Legislature(2015 - 2016)BARNES 124
02/27/2015 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB32 | |
| HB116 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 32 | TELECONFERENCED | |
| *+ | HB 116 | TELECONFERENCED | |
HB 32-WORKERS COMP: CONTROLLED SUBSTANCES TESTS
3:18:32 PM
CHAIR OLSON announced that the first order of business would be
HOUSE BILL NO. 32, "An Act relating to employer-required drug
testing; requiring the Alaska Workers' Compensation Board to
adopt regulations relating to the prescription of controlled
substances to employees; and relating to the prescription of
controlled substances to employees."
3:19:03 PM
KONRAD JACKSON, Staff, Representative Kurt Olson, Alaska State
Legislature, on behalf of the prime sponsor, Representative Kurt
Olson, stated that HB 32 is intended to address opioid use,
which is one of the factors leading to the high cost of workers'
compensation insurance in Alaska. The sponsor introduced a
similar bill last legislature on the same topic. This bill
would allow for drug testing for workers' compensation patient
opioid use under very specific circumstances by limiting
prescriptions for opioids to a 30-day supply. He said the
bill's focus is aimed to help reduce the high cost of workers'
compensation in Alaska by addressing the epidemic use of opioid
use and abuse of prescription drugs by workers' compensation
patients.
MR. JACKSON gave a brief section-by-section analysis of HB 32,
relating that Section 1 would authorize drug testing of injured
workers if the employees have been prescribed a controlled
substance for over 90 days. He said a negative test could
result in denial of future payments for the controlled substance
by the employer, although negative or positive test results may
not result in any adverse employment action. He directed
attention to the "may" language, which is permissive since it
does not mandate a test after 90 days.
MR. JACKSON stated that Section 2 requires the Workers'
Compensation Board to adopt regulations pertaining to the
provisions in Section 3 of HB 32.
3:20:53 PM
MR. JACKSON stated Section 3 will limit prescriptions of
controlled substances listed in schedule IA, IIIA, or VA in AS
11.71 to a 30-day supply; however, an employer or insurer may
use an employee's negative test result under AS 23.10 to claim
that the employee may not be eligible for future payments for
schedule IA controlled substance prescription. Again, this bill
is designed to limit and discourage use of long-term opioids by
restricting prescriptions to controlled substances to 30 days,
he said. He reported statistics that show one in four
prescriptions is being used by someone who has not been
prescribed the medication that employers are paying for, either
directly or through insurer premiums.
3:22:06 PM
MR. JACKSON emphasized that the drugs in question are not mild
drugs, but are opioids, which are a synthetic version of opium-
derived drugs as defined in AS 11. Higher usage and dosage of
opioids over long periods of time can lead to addiction,
increased disability or work loss, and potentially even death.
He reported that deaths from overdoses have grown dramatically
and in many states have now exceeded deaths from automobile
crashes. He concluded by stating that prescription drug abuse
has been declared an epidemic by the Centers for Disease Control
(CDC).
3:23:45 PM
CHAIR OLSON asked whether patients can obtain a new prescription
so long as they see their doctor.
MR. JACKSON answered yes. The bill proposes reducing a 90-day
prescription of controlled substances to 30 days. Patients can
obtain refills by visiting their physicians, who can prescribe
an additional 30-day refill, if deemed necessary. The overall
goal is to reduce workers' compensation costs, but also to get
workers healthy and back to work as quickly as possible, and
proper pain management is a key component.
3:24:42 PM
REPRESENTATIVE HUGHES asked for further clarification if the
drug test is negative and the opioids are not in the patient's
system, whether it is possible that these drugs might be
diverted and are being illegally sold. She further asked
whether the statistics for overdoses are for patients being
prescribed the drugs or by people illegally buying diverted
prescription drugs.
MR. JACKSON replied that a negative test may result in denial of
a prescription refill for controlled substances, noting these
costs are being passed on to the insurer or the employer. Thus
if the patients do not need the medication, their employers need
to stop paying for it. He clarified that this bill does not
accuse workers' compensation patients of selling their
prescription drugs, in fact, patients may simply be putting
their prescriptions in the medicine cabinet. This bill allows
the drug testing to occur to ensure that patients are taking
their medications. If patients have been consciously attempting
to wean themselves off their pain medication, and some have done
so, they must do so in conjunction with their doctors. He
reiterated that this bill does not intend to harm the injured
worker. He directed attention to some of the reports in
members' packets that provide information on drug overdoses,
although he did not specifically recall the figures.
