Legislature(1993 - 1994)

03/09/1994 03:00 PM House HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
txt
                                                                               
           HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES                         
                       STANDING COMMITTEE                                      
                           March 9, 1994                                       
                            3:00 p.m.                                          
                                                                               
  MEMBERS PRESENT                                                              
                                                                               
  Rep. Cynthia Toohey, Co-Chair                                                
  Rep. Con Bunde, Co-Chair                                                     
  Rep. Gary Davis, Vice Chair                                                  
  Rep. Al Vezey                                                                
  Rep. Harley Olberg                                                           
  Rep. Bettye Davis                                                            
  Rep. Irene Nicholia                                                          
  Rep. Tom Brice                                                               
                                                                               
  MEMBERS ABSENT                                                               
                                                                               
  Rep. Pete Kott                                                               
                                                                               
  COMMITTEE CALENDAR                                                           
                                                                               
  *HB 468:  "An Act extending the termination of the Citizens'                 
            Review Panel for Permanency Planning."                             
                                                                               
            PASSED OUT OF COMMITTEE                                            
                                                                               
  HB 414:   "An Act creating the Alaska Health Commission;                     
            relating to the delivery, quality, access, and                     
            financing of health care; relating to review and                   
            approval of rates and charges of health insurers;                  
            relating to certain civil actions against health                   
            care providers and health insurers; repealing                      
            Alaska Rule of Civil Procedure 72.1; and providing                 
            for an effective date."                                            
                                                                               
            HEARD AND HELD                                                     
                                                                               
  (* First public hearing.)                                                    
                                                                               
  WITNESS REGISTER                                                             
                                                                               
  ROBERLY WALDRON, Deputy Commissioner                                         
  Services to the Public                                                       
  Department of Administration                                                 
  900 W 5th Ave., Ste. 710                                                     
  Anchorage, Alaska 99501-2029                                                 
  Phone:  (907) 258-6117                                                       
  Position Statement:  Testified in support of HB 468                          
                                                                               
  SHERRIE GOLL, Lobbyist                                                       
  Alaska Women's Lobby; KIDPAC                                                 
  P.O. Box 22156                                                               
  Juneau, Alaska 99802                                                         
  Phone:  (907) 463-6744                                                       
  Position Statement:  Testified in support of HB 468                          
                                                                               
  NANCY USERA, Commissioner                                                    
  Department of Administration                                                 
  P.O. Box 110200                                                              
  Juneau, Alaska 99811-0200                                                    
  Phone:  (907) 465-2200                                                       
  Position Statement:  Offered amendments to HB 414                            
                                                                               
  STEVE LEBRAUN, Account Manager                                               
  Aetna Health Plan                                                            
  P.O. Box 91032                                                               
  Seattle, Washington 98111-9132                                               
  Phone:  (206) 467-2803                                                       
  Position Statement:  Testified in support of HB 414                          
                       (spoke via offnet)                                      
                                                                               
  JAY LIVEY, Deputy Commissioner                                               
  Department of Health and Social Services                                     
  P.O. Box 110601                                                              
  Juneau, Alaska 99811-0601                                                    
  Phone:  (907) 465-3068                                                       
  Position Statement:  Answered questions on HB 414                            
                                                                               
  BONNIE NELSON, Representative                                                
  Alaska Public Interest Research Group                                        
  20615 White Birch Rd.                                                        
  Chugiak, Alaska 99567                                                        
  Phone:  (907) 688-3017                                                       
  Position Statement:  Testified on HB 414                                     
                       (spoke via teleconference)                              
                                                                               
  PREVIOUS ACTION                                                              
                                                                               
  BILL:  HB 468                                                                
  SHORT TITLE: FOSTER CARE REVIEW PANEL                                        
  SPONSOR(S): REPRESENTATIVE(S) TOOHEY,Ulmer,Brown,Nordlund                    
                                                                               
