Legislature(2013 - 2014)CAPITOL 106
04/03/2014 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB169 | |
| SB162 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 290 | TELECONFERENCED | |
| + | SB 162 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 169 | TELECONFERENCED | |
SB 169-IMMUNIZATION PROGRAM; VACCINE ASSESSMENTS
3:10:12 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." [In front of the committee was CSSB
169(FIN), labeled 28-LS1219\I.]
REPRESENTATIVE KELLER moved to adopt the proposed committee
substitute (CS) for CSSB 169, labeled 28-LS1219\T,
Wallace/Mischel, 4/2/14, as the working draft. There being no
objection, it was so ordered.
3:10:53 PM
The committee took an at-ease from 3:10 p.m. to 3:12 p.m.
3:12:49 PM
TOM STUDLER, Staff, Representative Pete Higgins, Alaska State
Legislature, directed attention to the changes proposed in the
working draft: page 2, line 4, which established a three year
phase in program, and provided for voluntary participation; page
2, lines 30 - 31, which included two health care providers
licensed in the state, one of whom must be a pediatrician, for
the council; page 4, lines 1 - 4, which added a requirement to
submit to the commissioner and the legislature an annual
financial report, including assessment determinations and
overall costs of the program, for an on-going review of the
program; page 4, line 13, which added an incremental phase-in of
the entities at the discretion of the commissioner; page 5,
lines 5 - 6, which added an opt out of the program clause under
procedures approved by the commissioner; page 5, lines 10-12,
which stated that an assessable entity may not deny a claim for
coverage of vaccines based on the decision of a health care
provider to elect not to participate in the program; page 7,
line 7, which extended the sunset date for repeal to allow three
years of a phase in period with an additional two years of
operation to determine the viability of the program; and [page
7], line 15, which declared that this would take effect on
January 1, 2015. He explained that an amendment by the
committee could resolve an inadvertent error on [page 7] line
15, which included Section 7 to take effect on January 1, 2015.
He explained that Section 6, page 7, line 8, repealed the act,
removed the money, and placed it in the unobligated funds;
however, waiting for an effective date of January 1, 2015 meant
that the department could not access those funds until that
date, and would miss the flu season vaccines.
3:17:29 PM
REPRESENTATIVE SEATON referred to page 2, line 4, and asked if,
after three years to implement the procedure for phase in to the
program, everyone was then included.
MR. STUDLER replied that this was correct.
CHAIR HIGGINS explained that the three year phase in period
would allow the commissioner latitude to make the program work.
He pointed to the opt out language which allowed any entity out
during the transitional period. He opined that this three year
period allowed plenty of time for each entity to determine if
the program worked for them.
MR. STUDLER pointed out that this was detailed on page 5, line
5.
REPRESENTATIVE SEATON asked where it stated that the program was
mandatory participation, or voluntary participation, after three
years.
CHAIR HIGGINS explained that it was mandatory under the earlier
version, but that the proposed CS allowed "a slow but sure
process, a three year transitional period for the entities." He
declared that the point was to bring everyone on board, and to
ensure that self-insured third party payers could come on board
immediately or at a slower rate if need be.
3:20:06 PM
REPRESENTATIVE KELLER asked how this would affect the vaccine
pricing, as the point was to get the purchase cost down.
CHAIR HIGGINS replied that he did not know the answer, as they
did not know who would participate. He opined that Premera
covered the most people in the state, and would most likely
cover 70 percent.
3:21:06 PM
REPRESENTATIVE SEATON directed attention to page 3, line 5, the
director of the division of insurance or the director's
designee, and page 2, line 28, the department's chief medical
officer for public health, and asked if there was any intention
to allow a designee for the chief medical officer.
CHAIR HIGGINS asked that the sponsor address this.
3:22:31 PM
SENATOR CATHY GIESSEL, Alaska State Legislature, explained that
there was a not yet proposed committee substitute (CS) which had
made that change to include chief medical officer or designee.
