Legislature(2019 - 2020)BARNES 124

02/21/2020 03:15 PM House LABOR & COMMERCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
<Bill Hearing Canceled>
Heard & Held
-- Testimony <Invitation Only> --
Heard & Held
-- Testimony <Invitation Only> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
        HB 229-HEALTH INFORMATION/DATABASE/PUBLIC CORP.                                                                     
4:21:05 PM                                                                                                                    
CHAIR SPOHNHOLZ announced that the  final order of business would                                                               
be HOUSE  BILL NO.  229, "An Act  establishing the  Alaska Health                                                               
Care Transformation Corporation; relating  to an all-payer claims                                                               
database; and providing for an effective date."                                                                                 
4:21:54 PM                                                                                                                    
SANDRA   HEFFERN,   Project    Coordinator,   Alaska   Healthcare                                                               
Transformation Project, began by  discussing the numerous efforts                                                               
to  address  Alaska's  health  care  system  by  the  last  three                                                               
administrations.   She  noted  the  Alaska Healthcare  Commission                                                               
under  the Palin  administration that  studied issues  related to                                                               
health   care  in   Alaska  and   reported  recommendations   and                                                               
activities to  the legislature.   The commission was  defunded in                                                               
2015 and  is no longer  active.  Additionally, under  the Parnell                                                               
administration there  was a Medicaid  taskforce in 2010,  as well                                                               
as a  Medicaid reform  advisory group  in 2014.   The  purpose of                                                               
those groups was  to look at the stability  and predictability in                                                               
budgeting,  increase the  ease and  efficiency of  navigating the                                                               
system by  providers, and provide  whole care for the  patient by                                                               
uniting  physical  and behavioral  health  treatment.   She  also                                                               
mentioned  SB  74, the  omnibus  Medicaid  reform bill  that  was                                                               
signed into  law in 2016  during the Walker administration.   She                                                               
said  that while  there have  been incremental  improvements, the                                                               
Anchorage  Economic &  Development Corporation  found that  since                                                               
2010 the rising cost of employee  health has been reported as the                                                               
number two issue in hindering  business growth.  Furthermore, the                                                               
cost of health  care in Alaska continues to be  close to the most                                                               
expensive in the U.S.  She  reported that the per capita spending                                                               
on health care is higher  than other high-income countries, which                                                               
could lead  one to believe  that Alaska  has some of  the highest                                                               
health care costs in the world.                                                                                                 
MS. HEFFERN  directed attention  to her  PowerPoint presentation,                                                               
entitled  "Alaska   Healthcare  Transformation  Project."     She                                                               
informed the committee that  the Alaska Healthcare Transformation                                                               
project  is a  cross sector  collaboration of  payers, providers,                                                               
policymakers,   and  patient   advocates   working  together   to                                                               
transform Alaska's  health care  system (slide  2).   The project                                                               
management   committee   consists    of   7   people,   including                                                               
Representative Spohnholz and Senator  von Imhof.  The committee's                                                               
role is  to provide overall  direction, guidance, and  support to                                                               
the project, and  to monitor it to ensure  successful delivery of                                                               
expected outputs and outcomes within  the scope and budget (slide                                                               
4:27:20 PM                                                                                                                    
REPRESENTATIVE FIELDS  asked how  many of the  project management                                                               
committee members'  employers have  endorsed the  current version                                                               
of HB 229.                                                                                                                      
MS. HEFFERN  replied that both  the Mat-Su Health  Foundation and                                                               
the Alaska Primary Care Association support HB 229.                                                                             
4:28:31 PM                                                                                                                    
REPRESENTATIVE STUTES asked if HB 229  is meant to be a precursor                                                               
to health care reform.                                                                                                          
MS.  HEFFERN said  to effectuate  change  within Alaska's  health                                                               
care system with  a small population, it will  require looking at                                                               
the entire health  care system rather then just  one siloed area,                                                               
like Medicaid.                                                                                                                  
REPRESENTATIVE  STUTES  questioned  whether the  intent  of  this                                                               