3:27:48 PM
CHAIR OLSON said that he has heard that one-third of Alaskan
workers are subject to random UAs (urine analysis) with more
stringent actions allowed for positive tests. For example,
North Slope workers will lose their jobs if they have a negative
test. Employees of many industries, including ones related to
transportation, maritime, and the military currently subject to
drug testing, he reported.
3:28:28 PM
REPRESENTATIVE HUGHES said it is a good bill and she supports
it. She emphasized the importance of reducing workers'
compensation costs in Alaska. She asked whether any employers
are subject to rules regarding administering random UAs, for
example, whether employees are forewarned.
MR. JACKSON answered that this bill specifically addresses Title
23, which relates to workers' compensation and does not apply to
other workers. He clarified that this bill applies to injured
workers who have been taking prescriptions opioids for more than
90 days. However, this bill would not apply to patients taking
prescription drugs for opioids for less than 90 days; instead,
the trigger for drug testing of workers' compensation patients
is for patients have been taking prescription opioids for 90
days or longer. He stated that the details for testing will be
laid out in regulation upon passage of HB 32.
3:30:44 PM
REPRESENTATIVE COLVER asked who can order the tests, whether it
is the employer or the workers' compensation carrier.
MR. JACKSON answered that it is not spelled out in the bill, but
it will be established in regulation. He directed attention to
Section 1, which allows the employer, or essentially the claims
manager to order the testing. He deferred to Mr. Monagle to
further address this during his testimony.
3:31:49 PM
REPRESENTATIVE KITO said this is the first time he has seen the
bill. He expressed concern that the state would establish
different classes of care for people. He offered if the state
believes that it needs to assure that there isn't abuse of
scheduled drugs, the statutes should apply to everyone, not just
those receiving workers' compensation. However, if there is
further concern about keep people from illegally selling
narcotics, it is already illegal to do so. He suggested that
there should be other ways to investigating whether that
activity is taking place. He did not think that doctors could
provide evidence to an investigator as to whether a patient is
potentially selling narcotics.
3:33:09 PM
REPRESENTATIVE KITO asked how long it takes for prescription
drugs listed in schedule IA to clear a patient's bloodstream.
He wondered when workers' compensation patients will have clear
urine analysis tests. He further asked for the percentage of
cases that this would apply to in Alaska, for example, if the
state has 100 workers' compensation cases, how many cases would
involve prescriptions for narcotics beyond 30 days. He asked
whether the doctor will need to refill the prescriptions after
30 days for patients who have prescriptions for narcotics.
MR. JACKSON answered he is absolutely correct that it is illegal
for anyone to resell prescriptions that are not prescribed to
them. Thus only pharmacies can sell prescription drugs. In
terms of the length of time for opioids to leave a person's
system, he surmised that it would depend on the body mass and
the drug; however, he was not certain. He deferred to Mr.
Monagle, but also offered to research the matter.
3:35:42 PM
REPRESENTATIVE KITO felt it was important to know what workers'
compensation patients were being testing for and if a
prescription drug clears in one day or seven days would mean
different things.
MR. JACKSON provided some statistics for Alaska, noting that in
2011, prescription drugs comprised almost 20 percent of the
medical costs of workers' compensation claims. Over 90 percent
of the time, injured workers missing one or more weeks had
prescriptions covered by workers' compensation, of which, 60 to
90 percent received opioids or narcotics.
3:36:42 PM
REPRESENTATIVE KITO asked for further clarification if he was
indicating 60 percent of 90 percent of the 20 percent of medical
costs were for workers' compensation claims.
MR. JACKSON answered yes.
3:37:09 PM
CHAIR OLSON asked whether that amounted to 11 percent of injured
workers.
MR. JACKSON deferred to Chair Olson on the math.
3:37:20 PM
MR. JACKSON, referring to the 30-day renewal, stated that the
sponsor's hope was to encourage a stronger and more robust
communication between doctors and injured workers, which will
allow for 30-day refills of prescriptions for opioids, which
could encourage a conversation between doctors and patients that
could mean patients don't need prescriptions for additional
drugs.
3:38:11 PM
REPRESENTATIVE JOSEPHSON asked for clarification on the
statistics.
MR. JACKSON responded that 20 percent of the medical costs in
workers' compensation claims were for prescription drugs in
2011. Ninety percent of the injured workers who missed a week
or more received workers' compensation prescriptions, with 60-90
percent of them receiving opioids.
3:39:25 PM
REPRESENTATIVE JOSEPHSON said that the statistics tell him that
injured workers are prescribed lots of drugs. He contemplated
how best to use that information and whether this bill
represents the right means to reduce costs.
