Legislature(2017 - 2018)CAPITOL 106

03/14/2017 03:00 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
-- Testimony <Invitation Only> --
<Bill Hearing Canceled>
-- Testimony <Invitation Only> --
<Bill Hearing Canceled>
-- Testimony <Invitation Only> --
Moved HB 174 Out of Committee
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
       HB 174-EXTEND DISASTER EMERGENCY: OPIOID EPIDEMIC                                                                    
3:50:59 PM                                                                                                                    
CHAIR SPOHNHOLZ announced that the  final order of business would                                                               
be  HOUSE  BILL  NO.  174,   "An  Act  extending  the  governor's                                                               
declaration  of   disaster  emergency   to  address   the  opioid                                                               
epidemic; and providing for an effective date."                                                                                 
3:51:17 PM                                                                                                                    
JAY  BUTLER, MD,  Chief Medical  Officer/  DPH Director,  Central                                                               
Office,  Division  of Public  Health,  Department  of Health  and                                                               
Social  Services, declared  that there  were challenges  with the                                                               
opioid epidemic, as  there had been a fourfold  increase of death                                                               
from opioids in  the past 20 years.  He  said that the Department                                                               
of Health  and Social Services was  awarded a five year  grant to                                                               
support opioid  overdose prevention  programs in  2016.   He said                                                               
that this included distribution  of naloxone, the lifesaving drug                                                               
administered for an opioid overdose.   He shared that there was a                                                               
nasal  spray form  which  was  now part  of  the  rescue kits  in                                                               
Project   HOPE,   Harm   reduction,  Overdose   Prevention,   and                                                               
Education.     He   said  that   Project  HOPE   had  prioritized                                                               
partnerships with the  staff of organizations which  did not have                                                               
medical direction,  but were  most likely to  be present  when an                                                               
overdose occurred.   The department had explored  ways to provide                                                               
the kits  under a  standing medical order,  but the  authority to                                                               
declare the standing  order required a disaster  declaration.  He                                                               
added that although there were  a number of mechanisms to achieve                                                               
the authority, this seemed  to be the way to do  it as quickly as                                                               
possible and  take advantage  of the  federal resources  that had                                                               
been made available.   Governor Walker issued  the declaration on                                                               
February   14,  with   an   anticipated  legislative   concurrent                                                               
resolution to extend the declaration  longer that the than the 30                                                               
day duration  defined by Alaska  statute.  He emphasized  that no                                                               
state general  funds were requested  to support Project  HOPE, as                                                               
it  was supported  entirely by  the  federal grant.   Since  that                                                               
declaration, 12  partner organizations  had received  training to                                                               
dispense  the medication  and provide  the kit,  and nearly  1300                                                               
kits  had been  dispensed.   He reported  that Legislative  Legal                                                               
Services  had a  different interpretation  for the  meaning of  a                                                               
concurrent resolution and had determined  that instead a bill was                                                               
required to  extend the declaration and  continue distribution of                                                               
the kits under the standing order.                                                                                              
3:54:50 PM                                                                                                                    
DR.  BUTLER  paraphrased  the  Sectional  Analysis  [Included  in                                                               
members' packets], which read:                                                                                                  
     Sec. 1  includes findings on  the extent of  the public                                                                    
     health threat;  acknowledgement and description  of the                                                                    
     Governor's disaster  declaration; and the need  for the                                                                    
     legislature to  extend the  declaration to  address the                                                                    
         Sec. 2 extends the February 14, 2017, disaster                                                                         
     declaration for one year to February 14, 2018.                                                                             
      Sec. 3 makes the effective date retroactive to March                                                                      
     15, 2017, when the disaster declaration expires.                                                                           
REPRESENTATIVE  JOHNSTON   asked  if  the  bill   was  mainly  to                                                               
distribute  [naloxone],  and  if  there  was  any  other  way  to                                                               
accomplish this.                                                                                                                