project  is  to  reform  the  health care  system  to  work  more                                                               
MS. HEFFERN  answered yes,  the focus  is to  look at  the entire                                                               
health care system instead of focusing only on one area.                                                                        
CHAIR   SPOHNHOLZ   clarified    that   the   Alaska   Healthcare                                                               
Transformation  Project's  effort  is  to  transform  the  entire                                                               
health  care  system;  however,  the  all-payer  claims  database                                                               
(APCD) will  not necessarily do  that work.  She  reiterated that                                                               
they are discussing two separate topics.                                                                                        
4:31:16 PM                                                                                                                    
MS. HEFFERN resumed  her presentation.  She  related the projects                                                               
vision,  which   is  to  improve  Alaskan's   health  while  also                                                               
enhancing patient  and health  professional's experience  of care                                                               
and lowering  the per capita  health care growth rate  (slide 4).                                                               
The  project's  guiding  principles  are to  focus  on  improving                                                               
individual and  population health, consider health  coverage with                                                               
common  basic  benefits  for  all,  focus  on  whole  person  and                                                               
integrated  systems of  care, use  evidence-based practices,  and                                                               
recognize the effect of social  determinants of health (slide 5).                                                               
She went  on to  paraphrase slide 6,  the project's  goals, which                                                               
read as follows [original punctuation provided]:                                                                                
     Healthy Alaskans:                                                                                                        
       ? The percentage of Alaskan residents with a usual                                                                       
       source of primary care will increase by 15% within                                                                       
     five years                                                                                                                 
     Healthy Economy:                                                                                                         
     ? Reduce overall per capita healthcare growth rate to                                                                      
     the greater of 2.25% or CPI within five years                                                                              
     Everybody's Business:                                                                                                    
     ? Align all payers, public and private, towards value-                                                                     
       based alternative payment models with streamlined                                                                        
     administrative requirements within five years                                                                              
MS. HEFFERN  directed attention to  a graph on slide  7, entitled                                                               
"Alaska  Healthcare Per  Capita Growth  Rate."   She stated  that                                                               
from  1991 to  2014  the health  care cost  growth  rate was  7.8                                                               
percent in Alaska  compared to 6 percent in  the U.S., indicating                                                               
that  medical prices  in Alaska  are growing  faster than  in the                                                               
rest  of  the  country.   The  Alaska  Healthcare  Transformation                                                               
Project  narrowed its  focus to  five strategy  areas: increasing                                                               
primary  care utilization,  coordinating  patient care,  changing                                                               
the  way health  care  is  paid for  in  Alaska, increasing  data                                                               
analytics capacity, and addressing  social determinants of health                                                               
(slide  8).   The project  gathered a  strategy development  team                                                               
that decided to assemble the previous  work that had been done in                                                               
Alaska.   Slide 6 highlights  the research compiled by  the NORC,                                                               
which  read  in its  entirety  as  follows [original  punctuation                                                               
        Meta-Analysis.  Identify  and   assess  a  group  of                                                                  
     Alaska-focused  reports  and  studies issued  over  the                                                                    
     past  decade  (2008  to  the  present)  that  focus  on                                                                    
     delivery  system reform  related to  the triple  aim of                                                                    
     improved   health,  improved   quality   of  care   and                                                                    
     experience with care delivery (for  patients as well as                                                                    
     the  health care  workforce),  and  reduced per  capita                                                                    
       Alaska  Historical Project Scan. Identify  and assess                                                                  
     selected delivery  system reform experiments  in Alaska                                                                    
     over  the  past  decade  (2008 to  the  present),  with                                                                    
     priority to  characterizing regional  innovation within                                                                    
     the state.                                                                                                                 
        National Scan.  Develop  case  studies for  selected                                                                  
     states  where   delivery  system  reform   relevant  to                                                                    
     Alaska's  five key  topics of  interest offers  lessons                                                                    