  JRN-DATE    JRN-PG                     ACTION                                
  02/14/94      2374    (H)   READ THE FIRST TIME/REFERRAL(S)                  
  02/14/94      2374    (H)   HES, FINANCE                                     
  03/09/94              (H)   HES AT 03:00 PM CAPITOL 106                      
                                                                               
  BILL:  HB 414                                                                
  SHORT TITLE: COMPREHENSIVE HEALTH CARE                                       
  SPONSOR(S): RULES BY REQUEST OF THE GOVERNOR                                 
                                                                               
  JRN-DATE    JRN-PG                     ACTION                                
  01/28/94      2182    (H)   READ THE FIRST TIME/REFERRAL(S)                  
  01/28/94      2182    (H)   HES, JUDICIARY, FINANCE                          
  01/28/94      2182    (H)   -2 FISCAL NOTES (GOV, DCED)                      
                              1/28/94                                          
  01/28/94      2183    (H)   GOVERNOR'S TRANSMITTAL LETTER                    
  02/15/94              (H)   HES AT 03:00 PM CAPITOL 106                      
  02/15/94              (H)   MINUTE(HES)                                      
  03/02/94              (H)   MINUTE(HES)                                      
  03/04/94              (H)   HES AT 03:00 PM CAPITOL 106                      
  03/04/94              (H)   MINUTE(HES)                                      
  03/09/94              (H)   HES AT 03:00 PM CAPITOL 106                      
                                                                               
  ACTION NARRATIVE                                                             
  TAPE 94-41, SIDE A                                                           
  Number 000                                                                   
                                                                               
  CHAIR TOOHEY called the meeting to order at 3:07 p.m., noted                 
  members present and announced the calendar.  She brought HB
  468 to the table.  She indicated that Deputy Commission                      
  Waldron was in attendance.  She then passed the gavel over                   
  to Rep. Bunde who presided over portions of the remainder of                 
  the meeting.                                                                 
                                                                               
  CHAIR BUNDE stated that perhaps there might be a conflict of                 
  interest as his aid, Patty Swenson, is a member of the                       
  Foster Care Review Panel.                                                    
                                                                               
  REP. TOOHEY said she had no objections.                                      
  HB 468 - FOSTER CARE REVIEW PANEL                                            
                                                                               
  Number 106                                                                   
                                                                               
  (Chair Bunde stated for the record that Rep. Nicholia                        
  arrived at 3:08 p.m.)                                                        
                                                                               
  Number 125                                                                   
                                                                               
  REP. CYNTHIA TOOHEY, Prime Sponsor of HB 468, stated that                    
  the legislation would extend the sunset date for citizen's                   
  review panels for permanency planning until 1997.  She                       
  indicated that the proposal had bi-partisan support and                      
  passed the legislature unanimously in 1990 and was signed                    
  into law.  The purpose of external citizen reviews is to                     
  assure that children do not linger unnecessarily in out-of-                  
  home care, and they receive the support and benefits of a                    
  permanent home as soon as possible.                                          
                                                                               
  REP. TOOHEY further indicated that in the United States                      
  almost 500,000 children pass through state foster care                       
  systems each month.  She said U.S. judges, social workers,                   
  attorneys, and child advocacy groups have recognized that                    
  the foster care system is failing to respond to the needs of                 
  many abused and neglected children and their families.                       
  Crowded court calendars and understaffed child welfare                       
  agencies are contributing to the increase in the number of                   
  children in the system and their length of time spent in                     
  substitute care.                                                             
                                                                               
  REP. TOOHEY said that among solutions proposed by child                      
  advocacy organizations were the implementation of permanency                 
  planning case work and foster care placement monitoring                      
  through regular case reviews.  To help monitor the                           
  situation, citizen volunteers were selected to sit on review                 
  panels in 24 states, including Alaska.  She indicated that                   
  the Department of Administration (DOA) implemented a model                   
  project in Anchorage that began reviews in December of 1993.                 
                                                                               