DR. BUTLER explained  that naloxone was an FDA (US  Food and Drug                                                               
Administration)  approved drug  which  could be  acquired with  a                                                               
physician's  prescription.   To  work with  the  partners in  the                                                               
program and  distribute the  overdose kits,  it was  necessary to                                                               
have  a standing  order under  the authority  of his  prescribing                                                               
license, although the best way forward  appeared to be as part of                                                               
a disaster declaration.                                                                                                         
REPRESENTATIVE  JOHNSTON asked  if DHSS  was looking  for further                                                               
federal grants.                                                                                                                 
DR.  BUTLER   replied  that   this  disaster   declaration  would                                                               
primarily  achieve  the  goal  of  the  standing  order  for  the                                                               
naloxone distribution,  although other  grants and  other funding                                                               
sources were being reviewed.                                                                                                    
REPRESENTATIVE JOHNSTON asked if  the proposed bill was necessary                                                               
to apply for the grants.                                                                                                        
DR. BUTLER  said they could  have applied for the  grants without                                                               
the proposed bill.                                                                                                              
3:57:54 PM                                                                                                                    
REPRESENTATIVE KITO  asked what  would happen after  the deadline                                                               
in the disaster declaration of February 14, 2018.                                                                               
DR. BUTLER  replied that  an extension would  be necessary  if it                                                               
was decided to continue distribution under the standing order.                                                                  
REPRESENTATIVE KITO  asked if there  was a designated  time frame                                                               
for the grant.                                                                                                                  
DR.  BUTLER replied  that  this  was a  5  year grant,  effective                                                               
October 1, 2016, the beginning of the federal fiscal year.                                                                      
REPRESENTATIVE EASTMAN asked about  the number of heroin overdose                                                               
deaths in 2015.                                                                                                                 
DR. BUTLER  reported that  there were 38  deaths when  heroin was                                                               
associated  or morphine  was detected  in post  mortem.   He said                                                               
that  although it  was  not  uncommon for  there  to be  multiple                                                               
drugs,  multiple  opioids  could  be recognized  at  death.    He                                                               
pointed  out that  the trend  was  increasing significantly,  and                                                               
mirrored other parts of the U.S. and Canada.                                                                                    
REPRESENTATIVE EASTMAN asked about the number of deaths in 2016.                                                                
DR. BUTLER opined that this was in the mid-40s.                                                                                 
REPRESENTATIVE  EASTMAN asked  when  the final  numbers would  be                                                               
DR. BUTLER  replied that he  hoped to  have the final  numbers by                                                               
the end of March.                                                                                                               
REPRESENTATIVE  SULLIVAN-LEONARD  asked  if the  statistics  were                                                               
heroin related only or opioid and/or heroin related.                                                                            
DR. BUTLER  replied that these  were related to  heroin, although                                                               
there were more  than 80 opioid associated deaths.   He explained                                                               
that prescription  opioids were frequently  used interchangeably,                                                               
and about 80  percent of heroin users reported  that they started                                                               
with prescription opioids.                                                                                                      
CHAIR SPOHNHOLZ asked  about the best tool  for utilization after                                                               
a year, as proposed HB 174 would expire after one year.                                                                         
DR. BUTLER said that  he was not sure of the  best mechanism.  He                                                               
said that  current state  law did not  provide the  authority for                                                               
the state  medical officer  to issue  standing orders,  which had                                                               
been  the  reason  for  the earlier  disaster  declaration.    He                                                               
declared  that the  proposed  bill was  a short  term  fix for  a                                                               
possibly longer term administrative fix.                                                                                        
4:03:42 PM                                                                                                                    
STACIE  KRALY,   Chief  Assistant  Attorney   General,  Statewide                                                               
Section  Supervisor,  Human   Services  Section,  Civil  Division                                                               
(Juneau), Department  of Law,  said that  she concurred  with the                                                               
