ALASKA STATE LEGISLATURE  SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  April 4, 2018 2:01 p.m. MEMBERS PRESENT Senator David Wilson, Chair Senator Natasha von Imhof, Vice Chair Senator Cathy Giessel Senator Tom Begich MEMBERS ABSENT  Senator Peter Micciche COMMITTEE CALENDAR    CS FOR HOUSE BILL NO. 151(FIN) "An Act relating to the duties of the Department of Health and Social Services; relating to training and workload standards for employees of the Department of Health and Social Services and providing immunity from damages related to those standards; relating to foster care home licensing; relating to civil and criminal history background checks for foster care licensing and payments; relating to placement of a child in need of aid; relating to the rights and responsibilities of foster parents; requiring the Department of Health and Social Services to provide information to a child or person released from the department's custody; and providing for an effective date." - MOVED SCS CSHB 151(HSS) OUT OF COMMITTEE COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 123(HSS) "An Act relating to disclosure of health care services and price information; and providing for an effective date." - MOVED SCS CSHB 123(HSS) OUT OF COMMITTEE PREVIOUS COMMITTEE ACTION    BILL: HB 151 SHORT TITLE: DHSS;CINA; FOSTER CARE; CHILD PROTECTION SPONSOR(s): REPRESENTATIVE(s) GARA 03/01/17 (H) READ THE FIRST TIME - REFERRALS 03/01/17 (H) HSS, FIN 03/16/17 (H) HSS AT 3:00 PM CAPITOL 106 03/16/17 (H) Heard & Held 03/16/17 (H) MINUTE(HSS) 03/21/17 (H) HSS AT 3:00 PM CAPITOL 106 03/21/17 (H) Heard & Held 03/21/17 (H) MINUTE(HSS) 03/23/17 (H) HSS AT 3:00 PM CAPITOL 106 03/23/17 (H) Moved CSHB 151(HSS) Out of Committee 03/23/17 (H) MINUTE(HSS) 03/24/17 (H) HSS RPT CS(HSS) NT 3DP 1DNP 1NR 2AM 03/24/17 (H) DP: TARR, EDGMON, SPOHNHOLZ 03/24/17 (H) DNP: EASTMAN 03/24/17 (H) NR: KITO 03/24/17 (H) AM: JOHNSTON, SULLIVAN-LEONARD 03/28/17 (H) HSS AT 3:00 PM CAPITOL 106 03/28/17 (H) 04/12/17 (H) FIN AT 1:30 PM HOUSE FINANCE 519 04/12/17 (H) Heard & Held 04/12/17 (H) MINUTE(FIN) 04/13/17 (H) FIN AT 1:30 PM HOUSE FINANCE 519 04/13/17 (H) Heard & Held 04/13/17 (H) MINUTE(FIN) 05/15/17 (H) FIN AT 1:30 PM HOUSE FINANCE 519 05/15/17 (H) Moved CSHB 151(FIN) Out of Committee 05/15/17 (H) MINUTE(FIN) 05/16/17 (H) FIN RPT CS(FIN) NT 4DP 1NR 4AM 05/16/17 (H) DP: ORTIZ, GARA, SEATON, FOSTER 05/16/17 (H) NR: GUTTENBERG 05/16/17 (H) AM: TILTON, THOMPSON, KAWASAKI, WILSON 05/17/17 (H) TRANSMITTED TO (S) 05/17/17 (H) VERSION: CSHB 151(FIN) 01/18/18 (S) READ THE FIRST TIME - REFERRALS 01/18/18 (S) HSS, FIN 03/19/18 (S) HSS AT 1:30 PM BUTROVICH 205 03/19/18 (S) Heard & Held 03/19/18 (S) MINUTE(HSS) 03/21/18 (S) HSS AT 1:30 PM BUTROVICH 205 03/21/18 (S) Heard & Held 03/21/18 (S) MINUTE(HSS) 04/04/18 (S) HSS AT 1:30 PM BUTROVICH 205 BILL: HB 123 SHORT TITLE: DISCLOSURE OF HEALTH CARE COSTS SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ 02/13/17 (H) READ THE FIRST TIME - REFERRALS 02/13/17 (H) HSS, JUD 03/02/17 (H) HSS AT 3:00 PM CAPITOL 106 03/02/17 (H) Heard & Held 03/02/17 (H) MINUTE(HSS) 03/09/17 (H) HSS AT 3:00 PM CAPITOL 106 03/09/17 (H) Moved CSHB 123(HSS) Out of Committee 03/09/17 (H) MINUTE(HSS) 03/10/17 (H) HSS RPT CS(HSS) 5DP 2NR 03/10/17 (H) DP: JOHNSTON, TARR, EDGMON, SULLIVAN- LEONARD, SPOHNHOLZ 03/10/17 (H) NR: KITO, EASTMAN 03/24/17 (H) JUD AT 1:00 PM GRUENBERG 120 03/24/17 (H) Heard & Held 03/24/17 (H) MINUTE(JUD) 03/27/17 (H) JUD AT 1:00 PM GRUENBERG 120 03/27/17 (H) Heard & Held 03/27/17 (H) MINUTE(JUD) 03/29/17 (H) JUD AT 1:00 PM GRUENBERG 120 03/29/17 (H) Moved CSHB 123(HSS) Out of Committee 03/29/17 (H) MINUTE(JUD) 03/31/17 (H) JUD RPT CS(HSS) 1DP 1NR 4AM 03/31/17 (H) DP: CLAMAN 03/31/17 (H) NR: EASTMAN 03/31/17 (H) AM: KOPP, KREISS-TOMKINS, FANSLER, REINBOLD 04/07/17 (H) TRANSMITTED TO (S) 04/07/17 (H) VERSION: CSHB 123(HSS) 04/10/17 (S) READ THE FIRST TIME - REFERRALS 04/10/17 (S) HSS, JUD 03/16/18 (S) HSS AT 1:30 PM