     for prospective innovation.                                                                                                
        Drivers  of  the  Health Care  Costs  and  Spend  in                                                                  
     Alaska. Review  health care spending  in the  state and                                                                  
     the  prospects   and  limitations  of   available  data                                                                    
     sources that  would support a fine-grained  analysis of                                                                    
     cost drivers  relevant to these reforms.  Based on this                                                                    
     review,  prepare  a  set   of  estimates  of  potential                                                                    
     reform-related  savings   and  a  draft   roadmap  with                                                                    
     proposed  short-term (within  one  year) and  long-term                                                                    
     steps that comprise one or more pathways to reform.                                                                        
MS.   HEFFERN   reported   that    they   narrowed   eight   NORC                                                               
recommendations down  to three areas:  set multi-payer  goals for                                                               
value-based  payment  using  the  Health  Care  Payment  Learning                                                               
Action Network  framework; develop  the details,  parameters, and                                                               
build consensus  around the collection  of cost and  quality data                                                               
and ensuring sufficient analytic  capacity to effectively analyze                                                               
and   use   the   data;   and   determine   the   structure   and                                                               
responsibilities  of  leadership  governance (slide  10).    From                                                               
those  recommendations, she  said,  they decided  to consider  an                                                               
all-payer  claims database  (APCD).   The  recommendation was  to                                                               
develop  a corporation  that was  connected  to state  government                                                               
while remaining dependent  of state government.   She stated that                                                               
the result is HB  229.  In closing, she said  Alaska is not alone                                                               
in its efforts to collect,  analyze, and report health care data.                                                               
Nationally, people  are trying  to get  a handle  on the  cost of                                                               
health care  and an  APCD is  one of the  ways to  do that.   She                                                               
added  that President  Trump issued  an executive  order in  June                                                               
2019, with the focus on  improving price and quality transparency                                                               
in American health care.                                                                                                        
4:43:14 PM                                                                                                                    
MS. HEFFERN said, in closing, there  are states in the process of                                                               
transforming  or reforming  their  health care  system that  have                                                               
utilized their  health care cost  data to set a  statewide growth                                                               
rate, which can't be done without  data.  She reiterated that the                                                               
recommendation for  establishing an APCD would  require a trusted                                                               
entity so  all parts  of the health  care industry  would support                                                               
the information and the story that the data is telling.                                                                         
4:44:28 PM                                                                                                                    
REPRESENTATIVE HANNAN  asked where  Mark Foster derived  the data                                                               
for his study, which found that  Alaska has spent $8.5 billion on                                                               
health care.                                                                                                                    
MS. HEFFERN  said she can  provide a  copy of that  report, which                                                               
cites all  his references.   She added  that it  further supports                                                               
the need for an APCD.                                                                                                           
4:45:54 PM                                                                                                                    
REPRESENTATIVE   FIELDS  questioned   whether  the   project  has                                                               
performed an  analysis to  find the  percentage of  rising health                                                               
care  cost that  is related  to  Alaska's aging  population.   He                                                               
offered  his  understanding  that  it's the  most  rapidly  aging                                                               
population on a per capita basis in the country.                                                                                
MS. HEFFERN  replied they  couldn't get to  that level  of detail                                                               
because they couldn't get their hands on the data.                                                                              
REPRESENTATIVE  FIELDS   questioned  whether  it's   possible  to                                                               
establish an all or most-payer  claims database with or without a                                                               
MS. HEFFERN opined  that an APCD could be  established in several                                                               
different ways.   Other states have done it through  an office of                                                               
financial   management,   division   of   insurance,   healthcare                                                               
authority, and a nonprofit organization.   The issue is finding a                                                               
trusted entity that  everyone in the state will  trust to produce                                                               