testimony of  Dr. Butler, that  the proposed bill was  a response                                                               
to the  emergency nature of  the event.   She offered  her belief                                                               
that an additional statutory fix  would be necessary, although it                                                               
would not  require extension of  the proposed bill.   She relayed                                                               
that it would  be necessary to find the authority  for Dr. Butler                                                               
to issue  the standing orders.   She said that there  had been an                                                               
oversight  in the  passage of  Senate  Bill 23  last year,  which                                                               
created the  mechanism for  the distribution  of naloxone,  as it                                                               
did not  allow for  the chief medical  officer to  issue standing                                                               
orders, although there was intent for that to be fixed.                                                                         
CHAIR  SPOHNHOLZ   suggested  that  the  proposed   bill  was  an                                                               
intermediate remedy.                                                                                                            
MS. KRALY expressed agreement.                                                                                                  
REPRESENTATIVE EASTMAN asked  what would be done  if the proposed                                                               
bill did not pass.                                                                                                              
MS. KRALY replied that, as there  would not be any standing order                                                               
for the authority to issue the  kits, a statutory change would be                                                               
necessary for the authorization.                                                                                                
REPRESENTATIVE  EASTMAN asked  what  could  be accomplished  with                                                               
memorandums of agreement instead of a statutory change.                                                                         
MS. KRALY  offered her belief  that, without  licensed physicians                                                               
to step  in and  provide oversight  and standing  order services,                                                               
the memorandums of  understanding or agreement "would  not get us                                                               
very far."   She declared  that it  was necessary for  a licensed                                                               
physician to  issue the standing  order, and without  that, there                                                               
would be a large gap period for administering the kits.                                                                         
REPRESENTATIVE EDGMON asked  about the zero fiscal  note in light                                                               
of  page 2,  line  6 of  the proposed  bill  which discussed  the                                                               
establishment  of  a statewide  overdose  response  program.   He                                                               
asked "how much teeth" this would have.                                                                                         
DR. BUTLER  replied that this  was a  valuable tool for  saving a                                                               
life, but it did not cure  addiction.  He stated that the broader                                                               
response  needed   to  include  access   to  care  and   the  de-                                                               
stigmatizing of  addiction.   He explained  that addiction  was a                                                               
condition of  the brain which needed  to be managed as  a chronic                                                               
health  condition.   He added  that it  was necessary  to address                                                               
ways to  manage pain,  some of  the drivers  for self-medication,                                                               
and the  amount of opioid  pain relievers  in the community.   He                                                               
reported   that  the   fiscal  note   focused  entirely   on  the                                                               
aforementioned  Project Hope.   He  stated that  this would  be a                                                               
long  term  emergency  response,   similar  to  a  major  natural                                                               
disaster, with  an incident command  structure to  coordinate the                                                               
prolonged recovery phase.                                                                                                       
REPRESENTATIVE EDGMON said  that he was supportive  of the effort                                                               
and the proposed  bill, but that he was skeptical  in the broader                                                               
sense  that   the  necessary  resources  to   effectively  combat                                                               
substance abuse in Alaska were being made available.                                                                            
DR. BUTLER  acknowledged that Representative Edgmon  had captured                                                               
the complexity  of the issue,  although, he pointed  out, alcohol                                                               
still killed more  Alaskans than opioids.  He  added that alcohol                                                               
deaths had  not been on  the same  dramatic increase.   He stated                                                               
that there was not a similar tool for alcohol related mortality.                                                                
4:13:16 PM                                                                                                                    
VALERIE  DAVIDSON,  Commissioner,  Office  of  the  Commissioner,                                                               
Department  of Health  and Social  Services (DHSS),  acknowledged                                                               
that  the  proposed  bill  would  not solve  the  problem.    She                                                               
explained  that  Department of  Health  and  Social Services  was                                                               