BUTROVICH 205 03/16/18 (S) Heard & Held 03/16/18 (S) MINUTE(HSS) 04/04/18 (S) HSS AT 1:30 PM BUTROVICH 205 WITNESS REGISTER REPRESENTATIVE GARA Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Sponsor of HB 151. Tracy Spartz Campbell, Deputy Director Office of Children's Services Department of Health and Social Services (DHSS) Juneau, Alaska POSITION STATEMENT: Provided information on HB 151. REPRESENATIVE IVY SPOHNHOLZ Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Sponsor of HB 123. BERNICE NESBITT, Staff Representative Ivy Spohnholz Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Provided information on HB 123. LORI WING-HEIER, Director Division of Insurance Department of Commerce, Community and Economic Development Anchorage, Alaska POSITION STATEMENT: Provided information on HB 123. ACTION NARRATIVE 2:01:19 PM CHAIR DAVID WILSON called the Senate Health and Social Services Standing Committee meeting to order at 2:01 p.m. Present at the call to order were Senators Giessel, von Imhoff, Begich and Chair Wilson. ^HB#151 HB 151-DHSS;CINA; FOSTER CARE; CHILD PROTECTION  2:01:28 PM CHAIR WILSON announced the consideration of HB 151. [CSHB 151(FIN) was before the committee.] 2:02:03 PM REPRESENTATIVE GARA, Alaska State Legislature, sponsor of HB 151, said he wanted to point out that the bill only works as a whole. 2:02:34 PM CHAIR WILSON moved Amendment 1, labeled 30-LS0451\L.5. 30-LS0451\L.5 Laffen 4/2/18 AMENDMENT 1 OFFERED IN THE SENATE BY SENATOR WILSON TO: CSHB 151(FIN) Page 1, line 6, following "parents;": Insert "relating to completed investigations of  reports of harm to a child;" Page 7, following line 4: Insert a new bill section to read:  "* Sec. 10. AS 47.10.093(a) is amended to read: (a) Except as permitted in AS 47.10.092, [AND IN] (b) - (g) and (i) - (l) of this section, and AS 47.17.030(g), all information and social records pertaining to a child who is subject to this chapter or AS 47.17 prepared by or in the possession of a federal, state, or municipal agency or employee in the discharge of the agency's or employee's official duty are privileged and may not be disclosed directly or indirectly to anyone without a court order." Renumber the following bill sections accordingly. Page 12, following line 23: Insert a new bill section to read: "* Sec. 18. AS 47.17.030 is amended by adding a new subsection to read: (g) When the department or a local government health or social services agency (1) completes an investigation of a report of harm concerning a child, (2) determines, based on the investigation findings, that department or local agency services to protect the child are not required, and (3) identifies an appropriate community organization that will actively reach out to families to provide needed support services, the department or local government health or social services agency shall seek the written consent of the child's parent or guardian to refer the family to the community organization. If the parent or guardian consents to the referral, the department or local government health or social services agency shall refer the parent or guardian to the community organization identified by the department. If the child has more than one parent or guardian and only one parent or guardian consents to the referral, the department or local government health or social services agency shall refer the parent or guardian who consents to the community organization but may not provide information to the community organization concerning the parent or guardian who does not consent to the referral. A community organization that receives information from the department or a local government health or social services agency under this subsection may not disclose the information to a person who is not authorized by law to receive it." Renumber the following bill sections accordingly. Page 13, lines 17 - 19: Delete all material and insert: "APPLICABILITY. (a) Sections 2, 7 - 9, 11 - 15, 17, and 