accurate and fair data that won't be used against them.                                                                         
REPRESENTATIVE  FIELDS asked  how  many states  have a  something                                                               
like  the  project's  proposed corporation  that  has  regulatory                                                               
4:48:27 PM                                                                                                                    
NORM  THURSTON,  Executive   Director,  National  Association  of                                                               
Health Data Organizations, addressed  questions from the previous                                                               
bill  hearing.   First,  he said  of the  10  smallest states  by                                                               
population, four  of them  have all-payer  claims databases.   He                                                               
noted that this  has traditionally been a movement  coming out of                                                               
the smaller states  and into the larger states.   Second, he said                                                               
states that have a good  relationship with the business community                                                               
tend to  do very well, some  getting upwards of 30-40  percent of                                                               
businesses  to  participate  voluntarily.     He  said  it's  not                                                               
unreasonable to  think that a  state like Alaska could  easily be                                                               
at 60  percent of  its population with  the possibility  of going                                                               
much higher.                                                                                                                    
4:50:53 PM                                                                                                                    
REPRESENTATIVE  STUTES asked  of the  states that  participate in                                                               
all-payer  plans, how  many have  shown  quantifiable savings  in                                                               
their medical expenses.                                                                                                         
MR. THURSTON stated  it's a difficult question  to answer because                                                               
data is collected,  analyzed, and released, followed  by the cost                                                               
- not decreasing - but  increasing less rapidly, which is bending                                                               
the  cost curve  down.   He  approximated that  one-third of  the                                                               
participating states  have had  a major  strategic effort  to use                                                               
the data to bend the cost curve with varying degrees of success.                                                                
4:52:23 PM                                                                                                                    
REPRESENTATIVE  FIELDS  inquired  as  to  how  many  states  have                                                               
corporations with  regulatory power  that manage  their all-payer                                                               
claims databases.                                                                                                               
MR. THURSTON said  he does not know.  He  noted that Colorado has                                                               
an independent  regulatory agency  that has  the ability  to make                                                               
rules of  its governance.   Mr.  Thurston informed  the committee                                                               
that he  is a legislator in  Utah, adding that most  of the APCDs                                                               
can  regulate  within their  sphere  to  set standards  for  data                                                               
submission and enforce compliance.                                                                                              
REPRESENTATIVE  FIELDS asked  how many  of the  20 states  manage                                                               
their APCDs through some entity  within state government versus a                                                               
standalone corporation.                                                                                                         
MR. THURSTON  approximated that  half of them  are embedded  in a                                                               
state agency, while the other half do something else.                                                                           
REPRESENTATIVE FIELDS asked  how much it costs  those states with                                                               
a standalone corporation.                                                                                                       
MR. THURSTON recounted from his  experience in Utah that the core                                                               
operations of a  database costs roughly $600,000.   He added that                                                               
the database  costs the  same regardless of  the population.   He                                                               
said it would be consistent as a fixed cost of operations.                                                                      
4:56:36 PM                                                                                                                    
REPRESENTATIVE HANNAN inquired  as to the first state  to have an                                                               
MR.  THURSTON offered  his belief  that  Maine and  Massachusetts                                                               
were the pioneers.                                                                                                              
REPRESENTATIVE  HANNAN questioned  whether  APCDs have  addressed                                                               
policy  issues  related  to people  leaving  a  jurisdiction  for                                                               
medical cost reasons.                                                                                                           
MR. THURSTON  said he is  not aware of  any state where  that has                                                               
been a policy priority.                                                                                                         
4:59:03 PM                                                                                                                    
REPRESENTATIVE FIELDS asked of the  20 states with an APCD, which                                                               
is  most similar  to Alaska  in the  sense that  there are  a low                                                               
percentage of  people with private  health insurance plans  and a                                                               
