Legislature(2013 - 2014)CAPITOL 106
03/27/2014 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB169 | |
| HB319 | |
| HB355 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 347 | TELECONFERENCED | |
| *+ | HB 355 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 169 | TELECONFERENCED | |
| += | HB 319 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 27, 2014
3:03 p.m.
MEMBERS PRESENT
Representative Pete Higgins, Chair
Representative Wes Keller, Vice Chair
Representative Lora Reinbold
Representative Geran Tarr
MEMBERS ABSENT
Representative Benjamin Nageak
Representative Lance Pruitt
Representative Paul Seaton
COMMITTEE CALENDAR
COMMITTEE SUBSTITUTE FOR SENATE BILL NO. 169(FIN)
"An Act establishing in the Department of Health and Social
Services a statewide immunization program and the State Vaccine
Assessment Council; creating a vaccine assessment account;
requiring a vaccine assessment from assessable entities and
other program participants for statewide immunization purchases;
repealing the temporary child and adult immunization program;
and providing for an effective date."
- HEARD & HELD
HOUSE BILL NO. 319
"An Act relating to wholesale drug or device distributors;
relating to prescription benefits under the state health
insurance plan; and providing for an effective date."
- HEARD & HELD
HOUSE BILL NO. 355
"An Act establishing in the Department of Health and Social
Services a first aid training program for mental health
interventions."
- HEARD & HELD
HOUSE BILL NO. 347
"An Act relating to the disqualification of persons convicted of
certain felony drug offenses from participation in the food
stamp and temporary assistance programs."
- SCHEDULED BUT NOT HEARD
PREVIOUS COMMITTEE ACTION
BILL: SB 169
SHORT TITLE: IMMUNIZATION PROGRAM; VACCINE ASSESSMENTS
SPONSOR(s): SENATOR(s) GIESSEL
02/10/14 (S) READ THE FIRST TIME - REFERRALS
02/10/14 (S) HSS
02/21/14 (S) HSS AT 1:30 PM BUTROVICH 205
02/21/14 (S) Heard & Held
02/21/14 (S) MINUTE(HSS)
02/24/14 (S) HSS RPT CS 4DP NEW TITLE
02/24/14 (S) DP: STEDMAN, MICCICHE, MEYER, ELLIS
02/24/14 (S) FIN REFERRAL ADDED AFTER HSS
02/24/14 (S) HSS AT 1:30 PM BUTROVICH 205
02/24/14 (S) Moved CSSB 169(HSS) Out of Committee
02/24/14 (S) MINUTE(HSS)
03/03/14 (S) FIN AT 5:00 PM SENATE FINANCE 532
03/03/14 (S) Scheduled But Not Heard
03/05/14 (S) FIN AT 5:00 PM SENATE FINANCE 532
03/05/14 (S) Moved CSSB 169(FIN) Out of Committee
03/05/14 (S) MINUTE(FIN)
03/07/14 (S) FIN RPT CS 5DP NEW TITLE
03/07/14 (S) DP: MEYER, KELLY, BISHOP, DUNLEAVY,
OLSON
03/21/14 (S) TRANSMITTED TO (H)
03/21/14 (S) VERSION: CSSB 169(FIN)
03/24/14 (H) READ THE FIRST TIME - REFERRALS
03/24/14 (H) HSS, FIN
03/25/14 (H) HSS AT 3:00 PM CAPITOL 106
03/25/14 (H) Heard & Held
03/25/14 (H) MINUTE(HSS)
03/27/14 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 319
SHORT TITLE: DRUG/DEVICE DISTRIBUTORS; COMPOUNDED RX
SPONSOR(s): REPRESENTATIVE(s) T.WILSON
02/21/14 (H) READ THE FIRST TIME - REFERRALS
02/21/14 (H) HSS, L&C
03/20/14 (H) HSS AT 3:00 PM CAPITOL 106
03/20/14 (H) Heard & Held
03/20/14 (H) MINUTE(HSS)
03/27/14 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 355
SHORT TITLE: MENTAL HEALTH FIRST AID TRAINING
SPONSOR(s): REPRESENTATIVE(s) TARR
02/26/14 (H) READ THE FIRST TIME - REFERRALS
02/26/14 (H) HSS, FIN
03/27/14 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
DAVID TEAL, Legislative Fiscal Analyst
Legislative Finance Division
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Provided information to the committee on SB
169.
JILL LEWIS, Deputy Director - Juneau
Central Office
Division of Public Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of SB 169.
JANE CONWAY, Staff
Senator Cathy Giessel
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Answered questions on SB 169 for the bill
sponsor, Senator Cathy Giessel.
WARD HURLBURT, MD, Chief Medical Officer/Director
Division of Public Health
Central Office
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Testified and answered questions during
discussion of SB 169.
PATRICIA SENNER, Professional Practice Director
Alaska Nurses Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 169.
JODYNE BUTTO, Past President
American Academy of Pediatrics
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of SB 169.
PAUL RICHARDS
Pharmaceutical Research and Manufacturers of America (PhRMA)
POSITION STATEMENT: Offered to answer questions during
discussion of the proposed bill.
