Legislature(2021 - 2022)ADAMS 519

03/15/2022 09:00 AM House FINANCE

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Heard & Held
-- Public Testimony --
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
                  HOUSE FINANCE COMMITTEE                                                                                       
                      March 15, 2022                                                                                            
                         9:01 a.m.                                                                                              
9:01:44 AM                                                                                                                    
CALL TO ORDER                                                                                                                 
Co-Chair Merrick called the  House Finance Committee meeting                                                                    
to order at 9:01 a.m.                                                                                                           
MEMBERS PRESENT                                                                                                               
Representative Kelly Merrick, Co-Chair                                                                                          
Representative Dan Ortiz, Vice-Chair                                                                                            
Representative Ben Carpenter                                                                                                    
Representative Bryce Edgmon                                                                                                     
Representative DeLena Johnson                                                                                                   
Representative Andy Josephson                                                                                                   
Representative Bart LeBon                                                                                                       
Representative Sara Rasmussen                                                                                                   
Representative Steve Thompson                                                                                                   
Representative Adam Wool                                                                                                        
MEMBERS ABSENT                                                                                                                
Representative Neal Foster, Co-Chair                                                                                            
ALSO PRESENT                                                                                                                  
Representative   Andi    Story,   Sponsor;    Kris   Curtis,                                                                    
Legislative Auditor,  Alaska Division of  Legislative Audit;                                                                    
Fate Putman, Staff, Representative Louise Stutes.                                                                               
PRESENT VIA TELECONFERENCE                                                                                                    
Barry    Christensen,    Pharmacist,    Alaska    Pharmacist                                                                    
Association,  Ketchikan; Dr.  James Delker,  Self, Soldotna;                                                                    
Renee  Robinson,   Self,  Licensed   Pharmacist,  Anchorage;                                                                    
Ronald   Wagoner,  Pharmacist   Intern,  Anchorage;   Justin                                                                    
Ruffridge,  Chair,  Board   of  Pharmacy,  Soldotna;  Pamela                                                                    
Kelley, Executive Director,  Alzheimer's Resource of Alaska,                                                                    
Anchorage; Nona  Safra, Member, Alaska Commission  on Aging,                                                                    
Homer;  Karol  Fink,  Section   Chief,  Division  of  Public                                                                    
Health, Department of Health and Social Services.                                                                               
HB 306    EXTEND BOARD OF PHARMACY                                                                                              
          HB 306 was HEARD and HELD in committee for                                                                            
          further consideration.                                                                                                
HB 308    DEMENTIA AWARENESS                                                                                                    
          HB 308 was HEARD and HELD in committee for                                                                            
          further consideration.                                                                                                
Co-Chair Merrick reviewed the meeting agenda.                                                                                   
HOUSE BILL NO. 306                                                                                                            
     "An Act extending the termination date of the Board of                                                                     
     Pharmacy; and providing for an effective date."                                                                            
9:02:25 AM                                                                                                                    
Co-Chair Merrick relayed  that the bill had  last been heard                                                                    
on March  11 where extensive  discussion had taken  place on                                                                    
the Prescription  Drug Monitoring  Program (PDMP).  The bill                                                                    
pertained to how long to  extend the Board of Pharmacy whose                                                                    
primary job  was the regulation of  pharmacists. She invited                                                                    
the bill sponsor to make opening comments.                                                                                      
REPRESENTATIVE   ANDI  STORY,   SPONSOR,  provided   opening                                                                    
remarks  and  thanked the  committee  for  hearing the  bill                                                                    
again so quickly. She reminded  the committee that the Board                                                                    
of  Pharmacy regulated  the admission  into the  practice of                                                                    
pharmacy;  licensed   pharmacists,  pharmacy   interns,  and                                                                    
pharmacy  technicians; established  and enforced  competency                                                                    
by  ensuring  compliance  with professional  standards;  and                                                                    
adopted  regulations amongst  other duties.  She highlighted                                                                    
the importance  of regulating the practice  for the public's                                                                    
health, safety, and welfare.                                                                                                    
Representative Story appreciated  the committee's discussion                                                                    
in the previous  hearing on the bill. She  remarked that the                                                                    
opioid epidemic  and substance abuse disorders  had impacted                                                                    
many Alaskan  families greatly. She  stated it  was critical                                                                    
for the state to continue to  address the issue. As noted in                                                                    
the  audit, the  Board of  Pharmacy was  just one  regulated                                                                    
profession  with   responsibility  to   the  PDMP   and  the                                                                    
controlled  substance  prescription  database.  The  Medical                                                                    
Board, Board  of Nursing, Board  of Dental  Examiners, Board                                                                    
of  Examiners and  Optometry, and  the  Board of  Veterinary                                                                    
Examiners  also  had  responsibility   to  ensure  the  safe                                                                    
prescribing and  distribution of controlled  substances. The                                                                    
Department of  Commerce, Community and  Economic Development                                                                    
(DCCED)    also     had    compliance     and    enforcement                                                                    
responsibilities. There  may also  be a need  for additional                                                                    
investment in the department and  the divisions that support                                                                    
the PDMP and the regulatory boards.                                                                                             
Representative Story shared that  she had some conversations                                                                    
on  the best  venue  and  process to  keep  focus and  drive                                                                    
improvements related to the PDMP  and had confirmed that the                                                                    
[House]  Labor and  Commerce Committee  would  be holding  a                                                                    
hearing on  the program.  She referenced  a couple  of ideas                                                                    
that  had  been suggested  including  a  consultant to  help                                                                    
shepherd  a  taskforce,  a  workgroup on  the  PDMP,  and  a                                                                    
special  audit.  She  reminded committee  members  that  the                                                                    
focus of an audit was  on compliance with existing laws, not                                                                    
necessarily  changes.  She hoped  they  could  all agree  on                                                                    
extending the board for a reasonable time.                                                                                      
Co-Chair Merrick OPENED public testimony.                                                                                       
BARRY    CHRISTENSEN,    PHARMACIST,    ALASKA    PHARMACIST                                                                    
ASSOCIATION,   KETCHIKAN   (via   teleconference),   thanked                                                                    
Representative  Story  for  introducing the  legislation  to                                                                    
extend  the   board.  He  provided  information   about  his                                                                    
personal  history and  work with  the association  that went                                                                    
back to  2008. He  shared that  in 2008  he had  worked with                                                                    
former  Senator  Lyda  Green to  put  the  PDMP  legislation                                                                    
forward aiming to limit prescription  abuse and diversion of                                                                    
controlled substances. He believed  it had done an excellent                                                                    
job  in  helping to  do  so,  but it  was  only  a tool.  He                                                                    
remarked  that if  he had  been  a layman  listening to  the                                                                    
previous hearing on HB 306,  he would have perhaps concluded                                                                    
the PDMP  was broken; however,  he did not believe  that was                                                                    
the  case.  He detailed  that  he  and  his staff  used  the                                                                    
database daily  and he  thought it worked  well for  what it                                                                    
was  intended  to do.  He  remarked  there were  areas  that                                                                    
needed to be tweaked, but  he did not believe shortening the                                                                    
sunset date would necessarily fix the issues.                                                                                   
Mr.  Christensen   believed  the  key  was   for  the  other                                                                    
prescribing  boards (mentioned  by Representative  Story) to                                                                    
work with the Board of  Pharmacy on putting some corrections                                                                    
in  place to  ensure  the  PDMP program  worked  as well  as                                                                    
possible. He remarked there had  been very effective leaders                                                                    
and  members on  the Board  of Pharmacy  during his  career,                                                                    
including  the current  chair Dr.  Ruffridge. He  encouraged                                                                    
the committee to pass the bill.                                                                                                 
9:08:11 AM                                                                                                                    
Vice-Chair Ortiz thanked Mr.  Christensen for his testimony.                                                                    
He addressed  a question  about whether the  board extension                                                                    
should be six  years or a different number.  He surmised the                                                                    
question was not  directly related to issues  related to the                                                                    
PDMP.  He  stated  his  understanding   that  the  Board  of                                                                    
Pharmacy and  a number of  other boards and agencies  were a                                                                    
part of  the PDMP  program. He  asked for  verification that                                                                    
the  effectiveness of  the PDMP  should not  necessarily tie                                                                    
into the Board of Pharmacy extension time.                                                                                      
Mr. Christensen agreed. He stated  the Board of Pharmacy did                                                                    
many things outside of administering  the PDMP. He explained                                                                    
that pharmacies could not exist  without the board providing                                                                    
the   necessary  licensing   and  oversight.   For  example,                                                                    
pharmacies could not credential  with insurance companies to                                                                    
do business without  a valid pharmacy license  for the State                                                                    
of  Alaska. He  characterized  the functioning  of the  PDMP                                                                    
monitoring  program  as  "a totally  different  animal."  He                                                                    
believed  the   Board  of  Pharmacy  had   been  effectively                                                                    
administering the  PDMP since 2008.  He thought the  key was                                                                    
communication between  the Board  of Pharmacy and  the other                                                                    
prescribing healthcare  boards. He thought it  could be done                                                                    
in a manner that did not impact the board's sunset date.                                                                        
Representative  Carpenter   asked  about   the  relationship                                                                    
between the other boards and  the Board of Pharmacy and what                                                                    
may be standing in the way of better communication.                                                                             
Mr. Christensen deferred the question  to Dr. Ruffridge, the                                                                    
chair  of the  board. He  gave an  example of  a frustrating                                                                    
experience  when  the  pharmacy  identified  a  patient  had                                                                    
received  a prescription  from  multiple  providers and  the                                                                    
pharmacy called a provider to ask  if they were aware of the                                                                    
situation.  He  relayed  that  sometimes  the  provider  was                                                                    
unaware,  which meant  they  had not  checked  the PDMP.  He                                                                    
stated it was a professional frustration.                                                                                       
Co-Chair  Merrick noted  that Dr.  Ruffridge would  be heard                                                                    
from after public testimony.                                                                                                    
Representative  Carpenter  remarked   that  the  caller  had                                                                    
indicated that the other boards  just work with the Board of                                                                    
Pharmacy.  He was  trying  to get  an  understanding of  the                                                                    
reason for the  comment. He wondered if it  meant the boards                                                                    
were not working with the Board of Pharmacy.                                                                                    