high percentage  of residents on  IHS health care,  tri-care, and                                                               
MR. THURSTON answered New Mexico.                                                                                               
5:00:52 PM                                                                                                                    
REPRESENTATIVE STORY asked what the  framework is for creating an                                                               
APCD within a state department.                                                                                                 
MR. THURSTON explained that the Utah  APCD is a bureau within the                                                               
Utah Department of  Health.  He said it's a  sister agency to the                                                               
Medicaid  agency  and is  set  up  with  a bureau  director  that                                                               
reports  to a  division director.   He  said Utah's  APCD is  the                                                               
quintessential   example  of   an   APCD   embedded  within   the                                                               
government.    He added  that  most  of the  work  is  done by  a                                                               
contracted  vendor, leaving  the [Utah]  Department of  Health to                                                               
focus mainly on project management.                                                                                             
REPRESENTATIVE STORY asked how much that costs.                                                                                 
MR. THURSTON  said the contracted  cost for an outside  vendor is                                                               
roughly  $400,000  per year.    Furthermore,  there's the  agency                                                               
staff to manage the contract and analyze the data.                                                                              
5:02:50 PM                                                                                                                    
CHAIR SPOHNHOLZ  asked if  there are other  states that  have put                                                               
their APCD within another agency  like, for example, the Division                                                               
of Insurance.                                                                                                                   
MR. THURSTON  said in Arkansas  they developed everything  in the                                                               
Arkansas  Center for  Health Improvement,  which is  part of  the                                                               
state  government.    He  noted  that  Arkansas  doesn't  do  any                                                               
contract outsourcing at all.                                                                                                    
CHAIR  SPOHNHOLZ asked  for the  advantages and  disadvantages of                                                               
both routes.                                                                                                                    
MR. THURSTON  explained that  the advantage  of using  an outside                                                               
vendor  is that  the technology  already exists,  which makes  it                                                               
easier to  set up.   He  added that the  analytics tools  that an                                                               
outside vendor  offers will  be much more  powerful than  a state                                                               
could develop on  its own.  The disadvantages of  working with an                                                               
outside vendor is the lack of stability.                                                                                        
REPRESENTATIVE FIELDS asked if there  is a consistent time lag in                                                               
the data.                                                                                                                       
MR. THURSTON stated that most  states now have monthly submission                                                               
processes,  so claims  that were  processed in  January would  be                                                               
submitted to  the APCD  by February 15th.   Subsequently,  by the                                                               
end  of March,  the January  payments  should be  available in  a                                                               
preliminary format.  He  noted that the lag is not  as big on the                                                               
data  collection  and processing  site  as  it  is on  the  claim                                                               
payment  site.   Most states  allow  claims to  be submitted  for                                                               
payment up  to one or  two years after  service is rendered.   He                                                               
added that  any service  provided in October  would be  ready for                                                               
examination in six months.                                                                                                      
5:07:35 PM                                                                                                                    
JOHN  CULLEN,  MD,  Valdez Medical  Clinic,  LLC;  Board  Member,                                                               
Alaska  Academy of  Family Physicians,  stated that  the American                                                               
Academy  of  Family Physicians  is  in  favor  of  an APCD.    He                                                               
reported that he  has seen it work in practice,  adding that it's                                                               
a necessary  step towards  health transformation.   He  said that                                                               
family physicians have a strong  interest in reducing the cost of                                                               
health care for their patients.   He noted that other states have                                                               
had success with  mandatory primary care investment.   He offered                                                               
his belief  that creating an  APCD is  a necessary first  step in                                                               
figuring out why the cost of health care is so high.                                                                            
5:11:29 PM                                                                                                                    
REPRESENTATIVE  FIELDS surmised  that much  of the  high cost  of                                                               
health care in America is  related to federal policies that allow                                                               
