Legislature(2007 - 2008)BUTROVICH 205
03/12/2008 05:00 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SCR14 | |
| SB300 | |
| SB245 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| = | SB 300 | ||
| += | SB 245 | TELECONFERENCED | |
| *+ | SCR 14 | TELECONFERENCED | |
SB 300-HEALTH CARE: PLAN/COMMISSION/FACILITIES
5:21:07 PM
CHAIR DAVIS announced the consideration of SB 300.
5:22:48 PM
SENATOR THOMAS joined the meeting.
DON BURRELL, Staff to Senator Davis, read the sponsor statement
into the record as follows:
The Alaska Health Care Strategies Council, established
by Governor Sarah Palin, met during the 2007
Legislative Interim to set long term goals for the
health care of Alaskans. During the Legislative
Interim these legislators, health care professionals,
and committed citizens of Alaska provided seven
clearly delineated goals for 'Making Alaskans the
healthiest people in the nation.'
Among the Council's top recommendations, Senate Bill
300, sponsored by the Senate Health, Education, &
Social Services committee, would establish the Alaska
Health Care Commission to develop policy
recommendations and oversee the newly formed Health
Care Information Office. The Alaska Health Care
Commission would also oversee the database and website
implementation regarding health care and healthy
living in Alaska.
The commission would be comprised of 15 members
including Alaska health care providers, a small
business owner, state officials and public members.
Chaired by the Medical Director of the Department of
Health & Social Services, the Alaska Health Care
Commission would meet regularly, establishing specific
goals designed to promote the health and well being of
the citizens of the State of Alaska.
SB 300 will also establish the Alaska Health Care
Information Office and related database Internet sites
to provide transparency to the Alaska Health care
industry for health care consumers. The information
provided by the Alaska Health Care Information Office
would be consistently updated as specified in the
bill.
These two functions of the bill will provide the
citizens of Alaska a great avenue for choosing health
care for themselves and their families. It is with
Alaskan citizens in mind that your consideration and
passage of this bill to the next committee of referral
is requested.
5:24:12 PM
CHAIR DAVIS said this bill had taken Sections 1 and 2 from SB
245, addressing only the commission and the database system. She
noted that this would be the first time it had been heard in
committee so she would like to hear any questions or concerns
from the committee; she intended to bring it back on the
following Friday under previous bills heard.
SENATOR ELTON said he'd like to discuss the effective dates.
Discussion on the previous bill indicated there were stress
points from effective dates just over the horizon; in this bill,
the effective date for Section 2 was July 1, 2013.
CHAIR DAVIS interjected that the 2013 date was actually the
sunset date of the commission. The effective date for
establishment of the commission was July of 2008.
SENATOR ELTON understood that, with regard to the information
office component, an aggressive effective date could be
problematic for the department.
SENATOR DAVIS said she could have the department speak to that.
She also recollected that in one version of the bill,
establishment of the database would be in 2009 and the effective
date [of the commission] in 2008.
5:27:30 PM
MR. BURRELL responded that those dates were still in the current
bill. On page 9, line 5, under Mandatory Reporting, the
effective date of mandated reporting was July 1, 2009. page 11,
line 26, Sec. 7 was the sunset date for the Alaska Health Care
Commission; line 28, Sec. 9 was the effective date for the
Alaska Health Care Commission.
5:28:02 PM
SENATOR ELTON queried how Section 2, the reference on page 11,
line 26, sunsetted anything.
MR. BURREL said the drafter, Jean Mischel, was on line and could
answer that.
CHAIR DAVIS said Jean Mischel should be able to walk them
through it; those were the requested dates.
SENATOR ELTON said that on page 11, lines 17-18 did say that
some of the statutory provisions were repealed, but line 26
seemed to indicate that Section 2 did not take effect until July
1, 2013.
CHAIR DAVIS said Jean Mischel would have to address that.
SENATOR COWDERY asked if Chair Davis intended to work on this
bill during the summer.
CHAIR DAVIS said no, she intended to pass it during this
legislative session.