She pointed out that, as this was a council and not a board or
commission, there was not any cost. In response to
Representative Keller and Chair Higgins, she clarified her
agreement for the change to add "or designee" after chief
medical officer.
JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State
Legislature, pointed to page 2, line 28, for the addition of "or
designee" after chief medical officer.
3:24:32 PM
CHAIR HIGGINS opened public testimony.
3:25:02 PM
MARISSA WATKINS, Director of State Policy, PhRMA, explained that
PhRMA represented the leading bio-pharmaceutical researchers in
the country, and its "members are committed to finding
tomorrow's cures and treatments for some of the most serious
diseases." She stated opposition by PhRMA for SB 169, and
offered the belief that the proposed legislation would not
achieve its goal for ease of vaccine administration and high
vaccination rates. She stated that the proposed bill would make
the vaccine market more complex. She noted that the Affordable
Care and Patient Protection Act "ensures much more
comprehensive, first dollar coverage for vaccines for the
insured population." She stated that the "complicated program
envisioned by SB 169 is unnecessary to raise vaccination rates
and adds administrative burden on providers." She opined that
the proposed bill could jeopardize the competitive vaccine
market. She warned that the use of Medicaid funding for vaccine
purchase for non-Medicaid recipients could warrant review by the
federal government and jeopardize the Medicaid funding to
Alaska. She detailed that PhRMA members wanted to ensure the
existence for all possible avenues to achieve the widest
vaccination rates in every state. She opined that SB 169 would
do more harm than good.
3:27:22 PM
CHAIR HIGGINS asked if PhRMA had also rejected the other eight
states which currently had this program.
MS. WATKINS replied that PhRMA companies had worked with some of
these states to implement the programs however, PhRMA now
opposed the creation of universal purchase programs. She
suggested that there were better solutions for more
vaccinations.
3:28:17 PM
CHAIR HIGGINS asked for clarification that PhRMA previously
supported these programs, however PhRMA now believed that these
programs for adults or children should not be implemented.
MS. WATKINS expressed her agreement, stating that PhRMA member
companies no longer felt it was in the best interest of the
vaccine community for a universal purchase program.
CHAIR HIGGINS relayed that he had spoken with other states
having this program, and "it seems to be working very well for
them." He asked why PhRMA was opposed to the program, other
than its claim that the program was "directing market forces."
3:29:44 PM
REPRESENTATIVE TARR asked for clarification about the
aforementioned statement regarding Medicaid dollars.
MS. WATKINS explained that PhRMA believed that the use of
Medicaid dollars to purchase vaccines for non-Medicaid
recipients could warrant review by the federal government,
thereby jeopardizing Medicaid funding to Alaska.
CHAIR HIGGINS expressed his agreement that Medicaid funding
could not be used for private insurance.
3:30:47 PM
SHEELA TALLMAN, Premera Blue Cross Blue Shield of Alaska,
relayed that Premera Blue Cross Blue Shield had been working
with the Division of Public Health, as well as other
stakeholders, and were supportive of the concept of the proposed
bill to maintain the universal vaccine program. She referenced
the letter of support, [Included in members' packets] which was
for a previous version of the proposed bill. She noted that the
Alaska Health Care Commission had included a recommendation in
its 2011 report to ensure that the vaccine program was
adequately funded, and had included consequences for the
elimination of the vaccine program in Alaska. She reported that
Premera had not had a chance to review the most current
proposals. She expressed concern for making the program
voluntary for the payers. She pointed out that a critical
component of the program was that all payers participate and pay
for the share of vaccines for its membership. If all entities
did not participate, the costs would increase for Alaska
residents. She stated that vaccines were more cost effective
than treatment of illness and disease. She offered the belief
that a statewide universal vaccine program would help to
alleviate any issues for access, especially with a goal of
improvement to the immunization rate.