KURT STEMBRIDGE, Task Force Chair
PhRMA
Idaho
POSITION STATEMENT: Testified during discussion of SB 169.
DENISE DANIELLO, Executive Director
Alaska Commission on Aging
Division of Senior and Disabilities Services
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 169.
REPRESENTATIVE TAMMIE WILSON
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions as the
sponsor of HB 319.
RICHARD HOLM, Pharmacist
Fairbanks, Alaska
POSITION STATEMENT: Testified during discussion of HB 319.
JILL RAMSEY, Training Coordinator
Center for Human Development
University of Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 355.
DAVID D'AMATO, Senior Director
Health Policy
Alaska Primary Care Association
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 355.
ACTION NARRATIVE
3:03:53 PM
CHAIR PETE HIGGINS called the House Health and Social Services
Standing Committee meeting to order at 3:03 p.m.
Representatives Higgins, Keller, Tarr, and Reinbold were present
at the call to order.
SB 169-IMMUNIZATION PROGRAM; VACCINE ASSESSMENTS
3:04:48 PM
CHAIR HIGGINS announced that the first order of business would
be CS FOR SENATE BILL NO. 169(FIN), "An Act establishing in the
Department of Health and Social Services a statewide
immunization program and the State Vaccine Assessment Council;
creating a vaccine assessment account; requiring a vaccine
assessment from assessable entities and other program
participants for statewide immunization purchases; repealing the
temporary child and adult immunization program; and providing
for an effective date."
3:05:44 PM
DAVID TEAL, Legislative Fiscal Analyst, Legislative Finance
Division, Alaska State Legislature, referred to Fiscal Notes 6
and 7 [Included in members' packets], and explained that Fiscal
Note 6 was for the fund capitalization, and Fiscal Note 7 was
for epidemiology. He directed attention to Fiscal Note 7, and
pointed to the almost $4.5 million in the governor's Fiscal Year
2015 budget from general funds, which was also listed as a
negative figure in the requested appropriation. He explained
that $4.5 million was being taken away from epidemiology and the
Division of Public Health, Fiscal Note 6, and moved to the
Vaccine Assessment Account fund, Fiscal Note 7. He clarified
that there was not any spending of new general funds, that the
purpose of the funds remained the same, and that this would
create a more permanent program. Referring back to Fiscal Note
6, he pointed to the almost $27 million from the general fund
receipts, which were raised from the assessment fee for
vaccines. He explained that these funds are used to buy more
vaccine, which was distributed after payment of assessment fees,
and then these fees were sued to maintain the cycle. He pointed
out that there would not be any need for additional general
funds, as long as the assessment fees were used to replenish the
fund. He had questioned whether the $31 million in Fiscal Note
6 was sufficient, and Department of Health and Social Services
had assured him that the $31 million would not be exceeded. He
concluded that the net effect on the general fund was zero, as
money was simply being moved from one place to another.
3:10:04 PM
JILL LEWIS, Deputy Director - Juneau, Central Office, Division
of Public Health, Department of Health and Social Services,
clarified that the vaccine was not sold or re-sold, but that the
assessments were based on the projected cost for the annual
purchase of vaccines. She said that there were also assessments
and payments made throughout the year that generated the revenue
over the course of the year to keep pace. She reported that the
program bought vaccine every month, allowing management for the
expiration dates and the necessary volume to respond to any
disease outbreaks or demand in the state. She explained that
the aforementioned $4.5 million was enough capitalization as 50
percent of the children's vaccine was purchased with a federal
grant, which, as it was not forwarded to the state coffers, did
not reflect in the fiscal notes. She pointed out that, as there
was already vaccine on the shelf to use, this would be enough
capital to get started. She declared that this system had
worked well in other states.
CHAIR HIGGINS offered his understanding that the program worked
well in other states as those were only pediatric programs,
whereas the proposed bill included adult vaccines. He asked if
the assessment value to the insurers had been determined.
MS. LEWIS replied that the amount of assessment per dosage had
not yet been determined, although it was $50 - $200 per person
in other states. She explained that there were a variety of
variables for determining the assessment.
CHAIR HIGGINS returned attention to the assessment formula and
asked about letters of support from the insurance carriers.
MS. LEWIS offered her belief that there had only been the letter
of support from Premera Blue Cross [Included in members'
packets], although the Medicaid program had plans to
participate, and its program covered "a significant portion of
the population."
CHAIR HIGGINS asked if, as payment of the assessment was
important, it would be beneficial to have letters of support
from the insurance industry.
MS. LEWIS replied that there had been discussions with the human
resource departments and Dr. Hurlburt regarding the willingness
to participate in the program. She pointed out that Premera
Blue Cross served almost 75 percent of the private health care
market in Alaska.
CHAIR HIGGINS surmised that a lot of confusion had arisen from
the Fiscal Note.
3:17:27 PM
JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State
Legislature, referred to the sectional analysis [Included in
members' packets]. She directed attention to the two graphics
titled SB 169 Statewide Immunization Program [Included in
members' packets] which offered a pictorial analysis of each
step of the program.