5:30:14 PM
JEAN MISCHEL, Attorney at Law, Legislative Legal and Research
Services Division, Legislative Affairs Agency, replied that
Section 2 simply removed the reference to the commission at
sunset in 2013, causing existing law to revert to the way it was
before the Act. She agreed that it was confusing, but explained
that Section 1 added a cross reference to the Alaska Health
Commission to the duties of the department; Section 2 removed
that cross reference on the sunset date in 2013.
SENATOR ELTON said it would be helpful if someone from the
hospital association would chime in and tell the committee
whether this bill addressed the concerns they had expressed
earlier.
5:32:04 PM
ROD BETIT, CEO, Alaska State Hospital and Nursing Home
Association (ASHNH), said the association could support the
language in this version of the bill [CSSB 300 Version \O]. It
addressed the time lines, making it clear that July 1, 2008 was
the beginning of a long journey in terms of trying to understand
what health care information would be helpful to consumers, and
putting that into a user friendly web format. He admitted that
the July 1, 2009 date as a starting point to actually begin
loading information into the system was still very ambitious;
but information was already being provided to the department
that could be made available and added to as the site evolved.
CHAIR DAVIS opened the meeting to public testimony.
5:33:40 PM
MARIE DARLIN, Coordinator, AARP Capital City Task Force, said
the task force had submitted a letter of support for SB 300. She
said they would have preferred to have the three issues that
were addressed in the original bill separated into three
distinct bills; however since CON had been dropped, they were
able to support this version. With regard to establishment of
the commission, she questioned whether the Governor ought to be
making so many of the appointments. They were confident that the
information office would be very helpful in making the
marketplace more competitive by spotlighting information on the
cost and quality of services to the public.
5:35:57 PM
DON KUBLEY, Lobbyist, Mat-Su Regional Hospital, thanked the
committee for their time and effort in the area of health care
and expressed support for SB 300.
5:37:53 PM
DR. TODD CURZIE, Treasurer, Alaska Chiropractic Society, said
the Society had reviewed SB 245 and SB 300 and were generally
supportive of the idea of a health planning commission. They
were concerned about the composition of the committee; both
bills provided seats for 3 public members from the health care
community, one representing physicians. State statute designated
3 classes of primary physicians: Allopathic, Osteopathic and
Chiropractic. If all of the physicians appointed to the
committee were Allopathic, they were not confident that
chiropractic patients would be well represented. They proposed
the bill be amended to seat a chiropractic physician as a member
of the commission.
5:39:37 PM
KARLEEN JACKSON, Commissioner, Department of Health and Social
Services (DHSS), said they would like the Governor's Health Care
Transparency Act to pass; if that was not possible, they would
support this bill as a vehicle to help them with these two
components [Alaska Health Care Commission and Alaska Health Care
Information Office].
CHAIR DAVIS announced that she would like to propose an
amendment to SB 300 and had distributed copies to the committee.
5:40:50 PM
DON BURRELL, Staff to Senator Davis, said the amendment would
add the phrase "relating to a certificate of need study;" to the
title starting on page 1, line 2 of the bill. The title would
then read:
"An Act establishing the Alaska Health Care Commission
and the Alaska Health Care Information Office;
relating to health care planning and information;
relating to a certificate of need study: and providing
for an effective date."
This would require the commission to conduct a study of the CON
and come up with recommendations for regulatory and statutory
changes.
5:42:29 PM
SENATOR THOMAS pointed out that the new verbiage was actually
inserted as the second information in the title [after the
phrase "relating to health care planning and information;"]. He
also suggested that they discuss a timeframe for bringing the
results of that study to the legislature.
SENATOR ELTON said that as he read the title, it now had three
components: 1) establish the Health Care Commission and the
health care information office, 2) relating to health care
planning and information, and 3) providing for an effective
date. He assumed they wanted the Health Care Commission to do
the contracting, and wondered if the title change was in the
right spot.
5:44:08 PM
MS. MISCHEL, responded that Senator Thomas was correct. It was a
stand-alone phrase that appeared after "information;" and was a
generic reference to put people on notice that the Certificate
of Need study was also in the bill. The title change did not
reference who would conduct the study or modify the first phrase
in the title. page 1, lines 6-11 of the amendment inserted the
study into uncodified law for the end of the bill, just as the
House version had done; but it placed the authority to conduct
the study with the Health Care Commission itself. She agreed
that they could certainly add a time frame for that study.