19 of this Act apply to a child in the custody or under the supervision of the Department of Health and Social Services under AS 47.10 on or after the effective date of secs. 2, 7 - 9, 11 - 15, 17, and 19 of this Act. (b) Sections 3 - 6 and 20 of this Act apply to applications for a license, license renewal, certification, certification renewal, or payment received by the Department of Health and Social Services on or after the effective date of secs. 3 - 6 and 20 of this Act." Page 13, line 31: Delete "11 - 13, and 15" Insert "12 - 14, and 16" Page 14, line 3: Delete "sec. 11" Insert "sec. 12" Delete "sec. 12" Insert "sec. 13" Page 14, line 4: Delete "sec. 13" Insert "sec. 14" Page 14, line 5: Delete "sec. 15" Insert "sec. 16" Page 14, line 6: Delete "10, and 14 - 18" Insert "11, 15 - 17, 19, and 20" Page 14, line 10: Delete "sec. 10" Insert "sec. 11" Page 14, line 11: Delete "sec. 14" Insert "sec. 15" Page 14, line 12: Delete "sec. 15" Insert "sec. 16" Delete "sec. 16" Insert "sec. 17" Page 14, line 13: Delete "sec. 17" Insert "sec. 19" Delete "sec. 18" Insert "sec. 20" Page 14, line 14: Delete "Section 20" Insert "Section 22"   2:02:49 PM SENATOR VON IMHOF objected for purpose of discussion. 2:03:25 PM CHAIR WILSON said he worked on creating the amendment with R.O.C.K. Mat-Su [Raising Our Children with Kindness]. It creates a formal response for the screen out reports for alleged maltreatment of children; it provides a mechanism to provide voluntary case management services for families with reports of harm that are not screened into initial assessment. This is a similar approach being used with tribal organizations through Alaska child welfare compacts. Changing the system will allow appropriate community organizations across Alaska to serve at- risk families, thereby preventing maltreatment of children and reducing the burden to the Office of Children's Services (OCS). CHAIR WILSON said that the amendment inserts on page 1, line 6, "relating to completed investigations of reports of harm to a child," changing the title of the bill. On page 7, following line 4, it amends the statute to provide the sharing of information to social service agencies through parental consent in the new subsection 18(g), and the information may not be disclosed without a court order. The amendment inserts a new subsection 18(g) containing language relating to obtaining written consent of the parent or guardian to refer the family to a community organization and the confidentiality surrounding the sharing of information. The amendment on page 13, lines 17-19, deletes all material and inserts new applicability language and renumbers accordingly through the rest of the bill. SENATOR BEGICH asked the bill sponsor's thoughts on the amendment. REPRESENTATIVE GARA said Senator Wilson, R.O.C.K. Mat-Su, and he have all spoken to each other. It is a good amendment. When a family is in trouble, groups like R.O.C.K. Mat-Su will reach out to the family so they don't end up in the OCS system. The goal of the bill is get kids out of foster care. This will hopefully prevent them from coming in. R.O.C.K. Mat-Su has done great work and other groups around the state will be doing that soon. 2:05:58 PM SENATOR VON IMHOF withdrew her objection. 2:06:03 PM CHAIR WILSON found no further objection and announced that Amendment 1 passed. 2:06:10 PM CHAIR WILSON moved Amendment 2, labeled 30-LS0451\L.7. 30-LS0451\L.7 Laffen 4/3/18 AMENDMENT 2 OFFERED IN THE SENATE BY SENATOR WILSON TO: CSHB 151(FIN) Page 13, line 31: Delete "one year" Insert "90 days" Delete ", 11 - 13, and 15" Insert "and 11 - 13" Page 14, lines 4 - 5: Delete "AS 47.14.100(i), as amended by sec. 13 of this Act, and AS 47.14.112(a)(3)(A), enacted by sec. 15 of this Act;" Insert "and AS 47.14.100(i), as amended by sec. 13 of this Act;" Page 14, line 6: Delete "three years" Insert "one year" Page 14, line 11: Delete "(a)(3)(B), (b), and (c)" Insert "(a)(3)(A) and (b)" Page 14, following line 13: Insert a new paragraph to read: "(3) two years after the effective date of sec. 15 of this Act, implement the changes made by AS 47.14.112(a)(3)(B) and (a)(4), enacted by sec. 15 of this Act." 2:06:28 PM SENATOR VON IMHOF objected for purposes of discussion. 