MS. TALLMAN, in response to Chair Higgins, explained that her
understanding was that the opt-in, opt-out option for providers
was directed predominantly at the adult population.
CHAIR HIGGINS replied that the previous version had not
designated for children or adults.
MS. TALLMAN offered her belief that the opt-in was not an issue
for the payer accessible entity side.
CHAIR HIGGINS asked for clarification that it was now a concern,
although it had not previously been a concern. He stated that
it had not been changed in this version of the proposed bill.
MS. TALLMAN expressed her understanding that this was now
voluntary for the payers.
CHAIR HIGGINS said this was the same as previously.
3:34:38 PM
MS. TALLMAN said that Premera had concerns for unintended
consequences from the changes in the proposed bill, as it could
undermine the entire program. She suggested that there would be
few, if any, vaccines purchased by the state, and costs would
increase. She pointed out that Premera participated in the
universal vaccine programs in other states, and was key in
development of the successful program in Washington State, which
was very similar to the concept of proposed SB 169.
CHAIR HIGGINS replied that SB 169 was different than the program
in Washington State, as the proposed bill included adults,
similar only to Vermont.
MS. TALLMAN replied that Premera was aware that the proposed
bill included adult vaccines. She suggested that the program
begin with vaccine for kids, and then implement the vaccine for
adults.
CHAIR HIGGINS asked that testimony be limited to the mechanics
of the proposed bill.
3:37:23 PM
LAURA SARCONE, Nurse Midwife, said that her testimony was based
on the essential nature of vaccines for pregnant women, as the
immune system was compromised during pregnancy. She spoke about
the risks and dangers of flu for pregnant women, including pre-
term labor, respiratory failure, and premature birth. She
reported that Centers for Disease Control and Prevention (CDC)
had recommended that all pregnant women be vaccinated against
tetanus, diphtheria, and pertussis in the third trimester of
pregnancy, regardless of prior history for this vaccination.
She declared that the proposed bill would allow private
obstetric and family practice providers to provide the
recommended vaccine protection to pregnant patients. She urged
support for the proposed bill.
3:39:48 PM
CARRIE DOYLE, MD, Alaska Clinical Nurse Specialist Association,
said that she was concerned with the health of adult patients,
especially for those patients administered to hospitals. She
reported that immunized patients were less likely to require
hospitalization from illnesses that were preventable through
vaccinations. She declared that the cost and availability of
immunizations was of the utmost concern. She urged support of
proposed SB 169.
3:41:10 PM
JANETTA SHOCKMAN, President, Alaska Nurses Association, said
that she specialized in adult, critical care medicine. She
spoke in support of SB 169. She declared that illnesses can be
life threatening, and life altering, and that it was necessary
for the vaccines to be easily accessible and affordable to
protect all Alaskans. She stated that the Alaska Nurses
Association supported the proposed bill.
3:43:07 PM
PATRICIA SENNER, Professional Practice Director, Alaska Nurses
Association, spoke about the need for a vaccine program for the
uninsured in order to buy vaccines at a much lower rate.
3:44:17 PM
MARIE DARLIN, Commissioner, Alaska Commission on Aging, pointed
to the letter from AARP in support of the bill [Included in
members' packets]. She stated that the Alaska Commission on
Aging was in support of vaccines for all. She declared that
seniors needed to have the option and the ability for vaccines.
She spoke of the concern for shingles and the need for its
vaccination. She explained that she wanted to see an
immunization program to cover both adults and children. She
declared full support of the proposed bill.
3:47:36 PM
WARD HURLBURT, MD, Chief Medical Officer/Director, Division of
Public Health, Central Office, Department of Health and Social
Services, directed his response to questions previously posed to
him. He explained that the patients, the public, the payers,
and the providers would all benefit from the vaccine program
presented in SB 169. He reported that it would result in a more
efficient system with less administrative workload and a lower
cost for the pharmaceutical manufacturers. He expressed his
agreement that the pharmaceutical industry was a critical
partner for keeping Americans healthy. He said that vaccine
prices would increase, and the assessments would also increase.