MS. CONWAY paraphrased from the SB Statewide Immunization
Program Sectional Analysis (LS 1219\I), which read:
Sec. 18.09.200(a). Establishes a statewide
immunization program in the Department for the purpose
of monitoring, purchasing, and distributing vaccines
to providers.
Sec. 18.09.200(b). The Department of Health and Social
Services shall maintain a list of recommended vaccines
for inclusion in the program; establish the 1st year's
assessment
& thereafter make annual assessments based on
commission determinations; notify insurers and other
program participants of the assessment amount; devise
a method for crediting overpayments; coordinate the
bulk purchase of vaccine; set procedures for
distributing vaccines; and review appeals for errors.
Sec. 18.09.210. Establishes the State Vaccine
Assessment Council within HSS for the purpose of
determining the assessment amount. The commission has
8 members appointed by the Commissioner: the state's
Chief Medical Officer (chair); Division of Insurance
Director; 3 health care insurers, one of whom must be
a plan administrator; 2 health care providers; and 1
representing a tribal or public health insurance plan
who serve without compensation or reimbursement of
expenses. Terms are 3 years with a 2- term limit. HSS
will provide staff and other assistance to the
commission. The commission establishes and implements
a plan of operation, submits an annual financial
report to HSS each July 1st, and monitors compliance
with the program.
CHAIR HIGGINS asked who would run the assessment council.
MS. CONWAY directed attention to page 2, line 19, of the
proposed bill, which discussed the makeup of the council. She
reported that the council would be chaired by the Chief Medical
Officer for the [Division] of [Public] Health. She directed
attention to page 2, line 24, which described that the council
consisted of eight members appointed by the commissioner, and
included the "department's chief medical officer for public
health," two health care providers licensed in the state, and
three members representing health care insurers licensed in the
state, one of whom must be a health care plan administrator.
She noted that each insurer member must represent a different
organization in the state. She continued, and stated that there
would also be a representative of a tribal or public health
insurance plan, and the director of the division of insurance or
the designee.
CHAIR HIGGINS acknowledged that, although Vermont included an
adult portion in their program, the state was "still working out
the nuts and bolts even though they've been at it for a few
years." He pointed out that Vermont was now having a company
run this program, and he asked if the bill sponsor had
investigated this option.
MS. LEWIS directed attention to page 3, line 8, which read:
"The department shall provide staff and other assistance to the
council." She relayed that seven of the nine states with
similar programs had contracted with a company experienced in
administration of these programs. She noted that those costs
were included as a surcharge in the assessment and program
receipts, so there were no state general funds in support. She
estimated that cost to be about one percent, $300,000, each
year.
CHAIR HIGGINS reported that the fee in Vermont for the overall
cost of vaccines was $50,000 annually, three percent the first
year, two percent the second year, and one percent for the third
year.
3:23:06 PM
MS. CONWAY returned to her discussion of the sectional analysis,
and paraphrased the section, which read:
Sec. 18.09.210(f)(1). The "plan of operation" must
include the method for calculating the assessment
amount for each covered individual; the method for
determining proportional costs to assessable
entities/participants; procedures for the collection
and deposit of assessment fees; procedures for
collecting data which includes at a minimum the number
of covered individuals and vaccine usage; and a system
for crediting overpayments.
Sec. 18.09.220(a). Requires the assessable
entities/participants to pay the assessment to the
department for each covered individual; provide
information about number of covered individuals and
actual usage; and provide audited financial statements
upon request.
Sec. 18.09.220(b). Requires that the assessment
include reasonable costs for overhead. The provider's
fee for administration of the vaccine is excluded from
the assessment.
Sec. 18.09.220(c). States that an assessment is a
medical expense for the assessable entity/participant.
Sec. 18.09.220(d). Provides for a process to appeal
the assessment determination to the commissioner.
Sec. 18.09.225. Allows health care providers to opt
into the program to purchase vaccine.
Sec. 18.09.230. Creates a special account in the
general fund for the purpose of purchasing vaccines.
The legislature may appropriate program receipts from
vaccine assessments, money from other sources, and
interest earned. Appropriations do not lapse.
REPRESENTATIVE KELLER, referencing Sec. 18.09.225, asked why
someone would not be approved.
MS. LEWIS explained that she could only think of a very rare
instance when a provider was not already enrolled with the
immunization program, and had not yet completed the paperwork.
She stated that the department would work with the provider to
fulfill the requirements.
3:26:27 PM
MS. CONWAY paraphrased the next section, which read:
Sec. 18.09.240. Allows the commissioner to determine a
monetary penalty for noncompliance.
MS. LEWIS, in response to Chair Higgins, explained that should
an entity not pay, the commissioner may assess a penalty "on top
of the assessment," although the penalty was not required.
CHAIR HIGGINS asked for clarification that assessment payments
would be quarterly.
MS. LEWIS replied that this was currently being discussed, as it
was the most common payment schedule in other states. She
shared that there was also the possibility for monthly payments,
and could be determined by the best cash flow scenario for the
payers and providers.
CHAIR HIGGINS suggested that quarterly payments be paid up
front, prior to the start of the quarter, to ensure
participation in the program and to eliminate any need for a
penalty.