CHAIR OLSON added that HB 32 will provide one tool to do so.
Ultimately, he hoped that the best practices for pain management
will be completed in the next year or two. Although he is not a
doctor, it seemed to him that prescribing drugs to injured
workers that were intended as end of life drugs for cancer
patients without first trying other options can create some
problems. For example, after several months of being on
opioids, injured workers are much less likely to return to their
jobs. He offered to provide statistics, but reiterated that the
longer injured workers are on drugs like oxycodone, the less
likely they are to return to work.
3:41:04 PM
REPRESENTATIVE JOSEPHSON asked whether any study or data
supported that legislation of this type in other states has
achieved results, in other words if premium costs were then
reduced.
MR. JACKSON related that Florida, Washington, Colorado and Texas
have initiated reforms and Texas and Washington have also seen
significant reductions in deaths from opioid use. Other states,
including Florida have restricted physicians from dispensing and
all of those measures have contributed to a reduction in deaths
and abuse of prescription opioids. He did not have the
statistics on hand, he said.
3:42:42 PM
CHAIR OLSON recalled that the committee has a relatively recent
national study from the Workers' Compensation Research Institute
it can distribute to members.
3:43:55 PM
REPRESENTATIVE TILTON related her understanding that long-term
use leads to addiction. She asked whether workers' compensation
covers rehabilitation.
MR. JACKSON deferred to Mr. Monagle to respond. He referred to
a study in members' packets by the Lockton Companies entitled,
"Opioids Wreak Havoc on Workers' Compensation Costs" that
highlighted the addiction and other problems observed throughout
the country. He added that members' packets also include some
charts that show the number of deaths attributed to overdoses.
3:45:19 PM
REPRESENTATIVE TILTON asked whether any information is available
on prescription paid medicines prescribed in workers'
compensation claims that have been seized in investigations.
MR. JACKSON answered that he was unsure whether the Department
of Public Safety (DPS) tracks the source, but he offered to
check. He stated the DPS provided information in members'
packets on hydrocodone seized in 2011-2013.
REPRESENTATIVE TILTON suggested it may be difficult to track
that type of information, but it could be useful information.
CHAIR OLSON offered to request any information that is available
from the department.
3:46:54 PM
REPRESENTATIVE KITO pointed to the earlier statistics. He said
he was surprised only 20 percent of workers' compensation claims
involve prescriptions, but it seemed as though about 1 or 1.2
people per hundred were using opioids. He asked for further
clarification on whether there are any anticipated cost savings
by implementing this bill.
MR. JACKSON answered that not have the figures, which were
calculated by the National Council on Compensation Insurance
(NCCI). He anticipated that it may take time to quantify costs
and savings that may be realized from passage of HB 32. He
offered to try to obtain the information.
3:48:24 PM
REPRESENTATIVE KITO asked for further clarification on whether
the information would be nationwide or applicable to Alaska.
MR. JACKSON answered that the estimated savings would be
specific to Alaska, assuming that this bill passes.
3:48:46 PM
REPRESENTATIVE KITO expressed an interest in identifying a
ballpark figure of cost savings. He reiterated his interest in
how much money Alaska insurers stand to save on workers'
compensation costs. He suggested that if the state hopes to
save money it would be good to identify any savings.
MR. JACKSON emphasized that he agreed it is important to
determine savings, plus, another benefit in passing the bill
could be the number of people that may never abuse narcotics or
have prescription drugs diverted and found by children.
3:50:17 PM
CHAIR OLSON stated that approximately half the states have
enacted similar legislation. He offered to obtain the
information on the number of states that have implemented
measures of this type. He offered his belief that other states
have seen significant savings.
3:50:45 PM
REPRESENTATIVE HUGHES offered her belief that it is important to
have a foundation on this issue. She asked for further
clarification, in terms of protection of privacy, of how
employers become aware of their employees being on workers'
compensation.
MR. JACKSON deferred to Mr. Monagle to respond.
REPRESENTATIVE HUGHES asked for further clarification on the
information that employers are provided.
3:52:33 PM
REPRESENTATIVE JOSEPHSON agreed this could be in the workers'
best interests; however, he imagined that injured workers will
be taking painkillers and not be getting a flu shot. He looked
forward to a discussion on the nature of employer being privy to
this type of medical information.
