes place in your home and is incredibly intrusive.
Not every family is willing to make the lifestyle adjustments
and in rural areas there may be provider issues.
One reason that South Carolina's fiscal note was so far off is
that the budget analyst took the prevalence number and
multiplied it by the cap. They assumed that every child would be
prescribed and get the maximum treatment, but it doesn't work
that way. In South Carolina 62,000 kids were within the age 2-16
target range and just 64 were actually prescribed and took
advantage of the therapy in 2009.
SENATOR THOMAS asked if she has examples from other states that
have had legislation in place for a longer period of time and
why she included a slide that lists businesses that have self-
funded ERISA plans.
2:53:07 PM
MS. UNUMB said it's difficult to get detailed data because
private insurers are less forthcoming, but she does have data
from Minnesota. That benefit has neither an age nor a dollar cap
and it's been in effect for nine years. Blue Cross/Blue Shield
said that the average utilization on an ABA program was $30,000
per year and the premium increase has been $.83 per member per
month. She noted that Autism Speaks hired an independent actuary
to conduct an analysis on the companion bill to SB 250 and he
projected a cost of $1.34 per member per month.
She explained that she included the information on the ERISA
plans because she likes to point out that when a state chooses
to mandate a benefit many ERISA regulated plans voluntarily
follow suit. The slide offers a small list of companies that
have elected to provide an autism benefit. She believes that the
Microsoft administrator is Premera Blue Cross Blue Shield and
she understands they are a predominant insurer in Alaska.
SENATOR PASKVAN asked if there's a rational explanation for some
states placing a different dollar cap on therapy based on age.
MS. UNUMB replied they're the result of a political process.
Some states have decided that kids don't need as much treatment
once they enter school and that might be true depending on
severity.
2:57:28 PM
SHEELA TALLMAN, Legislative Affairs, Premera Blue Cross Blue
Shield of Alaska, confirmed that this legislation will not
impact self-funded plans, which are subject to ERISA and it's
not subject to state mandates. However, the bill will impact the
40 percent of the market that represents individuals and small
employers in Alaska that are already price stressed. It imposes
a mandate on health insurers like Blue Cross by requiring all
policies to include coverage for ASDs including social skills-
based therapies that generally considered outside the realm of
health care. They estimate that this mandate could increase
health insurance premiums up to 3 percent so it's not cost free.
2:59:15 PM
SENATOR PASKVAN asked if she disputes the estimated $1.34 per
person per month premium increase.
MS. TALLMAN replied they believe it will be slightly higher but
she doesn't have the exact number.
SENATOR PASKVAN asked if the premium would likely be lower if it
were spread over a larger population base.
MS. TALLMAN replied their calculations already include the small
and large groups of insured.
CHAIR DAVIS asked if she could meet with the committee again and
provide the additional information.
MS. TALLMAN agreed to do so.
CHAIR DAVIS held SB 250 in committee.
3:00:50 PM
There being no further business to come before the committee,
Chair Davis adjourned the Senate Health and Social Services
Standing Committee hearing at 3:00 p.m.
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