MS. LEWIS expressed her agreement.
MS. CONWAY moved on to paraphrase Section 2, page 5, line 16,
which read:
Section 2. 18.09.900. Defines the terms assessable
entity, commissioner (Health & Social Services),
council, covered individual, other program
participant, program, provider, recommended vaccine,
and vaccine.
Sec. 18.09.900(3). An "assessable entity" means a
health care insurer, the state health care plan, a
public or private entity that offers a publicly funded
plan (to the extent allowed by law), and third-party
administrators.
MS. CONWAY paraphrased Section 3, Section 4, Section 5, Section
6, and Section 7, which read:
Section 3. Requires assessable entities to provide
information to the department under (AS 21.09.242)
Section 4. Adds the vaccine assessment account to the
list of special accounts for program receipts in (AS
37.05.146(c))
Section 5. Repeals Ch. 24, SLA 2012 (HB310), a
temporary statewide immunization program.
Section 6. Redirects the remaining HB310 funds to be
deposited to the vaccine account.
Section 7. Makes the act effective July 1, 2014.
3:30:05 PM
CHAIR HIGGINS opened public testimony.
3:30:34 PM
WARD HURLBURT, MD, Chief Medical Officer/Director, Division of
Public Health, Central Office, Department of Health and Social
Services, declared that five years earlier, Alaska had been 49th
nationally in immunization rates for two year olds; however, the
vaccine money for the uninsured and underinsured had improved
the immunization rates for 2 year olds in Alaska to 37th or
38th. He stated that although this was not good, it was
significantly better than it had been, and further improvement
was intended. Directing attention to the aforementioned
comparable programs in nine other states, he offered his belief
that the proposed program presented the best of these programs.
He noted that Premera Blue Cross was the chair for the vaccine
advisory commission in the State of Washington, and had shared
its experiences. He stated that essentially all the insurers in
Alaska had participated in that Washington vaccine advisory
council. He mentioned that New Hampshire had improved its
immunization rates for two year olds and was now second only to
Hawaii. He explained that the approach by Alaska was to do "the
right thing" and provide all Alaskans with the immunizations
recommended for national standards by the [Advisory] Committee
on Immunization Practices (ACIP), although it was understood
that the state could not be placed in financial risk for more
general funding to the program. He stated that the insurers and
the vendors needed an assurance of no risk for double payment or
a higher cost. He offered examples that the proposed
legislation offered the flexibility to prioritize. He noted
that if there were any savings over current costs, and the
surcharge covered administrative costs with sufficient funding
for the uninsured and underinsured, then the program would offer
all the recommendations of vaccines for all Alaskans. However,
kids would have priority over adults, and certain diseases would
have priority. He noted that there would be a review of the
return on investment, as some vaccines were a much better
investment for the benefits. He declared that the state would
continue to purchase children vaccines on the favorable federal
schedule, and there were multi-state purchasing cooperatives for
adult vaccines, if necessary. He shared that some states
included Employment Retirement Income Security Act (ERISA)
employers. He stated that the administrative surcharge would be
kept as low as possible, with a long term projection of 1
percent. He pointed out that Alaska could not mandate
participation by federal programs or the Tribal Health system,
although there had been discussion with these entities for the
level of participation. He noted that Tricare wanted to pay
retail prices to providers after the fact, although there were
discussions for the advantages to saving money and getting
better immunization rates. He relayed that Idaho had allocated
some general funds to provide immunizations for Tricare children
beneficiaries. In the other states with similar programs, it
was about 60 percent more likely for protection of the
population through immunizations. He declared that there was
strong support in Alaska from the Alaska chapter of the American
Academy of Pediatrics, the Alaska Primary Care Association,
Premera Blue Cross, and the Alaska Nurses Association. He noted
that the proposed bill would allow medical professionals to
provide immunizations more easily. He reiterated that the
administration of the program would be contracted, and that the
vaccine assessment council would be comprised of representatives
of providers and payers. He declared that involvement from the
private sector would be much stronger.
REPRESENTATIVE REINBOLD asked which adult vaccines would be
provided.
DR. HURLBURT replied that the most cost effective adult vaccines
were the annual flu vaccine and the once-given pneumococcal
vaccine to prevent pneumonia. He reported that the shingles
vaccine, which was not recommended until 60 years of age, was
more expensive and was about 50 percent effective.
REPRESENTATIVE REINBOLD offered her belief that it was necessary
to have vaccine plans for adults, and asked whether it was the
state, the federal government, the insurance company, or the
patient who would save money with this program.
DR. HURLBURT replied that the Affordable Care and Patient
Protection Act required the provision of vaccines, although not
everyone would be insured. He noted that those insured through
a private company or Medicaid would purchase vaccines at retail,
while there could be significant increases to premiums in the
plans under the Affordable Care and Patient Protection Act in
the next year. Lower cost for vaccines could mitigate these
premium increases, as well as the costs to Medicaid. He opined
that there would be fewer people either underinsured or without
coverage.
REPRESENTATIVE REINBOLD asked who was going to save money.