taking  a  multi-faceted  approach  with  application  to  "every                                                               
federal dollar  that we possibly  can" and that they  had secured                                                               
four  federal  grants  designed  to do  different  things.    She                                                               
explained that the grant mentioned  in the proposed bill would be                                                               
for administration  of an  immediate lifesaving  intervention for                                                               
people  during active  overdose.   She reported  that there  were                                                               
additional  federal grants  about  education  and prevention,  to                                                               
ensure  understanding for  the  dangers of  opioids,  as well  as                                                               
allowing for  treatment services.   She  relayed that  the Alaska                                                               
State Legislature  had made  funds available  in 2016  to provide                                                               
treatment  for  women  with  children.   She  said  that  Central                                                               
Peninsula Hospital had received a  grant to provide for immediate                                                               
detoxification services.  She reported  that DHSS had applied for                                                               
a $2 million grant to  allow for medication assisted treatment to                                                               
"assist folks to  be able to stay clean"  combined with available                                                               
therapy  to "get  to  the root  of the  problem"  "which was  why                                                               
people are  self-medicating."   She declared  that there  was not                                                               
any magic  treatment or  magic pill.   She  stated that  DHSS was                                                               
also pursuing  a [Section] 1115  behavioral health  waiver, which                                                               
would  allow for  a complete  redesign of  the behavioral  health                                                               
system  as  it  was  recognized  that  there  were  gaps  in  the                                                               
continuum of care.  She  reported that there were ongoing studies                                                               
for determining  "the best  place for  us to  be able  to provide                                                               
those services,  what are we  missing, can we  intervene sooner."                                                               
She shared that Alaska had  been disproportionately impacted by a                                                               
federal law which precluded facilities  with more than 16 beds to                                                               
seek reimbursement  from Medicaid.   She  reported that  DHSS had                                                               
received  guidance from  the Centers  for  Medicare and  Medicaid                                                               
Services for working through this  with an amended [Section] 1115                                                               
REPRESENTATIVE KITO  asked for explanation  to the  limitation on                                                               
16 beds for treatment.                                                                                                          
COMMISSIONER  DAVIDSON, in  response,  explained that  previously                                                               
individuals    experiencing    severe   mental    illness    were                                                               
institutionalized.   The  U.S. Congress  recognized that  housing                                                               
those with serious  mental illness was not an  efficacious way to                                                               
support  people,  and, instead,  to  treat  people in  the  least                                                               
restrictive  environment.   There was  an unintended  consequence                                                               
that facilities  with more than  16 beds providing  for substance                                                               
use  disorders were  impacted.   She  pointed out  that this  was                                                               
possible  in the  Lower  48, as  there was  a  larger economy  of                                                               
scale, but, as  this was not economically feasible  in Alaska, it                                                               
impacted the ability to provide more treatment services.                                                                        
REPRESENTATIVE  KITO suggested  that, as  smaller facilities  had                                                               
higher  incremental costs,  hopefully Alaska  could address  this                                                               
REPRESENTATIVE EASTMAN compared the number  of heroin deaths to a                                                               
murder epidemic  in Alaska.   He said  that he was  familiar with                                                               
the declaration process,  and that the disaster  act was designed                                                               
to   allow  cases   of   urgent  need   to   bypass  the   normal                                                               
appropriations   process,  and   allow  the   administration  the                                                               
opportunity   to   act   decisively  without   the   accompanying                                                               
bureaucracy  in the  budgeting process.   He  offered his  belief                                                               
that  the  declaration  in  the proposed  bill  would  allow  the                                                               
governor greater  access to funding.   He questioned  whether the                                                               
proposed bill was offering this temptation.                                                                                     
COMMISSIONER  DAVIDSON  explained   that  the  original  disaster                                                               
allocation  by  the  governor  was  "actually  drafted  extremely                                                               
narrowly  and limited  the resources  available to  the state  to                                                               