2:06:34 PM CHAIR WILSON said this is a request from the bill sponsor to amend the timelines for completing legislation. 2:07:51 PM SENATOR VON IMHOF removed her objection. 2:07:56 PM CHAIR WILSON found no further objection and Amendment 2 passed. 2:08:05 PM CHAIR WILSON moved Amendment 3, labeled 30-LS0451\L.6. 2:08:14 PM SENATOR VON IMHOF objected for purposes of discussion. 30-LS0451\L.6 Laffen 4/3/18 AMENDMENT 3 OFFERED IN THE SENATE BY SENATOR WILSON TO: CSHB 151(FIN) Page 10, line 22: Delete "report" Insert "reports" Page 12, line 6, following "under": Insert "(a) of" Page 12, following line 16: Insert a new subsection to read: "(d) The division of the department with responsibility over the custody of children shall prepare and make available to the legislature an annual report on employee recruitment and retention, including a five-year plan, for the division. The department shall deliver the report to the senate secretary and the chief clerk of the house of representatives and notify the legislature that the report is available not later than November 15 of each year. The report prepared under this subsection is separate from the annual report to the legislature required under AS 18.05.020." 2:08:21 PM CHAIR WILSON said Amendment 3 requires an annual report from OCS on employee recruitment and retention, including a five-year plan. This is separate from the report required under AS 18.05.020. This is similar to what the Department of Public Safety has done. He said he wants to see a formalized, strategic plan. The Director of OCS, Christy Lawton, has spoken about seeing the same issues occur during her years of service. He said he wants to start a conversation with a written plan that they can refer to instead of an oral statement and plan. SENATOR BEGICH asked the sponsor his opinion of the amendment. 2:10:06 PM REPRESENTATIVE GARA answered that it is consistent with the legislation and makes it stronger. He wants the department to do the things required in the bill and the amendment reinforces that. SENATOR VON IMHOF asked if anyone from the department was present to testify about this section. 2:10:45 PM Tracy Spartz Campbell, Deputy Director, Office of Children's Services, Department of Health and Social Services (DHSS), testified on HB 151. She said OCS is comfortable with the plan. They have various strategies that they are working on and so this plan may be a good option for to consolidate those into one plan. They are supportive of the amendment. 2:11:11 PM SENATOR VON IMHOF removed her objection. 2:11:17 PM CHAIR WILSON found no further objection and Amendment 3 passed. 2:11:35 PM SENATOR VON IMHOF moved the Senate Committee Substitute for Committee Substitute for HB 151 from committee with individual recommendations and forthcoming fiscal notes. 2:11:50 PM CHAIR WILSON found no objection and SCS CSHB 151(HSS) moved from the Senate Health and Social Services Standing Committee. 2:12:25 PM At ease. HB 123-DISCLOSURE OF HEALTH CARE COSTS  2:14:28 PM CHAIR WILSON announced the consideration of HB 123. [The committee adopted the work draft SCS for CSHB 123, labeled 30- LS0380\G, on 3/16/18.] 2:15:01 PM CHAIR WILSON moved Amendment 1, 30-LS0380\G.3. 30-LS0380\G.3 Bruce 3/30/18 AMENDMENT 1 OFFERED IN THE SENATE BY SENATOR WILSON TO: SCS CSHB 123( ), Draft Version "G" Page 5, line 26: Delete "$5,000" Insert "$10,000" Page 6, line 25: Delete all material. Reletter the following subparagraph accordingly. 2:15:17 PM SENATOR VON IMHOF objected for purposes of discussion. 