DR. HURLBURT replied that, as the costs of the immunization
services were divided and would cost less for those with
coverage, then the premiums would cost less, it would lower
Medicaid costs, and it would save tax dollars.
3:45:42 PM
REPRESENTATIVE KELLER expressed his approval that the providers
were engaged in the program. He opined that the size of the
fund defined the number of immunization services offered. He
asked if there would be a higher assessment to the providers if
the wholesale price changed. He opined that this system would
fluctuate with supply and market demand, and that the council
would have to make these decisions.
DR. HURLBURT replied that vaccines did become more expensive and
there were more diseases that could be prevented with vaccines.
He offered his belief that the cost of vaccines for a two year
old was now about $1700, and was continuing to increase. He
welcomed any constraints for expenses, and opined that, even if
the costs go up, the savings would still come to the payers,
insurance companies, and the employers. This program made the
vaccines more available and easier for the providers. He
explained that providers that chose not to participate would not
receive the vaccines.
REPRESENTATIVE KELLER asked to confirm that the priority for use
would be set by the council, and would be determined by cost
effectiveness.
DR. HURLBURT said that the upper limit would be all the vaccines
recommended by ACIP for all the citizens. He relayed that 50
percent of children were vaccinated through funding by the
federal program, Vaccines for Children. He said that about 25
percent now had insurance coverage. He stated that the goal was
to get immunizations for all the Alaskans who accepted it. He
reminded the committee that the priorities would be implemented
if there was not enough money.
CHAIR HIGGINS asked for clarification regarding the vaccines for
tribal health.
DR. HURLBURT replied that the Vaccines for Children program
covered all the Alaskan Native children, as well as those on
Medicaid. He said that the tribal entity was able to purchase
vaccines through the federal authority, and they could be a
community resource.
CHAIR HIGGINS pointed out that the tribal health was not part of
the assessment value, as they did not contribute to it. He
noted that the other providers would have to "front that portion
out for that." Reading from the proposed bill, he asked whether
an individual residing in the state was provided coverage for
recommended vaccines if they did not have insurance coverage.
DR. HURLBURT said that the intent of the proposed bill was to
cover everybody, whereas a portion of the savings by the
insurers would be paid as an assessment to provide the pool of
money.
3:56:33 PM
PATRICIA SENNER, Professional Practice Director, Alaska Nurses
Association, testified in support of SB 169. She relayed that
she had directed a clinic serving homeless teenagers, and
service had included immunizations for youth and its staff. She
explained that current Universal Coverage legislation required
separation when purchasing and storing the vaccines. She
pointed out that market rates for vaccines not eligible for
state vaccine programs were much more expensive. She reminded
the committee that young parents also needed vaccines in order
to protect their children who were too young to be vaccinated.
She reported that it was not possible to buy single doses of
vaccines, as most were sold in packages of ten, whether or not
that quantity was necessary. Reimbursement only came after
patient use, and the price to her clinic had been much more than
either the government or large providers paid. She stated that
access to vaccines sold through a state exchange would afford a
great savings to the providers. She pointed out that providers
were already familiar with the state vaccine depot. She offered
an anecdote about a case of polio in her clinic, and the
rapidity for transmission of diseases throughout the world. She
offered her belief that the proposed bill would reduce the
amount of reimbursement for immunizations by insurance companies
to providers.
4:00:09 PM
JODYNE BUTTO, Past President, American Academy of Pediatrics,
stated her agreement with the earlier testimony supporting the
proposed bill. She pointed to the ease for a universal system,
instead of a separate stash of vaccines, and separate
documentation for its use.
4:02:08 PM
PAUL RICHARDS, introduced another PhRMA representative and
offered to answer questions.
KURT STEMBRIDGE, Task Force Chair, PhRMA, relayed that Idaho had
started a pediatric [vaccine] assessment program in 2010. He
shared that PhRMA recommended three amendments to the proposed
bill. He directed attention to page 5, line 27, and recommended
that "an adult" be deleted, which would make this a pediatric
only program, similar to the other states. The second
recommendation was on page 2, line 19, and he suggested that a
member of each body of the Alaska State Legislature be added to
the State Vaccine Assessment Council. His final recommendation
was to designate that one of the health care provider council
members be a pediatrician.
MR. STEMBRIDGE, referencing his first suggestion for making the
immunization program pediatric only, explained that Idaho had
struggled with ERISA plans, which were governed by federal, not
state, control and allowed an option to either pay-in or pay-
out. He stated that Tricare was one of the biggest ERISA plans,
and that Tricare had not paid in in Idaho. He reported that, as
Idaho had to keep the program solvent, it was necessary to
support the program with state money. He pointed out that
Alaska had $4.6 million to cover the cost of getting the
pediatric program "up and running," and that there was time to
work through any problems if the ERISA plans did not pay into
the assessment. He declared that the problem with the ERISA
plans would be compounded with an adult program. He stated that
the Tricare adult program would not pay if the Tricare pediatric
program did not pay. He reported that there was also the
possibility that Medicare would not pay into the assessment. He
opined that there would be more time to get the program running
if it was pediatric only. He pointed out that there was only
one other state with an adult vaccination program, which limited
the modeling possibilities. He declared that there was a
"vibrant, growing adult market out there right now, where
people, because of the ACA [Affordable Care and Patient
Protection Act], requires that all insurance companies cover
preventative services." He stated that the adult portion would
only cover people with insurance. He offered his belief that,
although the bill declared that this was voluntary, it was not,
and he offered an anecdote in support. He explained that, under
the ACA, a person could not be charged for any out of pocket
expenses, and that any reimbursement to the pharmacist would be
denied because once an insurance company paid into the
assessment they would sever the reimbursement mechanism so they
would not be billed twice. He opined that there were only two
choices: join the program or don't give immunizations.