3:53:51 PM
MICHAEL MONAGLE, Director, Central Office, Division of Workers'
Compensation, Department of Labor & Workforce Development
(DLWD), said as he consider the bill, he does not look at it in
terms of cost savings to employers, but in terms of returning
someone back to work and preventing people from destroying their
lives by long-term opioid use. He recalled an instance in which
an injured worker reached a point of medical recovery, but due
to extensive use of opioids for several years, the worker had
developed such cognitive and other impairments that the doctor
classified the worker as permanently disabled. He said that it
was those types of concerns that this legislation will address.
The 90 days is identified by medical studies as the threshold
when the physical problems begin to develop. He said that the
curve for employees who return to work drops off sharply after
90 days on prescription pain killers. He explained that under
the bill, injured employees under workers' compensation claims
would obtain a 30-day supply of medication, followed by a
consultation with their physician who can determine the
effectiveness and necessity of prescribing an additional 30-days
prescription for opioids. In many cases there isn't any
functional improvement and the patients become addicted to
opioids and continue to use them. Nationwide, the emphasis is
to work to wean patients off opioids after 90 days in the hopes
that patients can discontinue these drugs and learn how to deal
with their pain management in more constructive ways.
3:56:29 PM
REPRESENTATIVE JOSEPHSON asked for further clarification on how
employee privacy and the employer's right to know would work.
MR. MONAGLE said that typically what was meant in referring to
the term "employer" in workers' compensation matters is the
employer, the insurance company, or the claims administrator.
Unless the entities are self-insured, most employers do not
interact with an injured worker; instead that contact is done by
the insurance company or the contracted claims administrator.
The claims administrator or claims adjustor provides regular
contact with the injured worker, who reviews the medical bills,
authorizes payment of medical bills, and issues disability
checks to the injured worker. He reiterated that the employer,
the insurance company, or the claims administrator are the ones
who will have access to the information on the prescription
drugs since they are the ones who have access to the frequency
that the injured worker is using prescription drugs. He
suggested the claims administrator would initiate any check on
the prescription, not the employer.
3:58:03 PM
REPRESENTATIVE JOSEPHSON asked whether the claims adjustors
confer to inquiries by small employers and if these adjustors
use some discretion.
MR. MONAGLE answered that workers' compensation was excluded
from HIPAA [Health Insurance Portability and Accountability Act
of 1996] law so the health care concerns between a provider and
the patient does not apply in workers' compensation cases.
Second, the provision of the Workers' Compensation Act says that
parties to workers' compensation cases are entitled to any of
the information about that case, which includes the employer,
the injured worker and their representatives, such as the claims
administrator or legal counsel. Thus any of the parties would
have access to the information, he said.
3:59:26 PM
REPRESENTATIVE JOSEPHSON asked whether any current statutes
requires drug testing other than for those employees operating
heavy equipment or for commercial carriers.
MR. MONAGLE answered that AS 23.10.600-699 outlines employer
drug testing. First, drug testing is a voluntary system so it
is not mandatory for any employer to test. Drug testing is not
administered by the state, but is left open to private action.
He suggested that if employees feel their rights have been
violated, their recourse is civil. It goes on to say that an
employer must meet certain requirements in order to put in a
policy for drug testing, for example, providing employees a 30-
day notice prior to implementing a plan, as well as advising
them of the conditions of testing, including the substances that
will be tested. These statutes also provide remedies for those
whose confidentiality has been violated or who suffer a false
positive test that occurred through negligence on the part of
the employer or the person doing the testing for the employer.
4:01:41 PM
AESHA PALLESEN, Assistant Attorney General, Labor & State
Affairs Section, Civil Division (Anchorage), Department of Law
(DOL), agreed that provisions are generally set out in AS 23.10
for drug testing and that Section 1 of this bill would add a
section to that drug testing regime for a negative drug testing
in workers' compensation cases.
4:02:19 PM
REPRESENTATIVE KITO recalled Mr. Monagle mentioned a patient who
was on opioids for a long period of time; however, he offered
his belief that this bill would not do anything about that and
would only allow an action to be taken if someone had not been
taking prescribed opioids.
REPRESENTATIVE KITO expressed concern about what would be
accomplished by the bill if the only denial is in regards to
those who are not taking their prescribed medication.
CHAIR OLSON stated that part of the bill was aimed at having
workers' compensation injured employees see their doctor monthly
and not refilling potent drugs via the pharmacy. He said that
this action may result in additional costs, but it may also
result in ultimate savings; however, the ultimate goal is to
assist in getting injured workers back to work.