2:15:30 PM CHAIR WILSON explained that on page 5, line 26, Amendment 1 changes the cap on the amount of civil penalties from $5,000 to $10,000 and on page 6, line 25, includes tribal facilities with health care facilities so that they have to comply with the bill's requirements. SENATOR BEGICH asked if he worked with the bill sponsor. 2:16:10 PM REPRESENATIVE IVY SPOHNHOLZ, Alaska State Legislature, sponsor of HB 123 said she did discuss the changes and supports them. 2:16:32 PM SENATOR VON IMHOF removed her objection. 2:16:37 PM CHAIR WILSON found no further objection and Amendment 1 passed. 2:16:41 PM CHAIR WILSON moved Amendment 2, labeled 30-LS0380\G.5. 30-LS0380\G.5 Bruce 4/3/18 AMENDMENT 2 OFFERED IN THE SENATE BY SENATOR WILSON TO: SCS CSHB 123( ), Draft Version "G" Page 7, following line 20: Insert new bill sections to read:  "* Sec. 3. The uncodified law of the State of Alaska is amended by adding a new section to read: TRANSITION: REGULATIONS. The Department of Health and Social Services may adopt regulations necessary to implement the changes made by this Act. The regulations take effect under AS 44.62 (Administrative Procedure Act), but not before the effective date of the law implemented by the regulation.  * Sec. 4. Section 3 of this Act takes effect immediately under AS 01.10.070(c)." Renumber the following bill section accordingly. Page 7, line 21: Delete "This" Insert "Except as provided in sec. 4 of this Act, this" SENATOR VON IMHOF objected for purposes of discussion. 2:16:52 PM CHAIR WILSON said these changes were requested by DHSS so that it can adopt regulations necessary to implement the changes made by this Act. 2:17:34 PM SENATOR VON IMHOF removed her objection. 2:17:41 PM There being no objection, Amendment 2 passed. 2:17:46 PM CHAIR WILSON moved Amendment 3, labeled 30-LS0380\G.6. 30-LS0380\G.6 Bruce 4/3/18 AMENDMENT 3 OFFERED IN THE SENATE BY SENATOR WILSON TO: SCS CSHB 123( ), Draft Version "G" Page 1, line 1, following "information;": Insert "relating to health care insurers;" Page 4, line 6: Delete "or health care facility" Insert ", health care facility, or health care insurer" Page 4, line 8: Delete "or health care facility" Insert ", health care facility, or health care insurer" Page 4, line 14: Delete "or health care facility" Insert ", health care facility, or health care insurer" Page 4, lines 23 - 24: Delete "or health care facility" Insert ", health care facility, or health care insurer" Page 5, line 17: Delete "or health care facility" Insert ", health care facility, or health care insurer" Page 5, line 25, following "section": Insert "or a health care insurer that fails to comply with the requirements of (g) and (h) of this section" Page 5, line 31: Delete "or health care facility" Insert ", health care facility, or health care insurer" Page 7, following line 20: Insert a new bill section to read:  "* Sec. 3. AS 21.96 is amended by adding a new section to read: Sec. 21.96.200. Good faith estimate. Upon request of a covered person who is receiving nonemergency health care services, a health care insurer shall provide a good faith estimate of the amount of the reasonably anticipated charges for treating the patient's specific condition under AS 18.23.400(g) and (h)." Renumber the following bill section accordingly. 2:18:08 PM SENATOR VON IMHOF objected for purposes of discussion. CHAIR WILSON said the amendment adds health care insurers to entities that shall provide a good faith estimate to patients who request non-emergency health care services. SENATOR BEGICH asked what the intent of the amendment was. CHAIR WILSON answered that the intent was to allow good faith estimates to be provided not only from those providing the services, but the insurers also because the posted prices may not be applicable for people who have insurance. If the doctor's office cannot contact the insurer, the patient can give the codes to the insurer to get a more detailed, specific estimate. It allows the same time frame to comply with the good faith estimates. SENATOR BEGICH asked if the bill sponsor supports the amendment. 