9:12:57 AM                                                                                                                    
Representative  Wool  referenced  the comment  made  by  the                                                                    
testifier about  what a  layman may  think listening  to the                                                                    
prior  committee conversation  about the  PDMP. He  asked if                                                                    
Mr. Christensen believed the layman  may put undue burden on                                                                    
the PDMP. For example, he  asked if people believed the PDMP                                                                    
should  stop all  diversionary action  and severely  improve                                                                    
the opioid  crisis. He  asked if there  was too  much burden                                                                    
put on the PDMP and that expectations were too high.                                                                            
Mr. Christensen  responded that  he did  not believe  so. He                                                                    
referenced  enhancements made  to the  database and  relayed                                                                    
that logging in and using  the database was far simpler than                                                                    
it had  been when introduced  in 2008. He remarked  that the                                                                    
data  was  much improved.  He  thought  that former  Senator                                                                    
Green would likely be amazed  by how well the data reporting                                                                    
worked.  He did  not believe  it was  overly burdensome.  He                                                                    
remarked that  it would  be great if  the database  could be                                                                    
discontinued  because  patients'   compliance  with  opiates                                                                    
vastly  improved;  however,  he  did not  believe  that  had                                                                    
occurred yet.                                                                                                                   
Representative  Josephson stated  his  understanding of  the                                                                    
scenario provided by Mr. Christensen  that when the pharmacy                                                                    
called providers  to ask  if they were  aware a  patient had                                                                    
received  a duplicate  prescription  from another  provider,                                                                    
sometimes  the  provider was  not  aware.  He asked  if  his                                                                    
understanding of the situation was accurate.                                                                                    
Mr. Christensen  confirmed the statement.  He stated  it was                                                                    
not as  common presently as  it had been several  years back                                                                    
prior to the  last major tweak to the PDMP  in 2017 or 2018.                                                                    
He detailed  the tweak required prescribers  to register and                                                                    
use the  PDMP prior  to prescribing a  controlled substance.                                                                    
He confirmed that it still happened.                                                                                            
Representative Josephson pointed out it was a lawsuit.                                                                          
9:16:14 AM                                                                                                                    
DR.  JAMES  DELKER,  SELF,  SOLDOTNA  (via  teleconference),                                                                    
spoke in support of the legislation.  He shared that he is a                                                                    
board member  on the Alaska Veterinary  Medical Association.                                                                    
He  followed some  of  the Board  of  Pharmacy meetings  and                                                                    
activities.  He  stated  that   the  bill  was  truly  about                                                                    
allowing the  Board of Pharmacy  to continue to  perform its                                                                    
necessary duties and oversight  of an ever evolving pharmacy                                                                    
profession.  He  stated that  the  board  had an  incredible                                                                    
number  of   diverse  issues,   not  limited   to  licensing                                                                    
pharmacists  and  technicians,  but   also  dealing  with  a                                                                    
daunting new  world of online  pharmacy sales  that included                                                                    
dealing with illegal and not approved or safe drugs.                                                                            
Mr.  Delker  remarked that  the  discussion  about the  bill                                                                    
seemed  to revolve  primarily around  the PDMP;  however, it                                                                    
was only  a portion of  what the  Board of Pharmacy  did. He                                                                    
believed there  were changes  needed to  make the  PDMP more                                                                    
effective in fighting the opioid  epidemic. He stated it was                                                                    
the  reason  veterinarians  had pushed  for  change  through                                                                    
bills  like HB  91  and  SB 132  to  allow  the database  to                                                                    
contain useable  data. He believed  it made little  sense to                                                                    
shortchange the  Board of Pharmacy  with a  two-year sunset.                                                                    
He suggested a six-year sunset.  In terms of the PDMP issue,                                                                    
he  suggested  the formation  of  a  much broader  taskforce                                                                    
including legislators and  all potentially impacted parties.                                                                    
He stated  that the veterinarians had  not historically been                                                                    
given a  seat at the planning  table. He was happy  to offer                                                                    
his  services going  forward to  provide  input and  insight                                                                    
from  a  veterinary  perspective.  He  hoped  members  would                                                                    
support the bill with a reasonable sunset period.                                                                               
9:18:43 AM                                                                                                                    
RENEE  ROBINSON, SELF,  LICENSED PHARMACIST,  ANCHORAGE (via                                                                    
teleconference), spoke  in support  of the  bill. She  was a                                                                    
practicing  pharmacist and  spoke about  the vital  role the                                                                    
Board of  Pharmacy played in  current practice  and practice                                                                    
advancement. She was  a faculty member at  the University of                                                                    
Alaska Anchorage  College of Pharmacy  where they  relied on                                                                    
the Board  of Pharmacy  to provide  licenses and  support to                                                                    
students, new graduates, and  expanding faculty members. She                                                                    
shared  that  oversight  from the  board  was  necessary  to                                                                    
ensure  standards were  maintained,  practice was  advanced,                                                                    
and  that patients'  safety was  paramount. She  stated that                                                                    
without  a  strong  Board of  Pharmacy,  the  profession  of                                                                    
pharmacy  would be  at risk.  She stated  that the  practice                                                                    
would be  guided by individuals  outside of  the profession,                                                                    
driven by  different and often  conflicting agendas  such as                                                                    
money or profit.  She stated that the Board  of Pharmacy had                                                                    
done  an  incredible job,  especially  in  the past  several                                                                    
years in keeping up with  the changing healthcare landscape.                                                                    
She asked the committee to extend the board for six-years.                                                                      
9:20:10 AM                                                                                                                    
RONALD   WAGONER,   PHARMACIST    INTERN,   ANCHORAGE   (via                                                                    
teleconference),  testified in  support of  the legislation.                                                                    
He  shared that  he  was currently  a  fourth year  pharmacy                                                                    
student.  He  had  seen in  practice  the  implications  and                                                                    
barriers to  care that waiting  for licensing could  have on                                                                    
practice   sites.  He   highlighted   that   the  longer   a                                                                    
technician,  intern, or  pharmacist  had to  wait for  their                                                                    
license, the  more patient care was  delayed, and pharmacies                                                                    
suffered from  loss of business and  productivity. He shared                                                                    
that  graduation   was  quickly   approaching  in   May  and                                                                    
licensing was a major priority  for him. He continued that a                                                                    
quick and  efficient licensing period  meant he  could begin                                                                    
practicing as  a licensed pharmacist  sooner. As  an intern,                                                                    
he was allowed  to do everything a pharmacist  could do with                                                                    
their supervision  but being able  to do  everything without                                                                    
supervision sooner  would be a  major benefit  to pharmacies                                                                    
and patients in Alaska.                                                                                                         
Representative   Rasmussen    thanked   Mr.    Wagoner   for                                                                    
testifying.  She  asked   if  he  had  noticed   a  lack  of                                                                    
pharmacists being  available. It was her  understanding that                                                                    
nothing could be filled if a pharmacist was not present.                                                                        
Mr.  Wagoner   confirmed  Representative   Rasmussen's  last                                                                    
statement. He shared that the  pharmacy had experienced some                                                                    
issues and had  needed to call people into work  who had not                                                                    
been  working  recently.  He elaborated  that  the  pharmacy                                                                    
almost  had  to  close  on   a  recent  Saturday  because  a                                                                    
pharmacist had been  working 12 days in a row.  He stated it                                                                    
was  an issue  having  to  go above  and  beyond to  recruit                                                                    
people to fill in as needed to keep pharmacies open.                                                                            
Co-Chair Merrick CLOSED public testimony.                                                                                       
9:22:46 AM                                                                                                                    
AT EASE                                                                                                                         
9:23:50 AM                                                                                                                    
Representative   Carpenter   MOVED   to   ADOPT   conceptual                                                                    
Amendment  1  to reduce  the  sunset  date from  a  six-year                                                                    
extension to a four-year extension.                                                                                             
Vice-Chair Ortiz OBJECTED.                                                                                                      
Representative  Carpenter  explained   that  his  desire  to                                                                    
reduce the  sunset date had  more to do with  continuing the                                                                    
conversation  about other  issues, not  just about  what the                                                                    
board did.  He believed  the board had  value and  needed to                                                                    
continue;   however,  he   believed  there   was  additional                                                                    
scrutiny  required  by  the   legislature.  He  thought  the                                                                    
legislature  needed   to  force   itself  to   have  another                                                                    
conversation on the  topic. He thought two  years was likely                                                                    
too soon and six years was too late.                                                                                            
Representative  LeBon supported  the  amendment  to set  the                                                                    
board's  renewal date  at four  years. He  reflected on  the                                                                    
audit   recommendations    that   indicated    the   working                                                                    
relationship  needed to  be improved  between the  state and                                                                    
Board of Pharmacy.                                                                                                              
Representative Johnson  stated they would get  a report back                                                                    
in four  years. She  reasoned there was  a good  chance some                                                                    
changes  may or  may not  have  been made.  She thought  the                                                                    
extension  was  four  or  five  years  the  last  time.  She                                                                    
highlighted there  had been  committee discussion  about the                                                                    
fact  that  some  of  the  members  already  knew  what  the                                                                    
problems were. She believed it  meant a management audit was                                                                    
likely unnecessary.  She thought it would  be appropriate to                                                                    
receive a report  from the board to the committee  in a year                                                                    
listing the existing  concerns. She thought it  would give a                                                                    
better  sense that  the  legislature  was paying  attention.                                                                    
She stated  it would be a  minor cost of about  $25,000. She                                                                    
noted the board had that  amount in its account. She thought                                                                    
perhaps  the report  could be  contributed to  by the  other                                                                    
boards.  She thought  it would  be  easier to  make a  small                                                                    
budget amount for  the legislature to do  its due diligence.                                                                    
She  was  interested  in the  committee's  opinion  and  was                                                                    
willing to offer a conceptual amendment.                                                                                        
9:28:18 AM                                                                                                                    
AT EASE                                                                                                                         
9:29:13 AM                                                                                                                    
Representative  Wool understood  there was  work to  be done                                                                    
and that  the legislature should  delve into the  PDMP issue                                                                    
and how  it impacted  the Board of  Pharmacy and  others. He                                                                    