                                                                               
  REP. TOOHEY stated that as the result of an audit the                        
  Division of Legislative Audit recommended to extend the                      
  sunset date to 1997 to allow the Anchorage project                           
  sufficient time to gather data that will determine the                       
  panels' effectiveness.  The length of time children remain                   
  in foster care and the savings associated with children no                   
  longer being part of the foster care system are factors that                 
  determine the panels' effectiveness.                                         
                                                                               
  REP. TOOHEY maintained that HB 468 has the support of the                    
  Alaska Chapter of the National Association of Social                         
  Workers, the Alaska Foster Parent Association, and the                       
  National Association of Foster Care Reviewers.  She then                     
  indicated that Roberly Waldron from DOA and Randy Welker                     
  form Legislative Audit were present to answer questions.                     
                                                                               
  Number 237                                                                   
                                                                               
  REP. B. DAVIS asked if there was someone from DOA to                         
  testify.                                                                     
                                                                               
  CHAIR BUNDE said yes.                                                        
                                                                               
  REP. B. DAVIS said she was interested in the zero fiscal                     
  note.                                                                        
  REP. TOOHEY asked if Rep. B. Davis would like her to address                 
  the fiscal note.                                                             
                                                                               
  CHAIR BUNDE suggested that the committee hear from Roberly                   
  Waldron.                                                                     
                                                                               
  Number 240                                                                   
                                                                               
  ROBERLY WALDRON, Deputy Commissioner, Services to the                        
  Public, Department of Administration, testified in support                   
  of HB 468.  She stated that in regards to the zero fiscal                    
  note that it does not cost the DOA anything to sunset or not                 
  sunset.  Although, she said, there is a cost to implement                    
  the program, but that would be addressed through another                     
  avenue, not through the proposed legislation.                                
                                                                               
  Number 278                                                                   
                                                                               
  REP. B. DAVIS asked what other avenue would address the                      
  implementation.  She said it was her understanding that the                  
  appropriation would have to come from the legislature unless                 
  it is already in the department's budget.  She felt that                     
  nothing would be accomplished if the sunset date were to be                  
  moved when there would be no funds to implement the program.                 
                                                                               
  MS. WALDRON explained that currently there is $125,000 in                    
  the budget for fiscal year 1995.  She said if the bill does                  
  not pass and there is no phase-out year, the $125,000 and                    
  the phase-out year would still be in effect.                                 
                                                                               
  REP. B. DAVIS asked if the $125,000 would carry through                      
  1995.                                                                        
                                                                               
  MS. WALDRON said yes.                                                        
                                                                               
  Number 308                                                                   
                                                                               
  MS. WALDRON stated that it took quite some time to get the                   
  panels appointed through the governor's office, but the                      
  reviews began in December 1993.  She said the system is                      
  working very well and all of the panelists are extremely                     
  dedicated to their cause.  She also indicated that foster                    
  parents have responded positively to being part of the                       
  review panels.  She said the model project will answer the                   
  questions of whether the panels will work and if children                    
  will be placed in permanent situations faster.  She further                  
  stated that there will be seven months of documentation to                   
  determine the panels' effectiveness.                                         
                                                                               
  Number 369                                                                   
                                                                               
  REP. TOOHEY explained that in other states the system has                    
  proven it saves money.  She said there is a considerable                     
  cost difference between paying foster care for placement of                  
  children and home care.                                                      
                                                                               
  CHAIR BUNDE asked how much the program costs per year.                       
                                                                               
  MS. WALDRON explained that $125,000 pays for three workers                   
  and pays for rent and supplies, but not for the full year.                   
  She said in the next fiscal year they would have to stop                     
  when the funds are completely depleted, but there would be                   
  sufficient data at that time to determine the effectiveness                  
  of the program.                                                              
  Number 401                                                                   
                                                                               
  CHAIR BUNDE clarified his question and said for the program                  
  to continue another $125,000 would be needed to carry the                    
  program through fiscal year 1995.                                            
                                                                               