He reported that the Idaho vaccine program was different than
the proposed program in Alaska, as the Alaska program would not
draw from the general fund. He relayed that tribal entities
would continue to receive the state distributed vaccine under
the Vaccines for Children program. He said that the tribal
program would have the option to opt in to the program. He said
that the proposed program was designed to pay for people without
insurance, as 30-45 million Americans would still be uninsured,
by choice or by need, even with the Affordable Care and Patient
Protection Act. He referred to herd immunity which protected
all of society. Directing attention to the adult programs, he
reported that the Vermont program, the only state program for
adults, was working very well. He stated that ERISA plans
cannot be mandated for coverage by the state, although other
states had successfully established that an assessment can be
imposed on the ERISA plans. He reported that payers who elected
to buy the vaccine themselves were reimbursed at a comparable
rate, often less than the retail purchase price; hence, an
incentive to participate. He explained that a successful
program would have a small positive economic impact on the
insurance companies, about a 2 percent profit margin. He said
there was an option to purchase adult vaccines through multi
state purchasing cooperatives. He explained that providers who
had purchased vaccines would have a phase in period, in order to
allow for reimbursement to those previous purchases. He stated
that 75 percent of Medicaid enrollees were women and children,
and were already covered. He clarified that federal dollars
would not be used inappropriately. He expressed concern for
opt-out payers and third party administrators, as it would make
it more difficult to have a successful program without their
participation.
3:55:19 PM
CHAIR HIGGINS said that many providers had contacted him
requesting a choice for the opt-out option, as their concern was
for directing market forces toward competitors. He explained
that it was up to the insurance companies how to pay. He
declared that insurance companies were very good at figuring the
rates. He stated that there was concern by the providers for
the unknown cost of the assessment.
3:58:46 PM
DR. HURLBURT pointed out that the assessment would be on the
payers, with an assurance that there was not double payment. He
said that the only possibility that providers pay an assessment
would be an optional participation by some unique providers. He
said that a disadvantage for non-participation would be the
increased administrative requirements for double record keeping
and double storage facilities. He noted that providers would
only have an assessment if they were both a payer and a
provider, such as Veterans Administration or the tribal
programs.
CHAIR HIGGINS directed attention to page 4 of the original bill,
which described the annual assessment reporting requirements.
He said that the aforementioned "other program participants"
created "a little bit of a grey area."
4:01:15 PM
REPRESENTATIVE SEATON directed attention to Version T, page 4,
line 18, and asked if there was any reason for "or other program
participant" if there were assessable entities.
DR. HURLBURT offered his understanding that the private practice
doctors would not be assessed. He offered that Indian Health
Service received vaccines at no cost for Native American
children and Medicaid enrollees, although the facilities often
also functioned as a community hospital for other payers. He
said that this gave the tribal program the option to participate
in order to lower their vaccine costs to the public, although
participation could not be mandated.
CHAIR HIGGINS directed attention to page 4, line 31, [Version I]
and said that a health care provider or group of providers may
opt into the program, if approved by the commissioner.
CHAIR HIGGINS, in response to Representative Seaton, clarified
that although he had referenced Version C, this was also stated
in Version T, page 5, line 7. He stated that any concerns were
corrected with the option to opt-in or opt-out.
DR. HURLBURT referenced earlier testimony for pregnant mothers,
stating that this allowed the opportunity to opt in, without
becoming an assessable entity.
4:04:48 PM
REPRESENTATIVE SEATON directed attention to page 4, lines 16-19,
and asked if the definition for program participant was better
clarified if included in the assessment portion.
DR. HURLBURT noted that he did not have expertise for writing
legislation, although the intent of the suggestion for
clarification was consistent.
REPRESENTATIVE SEATON clarified that the assessable entities
were being assessed, and not the providers; therefore, both
should not be included in the same sentence. He asked that this
be considered for clarification.