those of  the federal grant."   She  stated that the  zero fiscal                                                               
note  [Included in  members' packets]  accompanying the  proposed                                                               
bill was due to the limits  to available federal resources of the                                                               
original disaster declaration.                                                                                                  
REPRESENTATIVE  EASTMAN,  directing   attention  to  the  limited                                                               
resources and the  stop gap solution of the  proposed bill, asked                                                               
what would be the next options.                                                                                                 
COMMISSIONER  DAVIDSON replied  that  the  current challenge  was                                                               
that  the Chief  Medical Officer  did not  have the  authority in                                                               
state statute to provide the  standing order.  She explained that                                                               
DHSS  was  trying to  ensure  that  its community  based  partner                                                               
organizations  without medical  directors or  physicians able  to                                                               
write a standing  order could instead use the  standing orders of                                                               
the Chief  Medical Officer limited  to immediate  distribution of                                                               
the naloxone kits, and ensure that  as many kits as possible were                                                               
distributed  as quickly  as possible.   She  offered as  a longer                                                               
term  solution to  provide  the Chief  Medical  Officer with  the                                                               
authority to issue standing orders when necessary.                                                                              
REPRESENTATIVE EASTMAN  asked about  the liability  incurred with                                                               
any mishaps when naloxone was administered.                                                                                     
DR. BUTLER  said that he would  not be taking this  on beyond the                                                               
protections  afforded  under Senate  Bill  23,  which focused  on                                                               
establishing the guidelines  around the training.   He said that,                                                               
as Emergency  Medical Services personnel had  medical supervision                                                               
and were  already carrying  the kits,  they were  not a  focus of                                                               
Project HOPE.                                                                                                                   
REPRESENTATIVE  SULLIVAN-LEONARD  offered  a personal  story  and                                                               
reflected on  the progress of  the work in  the Matanuska-Susitna                                                               
Valley.   She reminded  the committee that  there were  also epi-                                                               
pens  for allergic  reactions, and  that more  training and  more                                                               
education would have a greater effect on the epidemic.                                                                          
4:26:18 PM                                                                                                                    
CHAIR SPOHNHOLZ opened public testimony.                                                                                        
4:26:52 PM                                                                                                                    
TERRIA  WALTERS,   President,  Founder,  Fallen   Up  Ministries,                                                               
offered a  personal story, and stated  that she was in  long term                                                               
recovery.  She spoke about using  a calculation for those who had                                                               
lived  because of  the administration  of [naloxone],  instead of                                                               
calculating the deaths.  She  declared support for HB 174, noting                                                               
that  the  lack of  resources  in  the  state ensured  that  many                                                               
individuals would  continue to  use drugs and  take the  risk for                                                               
overdose.    She reiterated  that  the  availability of  naloxone                                                               
meant  that an  overdose could  be  revived.   She reported  that                                                               
Fallen  Up Ministries  was  conducting  a detoxification  project                                                               
which  would  serve 25  patients,  and  would  be used  for  data                                                               
collection.   She shared that  she had  been clean and  sober for                                                               
almost 12  years.   She estimated  that 129  people died  of drug                                                               
overdose daily, declaring that this was a disaster.                                                                             
4:31:44 PM                                                                                                                    
MARK  WEAVER, Vice  President, Fallen  Up Ministries,  shared his                                                               
background  with  local  opioid  task  forces  and  declared  his                                                               
support  for   HB  174.     He  offered  some  of   his  personal                                                               
experiences.   He opined that  a gap in the  disaster declaration                                                               
would  "just  be  ridiculous."    He  compared  [naloxone]  to  a                                                               
defibrillator  or a  fire extinguisher.   He  stated that  once a                                                               
life  had been  saved, the  individual could  be directed  toward                                                               
available resources  for breaking "the entrapment  of addiction."                                                               