  MS. WALDRON explained that the amount is what is in the                      
  budget for a continuation level, and it is not an additional                 
  $125,000.                                                                    
                                                                               
  CHAIR BUNDE said he understood that, but asked if that                       
  amount would take the program through to the end of fiscal                   
  year 1994.                                                                   
                                                                               
  MS. WALDRON explained that in the current fiscal year the                    
  program has $125,000.  There is $125,000 in budget request                   
  for FY 1995.                                                                 
                                                                               
  CHAIR BUNDE asked for testimony from Sherrie Goll.                           
                                                                               
  Number 423                                                                   
                                                                               
  SHERRIE GOLL, Lobbyist, Alaska Women's Lobby and KIDPAC,                     
  testified in support of HB 468.  She stated that the present                 
  law had unanimous support in both legislative bodies and it                  
  was decided that the program would have a positive impact on                 
  children.  She said foster care "drift", children who are                    
  improperly tracked and spend much unnecessary time in the                    
  system, is a very significant problem.  She indicated that                   
  in the Executive Summary of the Annual Report, seventeen                     
  cases were addressed in the month of December and pointed                    
  out that one child was adopted.  She said the panelists, who                 
  were appointed by Governor Hickel, are not paid.  She said                   
  the social workers that are involved are pleased with the                    
  process and the additional input.                                            
                                                                               
  MS. GOLL asserted that the intent of the bill is to have                     
  panelists be composed of local citizens from all over the                    
  state as opposed to the model program in Anchorage.  She                     
  stressed how important the program is to children in the                     
  foster care system.  She then indicated that the money is in                 
  the budget, but it is not enough money to expand the                         
  program.  She said even if the Finance Committee cut the                     
  money from the budget, it would be a shame to have the law                   
  "go off the books," which is why the termination date should                 
  be extended.                                                                 
                                                                               
  Number 525                                                                   
                                                                               
  CHAIR BUNDE asked for further testimony.  There being none,                  
  he closed public testimony and asked for further discussion                  
  from the committee.                                                          
                                                                               
  REP. OLBERG asked how much it costs to keep a child in a                     
  foster home for one night.                                                   
                                                                               
  REP. TOOHEY explained that costs vary by the child's age and                 
  geographical location.  She said zero to 30 months equals                    
  $19.33 per day or $579 per month, or $7055 per year.  A                      
  child that is 31 months to 11 years costs $17.80 per day and                 
  12 years to 19 years is $20.40 per day.  She said the                        
  average is $18.97 per day or $6828 per year.  Rep. Toohey                    
  anticipated the next question to be how many children are in                 
  foster care in Alaska and deferred to Ms. Waldron.                           
                                                                               
  Number 567                                                                   
  MS. WALDRON answered between 1100 and 1600 children per                      
  month are in foster care.                                                    
                                                                               
  REP. TOOHEY said there is not much fluctuation.                              
                                                                               
  CHAIR BUNDE asked for further discussion.  He then asked the                 
  pleasure of the committee.                                                   
                                                                               
  REP. B. DAVIS made a motion to pass HB 468 out of committee                  
  with individual recommendations and accompanying fiscal                      
  note.                                                                        
                                                                               
  CHAIR BUNDE asked if there were any objections.                              
                                                                               
  REP. OLBERG objected.                                                        
                                                                               
  Number 602                                                                   
                                                                               
  CHAIR BUNDE called for the vote.  Reps. Bunde, G. Davis, B.                  
  Davis, Nicholia, and Toohey voted Yea and Reps. Olberg and                   
  Vezey voted Nay.  Chair Bunde declared that HB 468 was so                    
  moved.  He then handed the gavel over to Rep. Toohey who                     
  presided over portions of the remainder of the meeting.                      
  Number 628                                                                   
                                                                               
  CHAIR TOOHEY brought HB 414 to the table.                                    
                                                                               