highlighted  the  committee  had received  public  testimony                                                                    
from a member  of the Board of  Veterinarians. He understood                                                                    
the  Board of  Veterinarians had  issues with  the PDMP.  He                                                                    
noted that between 36 and 40  states did not require them to                                                                    
use the  PDMP. He believed  all of  the issues needed  to be                                                                    
brought  forward.   He  thought  shortening  the   Board  of                                                                    
Pharmacy  extension  and yet  requiring  a  deeper dive  was                                                                    
cumbersome.  He  remarked  that things  in  the  legislature                                                                    
moved at  a glacial pace.  He considered a scenario  where a                                                                    
taskforce was  formed to perform  a deeper dive,  a solution                                                                    
had to  be implemented, and  an audit was then  performed to                                                                    
make sure the solution worked.  He highlighted that an audit                                                                    
took two years.  He thought a two-year window  to figure out                                                                    
the  problem   and  implement  change  was   too  short.  He                                                                    
supported  a six-year  extension and  including language  to                                                                    
form a  taskforce made up of  stakeholders, legislators, and                                                                    
others to analyze  the problem and implement  a solution. He                                                                    
did not support conceptual Amendment 1.                                                                                         
Representative  Thompson  asked  the state  auditor  if  the                                                                    
reduction to  four years  would put an  undue burden  on the                                                                    
department.  He  highlighted  the  Division  of  Legislative                                                                    
Audit had  numerous audits and  one audit took two  years to                                                                    
complete. He wondered if a  four-year extension was feasible                                                                    
for  the division  and  if the  timeframe  would enable  the                                                                    
Board of Pharmacy to accomplish its work.                                                                                       
KRIS  CURTIS,   LEGISLATIVE  AUDITOR,  ALASKA   DIVISION  OF                                                                    
LEGISLATIVE AUDIT,  estimated that the audit  required about                                                                    
1,000 hours  and $850,000 [she  later clarified  this number                                                                    
was  $85,000]. She  addressed the  two-year mark  associated                                                                    
with  an extension  date and  explained it  was too  late to                                                                    
assign  anyone  to  do  an   audit  within  that  timeframe;                                                                    
projects  had   already  been  staffed.  The   earliest  the                                                                    
division could conduct  an audit was next  year. She relayed                                                                    
the division could  never do less than  a two-year extension                                                                    
presently. She confirmed the  division had other priorities.                                                                    
She  elaborated  that  the   Legislative  Budget  and  Audit                                                                    
Committee (LB&A) approved special  audit requests, which the                                                                    
division  conducted when  it  had  available resources.  She                                                                    
explained that  the financial audits and  federal compliance                                                                    
audits  accounted for  about 75  percent  of the  division's                                                                    
time.  The  division  then  did  sunset  audits  which  were                                                                    
statutorily  mandated,  followed   by  special  audits  when                                                                    
resources were available. She  highlighted that the division                                                                    
had a  limited pool of  auditors and audit  resources, which                                                                    
should be considered  when looking at resources  to do other                                                                    
things.  She noted  that because  the audit  was statutorily                                                                    
mandated  it   would  take   precedence  over   other  audit                                                                    
9:33:09 AM                                                                                                                    
Representative  Thompson  asked  if changing  the  extension                                                                    
date from  six years to four  years would give the  Board of                                                                    
Pharmacy time to accomplish its work.                                                                                           
Ms. Curtis answered there were  11 or 12 criteria in statute                                                                    
associated  with conducting  a sunset  audit. She  explained                                                                    
that  LB&A  could tell  the  division  specifically what  it                                                                    
wanted in regard  to a special audit, which  would provide a                                                                    
deeper  dive into  issues  she had  heard  discussed by  the                                                                    
House Finance  Committee. She clarified that  a sunset audit                                                                    
would only update information the  committee already had and                                                                    
would  not  necessarily  provide   answers  to  the  complex                                                                    
questions she  had heard [voiced by  committee members]. She                                                                    
furthered that a taskforce  would require dedicated funding.                                                                    
She detailed that audits were  expensive because they had to                                                                    
follow audit standards and provided  a high assurance to the                                                                    
reader. She  elaborated that  a consultant  did not  have to                                                                    
comply  with  audit  standards  and was  a  lower  level  of                                                                    
assurance; however, it  may serve the need  of the committee                                                                    
if there were  specific things it wanted to  know. She noted                                                                    
that  facilitating   a  taskforce  was  not   something  the                                                                    
division  would do;  it would  be a  different mechanism  to                                                                    
reach some of the questions  committee members may have. She                                                                    
observed that  the Board of  Pharmacy had an  evolving role,                                                                    
and she  had no problem  if it  was the committee's  wish to                                                                    
have  an  audit in  four  years.  She  noted it  would  take                                                                    
resources away from other things.                                                                                               
Vice-Chair Ortiz spoke to  the division's original extension                                                                    
recommendation of six years. He  stated his understanding of                                                                    
Ms. Curtis's testimony that an  audit in four years would be                                                                    
similar  to  the current  audit  and  would not  necessarily                                                                    
delve  into   the  issues  of  interest   discussed  by  the                                                                    
committee.  He  thought  Ms.  Curtis   stated  that  a  more                                                                    
specific audit  would more  suitably come  from LB&A  with a                                                                    
specific  direction.  He  asked  if  his  understanding  was                                                                    
Ms. Curtis  agreed. She clarified the  division would update                                                                    
the committee on the status  of the current recommendations.                                                                    
Additionally,  the  audit  would   use  the  12  [statutory]                                                                    
criteria  to report  on  how  the board  was  doing at  that                                                                    
moment in time. She clarified  that an audit looked back and                                                                    
not  forward.   She  heard  committee  members   wanting  to                                                                    
determine how  to make  changes going  forward. She  did not                                                                    
think the  sunset audit was  necessarily the right  tool for                                                                    
the job.                                                                                                                        
9:37:27 AM                                                                                                                    
Vice-Chair  Ortiz stated  his understanding  that the  audit                                                                    
that would be performed in four years would cost $850,000.                                                                      
Ms. Curtis  answered that it  was her  approximate estimate.                                                                    
She elaborated that  the division had done a lot  of work on                                                                    
the  audit and  had experienced  numerous problems  with the                                                                    
data. She  explained the auditors  had done a lot  of "bunny                                                                    
trail  chasing" to  try to  get their  arms around  what was                                                                    
going on to provide policy  makers with the information. She                                                                    
was  guessing the  audit  had taken  about  1,000 hours  and                                                                    
their standard rate  was around $85 per hour.  She stated it                                                                    
was a significant investment into this type of review.                                                                          
Representative  Josephson referenced  the  cost of  $850,000                                                                    
estimated by Ms. Curtis.                                                                                                        
Ms.  Curtis  corrected  that  the cost  for  the  audit  was                                                                    
approximately $85,000.                                                                                                          
Representative Josephson  asked for verification it  was the                                                                    
division's team doing the work.                                                                                                 
Ms. Curtis agreed.  She elaborated that the  division did an                                                                    
annual cost allocation plan where  it determined the cost of                                                                    
providing  its  services  in  order   to  bill  the  federal                                                                    
government. The  division also  developed budgets  for every                                                                    
audit.  She highlighted  that  the audit  for  the Board  of                                                                    
Pharmacy  was  more complex  given  all  of the  surrounding                                                                    
issues.  She  estimated  the audit  had  taken  about  1,000                                                                    
Representative Josephson  remarked that if he  supported the                                                                    
amendment, it was not punitive in  any way. He stated it was                                                                    
a  system where  they Board  of Pharmacy  was doing  what it                                                                    
could,  but  there  were  numerous  complexities  and  other                                                                    
9:39:47 AM                                                                                                                    
Representative  LeBon had  read  many audits  on banks.  His                                                                    
conclusion from the Division of  Audit's findings led him to                                                                    
believe  that shortening  the date  was in  the mutual  best                                                                    
interest of the  state and board. He asked if  he arrived at                                                                    
a right  conclusion. Alternatively,  he wondered if  he read                                                                    
too much into the audit  conclusions that a six-year renewal                                                                    
was normal. He had an  impression from the audit results and                                                                    
conclusions  that  told  him   maybe  four  years  was  more                                                                    
Ms.  Curtis answered  that the  audit recommendation  always                                                                    
came from  the evidence gathered through  the audit process.                                                                    
She believed six years was  appropriate, but she came from a                                                                    
different  view  and  respected the  wisdom  of  the  policy                                                                    
makers on  whatever additional information members  may have                                                                    
and how  important the subjects were  to their constituents.                                                                    
She  stated  that if  the  committee  wanted to  reduce  the                                                                    
extension it was fine from  her perspective. She often had a                                                                    
hard time when  she recommended a shorter  extension, and it                                                                    
was  extended.  She explained  that  she  would not  make  a                                                                    
recommendation  if she  did not  feel there  was a  need for                                                                    
oversight  and  a shorter  extension.  She  deferred to  the                                                                    
committee in regard to reducing the extension time.                                                                             
9:41:53 AM                                                                                                                    
Representative Wool deferred to  Ms. Curtis on her expertise                                                                    
on audits and she had  recommended six years. He pointed out                                                                    
that  the problems  the committee  was  discussing were  not                                                                    
only with  the Board of  Pharmacy, but  with a tool  used by                                                                    
the board  and many others.  He provided a scenario  where a                                                                    
broad solution  was agreed upon  that went beyond  the Board                                                                    
of Pharmacy. He  believed Ms. Curtis had  indicated an audit                                                                    
may  not be  the standard  sunset audit  because it  may not                                                                    
answer  the questions  being  asked; it  would  be a  deeper                                                                    
audit  that   would  require  potentially  more   hours  and                                                                    
questions. He asked  if the needed changes could  be done in                                                                    
four years. He thought Ms.  Curtis had recommended six years                                                                    
for a reason.                                                                                                                   
Ms. Curtis replied  that if there would  be legislation that                                                                    
changed the PDMP  she would wonder when it  would be passed.                                                                    