He noted  that many people who  did not live in  downtown locales                                                               
were struggling.   He declared his desire to  help the community.                                                               
He added that most of his group were volunteers.                                                                                
4:35:16 PM                                                                                                                    
SERENA  ESPINOZA, Vice  President,  Real  About Addiction,  Board                                                               
Administrator, Fallen  Up Ministries, reported that  she was also                                                               
a member  of the local opiate  task forces.  She  stated that she                                                               
had  seen too  many accidental  overdose deaths,  and that  there                                                               
would  have been  a chance  at recovery  if there  was access  to                                                               
[naloxone].   She declared  that it  was necessary  to distribute                                                               
naloxone  and have  continued  access  to it.    She offered  her                                                               
belief that  non-profit treatment facilities,  medical providers,                                                               
emergency   responders,  families   of   addicts,  and   recovery                                                               
advocates would  play an  important role in  saving the  lives of                                                               
Alaskans  if there  was immediate  access to  the [Project}  HOPE                                                               
kits.   She added  that the medication  disposal bags  would also                                                               
play a  large role in  prevention by  keeping opiates out  of the                                                               
hands of youth.  She stated her support for the proposed bill.                                                                  
4:37:49 PM                                                                                                                    
KARA  NELSON,   Director,  Haven   House,  Juneau,   shared  some                                                               
background of  Haven House and stated  that she was in  long term                                                               
recovery.   She said that  Haven House, as a  recovery residence,                                                               
was in  partnership with Project  HOPE, and offered help  to many                                                               
women  in the  community.   She shared  that they  were providing                                                               
peer support services  as volunteers.  She stated  her support of                                                               
HB  174 and  the extension  for  the declaration  of disaster  to                                                               
address  the opioid  epidemic.   She reiterated  that this  was a                                                               
place of  hope for  the many  organizations and  individuals that                                                               
allowed them to come together and move forward.                                                                                 
4:41:36 PM                                                                                                                    
JOHN GREEN,  Mat Su Opiate  Task Force, shared that  his daughter                                                               
had  died  in jail  of  complications  from detoxification.    He                                                               
reported that  getting into  recovery was  full of  obstacles and                                                               
barriers,  which included  required proof  of income  and waiting                                                               
lists.   It was daunting for  a parent to find  recovery help for                                                               
their child.   He stated his support  of HB 174.   He shared that                                                               
although  there was  a perception  that those  for recovery  were                                                               
soft on  crime, the option  to get  into recovery was  better for                                                               
the  community  and public  safety  because  once an  addict  had                                                               
recovered, they became  a productive member of  society and would                                                               
not continue  their criminal behavior.   He referenced  a concern                                                               
that naloxone  would make addicts  more careless,  comparing that                                                               
to having air  bags in cars and people driving  into trees to see                                                               
if they worked.  He emphasized  that no one wants to overdose and                                                               
die.   He stated that  naloxone offered  people a chance  to live                                                               
and  get  into recovery,  thereby  helping  other addicts  toward                                                               
4:45:14 PM                                                                                                                    
CHAIR  SPOHNHOLZ closed  public testimony.   She  said that  this                                                               
bill was an extremely urgent  and important piece of legislation,                                                               
even  as  it was  a  small  piece  of  an overall,  much  broader                                                               
strategy.  She added that  the emergency declaration would expire                                                               
in the next day.                                                                                                                
4:46:40 PM                                                                                                                    
REPRESENTATIVE EDGMON  moved to  report HB  174 out  of committee                                                               
with individual recommendations and  the accompanying zero fiscal                                                               
4:46:59 PM                                                                                                                    
REPRESENTATIVE EASTMAN  objected.  He  said that he  had reviewed                                                               