MR. STEMBRIDGE directed attention to the second recommendation
he had presented regarding the appointment of legislators to the
assessment council. He pointed out that, otherwise, there were
no elected officials on a council which had been given the
ability to tax without any accountability to the voting public.
He noted that Idaho had put two legislators on its vaccine
assessment council. Referring to his third suggestion to add
two practicing pediatricians to the council, he explained that
they would provide expertise on vaccines. He declared that the
proposed adult program would subsidize insurance companies "off
the back of the pharmaceutical industry." He reported that the
industry spent billions every year to invent medications and
vaccines to prevent diseases, and that the ACA coverage of
vaccines was built into the premiums. He declared his pride for
working in an industry that was "looking for the next cure" and
preventing more diseases.
CHAIR HIGGINS asked for clarification whether the provider
submitted billing for vaccinations was denied by the insurance
companies under the Idaho pediatric assessment program.
MR. STEMBRIDGE replied that insurance companies would not
reimburse for vaccines after the pediatric assessment program
was initiated, as the insurance companies declared this was a
double billing. He said that this would happen with an adult
assessment program, as well.
MR. STEMBRIDGE said that PhRMA wanted to provide as many
vaccines as possible to the people of Alaska, as vaccines saved
money and benefited the citizens.
CHAIR HIGGINS said that Alaska worked toward taking care of its
people. He offered an anecdote about enhanced dentistry
treatment in rural Alaska for adults.
MR. STEMBRIDGE added that the proposed bill did not address
patients without insurance. He referred to the analysis of
Fiscal Note 7, and read "all except uninsured adults and there
is not payer." He suggested putting effort and money into
support for those with no insurance, as opposed to subsidizing
the insurance industry.
4:14:03 PM
MR. STEMBRIDGE, in response to Representative Reinbold, said
that, as insurance companies were already paying into the
assessment program, they did not want to also reimburse claims
for vaccines.
REPRESENTATIVE REINBOLD asked who were the potential winners and
losers.
MR. STEMBRIDGE replied that, without the proposed PhRMA
amendments for this to become a pediatric bill, the winners were
the insurance companies, as they would receive a benefit for
covering all the immunizations. He declared that the adult
provision was merely a subsidy to the insurance companies.
REPRESENTATIVE KELLER asked for clarification that the drug
industry controlled the prices.
MR. STEMBRIDGE replied that competition set the prices. He
explained that multiple pharmaceutical companies were soliciting
flu vaccines for the upcoming year. He reported that the
contract had been designed and negotiated with Centers for
Disease Control and Prevention (CDC) for a very specific
clientele, those with no insurance, or insurance that does not
cover, as well as Native Alaskans. He questioned the
consequence if CDC said that this contract could not be
accessed.
4:19:06 PM
DENISE DANIELLO, Executive Director, Alaska Commission on Aging,
Division of Senior and Disabilities Services, Department of
Health and Social Services (DHSS), explained that the Alaska
Commission on Aging was a governor appointed commission that
planned services for seniors, educated Alaskans about senior
issues, and advocated for the needs of older Alaskans. She
declared support for the proposed bill, and reported that the
commission had been involved in prior legislation for ensuring
those un-insured and under-insured for access to vaccines. She
explained that the immune systems of seniors weakened with age,
hence the importance for access to vaccines. She listed the
recommended vaccines, which included influenza, shingles, and
pneumonia vaccines. She allowed that there was some
underutilization for some of these vaccines, noting that only 11
percent of seniors took advantage of the shingles vaccine. She
reported that lack of co-payment and deductible funds was often
the reason. She opined that the proposed bill would offer
improved access to the vaccines. She pointed out that the
proposed bill would also benefit grandparents who were living on
a fixed income and raising grandchildren.
4:22:24 PM
CHAIR HIGGINS said that public testimony would be kept open and
SB 169 was held over.
4:22:40 PM
The committee took an at-ease from 4:22 p.m. to 4:24 p.m.
HB 319-DRUG/DEVICE DISTRIBUTORS; COMPOUNDED RX
4:24:10 PM
CHAIR HIGGINS announced that the next order of business would be
HOUSE BILL NO. 319, "An Act relating to wholesale drug or device
distributors; relating to prescription benefits under the state
health insurance plan; and providing for an effective date."