She  remarked  there should  be  an  amount of  time  before                                                                    
Legislative  Audit did  another  audit  for evaluation.  She                                                                    
stated  that  the  Board of  Pharmacy  was  responsible  for                                                                    
administering and maintaining the  database, which the audit                                                                    
should look at.  She considered how much time  it would take                                                                    
to pass  legislation and for  any changes to  be determined.                                                                    
She  explained they  would want  some  time to  see how  the                                                                    
board was  doing in administering  the changes. She  had not                                                                    
thought  through six  years with  that in  mind, but  it had                                                                    
come to mind as she was considering it.                                                                                         
Representative  Wool supported  the  six-year extension.  He                                                                    
asked if whatever  problems pointed out in the  audit were a                                                                    
threat to public health or  something that just needed to be                                                                    
fixed  immediately.   Alternatively,  he  wondered   if  the                                                                    
database needed  to be fixed  to be  easier to use  and more                                                                    
effective in the future.                                                                                                        
Ms. Curtis answered  that she had strong  feelings about the                                                                    
need to  reduce the opioid  crisis. She believed the  law in                                                                    
place was  imperfect and could  be improved.  She encouraged                                                                    
policymakers to look at improving  the laws and database and                                                                    
doing  everything possible  to clarify  the board's  role in                                                                    
administering the database and  to get other boards onboard.                                                                    
She  recommended  vigorous   enforcement  of  laws,  meaning                                                                    
investigative  sections needed  to  be  staffed. She  stated                                                                    
there  were  many  things  that   could  be  done,  and  the                                                                    
extension bill was likely not the mechanism.                                                                                    
9:45:59 AM                                                                                                                    
Representative  Wool   thought  work   was  needed   by  the                                                                    
legislature and others separately.  He thought it would take                                                                    
time. He supported the six-year extension.                                                                                      
Vice-Chair  Ortiz perceived  that the  issues with  the PDMP                                                                    
and  the opioid  crisis  was a  separate  question from  the                                                                    
extension time.                                                                                                                 
Ms. Curtis  answered that the  question relevant to  her job                                                                    
was how  well the  board was  implementing changes  based on                                                                    
laws passed by the legislature.                                                                                                 
Vice-Chair  Ortiz asked  for clarification  that it  was not                                                                    
just about  how well  the Board of  Pharmacy was  doing with                                                                    
the PDMP but other boards as well.                                                                                              
Ms. Curtis answered  that a sunset audit  had been conducted                                                                    
for the  Board of  Optometry during  the current  session as                                                                    
well.  She  noted  the  audit  for  the  Medical  Board  was                                                                    
upcoming.   She  relayed   that   the   division  took   the                                                                    
opportunity  when it  did the  sunset audits  for the  other                                                                    
boards to  do a deep dive  on how well they  were monitoring                                                                    
registration and reporting.                                                                                                     
9:47:57 AM                                                                                                                    
Representative Edgmon  stated it felt awkward  because there                                                                    
was a  board extension before  the committee in  addition to                                                                    
very  important  policy  question  in the  middle  that  the                                                                    
committee   was  basically   unable   to   address  in   the                                                                    
legislation.   He  recalled   recent   testimony  from   the                                                                    
department [DCCED]  and he  had inferred  that there  was an                                                                    
understaffing issue  pertaining to  the database.  He stated                                                                    
that  the audit  addressed not  being able  to quantify  the                                                                    
reduction   of   inappropriate   use  or   prescription   of                                                                    
controlled substances  because the database did  not contain                                                                    
related  prosecutorial data  regarding  diversion cases.  He                                                                    
did not believe the database was doing what was intended.                                                                       
Representative  Edgmon relayed  that  he had  come into  the                                                                    
discussion being a solid supporter  of a four-year extension                                                                    
and may ultimately maintain his  support for that timeframe.                                                                    
He did  not know how  else to  keep the needed  attention on                                                                    
the topic unless a taskforce  was created, and the issue was                                                                    
brought  to  the  top  of  other  issues.  He  stressed  the                                                                    
importance of  the database. He underscored  that the opioid                                                                    
crisis was every  bit as challenging as it  had been several                                                                    
years  earlier. He  asked what  other tools  the legislature                                                                    
had  to  address   the  issue.  He  believed   there  was  a                                                                    
legislator  who planned  to take  the issue  on in  the next                                                                    
legislature;   however,  there   were   no  guarantees   for                                                                    
anything. He asked how to make  the issue rise to the top of                                                                    
the heap,  albeit shortening the  extension period  to four-                                                                    
years to require the auditor  to have continued focus on the                                                                    
issue. He directed the question to the bill sponsor.                                                                            
9:50:33 AM                                                                                                                    
Representative Story reminded committee  members that as the                                                                    
bill had  been going  through the  process, the  House Labor                                                                    
and  Commerce Committee  had been  concerned about  the PDMP                                                                    
and the chair was going to  have a meeting on the topic. She                                                                    
did not  know what would  come from the meeting.  She stated                                                                    
there were other legislators interested  in delving into the                                                                    
important issue.                                                                                                                
Representative Edgmon appreciated it,  but it did not create                                                                    
the imperative the  issue needed. He stressed  there was not                                                                    
a  lever to  create the  imperative for  the legislature  to                                                                    
act.  He highlighted  that  the issue  was  thorny, and  the                                                                    
stakeholders were  vast. Additionally, there  were differing                                                                    
viewpoints and  the privacy  aspect in  terms of  the public                                                                    
safety impact  was multifaceted. He thought  the legislature                                                                    
needed a mandate to address the issue.                                                                                          
Representative  Story  agreed   that  legislators  were  all                                                                    
concerned about the issue. She  thought they should consider                                                                    
whether  LB&A should  order a  special  audit. She  believed                                                                    
more money  should be put  into the investment  personnel in                                                                    
DCCED.  She   believed  it  was  what   the  department  had                                                                    
highlighted.  She thought  it would  take some  personnel to                                                                    
investigate the issue. She considered  funding for a special                                                                    
audit. She  stated it  was the  legislature's responsibility                                                                    
to get  a handle on  the laws it  wanted to have  to address                                                                    
the  opioid crisis.  She understood  the  Board of  Pharmacy                                                                    
housed  the PDMP  and  if  the legislature  asked  it to  do                                                                    
something  she believed  it  would be  all  of the  involved                                                                    
boards contributing.  She stated  it was the  dues collected                                                                    
from members  for targeted needs. She  appreciated the focus                                                                    
on the issue.                                                                                                                   
9:53:08 AM                                                                                                                    
Representative  Edgmon  asked  if something  like  the  idea                                                                    
mentioned by  Representative Story could  be put in  a board                                                                    
extension bill.                                                                                                                 
Ms.  Curtis answered  that she  had just  finished a  sunset                                                                    
audit  of the  Alcohol Beverage  Control (ABC)  Board and  a                                                                    
special  audit request  to  look at  the  ABC Board  license                                                                    
process  had  been merged  with  the  sunset, which  was  an                                                                    
efficient  way of  doing both  separately focused  requests.                                                                    
She explained  it would involve  a special  request approved                                                                    
by LB&A that was done at the same time as the next sunset.                                                                      
Representative Edgmon  asked if it would  be brought forward                                                                    
to   LB&A  by   Ms.  Curtis   based  on   the  legislature's                                                                    
Ms. Curtis replied that a  legislator would have to submit a                                                                    
request for a  special audit to LB&A. She  clarified she did                                                                    
not have a problem with a  four-year extension if it was the                                                                    
will  of the  committee. She  suggested it  may be  a better                                                                    
timeline to  look at an  additional topic at the  same time.                                                                    
She  encouraged  any legislator  who  may  be interested  in                                                                    
submitting  a special  audit  request to  work  with her  on                                                                    
drafting  the  questions  to  be  auditable  questions  that                                                                    
specified specific criteria to measure against.                                                                                 
Representative Edgmon communicated he  would be steadfast in                                                                    
his recommendation  that the bill  should be  accompanied by                                                                    
some  set  of recommendations  to  do  what Ms.  Curtis  had                                                                    
discussed.  He  did  not  know  where  the  issue  would  go                                                                    
otherwise, and  he did  not want to  be back  revisiting the                                                                    
situation again in several years.                                                                                               
9:55:13 AM                                                                                                                    
AT EASE                                                                                                                         
9:56:29 AM                                                                                                                    
Representative Johnson  associated herself with  the remarks                                                                    
made  by Representative  Edgmon.  She  thought his  comments                                                                    
were spot on. She referenced  page 23 of the audit requiring                                                                    
the  board to  annually report  performance measures  to the                                                                    
legislature.   She   pointed   out  that   the   board   was                                                                    
specifically  required to  report  on  the CSPD  [Controlled                                                                    
Substance  Prescription Database]  security and  reductions.                                                                    
She  moved  to  the  next paragraph  and  remarked  that  it                                                                    
specified  the  board  had  indicated  the  action  was  not                                                                    
possible. She  wanted standards that the  board could comply                                                                    
with. She was not certain where  to fix the problem (e.g., a                                                                    
via a  taskforce, amendment, or  other). She stated  that if                                                                    
people  were  set  up  to   fail,  that  is  what  ended  up                                                                    
Vice-Chair Ortiz  requested to ask  a question of  the Board                                                                    
of  Pharmacy  chair  Dr.  Ruffridge.   He  referred  to  the                                                                    
committee's conversation  about whether to extend  the Board                                                                    
of Pharmacy  for four or  six years. He  referenced concerns                                                                    
illustrated by  different members  about the PDMP.  He asked                                                                    
for comment  by Dr. Ruffridge and  what he viewed to  be the                                                                    
best way to move forward.                                                                                                       
9:59:40 AM                                                                                                                    
JUSTIN RUFFRIDGE,  CHAIR, BOARD  OF PHARMACY,  SOLDOTNA (via                                                                    
