03/19/2012 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Alaska Brain Injury Network | |
| SB5 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 5 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 19, 2012
1:36 p.m.
MEMBERS PRESENT
Senator Bettye Davis, Chair
Senator Dennis Egan
Senator Kevin Meyer
MEMBERS ABSENT
Senator Johnny Ellis
Senator Fred Dyson
COMMITTEE CALENDAR
PRESENTATION: ALASKA BRAIN INJURY NETWORK
- HEARD
SENATE BILL NO. 5
"An Act relating to eligibility requirements for medical
assistance for certain children and pregnant women; and
providing for an effective date."
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 5
SHORT TITLE: MEDICAL ASSISTANCE ELIGIBILITY
SPONSOR(s): SENATOR(s) DAVIS, EGAN, ELLIS, FRENCH, WIELECHOWSKI
01/19/11 (S) PREFILE RELEASED 1/7/11
01/19/11 (S) READ THE FIRST TIME - REFERRALS
01/19/11 (S) HSS, FIN
03/07/11 (S) HSS AT 1:30 PM BUTROVICH 205
03/07/11 (S) Heard & Held
03/07/11 (S) MINUTE(HSS)
03/23/11 (S) HSS AT 1:30 PM BUTROVICH 205
03/23/11 (S) Heard & Held
03/23/11 (S) MINUTE(HSS)
03/28/11 (S) HSS AT 1:30 PM BUTROVICH 205
03/28/11 (S) Moved SB 5 Out of Committee
03/28/11 (S) MINUTE(HSS)
03/30/11 (S) HSS RPT 3DP 1DNP 1AM
03/30/11 (S) DP: DAVIS, ELLIS, EGAN
03/30/11 (S) DNP: DYSON
03/30/11 (S) AM: MEYER
04/08/11 (S) FIN AT 9:00 AM SENATE FINANCE 532
04/08/11 (S) Heard & Held
04/08/11 (S) MINUTE(FIN)
04/11/11 (S) FIN RPT 4DP 2NR
04/11/11 (S) DP: HOFFMAN, THOMAS, EGAN, ELLIS
04/11/11 (S) NR: STEDMAN, OLSON
04/11/11 (S) FIN AT 9:00 AM SENATE FINANCE 532
04/11/11 (S) Moved SB 5 Out of Committee
04/11/11 (S) MINUTE(FIN)
04/14/11 (S) RETURNED TO RLS COMMITTEE
03/16/12 (S) RETURNED TO HSS COMMITTEE
03/19/12 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
Dr. Heather Macomber, Board Member
Alaska Brain Injury Network (ABIN)
Anchorage, Alaska,
POSITION STATEMENT: Presented information on the Alaska Brain
Injury Network.
THOMAS OBERMEYER, Staff
Senator Bettye Davis
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Explained the changes in version I of SB 5
on behalf of the sponsor.
ACTION NARRATIVE
1:36:22 PM
CHAIR BETTYE DAVIS called the Senate Health and Social Services
Standing Committee meeting to order at 1:36 p.m. Present at the
call to order were Senators Egan, Meyer, and Chair Davis.
^Presentation: Alaska Brain Injury Network
Presentation: Alaska Brain Injury Network
CHAIR DAVIS announced the first order of business was a
presentation by the Alaska Brain Injury Network.
1:36:43 PM
DR. HEATHER MACOMBER, Board Member, Alaska Brain Injury Network
(ABIN), presented information related to ABIN. She related that
AlaskaNeuro Associates has been managing the concussion program
for the Anchorage School District since [HB 15] was implemented
last year. She explained the definition of sports concussion and
listed facts related to them.
She said that sports concussion is defined as a complex
pathophysiological process affecting the brain, induced by
traumatic biomechanical forces. They are self-resolving and most
that occur do not have a loss of consciousness. Athletes who
have sustained concussions are 4 to 6 times more likely to
sustain a second concussion. Most concussions occur in football.