  HB 414 - COMPREHENSIVE HEALTH INSURANCE ACT                                  
                                                                               
  CHAIR TOOHEY stated that the committee would meet Saturday,                  
  March 13, 1994.  The committee took a brief technical at-                    
  ease to discuss a common meeting time and decided to meet                    
  from 1:00 p.m. until 3:00 p.m. and that the meeting would be                 
  teleconferenced.  Chair Toohey then indicated that there                     
  were several amendments to address and asked Commissioner                    
  Usera to testify.                                                            
                                                                               
  Number 635                                                                   
                                                                               
  NANCY USERA, Commissioner, Department of Administration                      
  (DOA), testified on HB 414 and offered several amendments.                   
  She stated that the DOA had five amendments in draft form to                 
  address and asked for guidance from the Chair on how to                      
  proceed.                                                                     
                                                                               
  CHAIR TOOHEY asked Commissioner Usera to present the                         
  amendments on Saturday and asked that she stay to answer                     
  questions.  She then said that there were four additional                    
  amendments.                                                                  
                                                                               
  REP. OLBERG asked if that meant there is a total of nine                     
  amendments.                                                                  
                                                                               
  CHAIR TOOHEY said yes and it's only the beginning.                           
                                                                               
  COMMISSIONER USERA said that some of the department's                        
  amendments have similar intent to the other four amendments.                 
                                                                               
  Number 735                                                                   
                                                                               
  CHAIR TOOHEY asked Commissioner Usera to indicate where the                  
  similarities are as the discussions progress.                                
                                                                               
  REP. BRICE asked for copies of the department's amendments.                  
  COMMISSIONER USERA asked for copies to be made.                              
                                                                               
  Number 760                                                                   
                                                                               
  CHAIR TOOHEY made a motion to move her Amendment 1.                          
                                                                               
  REP. BRICE objected for purposes of discussion.                              
                                                                               
  CHAIR TOOHEY asked for discussion.  She indicated that page                  
  1, line 8, addresses public health, and said she felt it                     
  would be better to include public health within HB 414.  She                 
  said, after the word health care on page 1, line 8, delete                   
  the phrase "is a vital public interest" and insert the                       
  phrase "the maintenance of the public's health is vital to                   
  the public interest."                                                        
                                                                               
  CHAIR TOOHEY further indicated that on page 1, line 11,                      
  after the word "insurance" the word "and" should be deleted;                 
  and on page 1, line 12, after the word "malpractice" the                     
  phrase "the lack of population based public health services"                 
  should be inserted.                                                          
                                                                               
  COMMISSIONER USERA interjected and asked in regard to the                    
  amendment, "Are we saying that in fact there aren't enough                   
  services or that the services that we have are poorly                        
  coordinated?"  She asked if the word "coordination" might be                 
  used instead of the word "services."  She felt the                           
  definition would be clearer.                                                 
                                                                               
  CHAIR TOOHEY read the suggested phrase, "...the lack of                      
  population based public health services coordination."  She                  
  asked for discussion.                                                        
                                                                               
  Number 869                                                                   
                                                                               
  REP. G. DAVIS noted that all three sets of amendments that                   
  were submitted were similar and suggested that any changes                   
  that needed to be made in any of the amendments be done on                   
  Saturday.  He felt the Saturday meeting would address the                    
  details of all submitted amendments.                                         
                                                                               
  REP. OLBERG asked if there were three people submitting very                 
  similar amendments.  He suggested looking at all three                       
  versions at the same time.                                                   
                                                                               
  CHAIR TOOHEY concurred.                                                      
                                                                               
  REP. OLBERG noted that Commissioner Usera's Amendment 1 and                  
  Chair Toohey's Amendment 1 were remarkably similar.                          
                                                                               
  REP. G. DAVIS interjected, "...as does Rep. Brice's number                   
  2."                                                                          
                                                                               
  REP. OLBERG suggested that perhaps the three sets of                         
  amendments could be sent to a bill drafter and returned to                   
  the committee as one amendment.                                              
                                                                               