teleconference), provided information about  his time on the                                                                    
board. He was extremely  appreciative for the opportunity to                                                                    
speak.  He shared  that he  had joined  the board  two years                                                                    
earlier  at  the same  time  the  pandemic had  started.  He                                                                    
elaborated that  during his  tenure on  the board,  they had                                                                    
been  adapting to  what the  situation had  been brought  to                                                                    
their world. During  the time, he had clearly  seen that the                                                                    
PDMP was a somewhat functioning  tool. He confirmed that the                                                                    
PDMP could function more efficiently and adeptly.                                                                               
Mr.   Ruffridge   referenced    an   earlier   question   by                                                                    
Representative  Carpenter  about  communication  with  other                                                                    
boards. He stated  the answer was a  "resounding yes." There                                                                    
was a  group of board  chairs mentioned in the  audit report                                                                    
that  met  twice monthly  for  a  total  of three  hours  to                                                                    
discuss  the  PDMP.  He explained  it  was  a  boots-on-the-                                                                    
ground, highly  trained, highly  motivated group  with great                                                                    
insight on  the PDMP, changes  that may be  needed, existing                                                                    
issues, and how the tool  was currently used. He opined that                                                                    
another audit  was not needed to  determine the information.                                                                    
He believed  what was  needed and what  he was  hearing from                                                                    
the legislature  was the need  for starting support  for the                                                                    
process  of adjusting  the use  and access  to the  PDMP. He                                                                    
communicated that  multiple board chairs were  ready to have                                                                    
the  conversation.   He  relayed   that  the   board  chairs                                                                    
communicated  well with  one  another;  however, they  could                                                                    
only regulate and could not make any statutory changes.                                                                         
Mr.   Ruffridge  referred   to   an   earlier  question   by                                                                    
Representative  Wool about  whether  the PDMP  was the  only                                                                    
source  of   solving  the   opioid  crisis.   He  referenced                                                                    
testimony  from multiple  people including  Ms. Curtis  that                                                                    
the  issue  was  near  and   dear  to  people's  hearts.  He                                                                    
underscored that  the issue  was near to  the hearts  of the                                                                    
board chairs  as well. He  stated they were all  invested in                                                                    
the  issue and  wanted the  tools to  work well.  He relayed                                                                    
that  if  the  committee  was hearing  the  tools  were  not                                                                    
working well, it was more of  a function of needing to adapt                                                                    
them. He  explained that just  like drug diversion  and drug                                                                    
use  was  adapted  because  people  would  always  seek  out                                                                    
opiates and had  always done so. He remarked  that the opium                                                                    
trade was a huge part  of the world's history. He elaborated                                                                    
that the state needed to be  able to adapt its tools to meet                                                                    
the adapting,  changing environment.  He referred to  one of                                                                    
the committee  member's comments about the  glacial pace. He                                                                    
stated it  was true;  sometimes, the  state was  behind what                                                                    
changes needed to be happening.                                                                                                 
Mr.  Ruffridge  referenced   Representative  Edgmon's  point                                                                    
about  needing a  lever.  He  was not  certain  a lever  was                                                                    
needed, he thought teamwork was  what was needed. He thought                                                                    
they needed  people who  were willing  to sit  in a  room to                                                                    
determine the  situation, how to  get from point A  to point                                                                    
B,  and the  steps  needed  to get  there.  He believed  the                                                                    
committee  had  heard  from  Dr.   Delker  that  there  were                                                                    
multiple individuals  standing by to have  the conversation.                                                                    
He  considered the  questions  of who  wanted  to start  the                                                                    
conversation  and   when  needed  to  be   answered  by  the                                                                    
committee. From  the Board of  Pharmacy perspective,  it was                                                                    
something the  board held dear  and believed it was  doing a                                                                    
good job. He  communicated that the board wanted  to be able                                                                    
to  do  a  better job  if  given  the  tools  to do  so.  He                                                                    
supported a  six-year extension because it  would take time.                                                                    
He emphasized  that the  boards wanted to  do the  work, but                                                                    
they  were unsure  of  the path  to take  to  get there  and                                                                    
needed help.                                                                                                                    
10:04:28 AM                                                                                                                   
Vice-Chair Ortiz  asked if one  viable idea would be  to add                                                                    
legislative participation in the  recurring meetings held by                                                                    
board chairs  twice a month. He  highlighted that ultimately                                                                    
any  needed  changes  would  have   to  take  place  through                                                                    
Mr. Ruffridge  replied, "Absolutely." He shared  that in his                                                                    
brief tenure as board  chair, the participants had discussed                                                                    
the  need  for  legislative sponsorship  and  activity  were                                                                    
uncertain  as to  how to  even address  that issue  to begin                                                                    
with. He shared that the  board chairs were uncertain how to                                                                    
find  someone from  the  legislature willing  to  come to  a                                                                    
meeting.  He  was incredibly  grateful  that  the topic  was                                                                    
coming forward  because he was  finding there  were multiple                                                                    
individuals   who  hold   the  issue   very  seriously.   He                                                                    
emphasized  the  board  chairs would  welcome  any  and  all                                                                    
legislative participants  to attend the meetings.  He shared                                                                    
there was a  meeting the current afternoon at  4:30 p.m. for                                                                    
anyone  interested.  He  provided   his  email  address  for                                                                    
interested parties.                                                                                                             
10:06:54 AM                                                                                                                   
Representative  Carpenter   stated  that  held   the  audits                                                                    
provided  by  Legislative  Audit   in  high  regard  and  he                                                                    
understood the board was comprised  of volunteer members. He                                                                    
referenced  Ms. Curtis's  estimate that  the division  spent                                                                    
1,000 hours  on the  audit and  some of  the time  was spent                                                                    
going down rabbit holes. He  did not know whether that meant                                                                    
the system was complex or  there were more requirements than                                                                    
resources for the  board to deal with, or  whether they were                                                                    
looking at  processes in  place that  were not  effective or                                                                    
there  were   management  issues.  The  committee   had  had                                                                    
testimony  from  a  pharmacist  there  were  still  multiple                                                                    
people  not doing  what they  should be  doing in  regard to                                                                    
checking the database.                                                                                                          
Representative   Carpenter  referenced   the  audit   report                                                                    
recommendation 3  specifying the failure of  a pharmacist in                                                                    
charge or a pharmacist to  register or submit information to                                                                    
the  database as  required in  statute was  grounds for  the                                                                    
board  to  take  disciplinary  action.  He  read  additional                                                                    
detail from  the requirement.  He considered  the idea  of a                                                                    
special  audit and  thought it  could  look across  multiple                                                                    
boards and  jurisdictions to determine the  number of claims                                                                    
of  failure there  had been  to  the Board  of Pharmacy.  He                                                                    
wondered how many investigations  had been conducted and how                                                                    
many disciplinary actions had been taken.                                                                                       
Representative Carpenter  stressed there was a  law in place                                                                    
and the authority  rested with the board to  take action. He                                                                    
recognized  in  a  small  state it  was  difficult  to  take                                                                    
disciplinary  action against  one's peers.  He stated  there                                                                    
was some peer  pressure involved. He thought it  may be part                                                                    
of the issue, but he did  not know. He highlighted there was                                                                    
evidence  from  one  testifier  that  the  process  was  not                                                                    
working. He remarked that with  all due respect to the board                                                                    
chair, the board had some authority  it may not be using. He                                                                    
thought more investigation was needed,  which was the reason                                                                    
be   believed  a   four-year  sunset   was  applicable.   He                                                                    
underscored  there was  a serious  problem with  one of  the                                                                    
audit  recommendations  that  the legislature  ought  to  be                                                                    
looking at sooner rather than later.                                                                                            
10:10:53 AM                                                                                                                   
Vice-Chair  Ortiz   referenced  Dr.   Christensen's  earlier                                                                    
testimony and had understood it  to be that the pharmacy had                                                                    
been  referring to  communications  with  doctors and  other                                                                    
participants  in the  program  rather  than pharmacists.  He                                                                    
asked Dr. Christensen for clarification.                                                                                        
Co-Chair Merrick  stated they  would get  clarification from                                                                    
Dr. Christensen prior to the next meeting.                                                                                      
Vice-Chair   Ortiz  thought   it   was   important  to   get                                                                    
clarification.  He agreed  with Representative  Carpenter if                                                                    
his testimony  had been referring  to other  pharmacists who                                                                    
were not complying  with the program. He stated  it would be                                                                    
a serious  situation. However,  he believed  Dr. Christensen                                                                    
had been referring to  conversations with other participants                                                                    
in the program, not necessarily pharmacists.                                                                                    
Co-Chair Merrick reiterated that  her office would reach out                                                                    
to Dr. Christensen prior to the next hearing on the bill.                                                                       
Ms.  Curtis responded  to  comments  made by  Representative                                                                    
Carpenter.  She relayed  that the  audit addressed  an issue                                                                    
discussed by  Representative Carpenter in  recommendation 5.                                                                    
She  elaborated  that  the   occupational  boards  were  not                                                                    
enforcing  the requirements.  She  pointed to  Exhibit 8  on                                                                    
page  18  of  the  audit   report  showing  the  percent  of                                                                    
subscribers   actually    reviewing   the    database.   She                                                                    
highlighted there was  a 35 to 43 percent  rate of reviewing                                                                    
the   database  prior   to   prescribing,  dispensing,   and                                                                    
administering medications. She stressed  the number was low.                                                                    
She  stated  that the  database  itself  had shown  numerous                                                                    
improvements. She  questioned whether it was  being used and                                                                    
whether   individual  boards   were  monitoring   licensees'                                                                    
requirements. She stated they were big questions.                                                                               
Mr.  Ruffridge   replied  it  was  an   excellent  point  by                                                                    
Representative   Carpenter.   He   stated  the   issue   was                                                                    
multifaceted;  however, the  issue  brought  forward by  Ms.                                                                    
Curtis and  Dr. Christensen  was one  of other  boards their                                                                    
requirement to  review. He detailed that  Chapter 30 clearly                                                                    
defined that  the practitioner, prior to  prescribing, had a                                                                    