2:20:20 PM REPRESENTATIVE SPOHNHOLZ said it is welcomed. Getting a good faith estimate from insurers in a timely manner is a reasonable thing to expect. SENATOR VON IMHOF asked for clarification that with this amendment, insurers will be participating in good faith estimates but not posting prices like health care facilities and providers are being asked to do. CHAIR WILSON said correct. SENATOR VON IMHOF asked if there is another definition of insurer that says private insurer, self-insured, Medicare/Medicaid, TRICARE, etc. 2:21:47 PM BERNICE NESBITT, Staff, Representative Ivy Spohnholz, Alaska State Legislature, testified on HB 123. She said page 6, line 30, of the bill states that "health care insurer" has the meaning given in AS 21.54.500. 2:22:25 PM At ease. 2:24:26 PM CHAIR WILSON reconvened the meeting. 2:24:41 PM SENATOR GIESSEL asked Director Wing-Heier to comment on the insurer component of the bill. LORI WING-HEIER, Director, Division of Insurance, Department of Commerce, Community and Economic Development (DCCED), testified on HB 123. She said that for transparency, the amount paid is an important factor that needs to be addressed. The amount paid is most often going to be what the insurance company has either negotiated or the insurer can inform the consumer how they will pay if it is the 80th percentile or some other formula, so that the consumer will understand what they may pay out of pocket. Without that component, a consumer might look at provider prices and decide to not go forward because the cost of services look too high. SENATOR GIESSEL asked if it would be impossible for insurers to put their reimbursement amounts up because it is so personalized to each insured person. MS. WING-HEIER said correct. Network contracts may differ between employers and health care plans may differ in deductibles and copays. Those factors have to be taken into account when someone is looking at the cost. SENATOR GIESSEL asked if insurers are required now to respond to client's request for that information. MS. WING-HEIER said yes. One of the largest insurers has a good website for clients to go to. Insurers are becoming more transparent to empower consumers to do the research on their own. It's a long way from perfect, but the attempt is starting. 2:27:20 PM SENATOR VON IMHOF removed her objection. 2:27:32 PM CHAIR WILSON found no further objection and Amendment 3 passed. SENATOR VON IMHOF thanked Representative Spohnholz for bringing the bill forward. It is a good start. She said she has put a lot of thought into this bill and would like to continue dialogue with Representative Spohnholz to do a new bill next year that adds the other components of the health care cycle. Providers such as doctors and hospitals provide the procedures and then insurers pay for the procedures. Health care trusts manage health care plans for public entities and then patients need to compare prices and pay attention to value and ask for good faith estimates. HB 123 addresses providers and insurers to an extent, it encourages patients to ask for good faith estimates, but there is more work to be done building on this bill to bend the cost of health care growth in the future. CHAIR WILSON said as Representative Spohnholz described, the bill is the first couple of steps in a marathon. There is a long way to go to lower health cost and unravel the complexity of health care in this state. This is a good faith effort toward that. 2:30:23 PM SENATOR VON IMHOF moved to report the Senate Committee Substitute for Committee Substitute for HB 123, Version G, as amended, from committee with individual recommendations and forthcoming fiscal notes. 2:30:39 PM CHAIR WILSON found no objection and SCS CSHB 123(HSS) moved from the Senate Health and Social Services Standing Committee. 2:30:58 PM At ease. 2:32:59 PM There being no further business to come before the committee, Chair Wilson adjourned the Senate Health and Social Services Standing Committee at 2:32 p.m.