4:05:06 PM
SCOTT JORDAN, Director, Division of Risk Management, Department
of Administration (DOA), in response to a question on privacy
issues, stated that Health Insurance Portability and
Accountability Act (HIPAA) does not apply to workers'
compensation cases so the state, which is self-insured, can
share these records. He reported that he obtains a quarterly
report of the workers' compensation individuals on opioid drugs.
4:06:05 PM
CHAIR OLSON asked for further clarification on how many injured
employees are taking scheduled drugs.
MR. JORDAN answered that 67 employees of 900 open claims, or
less than 1 percent are prescribed opioids. He characterized it
as a low amount.
4:06:31 PM
REPRESENTATIVE JOSEPHSON asked for further clarification that
these are injured Alaska state employees.
MR. JORDAN answered yes.
4:07:09 PM
LORI WING-HEIER, Director, Division of Insurance (DOI),
Anchorage Office, Department of Commerce, Community & Economic
Development (DCCED), stated that from the DOI's perspective,
after all is said and done, the data comes to the division and
the DOI sets the rates for employers, including rates for the
State of Alaska. These rates have gone up, and while they have
stabilized somewhat in the past year, the rates are still very
high. The division was proud that the state fell off the number
one spot in the nation; however, these rates still represent a
very high cost to employers across the state. Any impact to
bring down the cost of workers' compensation will be considered,
and this is one approach to do so. As a former risk manager,
she can attest to the fact that the cost of rehabilitation is an
expensive part of most workers' compensation claims when it
involves pulling someone back from being on an opioid for a long
period time. She reported that it increases the cost of the
claim, which goes back into the workers' compensation rate and
is shared by all employers.
4:08:52 PM
REPRESENTATIVE JOSEPHSON related his understanding that there
would normally be some type of tracking by the prescriber. He
asked whether that information would be shared to ensure that a
drug contract was followed. He asked whether that information
would make its way back to the adjuster.
MS. WING-HEIER answered that the adjuster will have a record of
prescriptions being prescribed to the injured employee.
However, this bill would require the employees to touch base
with the physician every 30 days. In fact, it isn't meant to
try to take the painkiller or narcotic away, but just requires
patients to touch bases with their physicians to help prevent
overprescribing.
REPRESENTATIVE JOSEPHSON referred to Section 1 of the bill
related to testing. He asked whether there is some redundancy
if the prescriber already doing some testing. He recalled that
in his experience as an attorney, that evidence he saw during
trial and drug contracts. He asked whether an insurance
adjuster will know those facts.
MS. WING-HEIER answered that the adjuster will know the
prescriptions were issued, but she was unsure whether the
adjuster will know if any prescriptions were not being used and
of the patient might be stockpiling the medication.
4:10:59 PM
REPRESENTATIVE JOSEPHSON asked whether costs can be reported for
the 67 of 900 injured employees. He recalled that 20 percent of
the cost is for prescription drugs so he wondered how much money
is being spent.
MS. WING-HEIER said she has cumulative data for the state, but
not the State of Alaska data. She deferred to Mr. Jordan. She
did not have the itemized costs for the 67 injured state
workers.
4:12:17 PM
REPRESENTATIVE KITO offered that not all of the 67 total
scheduled drug use cases will have prescriptions for controlled
scheduled drugs over 90 days or that all of them will be
violation cases. Thus it seemed as though out of 67, a very
small number might be subject to this law. He asked whether she
had any idea of the number of cases this would affect.
MS. WING-HEIER answered that she does not have the specific
information related to the state's plan; however, she agreed not
every case would be for injured workers with prescriptions for
controlled substances for over 30 days. She was unsure of
whether the 67 of 900 were for prescriptions of over 90 days or
if that was the current total for the state's claim record. She
offered to provide some state statistical data for all
employers.
4:13:51 PM
REPRESENTATIVE KITO asked for further clarification on whether
this applies to all employers. He expressed an interest in
seeing the data for all employers.
MS. WING-HEIER offered to provide it.
4:14:31 PM
REPRESENTATIVE JOSEPHSON related his understanding that the
state does not write workers' compensation checks to insurers
since the state is self-insured.
MR. JORDAN agreed that is correct. In further response to
Representative Josephson, he clarified that the division does
not pay a premium and he was unsure of the source of the $1,400
premium since the state is self-insured.
CHAIR OLSON answered that the $1,400 refers to the monthly major
medical health insurance cost for state employees. This bill
would not affect those premiums since it isn't related to
workers' compensation.
4:15:25 PM
CHAIR OLSON opened public testimony on HB 32 and held public
testimony open.
[HB 32 was held over.]