requirement to review  the PDMP. He underscored  that it did                                                                    
not include  pharmacies. He explained that  the pharmacy was                                                                    
the  reporter of  the PDMP.  He  elaborated that  pharmacies                                                                    
could  review  the  PDMP  if   they  wanted,  and  they  did                                                                    
frequently. He  highlighted that pharmacies  and pharmacists                                                                    
were  the  highest  users  of the  database.  He  noted  the                                                                    
information  was included  in  the audit  report. He  stated                                                                    
that pharmacies and pharmacists  had been the early adopters                                                                    
and early users and  they promoted, protected, and preserved                                                                    
the PDMP.                                                                                                                       
Mr.  Ruffridge  addressed  the question  of  discipline.  He                                                                    
communicated that  the Board of  Pharmacy brought  forward a                                                                    
disciplinary  matrix  the  previous   year  because  of  its                                                                    
importance. Additionally,  the board  had mailed  a strongly                                                                    
worded  letter to  licensees specifying  that  if they  were                                                                    
found to  have not reported on  a daily basis and  the board                                                                    
ran a report showing a  licensee did not report, there would                                                                    
be  discipline  and  the  licensee   would  be  referred  to                                                                    
investigations. However, after the  notice was sent out, the                                                                    
Board  of  Pharmacy received  notice  from  its vendor  that                                                                    
hosted the PDMP that the  reporting information would not be                                                                    
valid and  could not  be pulled  or used.  Consequently, the                                                                    
board  had to  go back  to the  drawing board  and were  now                                                                    
working  with a  tech company  to determine  how to  build a                                                                    
disciplinary  matrix  for  a  report  that  was  useable  to                                                                    
determine who may or may not be reporting.                                                                                      
Mr. Ruffridge detailed that reporting  did not seem to be an                                                                    
issue  with  pharmacy,  although  it  happened  occasionally                                                                    
where a  pharmacy had a technological  glitch, and something                                                                    
would not  be reported. He  relayed that  it was easy  to go                                                                    
back  and  clean that  up.  He  emphasized  it was  not  the                                                                    
responsibility  of  the  Board  of  Pharmacy  to  discipline                                                                    
members  of the  Board  of Medicine,  Board  of Nursing,  or                                                                    
other boards.  He clarified that  the Board of  Pharmacy was                                                                    
responsible  for   the  reporting   to  the  PDMP   and  the                                                                    
management of  the PDMP, meaning  it had to work  with other                                                                    
boards,  which was  the reason  the  twice monthly  meetings                                                                    
were so  important. He stated it  was an issue and  he hoped                                                                    
it could be addressed  in collaboration with the legislature                                                                    
going forward.                                                                                                                  
10:16:27 AM                                                                                                                   
Representative  Carpenter  referenced AS  17.30.200(e)  that                                                                    
specified a failure of a  practitioner to register or review                                                                    
the database as required  was grounds for the practitioner's                                                                    
licensing board. He  stated that if a  pharmacist was having                                                                    
a conversation  with a  prescribing doctor  and there  was a                                                                    
disconnect  because   the  doctor   was  not   checking  the                                                                    
database,  it was  an issue  for the  Medical Board  to deal                                                                    
with. He remarked there were  multiple boards with the power                                                                    
to enforce, but  it appeared they may not be  in some cases.                                                                    
He wondered why. He reasoned  it was ultimately what another                                                                    
investigation,  audit, or  conversation  amongst the  boards                                                                    
needed to identify. Subsequently,  if the legislature had to                                                                    
get involved, it would. He  thought the boards had what they                                                                    
needed. He remarked that they  may need additional resources                                                                    
and statute changes, but they  were supposed to be doing the                                                                    
enforcement currently  and it appeared  that may not  be the                                                                    
Co-Chair Merrick noted that Mr.  Christensen had called back                                                                    
into the meeting and was available online.                                                                                      
Vice-Chair  Ortiz  restated  his previous  question  to  Mr.                                                                    
Christensen.  He  referenced   Mr.  Christensen's  testimony                                                                    
earlier  in the  meeting that  he had  had discussions  with                                                                    
other  participants in  the PDMP  program and  it was  clear                                                                    
they were not following  through with reporting obligations.                                                                    
He  asked   if  Mr.   Christensen  had  been   referring  to                                                                    
interactions with  other pharmacists or participants  in the                                                                    
PDMP program outside of pharmacy.                                                                                               
Mr.  Christensen clarified  that  he had  been referring  to                                                                    
other   prescribers    such   as   physicians    and   nurse                                                                    
10:19:16 AM                                                                                                                   
Representative  Edgmon  thought  the discussion  was  really                                                                    
evolving and  he hoped  it got  to a  good place.  He agreed                                                                    
with Representative  Carpenter and was not  disagreeing with                                                                    
Vice-Chair  Ortiz and  his line  of  questioning and  others                                                                    
around the  table. He considered  from a broad  policy goal,                                                                    
the  legislature  had  created  taskforces  and  groups  for                                                                    
criminal   justice,  teacher   retention  and   recruitment,                                                                    
fisheries bycatch, fiscal policy, and  other. He asked if it                                                                    
led  to  political  change or  momentum  or  getting  things                                                                    
through the  legislature. He stated  it was  ultimately what                                                                    
was needed.                                                                                                                     
Representative Edgmon  appreciated the informed  comments by                                                                    
Mr. Christensen  and Mr. Ruffridge; however,  he underscored                                                                    
that teamwork was not going to  get the job done. He thought                                                                    
a  lever was  needed.  He stressed  that  they were  falling                                                                    
short on the  issue. He emphasized that the  audit could not                                                                    
come close  to measuring  the issue because  it was  not the                                                                    
objective of the audit. He  did not believe the audit looked                                                                    
back at the intent of the  bill sponsor in 2008, the changes                                                                    
made  in 2016,  adjustments in  2017, or  the concern  being                                                                    
registered by the committee.                                                                                                    
Representative  Edgmon thought  the  committee was  speaking                                                                    
about two  objectives including the  broader goal  of making                                                                    
the  PDMP more  impactful and  being able  to talk  to other                                                                    
entities  including  the  Department of  Health  and  Social                                                                    
Services (DHSS), which was about  to become two departments.                                                                    
From  his perspective  as  the chair  of  the Department  of                                                                    
Corrections  [budget  subcommittee],  the drug  problem  was                                                                    
every  bit as  robust as  it had  been. He  stated that  the                                                                    
database  was   supposed  to  help  with   the  problem.  He                                                                    
elaborated that  it sounded to  him like the PDMP  was doing                                                                    
its  job in  terms  of  what was  required  at the  pharmacy                                                                    
level, but in terms of  looking at the larger objectives, he                                                                    
believed if  it was  not falling  short, the  questions were                                                                    
still unanswered.  He wanted to get  the questions answered.                                                                    
He believed whether  it was via a  taskforce, special audit,                                                                    
or other,  the committee should  not leave work on  the bill                                                                    
without  identifying a  vehicle to  move forward  that could                                                                    
involve LB&A or a legislator taking on legislation.                                                                             
10:21:59 AM                                                                                                                   
Representative  LeBon thanked  Mr.  Ruffridge  for having  a                                                                    
conversation prior to the meeting.  He had learned there was                                                                    
participation  by   the  Board  of  Pharmacy   with  outside                                                                    
organizations seeking best practices to  do a better job for                                                                    
Alaskans.  He suggested  the board  consider  engaging in  a                                                                    
process to  look at  itself internally.  He pointed  out the                                                                    
board  was currently  doing so,  but  he suggested  formally                                                                    
seeking out  some type of  a relationship with  a consultant                                                                    
or  auditor to  validate its  best practices  to ensure  its                                                                    
application  of practices  in the  arena  of public  health,                                                                    
safety, and  welfare, was  as effective as  it could  be. He                                                                    
recommended the  board not just  wait for the  state auditor                                                                    
to determine best  practices in four to six  years, but also                                                                    
to take some ownership.                                                                                                         
Representative Josephson  thought Representative  Edgmon was                                                                    
getting  to  a possible  pathway.  He  stated that  even  if                                                                    
Exhibit 8  showed provider participation  that was  twice as                                                                    
good, he would  find it inadequate. He  highlighted it would                                                                    
mean  one-third of  the providers  were not  looking at  the                                                                    
PDMP, which was  awful. He stated that  providers would say,                                                                    
with some  legitimacy, that they needed  statutory delegates                                                                    
to  be able  to look  at the  PDMP. He  noted he  and former                                                                    
Senator Cathy  Giessel had worked  on a bill on  that topic,                                                                    
but it  had been inadequate to  the task. He added  he had a                                                                    
bill (HB  242) the previous  term that  was an effort  to go                                                                    
deep on the  subject and provide a  resolution. He observed,                                                                    
with  respect to  the provider  cohorts, that  they did  not                                                                    
seem to  want to play the  bad cop and have  levers on their                                                                    
own  people. He  considered that  perhaps he  was incorrect,                                                                    
but  the  participation  was wholly  inadequate.  He  stated                                                                    
another audit  would be  helpful, but  the situation  was so                                                                    
far off the  mark as it was. He thought  another audit would                                                                    
not be sufficient to get the job done.                                                                                          
10:25:24 AM                                                                                                                   
Vice-Chair Ortiz reminded the  committee about why they were                                                                    
speaking to the  issue and why the  conceptual amendment had                                                                    
been offered that  would reduce the sunset from  six to four                                                                    
years. The primary motivation was  a good motivation because                                                                    
the committee  felt they  needed a  lever to  address issues                                                                    
with the PDMP. He stated  it had become clear from testimony                                                                    
that it  was not the appropriate  lever. He stated it  was a                                                                    
separate   question  that   needed  to   be  addressed   and                                                                    
legislators  needed to  be participants  in the  process. He                                                                    
underscored that the current issue  before the committee was                                                                    
the  Board  of  Pharmacy   extension.  He  stated  that  the                                                                    
amendment addressed whether the  extension should be four or                                                                    
six years. He  thought it was a different  question than the                                                                    
problems discussed  by the  committee. He  supported dealing                                                                    
with the extension and separating the PDMP question.                                                                            