She related that concussion awareness has been developing over
the past ten years. Similar programs have been implemented in
the Lower 48. The Center for Disease Control (CDC) considers
concussions at an epidemic level. It is important to protect
student athletes because their brains are still developing and
they are vulnerable to lasting effects of a concussion.
DR. MACOMBER described the mechanism of concussions and the
neurometabolic change of concussions. She listed a concussion as
a metabolic injury which does not show up on a MRI.
She addressed why concussion management is important. It is
important to prevent cumulative effects of the injury and allow
players to return quickly and safely to play. Sideline
assessment helps identify when to seek immediate medical
attention. Second impact syndrome happens rarely, but it can be
fatal. Most often second impact syndrome occurs in athletes
younger than 21 years old. There is an increase in the risks of
concussions with more than one; each concussion is more serious
and the recovery is longer.
DR. MACOMBER addressed the common immediate post-concussive
symptoms; emotional, cognitive, physical, and sleep problems.
Most concussions recover in a couple of weeks.
DR. MACOMBER stressed that an athlete cannot be trusted to self-
report because they want to continue to play the sport. She said
that when the word "concussion" is removed from the questioning
of an athlete about his or her injury, the rate of reporting
increases dramatically. She showed a quotation from a New York
Times article: "Anonymous questionnaires that ask specifically
about concussions have reported rates among high school football
players at about 15 percent each season; when the word
concussion is omitted and a description of symptoms is provided
instead, close to 50 percent of players say they had one, with
35 percent reporting two or more."
She described former neurology guidelines and new concussion
management guidelines. Too much weight was given for loss of
consciousness in the past. She listed five steps of concussion
management: remove symptomatic athletes from play, restrict them
from play when they are symptomatic, graduate the return to
play, provide neurocognitive testing, and recognize the
differences when testing children.
DR. MACOMBER discussed the neuropsychology role in working with
concussion victims by using the Immediate Post-Concussion
Assessment and Cognitive Testing (ImPACT) method. She related
that ABIN is the only entity using this assessment tool. She
explained that ImPact is a 20 to 25 minute test covering a range
of symptoms. She listed the entities that use ImPACT, such as
the military, professional sports, colleges, and school
districts. She showed a graph listing the unique contribution of
neurocognitive testing to concussion management. She concluded
that the test reveals insight into concussions.
DR. MACOMBER talked about the ImPACT "Bell-Ringer" study
consisting of 64 high school athletes with "mild" concussions
and no loss of consciousness. Two groups were compared in terms
of outcome.
She pointed out that post-traumatic migraine is a common symptom
following sports concussions. She addressed the cumulative
effects of more than one concussion. Evidence exists that more
than three concussions is associated with ongoing adverse
effects in some athletes. She shared additional ImPACT research.
1:50:56 PM
DR. MACOMBER related the clinical protocol with neurocognitive
testing. She described baseline pre-testing, sideline
assessment, and principles of sideline assessment, which are to
remove the athlete from distracting activity and people, try to
maintain their full attention, speak in a loud and clear voice,
and have the athlete perform all tasks listed on the assessment
card. If they fail any questions, they cannot return to play.
Sideline assessment is completed by a coach, athletic trainer,
EMT, or someone who knows the signs of a concussion. Athletes
with severe signs go directly to the ER.
DR. MACOMBER showed a card containing the best approach to
concussion management that can be used by coaches. It contains
on-field cognitive testing. She showed an example of the pre-
test protocol. She gave examples of a design memory test.
1:56:36 PM
DR. MACOMBER reported on the Anchorage School District post-
injury protocol. She described how the injured student is
assessed. She listed steps in the return-to-play protocol. She
gave examples of what injured athletes can and cannot do.
DR. MACOMBER stressed what ImPACT will do when used properly by
trained professionals. It will determine the severity of the
concussion, provide valuable information to the athlete,
parents, athletic trainers, physicians, and teachers, determine
when it is safe to return to play, and reduce liability for
school districts.