the disaster  declaration, and he offered  his understanding that                                                               
it was intended  to limit authority to only  the federal program.                                                               
He asked for clarification.                                                                                                     
MS. KRALY explained that the  emergency declaration had been very                                                               
narrowly   drafted  within   the  construct   of  the   statutory                                                               
authorization.   She  said  that there  was  a companion  statute                                                               
which  allowed the  department to  use the  framework to  craft a                                                               
public  health  emergency.    She  stated  that  they  took  this                                                               
authorization and  that the presented documentation  provided the                                                               
fiscal analysis  along with the declaration  which identified how                                                               
the money  was limited  to the  federal grant.   She  pointed out                                                               
that this was narrowly crafted to  make clear that there would be                                                               
no  additional  fiscal impact.    She  directed attention  to  AS                                                               
26.23.020 and  said that the  documentation in the  packet, along                                                               
with the declaration, encompassed that detail.                                                                                  
REPRESENTATIVE EASTMAN said that he  only had the fiscal note and                                                               
the declaration of disaster which  authorized certain things.  He                                                               
offered his  belief that the  actual statute read that  all state                                                               
resources were now at the governor's  disposal.  He asked if this                                                               
was the correct declaration.                                                                                                    
MS. KRALY  replied that the  statutory authorization did  offer a                                                               
broad array of authority to  address an emergency.  She explained                                                               
that the opioid disaster finance  plan had limited the funding to                                                               
the $4.1  million from the federal  grant.  She said  that it had                                                               
been made  clear to the  governor's office and to  the leadership                                                               
of  both  bodies  that no  additional  authorizations  under  the                                                               
statute  were  being   sought.    She  offered   to  supply  this                                                               
additional documentation.                                                                                                       
CHAIR SPOHNHOLZ  asked if Representative  Eastman had  the fiscal                                                               
note, which she opined did address the issue.                                                                                   
REPRESENTATIVE  EASTMAN asked  if there  was anything  other than                                                               
the fiscal note.                                                                                                                
MS. KRALY reported that a budget document had also been created.                                                                
REPRESENTATIVE EASTMAN maintained his objection.                                                                                
4:52:00 PM                                                                                                                    
A roll  call vote  was taken.   Representatives  Spohnholz, Kito,                                                               
Sullivan-Leonard, Johnston, and Edgmon voted  in favor of HB 174.                                                               
Representative Eastman voted  against it.  Therefore,  HB 174 was                                                               
reported out  of the  House Health  and Social  Services Standing                                                               
Committee by a vote of 5 yeas - 1 nay.                                                                                          

Document Name Date/Time Subjects
HB 103 Sponsor Statement 2.22.17.pdf HHSS 3/14/2017 3:00:00 PM
HHSS 3/16/2017 3:00:00 PM
HHSS 3/18/2017 3:00:00 PM
HB 103
HB 103 Draft Proposed Blank CS ver D 3.13.2017.pdf HHSS 3/14/2017 3:00:00 PM
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HB 103
HB 103 Sectional Analysis (CS) 2.22.17.pdf HHSS 3/14/2017 3:00:00 PM
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HB 103
HB 103 Explanation of Changes (CS) 2.22.17.pdf HHSS 3/14/2017 3:00:00 PM
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HB 103
HB 103 Fiscal Note DCCED--DCBPL 3.13.17.pdf HHSS 3/14/2017 3:00:00 PM
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HB 103
HB 103 Supporting Document Regulation Flow Chart 3-10-17.pdf HHSS 3/14/2017 3:00:00 PM
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HB 103
HB103 Career Guide Optometry 2.22.17.pdf HHSS 3/14/2017 3:00:00 PM
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HB 103
HB 103 Supporting Documents Optometry Education Flyer 2.22.17.pdf HHSS 3/14/2017 3:00:00 PM
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HB 103
HB 103 Supporting Document Ohio State Optometry Curriculum 2.22.17.pdf HHSS 3/14/2017 3:00:00 PM
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HB 103
HB 103 Supporting Document-Optometrists Practicing in AK 2.22.17.pdf HHSS 3/14/2017 3:00:00 PM
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HB 103
HB 103 Supporting Document-Board of the Examiners in Optometry.pdf HHSS 3/14/2017 3:00:00 PM
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HB 103
HB 103 Supporting Document Medical Liability Premiums Fact Sheet 2.22.17.pdf HHSS 3/14/2017 3:00:00 PM
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HB 103
HB 103 Letters of Support 2.22.17.pdf HHSS 3/14/2017 3:00:00 PM
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HB 103
HB103 Letters of Opposition-Support.pdf HHSS 3/14/2017 3:00:00 PM
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HB 103
HB174 Sponsor Statement 3.19.17.pdf HHSS 3/14/2017 3:00:00 PM
HB 174
HB 174 Sectional Analysis Version A.pdf HHSS 3/14/2017 3:00:00 PM
HB 174
HB174 Fiscal Note DHSS-PHAS 3.10.17.pdf HHSS 3/14/2017 3:00:00 PM
HB 174