Co-Chair Merrick  reminded the committee that  Mr. Ruffridge                                                                    
had  invited  any  members to  participate  in  an  upcoming                                                                    
meeting at 4:30 p.m.                                                                                                            
Representative  Wool   agreed  with  Vice-Chair   Ortiz.  He                                                                    
thought  they were  conflating two  issues.  He referred  to                                                                    
Representative Edgmon's  mention of  DOC and  the continuing                                                                    
drug problem.  He believed DOC had  stopped allowing inmates                                                                    
from  receiving  original  copies  of  letters  from  family                                                                    
because DOC was concerned there  were drugs in the paper. He                                                                    
stated if  it was  true, it  was a problem,  but not  a PDMP                                                                    
problem.  He  thought  the  committee  was  ascribing  every                                                                    
existing problem to the PDMP.                                                                                                   
Representative Wool  believed the  database was  a necessary                                                                    
tool  and that  people had  been  educated on  the tool.  He                                                                    
thought   the    way   doctors   prescribed    had   changed                                                                    
significantly by  knowing the PDMP was  there. He referenced                                                                    
mention  of the  number  of  morphine milligram  equivalents                                                                    
prescribed. He  would be  interested to  know how  the trend                                                                    
had  been going  since the  implementation of  the PDMP.  He                                                                    
would also be  interested to hear from DHSS on  the cause of                                                                    
overdose. He believed the PDMP  needed some tweaking, and he                                                                    
supported new statutes. He thought  there had to be some way                                                                    
to ensure follow  through on the issue. He did  not know the                                                                    
answer, but he  thought some solutions needed  to happen and                                                                    
not merely the formation of a  taskforce. He did not want to                                                                    
pick on the  Board of Pharmacy, although he  noted they were                                                                    
integral to the  issue and needed to be at  the table, along                                                                    
with other boards.                                                                                                              
Representative Wool thought a lot  of good had happened with                                                                    
the  PDMP even  though  there were  some  problems with  the                                                                    
database.  He  considered  that   perhaps  not  all  of  the                                                                    
providers were using the PDMP  as they should, which was not                                                                    
good. He remarked  that when he was standing in  line at the                                                                    
pharmacy, he would not think  everyone in line was an opioid                                                                    
abuser. He  thought most were merely  getting a prescription                                                                    
filled. He  did not know  and until more data  was received,                                                                    
they would not  know. He acknowledged a  problem existed and                                                                    
the bill had brought up the discussion.                                                                                         
10:30:30 AM                                                                                                                   
Representative Carpenter  shared that his wife  had lost two                                                                    
brothers to opioid abuse. He  was very sensitive to learning                                                                    
there were medical providers who  were not following the law                                                                    
and using  the database  they should be  using to  help stem                                                                    
the problem. He  did not want to wait six  years to find out                                                                    
if recommendation 3  had been addressed. He did  not want to                                                                    
wait   two  years.   However,  in   the  current   political                                                                    
environment,  he  was agreeing  to  wait  four. He  WITHDREW                                                                    
conceptual  Amendment  1. He  planned  to  submit a  written                                                                    
amendment when appropriate.                                                                                                     
Co-Chair Merrick set an amendment  deadline for 6:00 p.m. on                                                                    
March 23.                                                                                                                       
HB  306  was  HEARD  and   HELD  in  committee  for  further                                                                    
10:31:59 AM                                                                                                                   
AT EASE                                                                                                                         
10:34:57 AM                                                                                                                   
HOUSE BILL NO. 308                                                                                                            
     "An Act relating to dementia awareness."                                                                                   
10:35:04 AM                                                                                                                   
Co-Chair  Merrick  indicated Representative  Stutes's  staff                                                                    
was available to introduce HB 308.                                                                                              
FATE   PUTMAN,   STAFF,    REPRESENTATIVE   LOUISE   STUTES,                                                                    
introduced the  bill. The  purpose of the  bill was  to draw                                                                    
awareness  to dementia  and  Alzheimer's.  He explained  the                                                                    
bill was designed  to create a public  awareness campaign to                                                                    
educate Alaskans about the issue  of Alzheimer's. He relayed                                                                    
there were currently  no known cures for  Alzheimer's or the                                                                    
dementia  diseases; however,  education and  early detection                                                                    
could  help   to  manage  the  disease   and  avoid  medical                                                                    
intervention  including  long-term  institutionalization  or                                                                    
hospitalization.  He  detailed  that   fewer  than  half  of                                                                    
Americans   living  with   Alzheimer's  disease   receive  a                                                                    
diagnosis.  Additionally, due  to  Alaska's  lack of  public                                                                    
health  infrastructure   for  dementia,  a  lower   rate  of                                                                    
Alaskans  with dementia  received  a  formal diagnosis.  The                                                                    
bill  was intended  to  improve the  rate  of diagnosis  for                                                                    
dementia  through   the  production  and   dissemination  of                                                                    
educational material to the public.                                                                                             
Mr. Putman relayed that Alzheimer's  was one of the ten most                                                                    
common  types  of dementia.  He  reported  there were  about                                                                    
12,500  people experiencing  dementia  in  Alaska and  about                                                                    
8,500  of the  total  were Alzheimer's  patients. He  stated                                                                    
Alaska needed  to be  prepared for the  coming years  of the                                                                    
"Alzheimer's  tsunami" and  delay the  onset of  dementia to                                                                    
help reduce  the disease impacts on  patients, families, and                                                                    
the  healthcare system.  The  sponsor's  office was  working                                                                    
with the Department of Health  and Social Services (DHSS) on                                                                    
the  legislation   to  represent   the  interest   of  those                                                                    
suffering  from  Alzheimer's  and dementia.  He  highlighted                                                                    
intent to change the legislation  to ensure it complied with                                                                    
an expanded intent  to look at the workforce as  well as the                                                                    
problem. He noted  there would be a fiscal  note coming from                                                                    
DHSS.  Additionally, there  was a  new committee  substitute                                                                    
(CS).  He  noted there  were  individuals  online to  answer                                                                    
10:37:38 AM                                                                                                                   
Representative  Rasmussen asked  about the  12,500 cases  of                                                                    
dementia  including 8,500  cases of  Alzheimer's in  Alaska.                                                                    
She asked if  the number reflected known  cases. She thought                                                                    
the number was probably low.                                                                                                    
Mr.  Putman replied  that the  problem  with Alzheimer's  is                                                                    
that people with  the disease may not realize  they have it.                                                                    
The number reflected the current diagnosed cases in Alaska.                                                                     
Vice-Chair  Ortiz  MOVED  to ADOPT  the  proposed  committee                                                                    
substitute  for  HB  308,  Work  Draft  32-LS1397\I  (Foote,                                                                    
Co-Chair Merrick OBJECTED for discussion.                                                                                       
Mr. Putman  explained the  changes in the  CS. The  CS added                                                                    
the words  "and healthcare capacity"  to the bill  title. He                                                                    
explained  the bill  would look  at the  healthcare capacity                                                                    
for Alzheimer's  and dementia patients  in the  state. There                                                                    
was  a  statutory  reference  to   include  the  words  "and                                                                    
healthcare capacity."  Additionally, the word  "program" had                                                                    
been removed and  replaced with the word  "campaign." In the                                                                    
body of  the statute,  the words "develop,  implement" would                                                                    
be  replaced   with  the  word   "build."  After   the  word                                                                    
"dementia"  the   word  "public"  had  been   inserted.  The                                                                    
reference to the [federal] BOLD  Act was removed because the                                                                    
funds  could   be  accessed  without  being   referenced  in                                                                    
statute.  Sections 1  through 6  were  removed and  replaced                                                                    
with new  language. Section  7 had been  added to  require a                                                                    
biannual report  to the legislature  about the  barriers and                                                                    
problems  with dementia  preparation. He  relayed an  eight-                                                                    
year  sunset   had  been  added,  which   would  enable  the                                                                    
legislature  to opt  not  to  renew the  program  if it  was                                                                    
deemed  unnecessary.   Additionally,  the  CS   included  an                                                                    
immediate effective date.                                                                                                       
Co-Chair  Merrick noted  that Mr.  Putman  had been  working                                                                    
with  stakeholders,  which  had  resulted  in  some  of  the                                                                    
changes. She WITHDREW  her OBJECTION to the  adoption of the                                                                    
There  being NO  further OBJECTION,  Work Draft  32-LS1397\I                                                                    
was ADOPTED.                                                                                                                    
Representative LeBon  asked if there was  an opportunity for                                                                    
federal funding in the future.                                                                                                  
Mr.  Putman   replied  affirmatively.  He   highlighted  the                                                                    
federal  Building  Our   Largest  Dementia  and  Alzheimer's                                                                    
(BOLD)   Act  and   relayed  that   $15  million   had  been                                                                    
appropriated  from   Congress  in  2021   for  informational                                                                    
educational  purposes  related   to  Alzheimer's  awareness.                                                                    
There were two levels of  funding including a $350,000 grant                                                                    
and a $500,000  grant depending on the level  of activity of                                                                    
the applying agencies.                                                                                                          
10:41:03 AM                                                                                                                   
Representative  LeBon asked  if  the  state's funding  level                                                                    
enabled leveraging of  the federal dollars. He  asked if the                                                                    
federal dollars required a level  of state support. He asked                                                                    
if there was  a relationship the state  could take advantage                                                                    
of with state dollars.                                                                                                          
Mr.  Putman  replied affirmatively.  There  was  a level  of                                                                    
funding required  from the state  in order to apply  for the                                                                    
federal funds. Additionally,  a program needed to  be up and                                                                    
running  in  order  for the  federal  government  to  decide                                                                    
whether the level of funding would be $350,000 or $500,000.                                                                     
Co-Chair Merrick asked to hear from invited testimony.                                                                          
PAMELA KELLEY,  EXECUTIVE DIRECTOR, ALZHEIMER'S  RESOURCE OF                                                                    
ALASKA,   ANCHORAGE  (via   teleconference),  relayed   that                                                                    
Alzheimer's  Resource of  Alaska  was  the largest  dementia                                                                    
services organization  operating in  Alaska with  offices in                                                                    
Fairbanks, Juneau,  Mat-Su, and Anchorage. She  was also the                                                                    
chair  of  the  Alaska   Dementia  Action  Collaborative,  a                                                                    
workgroup comprised  of more than 35  stakeholders including                                                                    
public, private, tribal, and  nonprofit entities. She shared                                                                    