CHAIR HIGGINS explained that this language had been included in
Version T, page 4, lines 13 - 15, and it allowed the
commissioner to approve who were the program participants.
4:07:23 PM
REPRESENTATIVE KELLER shared that this was tied to page 2, line
3, in which "the commissioner shall establish a procedure to
phase in the program over a three-year period." He stated that
the discretion of the commissioner had increased.
REPRESENTATIVE SEATON clarified that page 2 referenced an
assessable entity and not a program participant.
CHAIR HIGGINS read page 4, line 13, "an assessable entity and
other program participant." In response to Representative
Seaton, he offered his understanding that "other program
participant" could constitute other than a provider, such as a
third party insurer; hence, the decision to leave it in the
proposed bill.
REPRESENTATIVE SEATON suggested a review of this, so that there
would not be any confusion in the proposed bill.
REPRESENTATIVE KELLER expressed his agreement for the confusion,
and he pointed out that some entities were in both of the
categories, insurers and providers.
CHAIR HIGGINS offered his belief that this had been resolved
when providers were allowed to opt out.
4:10:14 PM
REPRESENTATIVE SEATON asked for clarification of the opt-out
provision on page 5, line 5, whereby an assessable entity could
opt-out at any time, and he asked if the providers should be
added to this provision. He stated that there would not be a
large enough assessment pool if the assessable entities, the
insurance companies, could opt out. He pointed out that the
sunset clause was only four years.
CHAIR HIGGINS asked whether insurance companies should be
mandated for their participation in the State of Alaska. He
declared that the Affordable Care and Protection Act mandated,
and "one of the things that offends me the most" was the
mandate. He offered his understanding that "this thing [the
proposed program] is the best thing since buttered toast." He
declared that all insurance companies wanted to opt-in to this
program, and therefore, there should not be any problems. He
noted that the insurance companies had three years to make this
determination. He declared that "I have a real problem
mandating insurance companies, forcing them to do a program."
He offered his belief that a mandate was not "the American way."
REPRESENTATIVE SEATON suggested that the flexibility to opt-out
at any time could affect the purchase for quantities of
vaccines.
CHAIR HIGGINS, directing attention to page 5, line 5, replied
that the opt-out only extended for the first three years of the
phase in period.
REPRESENTATIVE SEATON pointed out that, as vaccines had to be
ordered ahead, it would be beneficial to have an opt-out window
equivalent to the order period for vaccines.
CHAIR HIGGINS replied that was the idea of the three years.
REPRESENTATIVE SEATON asked about a window for commitment during
each year to allow for the order of vaccines.
CHAIR HIGGINS expressed his understanding and agreed to give
this idea more consideration.
4:14:48 PM
DR. HURLBURT said that he had concerns with the opt-out for the
assessable entities, the payers. He expressed his agreement
that the insurance companies should not be told what to do, even
if participation was in their best interest. He explained that
the proposed bill was for assessments to insurance companies
that were required, or had decided, to cover the vaccines, and
the assessment was only for the vaccine doses they required.
This proposed bill saved the insurance companies money, and it
also generated the funding to pay for vaccines for uninsured
individuals, which benefited everyone.
4:16:07 PM
REPRESENTATIVE KELLER asked for clarification that the insurance
companies were obligated to supply the vaccines, and that, in
reality, they did not have the choice.
DR. HURLBURT expressed his agreement, and "to date, it's been
their option, their enlightened option, because they save money
if they can prevent somebody my age from getting pneumonia with
the pneumococcal vaccine." He pointed out that the Affordable
Care and Patient Protection Act also mandated this coverage.
CHAIR HIGGINS said that the insurance company only had to pay
when the provider billed them for the services.
DR. HURLBURT explained that the two methods to levy the
assessment were based on either vaccine doses given or covered
lives. He relayed that Premera had expressed its preference for
the vaccine dosage basis. He opined that this may not be the
most favorable pricing approach. He said that the covered lives
liability could be adjusted according to the numbers of people
who refused the vaccine.