5:45:37 PM
SENATOR ELTON noted that another part of amendment went to page
11 and wanted to verify that it was just renumbering to
accommodate the addition of an earlier Section.
CHAIR DAVIS said that it was.
5:46:13 PM
SENATOR THOMAS said he would be willing to add a timeframe if
someone could suggest what an appropriate time would be to
complete such a study.
5:46:36 PM
SENATOR DYSON joined the meeting.
CHAIR DAVIS explained that she had not included a time frame for
that very reason, because she was not sure how long it would
take. She chose to leave it open-ended and let the commission
make the determination.
SENATOR THOMAS said he could accept that, but conjectured that
it would be done more timely if a date was specified.
CHAIR DAVIS proposed they set a starting date rather than a date
for completion.
MS. MISCHEL said the effective date of the bill as drafted, July
1, 2008, would apply to this section.
5:48:16 PM
SENATOR THOMAS asked if Ms. Mischel meant the effective date of
the bill determined the starting date of the study.
MS. MISCHEL said yes. It established the Health Care Commission
and included the mandate that they contract for a study as of
July 1, 2008. What was not included was when the report would be
due to the legislature, or any end date other than the sunset
date for the commission itself.
5:49:48 PM
SENATOR ELTON surmised that this might change the fiscal note
dramatically.
COMMISSIONER JACKSON said it would change the fiscal note; it
also assumed that the commission would be up and running before
they could contract for the study.
CHAIR DAVIS wondered how they would determine the amount of the
new fiscal note.
COMMISSIONER JACKSON said she could provide that information to
the committee when they met next to consider the bill.
SENATOR ELTON said he understood that a negotiated regulation
process by a group of stakeholders had already begun studying
the CON. He asked Commissioner Jackson what she thought the best
process would be: continue the negotiated regulation process
involving the stakeholders, begin an independent study, or both.
COMMISSIONER JACKSON replied it would depend on what the study
was trying to accomplish. If the study was intended to determine
what should happen with the Certificate of Need program in
Alaska, the committee had heard volumes of testimony both pro
and con from many experts, and that would be part of the body of
knowledge already out there. The Certificate of Need Task Force
had met and come up with some definitions that would also be
part of that body of knowledge. She expected all of that would
be taken into consideration, but she would not presume that the
providers who came together for the negotiated rule-making task
force would necessarily have the time and energy to do all of
that work on their own; she presumed they would need a
contractor to put the existing knowledge together in a report
and recommendation.
5:53:09 PM
SENATOR THOMAS reflected that this could be discussed forever;
but maintained that if they got someone with no dog in the fight
to evaluate the existing information, (s)he should be able to
provide a recommendation rather quickly. He reiterated that he
did not see why it should take more than a year to bring that
report to the legislature; because legislature would not be in
session July 1, 2009 however, they would probably have to make
it an 18 month study to bring the due date to January 2010.
COMMISSIONER JACKSON responded that the sticking point was going
to be how quickly the commission could get up and running, and
that would depend in part on who was responsible for assigning
people to that commission. If the Governor was making the
appointments that would be one thing; if legislators were also
appointed from each body, the time line would have to
accommodate them. Once the commission was operational and the
contract in place, she agreed that it should not take very long.
SENATOR THOMAS speculated that 18 months would allow 4 to 5
months to get the commission going and a year to complete the
study, which should be plenty of time.
COMMISSIONER JACKSON agreed and said she hoped they could do it
quickly, but reiterated that a lot depended on getting that
commission up and running.
5:55:44 PM
CHAIR DAVIS did not want to add a timeline to the amendment.
SENATOR THOMAS asked if they had adopted the original bill.
CHAIR DAVIS said they had not.
SENATOR THOMAS moved to adopt SB 300, Version \A the as the
working document of the committee. There being no objection, the
motion carried.
SENATOR THOMAS then moved to adopt Amendment 1 to SB 300,
Version \A. There being no objection, the motion carried.