4:24:12 PM
REPRESENTATIVE KELLER moved to adopt the proposed committee
substitute (CS) for HB 319, labeled 28-LS0199\P, Martin,
3/21/14, as the working draft. There being no objection, it was
so ordered.
4:24:48 PM
REPRESENTATIVE TAMMIE WILSON, Alaska State Legislature,
explained the changes to the proposed CS. She said that the
proposed bill required that all wholesalers be similarly
licensed. She stated that more than 400 out of state companies
did business in Alaska without the same license or regulation as
those in-state businesses. She relayed that a second part of
the proposed bill addressed compound prescriptions and access to
them by retirees. She stated that these compound prescriptions
had been available for many years, and that retirees had been
assured that access to these would not change with the new
[health care] administrator. She reported that the Department
of Administration (DOA) had requested more time "to study this
issue." She relayed that DOA had stated that compounding
prescriptions could have negative effects, although there had
not been any reported cases in Alaska. She reminded the
committee that it was the physicians prescribing the compound
prescriptions, and not the pharmacists. She opined that this
was "about big business running our local pharmacies out of
business." She asked what message was being sent to Alaska
retirees if they were no longer able to obtain the necessary
medication. She explained that compound medication was a pill
made from a specific recipe for an individual. She offered her
belief that DOA did not need to study the issue, and that it had
been an oversight to not notice the lack of authority for paying
for compound prescriptions when the health care administrator
changed. She read a memorandum from DOA which stated that
payment for compound prescriptions would be allowed throughout
the remainder of the year. She declared that there had not been
any problems with compound prescriptions in Alaska.
CHAIR HIGGINS offered his belief that this was an oversight.
REPRESENTATIVE WILSON stated that pharmacists were not doing
anything wrong.
4:31:10 PM
REPRESENTATIVE WILSON, in response to Representative Reinbold,
said that medical devices were brought into Alaska by more than
400 wholesalers without any licensing or oversight.
REPRESENTATIVE KELLER asked for clarification that the proposed
bill requested similar treatment for licensing to both in-state
and out-of-state distributors of medical devices.
REPRESENTATIVE WILSON said that was correct.
REPRESENTATIVE KELLER stated that he needed to review the
language for licensure in the proposed bill.
4:33:21 PM
CHAIR HIGGINS said that the proposed bill would be held over.
4:33:45 PM
REPRESENTATIVE REINBOLD stated that she had concerns for the
medical device issue, as she was unsure of the unintended
consequences. She requested further discussion.
REPRESENTATIVE WILSON explained that the request for licensing
was directed toward the companies, and not the devices. She
declared that she wanted the same process for in-state and out-
of-state companies.
REPRESENTATIVE REINBOLD asked again about the unintended
consequences, and whether other states also required a
wholesaler to register.
REPRESENTATIVE WILSON, in response, said, "honestly, I don't
care what other states are doing." She reiterated her belief
that she wanted the same process for in-state and out-of-state
companies.
REPRESENTATIVE REINBOLD asked for testimony from the providers.
CHAIR HIGGINS re-opened public testimony.
4:37:14 PM
RICHARD HOLM, Pharmacist, relayed that he was the immediate past
Chair of the Board of Pharmacy. He stated that the board was
interested in regulating the out-of-state wholesalers, as they
also sold drugs, chemicals, and devices. He declared that the
board should have the ability to regulate these wholesalers, not
the devices. He declared that this was a protection for Alaska
business owners, and allowed business owners to register any
complaints for investigation.
4:40:37 PM
CHAIR HIGGINS said that HB 319 would be held over.
4:40:48 PM
The committee took an at-ease from 4:40 p.m. to 4:42 p.m.
HB 355-MENTAL HEALTH FIRST AID TRAINING
4:42:27 PM
CHAIR HIGGINS announced that the next order of business would be
HOUSE BILL NO. 355, "An Act establishing in the Department of
Health and Social Services a first aid training program for
mental health interventions."
4:42:38 PM
REPRESENTATIVE TARR, as the sponsor of proposed HB 355, spoke
about mental health first aid (MHFA) training. She paraphrased
from the Sponsor Statement, which read:
Alaska has the highest suicide rate per capita in the
country, at almost twice the national rate. There is
an average of 136 suicides a year in Alaska and
between 2000 and 2009, there was at least one suicide
in 176 different Alaskan communities. Alaska Native
men between the ages of 15-24 have the highest rate of
suicide among all demographics in the United States,
and the rate of suicide for all Alaska youth in this
age group was nearly twice as high as the rate for
adults over 25. Compounding this problem, youth
exposed to suicide or suicidal behaviors are more
likely to attempt suicide. Notably, 90% of suicide
victims have a diagnosable, treatable mental or
substance abuse disorder. We must reverse this trend.
In your life, you are more likely to see a person
having a panic attack than you are to see someone
having a heart attack. Though many of us know how to
properly respond to a heart attack, few of us know
what to do when confronted with someone having mental
or emotional crises. Creating an environment where
people know how to properly respond to these
situations is a small step towards treating Alaska's
problems with suicide, addiction, and abuse. Mental
Health First Aid courses teach people how to recognize
the signs and symptoms of mental health problems and
how to provide initial aid before guiding a person
toward appropriate professional help.