  Number 906                                                                   
                                                                               
  COMMISSIONER USERA said there is a lot of similarity between                 
  two of the amendments and there is a tremendous difference                   
  in the third amendment, although they address the same                       
  subject.                                                                     
                                                                               
  REP. BRICE asked what the difference is and suggested that                   
  his amendment is more in depth.                                              
                                                                               
  COMMISSIONER USERA said, "This is very similar to the public                 
  health bill, commission bill, that was put in.  What this                    
  does is drop those provisions in under this commission,                      
  which philosophically... certainly we're O.K. about... but                   
  my recollection is that that bill had a fairly hefty fiscal                  
  note on it."                                                                 
                                                                               
  REP. BRICE said, "Where's your fiscal note on this?"                         
                                                                               
  CHAIR TOOHEY said it is $800,000.                                            
                                                                               
  REP. BRICE asked what the fiscal note is for Amendment 1                     
  from the DOA.                                                                
                                                                               
  Number 930                                                                   
                                                                               
  CHAIR TOOHEY said Rep. Sitton's bill has a $3 million fiscal                 
  note.                                                                        
                                                                               
  REP. BRICE said the amendment is similar but would provide a                 
  lot more structure and focus on the direction of the                         
  commission.  He said, "I think that the major questions of                   
  the fiscal note would probably be coming about due to the                    
  fact of the meeting of the commission, the establishment of                  
  the commission, the staff of the commission... that type of                  
  stuff.  My understanding is quite possibly that as an                        
  advisory committee, this would be a subset of the commission                 
  established by (HB) 414 with probably other members pulled                   
  in.  And, I'm sure we can minimalize the fiscal note."                       
                                                                               
  CHAIR TOOHEY said there is a great difference in the amount                  
  of people that Rep. Brice's amendment calls for than that of                 
  HB 414.                                                                      
                                                                               
  REP. BRICE said the differences needed to be discussed                       
  regarding how the public health commission should work.                      
                                                                               
  Number 963                                                                   
                                                                               
  CHAIR TOOHEY asked the committee how they wanted to address                  
  the numerous amendments.                                                     
                                                                               
  REP. BRICE stated that he would be out of town for the                       
  Saturday meeting and requested that the public health issue                  
  be addressed when he returns the following Wednesday.                        
                                                                               
  REP. VEZEY said, "If you snooze you lose, and we should move                 
  ahead."                                                                      
                                                                               
  REP. G. DAVIS agreed with Rep. Olberg in that the committee                  
  can address the public health issue now.                                     
                                                                               
  REP. BRICE asked Commissioner Usera where she saw the fiscal                 
  impact in his amendment.                                                     
                                                                               
  Number 990                                                                   
                                                                               
  (Rep. Bunde resumed as Chairman for the remainder of the                     
  meeting.)                                                                    
                                                                               
  CHAIR BUNDE recognized Commissioner Usera.                                   
                                                                               
  COMMISSIONER USERA said, "In the way that the amendment that                 
  Rep. Toohey... which is similar to the one we have                           
  drafted... does have some fiscal impact."  She said there                    
  will be meeting costs and travel costs associated with the                   
  concept.  She reiterated that what the DOA is trying to do                   
  is find a cost effective way to address the issue, and no                    
  one will be happy with the limitations put on the commission                 
  by fiscal constraints.  She asserted that when a bill                        
  becomes very specific, it must also be priced out                            
  specifically.  The more provisions that are mandated, the                    
  more costly the legislation becomes.                                         
                                                                               
  Number 031                                                                   
                                                                               
  REP. BRICE disagreed and said the commission needs to have                   
  direction and greater focus.  He felt there should be some                   
  type of analysis and that there would be no significant                      
  fiscal impact.  He suggested that travel and per diem could                  
  be priced down.  He felt as a policy matter that the                         
  legislature should establish clear guidelines for the                        
  function of the commission.                                                  
                                                                               