5:56:56 PM
SENATOR ELTON objected. He said that he was trying to find the
most polite way possible to voice his concern and hoped he had
been successful; in charging the Health Care Commission to do
this work, the Governor had made it very clear what she wanted
to happen with the CON. She had made it so clear that she was
not willing to negotiate a position in the middle. He pointed
out that this commission was a commission of 15, 11 of whom
would be appointed by the Governor. He would rather have the
program reviewed by the stakeholders, who were customers of the
state and the program, than by a commission, most of whom were
appointed by the Governor who had made very clear what she
thought the outcome should be. He said he was also uncomfortable
doing this without any idea what the cost would be.
CHAIR DAVIS said it was true that many of the members would be
appointed by the Governor, but the study would not be done by
the commission. She stressed that they had been discussing the
matter for years without coming to any conclusion; it had to be
done by another body. She was not sure how they could come up
with a cost however, and suggested they set an outside limit.
SENATOR ELTON said was not sure either, but reiterated that 11
out of 15 of these people would be appointed by Governor. He
remembered the expert witness hired by the department, the first
person to testify on the Governor's bill on her behalf, who he
felt did not have a good perspective and could not see any
shades of gray in a very important discussion. His concern was
that, because the Governor hadn't shown any flexibility on this,
that person could be the contractor if the Governor wanted and
she had 11 votes on the 15 member commission.
6:00:58 PM
SENATOR DYSON agreed the issue was convoluted and the lines were
firmly drawn in the sand; he hoped this study would get down to
the fundamental issues. Much of the problem was driven by the
actions of government, which had told many of the providers,
particularly the hospitals, that they must take everybody who
came in the door, knowing that a significant portion of the cost
of their care would not be recovered. That forced the providers
to shift costs; other patients and/or their insurers ended up
paying the cost for the indigent in kind of a shell game. He was
clear that he was not saying they should not offer services to
those people, but that this had put the health care providers in
an untenable position.
SENATOR DYSON continued that if the legislators as
representatives of the public, and the public decided to provide
some kind of health care to indigents, then that should be paid
for from the tax base and not forced on the care providers. He
noted that everyone he had heard supporting the existing or even
a modified CON process, agreed that they had to maintain it and
continue offering those services on which they could make a
profit in order to support the areas in which they were doing,
for want of a better term, charity work. He hoped this
commission and this study would point that out and rub their
noses in the fact that this was an unfunded mandate by
government and one that government should accept. He said that
he did not know this Governor's intention but sensed a cannon
shot across their bow. That's why he thought having the
commission deal with it would be a good thing; but he
appreciated Senator Elton's concern about the Governor
"stacking" it. He was worried about the composition being too
heavy with care providers whose fiscal life was on the line as
well. He thought that perhaps they should require the
commission to submit recommendations and let this committee
decide who would conduct the study, or let Legislative Council
choose.
In summary he said he appreciated Senator Elton's dedication to
getting this dealt with in a fair and straight way with all the
cards up on the table. Almost everybody that testified had a
pretty big, rabid dog in the fight, and it was all spun
information, with all due respect.
6:05:36 PM
CHAIR DAVIS added that both Senators Elton and Dyson had made
her think about more than just passing her amendment at this
time. She would like to know the approximate cost to do that.
She also liked the idea of having the commission bring back
recommendations for legislative approval of who whould conduct
the study. So rather than voting on the amendment as offered,
she proposed writing up another to replace it and withdrawing
the motion on the floor.
6:06:35 PM
CHAIR DAVIS withdrew Amendment 1, \A.1
SENATOR DYSON said he would like to see this whole process
finished by the time they reconvened in January. He pointed out
that the packets distributed by Mr. Burrell contained some
communications that raised significant questions, and asked if
those had been discussed.
CHAIR DAVIS replied that they had not.
SENATOR DYSON said some of them seemed to contain important
detail, so he would like to review those and get some answers.
SENATOR THOMAS asked if everyone was looking at the same fiscal
note, the contractual aspect of the fiscal note in the period of
2009-2013. He pointed out that was in the range of $250,000 for
each of those 5 years for contractual work alone. The total was
$750,000 in the first year and $660,000 in each of the other 4
years; so it was over $3 million during the 5 year period. He
thought that should be enough.
CHAIR DAVIS reiterated that she was going to come back with
another amendment on Friday. She asked if there were other
concerns or issues regarding SB 300 to be addressed at this
time. She held SB 300 in committee.
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