"big pharma"  to consistently rip  people off and  private health                                                               
insurers  that  have  higher  administrative  costs  compared  to                                                               
Medicaid, for  example.  He  questioned what is within  the state                                                               
government's control  versus what is  outside its control  at the                                                               
federal level.   He  asked where  the relative  opportunities for                                                               
achievable cost saving rests.                                                                                                   
DR. CULLEN  opined that  the reason America's  health care  is so                                                               
expensive is  due to pharmaceutical costs,  administration costs,                                                               
and  high-volume/high-cost procedures,  like MRIs  and CT  scans.                                                               
He said  from a  primary care perspective,  having and  APCD that                                                               
could  provide  information  on which  of  those  procedures  are                                                               
excessively  expensive could  help them  better choose  the right                                                               
providers for their  patients.  He added  that the administrative                                                               
and pharmaceutical costs are controlled at the federal level.                                                                   
REPRESENTATIVE  FIELDS  expressed  interest in  state  innovation                                                               
regarding high drug prices in the context of this conversation.                                                                 
CHAIR SPOHNHOLZ noted that Alaska's  health care costs have grown                                                               
significantly more  than the rest  of the  country.  She  said it                                                               
would be difficult  to argue that those are  completely driven by                                                               
the  federal government.   She  pointed out  that Alaska  adopted                                                               
several rules that were designed  to incentivize increased access                                                               
to  specialty  care by  allowing  specialists  to increase  their                                                               
rates,  which has  increased access  to  Alaska for  specialists,                                                               
like  cardiologists and  pulmonologists, while  also growing  the                                                               
cost of health care in the state.                                                                                               
5:15:35 PM                                                                                                                    
LAURA   YOUNG,   Executive   Director,   HealtheConnect   Alaska,                                                               
explained that HealtheConnect is  the health information exchange                                                               
for the  state of  Alaska that was  set up under  SB 133  and has                                                               
been  in  operation since  2013.    The organization  is  public,                                                               
nonprofit,  and  independent  and  has a  similar  structure  and                                                               
governance as  the "health care transformation  corporation" that                                                               
is being  proposed.  HealtheConnect  collects and  exchanges real                                                               
time  clinical data  versus claims  data.   She  said it's  their                                                               
believe both efforts should be  complementary.  She further noted                                                               
that  they've  set  standards  for  how  data  is  collected  and                                                               
exchanged and established privacy  and security requirements.  To                                                               
conclude, she  offered her belief that  "the independent, neutral                                                               
organization of  such an  effort is  really critical  rather than                                                               
aligning it  to any one entity  or agency is crucial  for keeping                                                               
the data neutral."                                                                                                              
5:18:19 PM                                                                                                                    
[HB 229 was held over.]                                                                                                         

Document Name Date/Time Subjects
HB 229 Bill Text Version M.pdf HHSS 2/20/2020 3:00:00 PM
HL&C 2/21/2020 3:15:00 PM
HB 229
HB 229 Sectional Analysis v.M.pdf HHSS 2/20/2020 3:00:00 PM
HL&C 2/21/2020 3:15:00 PM
HB 229
HB 229 Sponsor Statement v.M.pdf HHSS 2/20/2020 3:00:00 PM
HL&C 2/21/2020 3:15:00 PM
HB 229
HB 229 and supporting documents.pdf HL&C 2/20/2020 3:00:00 PM
HL&C 2/21/2020 3:15:00 PM
HB 229
HB 229 Testimony Dr. Cullen CV.pdf HL&C 2/21/2020 3:15:00 PM
HB 229
HB229 Testimony Dr. Cullens.pdf HL&C 2/21/2020 3:15:00 PM
HB 229
HB 113 v. S Amendment #1 HL&C 2.21.2020.pdf HL&C 2/21/2020 3:15:00 PM
HB 113
HB 113 v. S Amendment #2 HL&C 2.21.2020.pdf HL&C 2/21/2020 3:15:00 PM
HB 113
HB 113 Powerpoint The Blue Star and Gold Star Families Act 1.31.20.pdf HL&C 2/19/2020 3:15:00 PM
HL&C 2/21/2020 3:15:00 PM
HB 113
HB113 Backup Document NCSL veterans' state hiring preference 1.31.20.pdf HL&C 2/19/2020 3:15:00 PM
HL&C 2/21/2020 3:15:00 PM
HB 113
HB 235 Fiscal Note DOLWFD-AVTEC 2.14.2020.pdf HL&C 2/21/2020 3:15:00 PM
HB 235
HB 235 Fiscal Note DOLWFD-CAS 2.15.2020.pdf HL&C 2/21/2020 3:15:00 PM
HB 235
HB 235 Fiscal Note DOLWFD-WD 2.14.2020.pdf HL&C 2/21/2020 3:15:00 PM
HB 235
HB 235 Fiscal Note DOLWFD-UI 2.14.2020.pdf HL&C 2/21/2020 3:15:00 PM
HB 235
HB 235 Fiscal Note EED-SSA 2.14.2020.pdf HL&C 2/21/2020 3:15:00 PM
HB 235
HB 235 Fiscal Note UA-SYSBRA 2.18.2020.pdf HL&C 2/21/2020 3:15:00 PM
HB 235
HB 235 Sponsor Statement 2.21.2020.pdf HL&C 2/21/2020 3:15:00 PM
HL&C 3/9/2020 3:15:00 PM
HB 235
HB 235.Backup Flow Chart 2.21.2020.pdf HL&C 2/21/2020 3:15:00 PM
HL&C 3/9/2020 3:15:00 PM
HB 235
HB 235.Backup UA TVEP Advocacy 2.21.2020.pdf HL&C 2/21/2020 3:15:00 PM
HB 235
HB 235 Backup Distribution Sheet 2.5.2020.pdf HL&C 2/21/2020 3:15:00 PM
HB 235
HB 235 TVEP Annual Report 2019.pdf HL&C 2/21/2020 3:15:00 PM
HB 235
HB 235 Backup Intro Presentation 2.21.2020.pdf HL&C 2/21/2020 3:15:00 PM
HB 235
AHCTP House L and C 2.21.20.pdf HL&C 2/21/2020 3:15:00 PM
HB 229
HB 235 UA TVEP Background Information.pdf HL&C 2/21/2020 3:15:00 PM
HB 235
HB 235 TVEP Univ. of Alaska Presentation 02.20.20.pdf HL&C 2/21/2020 3:15:00 PM
HB 235