She said the ImPACT process is a team collaboration where
coordination between parents, coaches, nurses, teachers,
counselors, and the student is critical.
DR. MACOMBER talked about why schools choose ImPACT; concussions
are one of the most serious medical problems at the high school
level, proper management of concussions is the best form of
prevention of serious injury, litigation for improper management
of concussions can be avoided, and it creates a team approach to
concussion management.
She shared current Anchorage School District (ASD) data. ASD
middle and high school students completed 8,354 baseline
assessments and there were 30 post-injury tests. She opined that
there should be more post-injury tests: however, it is a brand
new program and students are reluctant to discuss their
symptoms. Also, some parents and coaches are unhappy with the
program.
DR. MACOMBER spoke of challenges to the program such as under-
reporting of concussions and the poor roll-out of the program by
schools. Some coaches did not cooperate and students
underreported injuries due to fear of prolonged/excessive
restriction. Teachers and support staff were sometimes unwilling
to meet students' needs or grant accommodations. A few coaches
directed students to re-take baselines in order to assess
concussion themselves, despite having no training in this
regard. Some students deliberately performed poorly on the
baseline, with the goal of being returned to play faster after a
concussion. Some baselines were conducted in suboptimal
conditions, resulting in low scores that do not reflex students'
true abilities.
DR. MACOMBER spoke of financial and insurance constraints such
as under-insured or uninsured students, higher co-pays, codes
denied or insurance unwilling to pay for assessment, no
additional resources available to alleviate patients' financial
burdens, and no insurance available.
2:07:35 PM
DR. MACOMBER reviewed the key points from the presentation.
DR. MACOMBER showed a video - Sports Concussions Are Brain
Injuries.
2:14:10 PM
CHAIR DAVIS pointed out that some parents agree and some don't
agree with the ImPACT assessment. She wondered how accurate the
numbers were that were obtained from the school district.
DR. MACOMBER said that all schools differ in their reporting.
CHAIR DAVIS asked what happens when neglect has occurred.
DR. MACOMBER replied that AlaskaNeuro Associates communicates
with the schools about any reported problem. The schools try to
address the problem internally.
CHAIR DAVIS suggested legislation might be the answer to this
dilemma. She stressed that she was concerned about the school-
age population. She asked where the grant money comes from.
DR. MACOMBER offered to provide that information. She recalled
that a student had applied to an agency called LINKS, which
turned out to be for those who were older than 18.
CHAIR DAVIS asked if students were required to have insurance in
order to play sports.
DR. MACOMBER said no.
2:17:56 PM
SENATOR EGAN asked why a parent would be against this program.
DR. MACOMBER listed various reasons. Some of the parents felt
they were being forced into the program or that their own
physician should determine the plan for evaluation and treatment
of a concussion.
SENATOR EGAN pointed out that this type of assessment is being
done in professional and high school sports.
DR. MACOMBER said Alaska was one of the last state's to have a
program. She described how the program came to be.
2:19:55 PM
SENATOR MEYER asked for DR. MACOMBER's background.
DR. MACOMBER said she was a neuropsychologist.
SENATOR MEYER asked if she specialized in brain injuries.
DR. MACOMBER said she did.
SENATOR MEYER inquired if concussions are brain injuries and if
they can cause permanent damage.
DR. MACOMBER replied that a concussion is considered the mildest
form of a brain injury and usually resolves itself, but it can
cause permanent damage.
SENATOR MEYER asked if the brain can be surgically fixed.
DR. MACOMBER gave examples of the instances when surgery could
be used; however, she said most concussions just require rest.
She described the role of glucose in the brain.
SENATOR MEYER related concussions to Fetal Alcohol Spectrum
Disorder.
2:22:11 PM
SENATOR MEYER wanted to know if treatment protocols for
concussions were practiced statewide.