that  the organization  had assisted  tens  of thousands  of                                                                    
Alaskans impacted  by dementia over  the past 38  years. She                                                                    
elaborated that  individuals came to the  organization after                                                                    
they  or a  family  member had  begun  to experience  memory                                                                    
problems  or another  symptom of  concern. She  explained at                                                                    
that  point  it  was  typically   too  late  for  prevention                                                                    
activities.  The  organization  worked with  individuals  to                                                                    
help slow  the rate  of cognitive decline  and to  help them                                                                    
plan and adapt for the future.                                                                                                  
Ms. Kelley was certain the  state should be building greater                                                                    
awareness about the disease and  brain health to reach those                                                                    
whose  risks  could  be reduced  well  before  the  worrying                                                                    
symptoms appeared.  The work was  needed in order  to reduce                                                                    
the  grim  forecasted  numbers. She  referenced  the  12,500                                                                    
individuals  currently diagnosed  with  dementia in  Alaska.                                                                    
She reported  that by  2030 the number  was projected  to be                                                                    
23,000. She  emphasized that paying attention  to a person's                                                                    
modifiable risk factors  in her 30s, 40s, or  50s could have                                                                    
an impact;  however, in reality,  most individuals  were not                                                                    
aware of dementia during those years.                                                                                           
Ms. Kelley did not want to  give the indication there was no                                                                    
public  awareness work  being done  in  Alaska. She  relayed                                                                    
there  was work  being  done,  but at  what  she called  the                                                                    
retail level  including health fairs, community  events, VFW                                                                    
halls, and  through speaking engagements.  The bill  would a                                                                    
population  level  campaign  over  time,  allowing  dementia                                                                    
awareness  to  be  taken wholesale.  She  communicated  that                                                                    
messages  about early  lifestyle  choices and  the value  of                                                                    
early  detection were  needed to  reduce risk.  The messages                                                                    
needed to be provided in  many languages to reach those with                                                                    
the  greatest  risk.  She supported  the  bill  because  she                                                                    
wanted to see  Alaska develop better data  around the extent                                                                    
of dementia in  the state. She noted  the state's prevalence                                                                    
rates were only  estimates. She knew the  Division of Public                                                                    
Health  had the  experience to  operate a  dementia campaign                                                                    
with  impact  and  she  knew   there  were  federal  dollars                                                                    
available  to  help  achieve the  effort.  She  thanked  the                                                                    
10:45:33 AM                                                                                                                   
NONA SAFRA,  MEMBER, ALASKA COMMISSION ON  AGING, HOMER (via                                                                    
teleconference),  she shared  information  on  her work  and                                                                    
shared she  was a  caregiver of  a person  with Alzheimer's.                                                                    
She read from prepared remarks:                                                                                                 
     You have  all of  the data on  Alzheimer's as  a public                                                                    
     health  crisis   that's  devastating  to   Alaska.  Our                                                                    
     workforce and our state budget  will be impacted by the                                                                    
     sheer  number of  Alaskans who  will be  diagnosed with                                                                    
     dementia  in  the  next decade.  So,  Alaska  needs  to                                                                    
     address  this crisis  now. The  fiscal note  covers one                                                                    
     position,   which   can  facilitate   federal   receipt                                                                    
     authority to meet the crisis.                                                                                              
     So,  not passing  HB 308  is a  missed opportunity  for                                                                    
     every  Alaskan   family  affected  by   dementia.  This                                                                    
     funding gives  Alaska better access to  focus on issues                                                                    
     like  increased  early  detection and  diagnosis,  risk                                                                    
     reduction,   prevention,    and   supporting   dementia                                                                    
     The Alzheimer's Impact Movement  shows Medicaid cost of                                                                    
     the disease in  Alaska is at $76 million  in 2020, with                                                                    
     $110  million  projected  in  2025,  which  is  a  44.6                                                                    
     percent  increase and  that doesn't  take into  account                                                                    
     the  latest research  published  this  month in  Nature                                                                    
     that brain  changes due to  COVID statistically  show a                                                                    
     cognitive decline in the population,  which adds to our                                                                    
     need to have [?] awareness.                                                                                                
     I speak because my odds  for dementia are increased due                                                                    
     to a  brain injury as  well as I  am a caregiver  and I                                                                    
     speak for Alaskans who don't  know their increased odds                                                                    
     of getting dementia and that  they can do things now to                                                                    
     change  that. I'm  also a  member of  the Brain  Injury                                                                    
     Taskforce  so  I'm  dealing   with  people  with  brain                                                                    
     injury. They need  HB 308 passed to learn  how to avoid                                                                    
     or delay the onset and  for all the caregivers who need                                                                    
     support.  So,  Alaskans  are   depending  on  you,  our                                                                    
     representatives, to  do that. I  urge the  committee to                                                                    
     support HB 308.                                                                                                            
Ms. Safra noted she was currently  in Nome for the finish of                                                                    
the Iditarod.  She had been  talking with people  during her                                                                    
visit and was  amazed by the number of  families impacted by                                                                    
dementia. She thanked the committee for its time.                                                                               
10:48:21 AM                                                                                                                   
Co-Chair Merrick  asked the Department of  Health and Social                                                                    
Services to review the fiscal note.                                                                                             
KAROL  FINK,  SECTION  CHIEF,  DIVISION  OF  PUBLIC  HEALTH,                                                                    
DEPARTMENT    OF   HEALTH    AND   SOCIAL    SERVICES   (via                                                                    
teleconference),   relayed   that   the   CS   had   changed                                                                    
significantly from  the original  bill and would  change the                                                                    
fiscal  note. The  amount  in the  current  fiscal note  was                                                                    
based  on the  most basic  foundational aspects  of creating                                                                    
and  implementing a  new evidence-based  education campaign.                                                                    
She noted  that the  amount could  be scaled.  She explained                                                                    
the  baseline   amount  could  be   reduced  if   there  was                                                                    
additional  funding or  the  state was  able  to secure  the                                                                    
federal grant in the future.  She explained the amount shown                                                                    
on the current fiscal note was the minimum required.                                                                            
Representative  Carpenter  saw the  same  costs  in the  out                                                                    
years shown on the note. He asked what scalable meant.                                                                          
Ms. Fink answered  that scalable pertained to  the reach and                                                                    
frequency  of   how  the   messages  met   individuals.  She                                                                    
explained that  a smaller budget  would mean  reaching fewer                                                                    
people with less frequency.                                                                                                     
Representative  Carpenter stated  his  understanding of  the                                                                    
statement.  He  asked   if  Ms.  Fink  meant   that  if  the                                                                    
legislature  funded under  $777,000,  the  program would  be                                                                    
scaled down.                                                                                                                    
Ms. Fink agreed.                                                                                                                
10:50:37 AM                                                                                                                   
Representative LeBon  referenced the sunset date  of July 1,                                                                    
2030.  He asked  if  it  was because  the  sponsor hoped  to                                                                    
utilize federal  participation and the sunset  date would be                                                                    
extended if  federal funds were received.  Alternatively, he                                                                    
wondered  if the  sunset would  occur if  the state  did not                                                                    
receive federal funding.                                                                                                        
Mr. Putman answered  it was the latter  scenario provided by                                                                    
Representative LeBon. He explained  the bill was designed to                                                                    
have funding  for eight  years through  undesignated general                                                                    
funds (UGF) if  necessary. He noted that the  grant could be                                                                    
a  one-time grant.  He  elaborated that  if  no new  federal                                                                    
funds came forward, the eight-year  sunset date was designed                                                                    
so the  legislature could  end the program  if there  was no                                                                    
funding  or  if it  determined  the  program was  no  longer                                                                    
Representative  Carpenter  asked  who  would  be  doing  the                                                                    
education  of  the  court   system,  law  enforcement,  fire                                                                    
fighters, and other.                                                                                                            
Mr.  Putman answered  the initial  intent was  to have  DHSS                                                                    
provide  the education.  The CS  took some  of the  specific                                                                    
language  out,   but  the  intent   remained  to   have  the                                                                    
department  educate  first   responders,  firefighters,  and                                                                    
others  about  what  they   were  experiencing  in  dementia                                                                    
Representative Carpenter stated the  original intent was for                                                                    
all training to  be done by DHSS. He elaborated  that the CS                                                                    
specified the  state would continue  to train. He  asked for                                                                    
verification  that some  of the  training would  be done  by                                                                    
DHSS  and   the  other   training  would   be  done   by  an                                                                    
unidentified party.                                                                                                             
Mr. Putman  clarified that DHSS  would be  fully responsible                                                                    
for the training.                                                                                                               
10:53:04 AM                                                                                                                   
Representative  Carpenter looked  at the  sectional analysis                                                                    
(copy  on file)  indicating  the new  statute would  require                                                                    
DHSS to  maintain a  list of  state providers  who diagnose,                                                                    
evaluate,  and  manage  dementia.  He asked  what  the  list                                                                    
enabled  DHSS  to do.  He  asked  if the  information  would                                                                    
enable DHSS to target its training.                                                                                             
Mr.  Putman responded  that  the list  was  intended in  the                                                                    
original  legislation to  ensure  that people  who may  have                                                                    
dementia  and   doctors  identifying   a  person   may  have                                                                    
dementia, to provide  the list to patients in  order for the                                                                    
patients  to   access  a  doctor.  He   clarified  that  the                                                                    
department would  prepare the documents and  provide them to                                                                    
medical  professionals and  the medical  professionals would                                                                    
hand them out to patients.                                                                                                      
Co-Chair Merrick  thanked Mr. Putman.  She set  an amendment                                                                    
deadline for Wednesday, March 23 at 6:00 p.m.                                                                                   
HB  308  was  HEARD  and   HELD  in  committee  for  further                                                                    
10:54:44 AM                                                                                                                   
The meeting was adjourned at 10:54 a.m.                                                                                         

Document Name Date/Time Subjects
HB 306 - PHA Bd Letter of Support - 2.25.22.pdf HFIN 3/15/2022 9:00:00 AM
HB 306
HB 308 CS WorkDRaft FIN v.I 031422.pdf HFIN 3/15/2022 9:00:00 AM
HB 308
HB 308 - Sectional on LH.pdf HFIN 3/15/2022 9:00:00 AM
HB 308
HB 308 Sponsor Statement.pdf HFIN 3/15/2022 9:00:00 AM
HB 308
HB 306 PDMP Board Chairs Letter to House Finance (3.21.22).pdf HFIN 3/15/2022 9:00:00 AM
HB 306