  COMMISSIONER USERA suggested that if the word "must" under                   
  subsection B, page 2, is changed to "may," it would avoid                    
  leaving the state open to law suit.  She said that she has                   
  seen more suits in the last two years than she wants to see                  
  for the rest of her lifetime because of mandates that use                    
  words like "shall" and "must."  She said if the word "may"                   
  is used, it would satisfy Rep. Brice's concerns that there                   
  be guidance for the commission, but would not lock the state                 
  into a mandate situation that could be exposed to possible                   
  litigation.                                                                  
                                                                               
  TAPE 94-41, SIDE B                                                           
  Number 000                                                                   
                                                                               
  REP. OLBERG asked if there were two sets or three sets of                    
  amendments.                                                                  
                                                                               
  REP. BRICE said he personally had three amendments.                          
                                                                               
  CHAIR BUNDE indicated that he had one set that was numbered                  
  1-4.  He then asked Rep. Brice which amendment he was                        
  speaking to.                                                                 
                                                                               
  REP. BRICE said he was speaking to his own amendment.                        
                                                                               
  REP. TOOHEY said she would withdraw her Amendment 1 to                       
  simplify matters.                                                            
                                                                               
  CHAIR BUNDE stated that Rep. Toohey withdrew her Amendment                   
  1.  He then stated that matters would be further simplified                  
  if Rep. Brice were to present a fiscal note on his                           
  amendment.                                                                   
                                                                               
  Number 052                                                                   
                                                                               
  REP. B. DAVIS asked if both Rep. Brice's amendment and the                   
  department's amendment were being discussed.                                 
                                                                               
  CHAIR BUNDE indicated that no amendment had been moved and                   
  said all were up for discussion.                                             
                                                                               
  REP. OLBERG said, "I believe that there is only one                          
  amendment that makes any changes to page 1."                                 
                                                                               
  CHAIR BUNDE said, "That being Amendment 2, by Rep. Brice."                   
  REP. OLBERG said, "No, that being Amendment 1, by                            
  Commissioner Usera."                                                         
                                                                               
  Number 077                                                                   
                                                                               
  CHAIR BUNDE indicated for clarity that Commissioner Usera's                  
  amendment would be called Administration Amendment 1.                        
                                                                               
  REP. OLBERG said, "...this amendment does not appear to                      
  conflict with any other amendment, and if we dealt with it                   
  individually, then we could cast it aside and clarify things                 
  even more."                                                                  
                                                                               
  CHAIR BUNDE thanked Rep. Olberg for his astute observation                   
  and asked him to continue.                                                   
                                                                               
  REP. OLBERG made a motion to adopt Administration Amendment                  
  1.                                                                           
                                                                               
  REP. BRICE objected for discussion purposes.                                 
                                                                               
  CHAIR BUNDE asked if all members were fixed on the correct                   
  amendment and said that it is the second page of the                         
  Administration hand-out, now labeled Administration                          
  Amendment 1 (Amendment A.1)                                                  
                                                                               
  Number 120                                                                   
                                                                               
  REP. BRICE said the amendments do not conflict conceptually                  
  except that his amendment is more in depth than the                          
  Administration Amendment 1.  He urged that the commission be                 
  established with a purpose and cited the many different                      
  aspects of public health; i.e., clean water and sewer,                       
  public health nurses, and maternal and child health care.                    
  He said he had no problem with Administration Amendment 1,                   
  but it should give focus and direction to the commission.                    
                                                                               
  REP. G. DAVIS agreed and said it would be beneficial to give                 
  as much direction as possible to the commission.  He said he                 
  would have faith in the commission that they would carry out                 
  all the provisions within Rep. Brice's amendment.                            
                                                                               
  REP. OLBERG suggested adopting Administration Amendment 1 in                 
  its entirety because it only conflicts in one area with Rep.                 
  Brice's Amendment 2.  He said then it could be set aside and                 
  they go on to Administration Amendment 2 and compare it to                   
  the adopted amendment.                                                       
                                                                               