4:19:38 PM
REPRESENTATIVE TARR asked if there was an option for two years,
instead of the current three years.
DR. HURLBURT replied that, as the first year was transitional
under the proposed bill, it was necessary to give the program
enough years to see if it was successful. He reported that the
New Hampshire program was in its eleventh year, and its
immunization rate for two year olds had increased by 20 percent
and was now the second best in the United States.
4:21:37 PM
REPRESENTATIVE SEATON, directing attention to page 7, line 7,
asked if those dates should be June 30 to repeal and July 1 to
take effect, in order to correspond to the fiscal year, or was
that not the most optimal when ordering an assessment.
DR. HURLBURT offered his belief that the fiscal year basis would
make more sense. He pointed out that currently there was still
funding and a supply of vaccine for the startup.
4:23:10 PM
CHAIR HIGGINS closed public testimony, and said that SB 169
would be held over.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 162 - Sponsor Statement.pdf |
HHSS 4/3/2014 3:00:00 PM |
SB 162 |
| SB 162 Ver A.PDF |
HHSS 4/3/2014 3:00:00 PM |
SB 162 |
| SB 162 - Fiscal Note.PDF |
HHSS 4/3/2014 3:00:00 PM |
SB 162 |
| SB 162 - Lentfer support.PDF |
HHSS 4/3/2014 3:00:00 PM |
SB 162 |
| SB 162 - FDA announcement.PDF |
HHSS 4/3/2014 3:00:00 PM |
SB 162 |
| SB 162 - Dobson support.PDF |
HHSS 4/3/2014 3:00:00 PM |
SB 162 |
| SB 162 - Blower support.PDF |
HHSS 4/3/2014 3:00:00 PM |
SB 162 |
| SB 162 - AK Optometric Association.PDF |
HHSS 4/3/2014 3:00:00 PM |
SB 162 |
| SB 162 AKhydrocodoneHouseHessltrsb162-1.pdf |
HHSS 4/3/2014 3:00:00 PM |
SB 162 |
| SB 162 2013 Annual Drug Report.pdf |
HHSS 4/3/2014 3:00:00 PM |
SB 162 |
| SB 169 CS for HSS vsn H.pdf |
HHSS 4/3/2014 3:00:00 PM |
SB 169 |
| SB 169 Sectional CS vsn H.pdf |
HHSS 4/3/2014 3:00:00 PM |
SB 169 |
| SB 169 Support Dorius.pdf |
HHSS 4/3/2014 3:00:00 PM |
SB 169 |
| SB 169 Support Juneau Empire.pdf |
HHSS 4/3/2014 3:00:00 PM |
SB 169 |
| SB 169 Support Lily Lou.pdf |
HHSS 4/3/2014 3:00:00 PM |
SB 169 |
| CS SB 169 Version T.pdf |
HHSS 4/3/2014 3:00:00 PM HHSS 4/8/2014 3:00:00 PM |
SB 169 |
| SB 169 responses HHSS.pdf |
HHSS 4/3/2014 3:00:00 PM |
SB 169 |
| SB 169 Support Ilona Farr.pdf |
HHSS 4/3/2014 3:00:00 PM |
SB 169 |
| SB 169_Premera.pdf |
HHSS 4/3/2014 3:00:00 PM |
SB 169 |
| SB 169 Support AARP.pdf |
HHSS 4/3/2014 3:00:00 PM |
SB 169 |
| HCS for CSSB 169 ver T Explanation of Changes.pdf |
HHSS 4/3/2014 3:00:00 PM HHSS 4/8/2014 3:00:00 PM |
SB 169 |
| HCS for CSSB 169 ver T Section Analysis.pdf |
HHSS 4/3/2014 3:00:00 PM HHSS 4/8/2014 3:00:00 PM |
SB 169 |