DR. MACOMBER did not know.
SENATOR MEYER suggested making the program standard for all high
schools.
DR. MACOMBER said the state standard now is that an athlete must
be cleared by a person certified in concussion management before
he or she can play again. She described the credentialing
program and who can deliver the program.
SENATOR MEYER asked if athletic trainers are qualified to make
the assessment.
DR. MACOMBER said they were not because they don't have the
training. She gave an example and discussed the liability issue.
SENATOR MEYER restated the question to ask about sideline
assessment.
DR. MACOMBER related that trainers and coaches could be trained
to do those assessments. She described how the information is
shared with the school district.
2:25:56 PM
CHAIR DAVIS asked if AlaskaNeuro reports back to the school
district and the Department of Education.
DR. MACOMBER explained they report to the school district, but
not the Department of Education.
CHAIR DAVIS stated that the issue of concussion treatment needs
more work in the state.
DR. MACOMBER opined that the bill was a start. Over 8,000
students have baseline data.
SENATOR MEYER asked who makes up AlaskaNeuro Associates.
DR. MACOMBER replied that it was just herself and Dr. Cherry.
She said Alaska is underserved by neuropsychologists with only
six in the state. It is challenging if Medicaid does not
reimburse for services or TriCare does not preauthorize
services.
CHAIR DAVIS asked if TriCare is military insurance.
DR. MACOMBER said it was. She reported that private insurance
does reimburse.
SB 5-MEDICAL ASSISTANCE ELIGIBILITY
2:28:43 PM
CHAIR DAVIS announced that SB 5 was before the committee.
SENATOR EGAN moved to adopt the proposed CS for SB 5, labeled
27-LS0057\I, as the work draft before the committee.
CHAIR DAVIS objected for discussion purposes.
THOMAS OBERMEYER, staff to Senator Bettye Davis, sponsor of SB
5, explained the changes in version I. The changes were made in
response to requests from the Senate to increase the 200 percent
federal poverty guideline only for children [12 and under], so
that there would be less opposition to including pregnant women
and children 13 through 19 in the increase.
He addressed changes in the bill. The title of the bill no
longer includes pregnant women. Women and children 13 and over
are covered at 175 percent of the federal poverty line.
Subsection 16 on page 4 of the bill is entirely new. It reads,
"persons under 13 years of age who are not covered under (a) of
this section and whose household income does not exceed 200
percent of the federal poverty line as defined by the United
Sates Department of Health and Human Services and revised under
42 U.S.C. 9902(2)."
MR. OBERMEYER said these changes were made to address concerns
by the department, the governor, and others, regarding the
possibility of abortions. The bill would add 968 more children
to the Denali KidCare Program who otherwise would be uninsured.
2:33:11 PM
SENATOR MEYER assumed there had been no pregnancies under the
age of 13.
MR. OBERMAYER opined that it would be extremely rare.
CHAIR DAVIS said it was a possibility, but she did not know of
any. She offered to provide that information; however, she said
the numbers would be difficult to attain.
MR. OBERMEYER corrected a previous statement to say "under 13."
CHAIR DAVIS clarified that the changes in the bill are small and
it now covers ages zero to 12 only. She understood that the
federal government will now pay the full 70 percent match.
MR. OBERMEYER pointed out that the fiscal notes were drafted for
the previous version of the bill. He explained that after the
committee adopts version I, the Department of Health and Social
Services will draft new fiscal notes.
MR. OBERMEYER emphasized that only children would be counted in
the new fiscal notes.
CHAIR DAVIS noted that the committee had adopted version I of SB
5. She requested new fiscal notes by Wednesday. [SB 5 was held
in committee.]
2:37:27 PM
There being no further business to come before the committee,
Chair Davis adjourned the Senate Health and Social Services
Standing Committee at 2:37 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Alaska Brain Injury Network.pptx |
SHSS 3/19/2012 1:30:00 PM |
lsncceh |