MHFA was introduced to the United States in 2008 and
since then over 50,000 state and municipal employees,
clergy members, police officers, and citizens have
been trained in 47 states and the District of
Columbia. Participants learn how to detect a number
of mental illnesses, including schizophrenia, bipolar
disorder, psychosis, substance use disorders,
depression, anxiety and eating disorders, and how to
respond to people who have them. This ultimately
saves municipalities money. People with untreated
mental illnesses frequently consume fire and police
department time, as well as emergency room costs. By
recognizing when mental health treatment is necessary
for young Alaskans, a community can begin to take care
of itself.
I ask for your consideration and support for Mental
Health First Aid training for our youth so that we can
have a healthier future and healthier Alaskans.
4:46:07 PM
CHAIR HIGGINS opened public testimony.
4:46:16 PM
JILL RAMSEY, Training Coordinator, Center for Human Development,
University of Alaska, relayed that she was the training
coordinator for mental health first aid, as well as other
trainings. She reported that the training had been coordinated
through the trust training cooperative for the past two and a
half years, and had been able to respond to the many different
populations requesting the training. She said there was a wide
group of people interacting with the public and seeking training
to deal with common mental health problems before they became a
crisis. She reported that 22 states and municipalities had
appropriated money for mental health first aid training, with a
focus on prevention and early intervention for mental health and
substance use problems. She relayed that many states had put
this on par with standard first aid, and, as the outcomes of the
training were being tracked, the barriers for help were being
broken down. She shared that Colorado had appropriated $750,000
to expand its mental health first aid program. She reported
that the lifesaving and cost saving effects were bringing
national attention.
CHAIR HIGGINS asked about the difference between a behavioral
health analyst and a mental health first aid provider.
MS. RAMSEY explained that this was a public education course for
anyone and not a clinical training. She shared that there were
calls from people who had lost a loved one, from high schools
and college campuses, all with a need to know what to do and how
to detect before there was any presentation of a threat to harm.
REPRESENTATIVE KELLER exclaimed that this was an innovative
model. He asked if they had approached employers, similar to
Red Cross training, instead of asking for general funds.
MS. RAMSEY replied that a number of large employers nationally
were interested. She explained that mental health first aid was
brand new in Alaska, and that they were currently targeting
direct service providers for trainings. She stated that
community wide public education was a new avenue in Alaska, and
that other states and employers were requiring this alongside
standard first aid training.
MS. RAMSEY, in response to Representative Reinbold, said that a
large percentage of completed suicides had a diagnosable mental
health issue and/or substance use issue. She explained that an
isolated or disenfranchised feeling, with depression or
substance use, and a lethal means often created a dangerous
situation.
MS. RAMSEY, in response to Chair Higgins, said that she had
received a Master's degree in Psychiatric Rehabilitation with a
Bachelor's degree in social work and psychology.
CHAIR HIGGINS asked about her training for mental health first
aid training.
MS. RAMSEY explained that two and a half years prior she was
hired to be a training coordinator for the Alaska Mental Health
Trust Authority training cooperative and the advisory council
had suggested including mental health first aid.
CHAIR HIGGINS asked about her training program.
MS. RAMSEY replied that the mental health first aid training had
been provided by the National Council on Behavioral Health Care
in Seattle. She explained that it had originated in Australia
in 2001, had been introduced into the United States in 2008, and
had been brought to Alaska in 2011.
4:56:08 PM
MS. RAMSEY, in response to Representative Reinbold, said that
the Alaska Mental Health Trust Authority had funded the initial
startup with a small grant that sent people from Alaska to
become mental health first aid trainers. She noted that, as
this was a public education course, there was a desire for other
funding support.
REPRESENTATIVE TARR, addressing the fiscal note, said that costs
could be reduced by almost 66 percent in the first year, with
additional reductions in future years.
4:58:02 PM
DAVID D'AMATO, Senior Director, Health Policy, Alaska Primary
Care Association, explained that the association recognized that
mental health first aid was significant for its populations. He
reported that the association was comprised of 160 community
health care centers throughout Alaska. The association had
decided to bring trainers to Alaska community health centers, as
this was a good place to start breaking down the barriers
regarding mental health matters in that community. He said that
there were now 30 trainers and teachers. He explained that part
of the agenda was to train trusted, respected people in each
community, even if they were not trained in specific behavioral
health areas. They could then begin to teach basic elements of
mental health recognition and intervention. He shared that
intervention was the piece that had been missing. He offered an
anecdote comparing mental health first aid with CPR, as Alaska
had a serious mental health epidemic. He stated that a goal of
the Alaska Primary Care Association (APCA) was to break down the
barriers that prevented true behavioral health and primary care
integration. He reported that the APCA and the Alaska Mental
Health Trust Authority were working in partnership on this
project. He acknowledged that trainings would be necessary for
other specific areas, including veterans, elders, and rural
issues, as this training had focused on children.
5:02:30 PM
CHAIR HIGGINS said that HB 355 bill would be held over and that
public testimony would be kept open.
5:03:04 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:03 p.m.