  CHAIR BUNDE, for clarity, reiterated Rep. Olberg's                           
  suggestion.  The committee agreed to proceed accordingly.                    
                                                                               
  REP. NICHOLIA concurred and said that Rep. Toohey's and                      
  Commissioner Usera's amendments were basically the same.                     
                                                                               
  CHAIR BUNDE asked for further discussion.  He said the                       
  motion to adopt Administration Amendment 1 was before the                    
  committee.  He asked for any objections.                                     
                                                                               
  REP. BRICE objected.                                                         
                                                                               
  Number 268                                                                   
                                                                               
  CHAIR BUNDE called for the vote.  Reps. G. Davis, Vezey,                     
  Olberg, B. Davis, Nicholia, Toohey, and Bunde voted Yea, and                 
  Rep. Brice voted Nay.  Chair Bunde declared that                             
  Administration Amendment 1 was so moved.  He then brought                    
  Administration Amendment 2 to the table.                                     
                                                                               
  REP. OLBERG said, "I'd like to get on the record, Mr.                        
  Chairman, the fact that that could have been the pinnacle of                 
  my legislative career right there."                                          
                                                                               
  REP. B. DAVIS said, "We better discuss this, so that we have                 
  the intent fully on the record."                                             
                                                                               
  Number 312                                                                   
                                                                               
  COMMISSIONER USERA stated that there is concern that HB 414                  
  does not specify a single payer system.  She said many of                    
  the amendments address issues that are implicit in the bill                  
  and that the amendments would drive the costs up by being so                 
  specific.  She explained that Administration Amendment 2                     
  specifies that one of the comprehensive reform proposals to                  
  be analyzed by the commission would be a single payer                        
  system.                                                                      
                                                                               
  CHAIR BUNDE asked for discussion.  He asked for someone to                   
  move the amendment.                                                          
                                                                               
  REP. TOOHEY said it was so moved.                                            
                                                                               
  REP. OLBERG suggested to number all of the Administration                    
  amendments at one time.  He then specified Administration                    
  Amendments 3-5 (or A.3 through A.5)                                          
                                                                               
  CHAIR BUNDE said Amendment A.2 was before the committee and                  
  asked for further discussion.                                                
                                                                               
  Number 369                                                                   
                                                                               
  REP. G. DAVIS said it was his understanding that one of the                  
  key health care reform proposals is a single payer system                    
  and asked Commissioner Usera to address the issue.                           
                                                                               
  COMMISSIONER USERA stated that she thought that option would                 
  be implied in the process.  She said, "If I may be frank;                    
  this is politics.  This is... Gee, it doesn't specify that                   
  the current single payer system proposal would be one that                   
  would be there... The outline in the governor's bill is that                 
  the plans be evaluated with either those requested by the                    
  governor or by a majority vote of the commission, who are                    
  appointed by the governor, and that there might be some                      
  political brinkmanship going on which would eliminate the                    
  current single payer system as one of those being evaluated.                 
  Certainly we didn't anticipate that kind of pettiness when                   
  we did this, but if it makes people feel better, more                        
  comfortable, that would be a serious consideration for this                  
  commission.  We felt it was worth putting in the bill."                      
                                                                               
  Number 400                                                                   
                                                                               
  CHAIR BUNDE said, "New to the legislative process, are you?"                 
                                                                               
  COMMISSIONER USERA said, "No, Sir. I love it."                               
                                                                               
  REP. TOOHEY said the idea is fair because there are people                   
  in the state that would like to see the single payer system                  
  and others who would not.                                                    
                                                                               
  REP. G. DAVIS asked how employer-based and HMO would be                      
  protected without specifying their inclusion.                                
  COMMISSIONER USERA replied that the DOA could try to                         
  identify the key proposals, but it is difficult to                           
  anticipate the end result of the various proposed plans, and                 
  pointed out how dramatically the Clinton plan has changed in                 
  the period of a month.  She asserted that at least one                       
  proposal based on a single payer strategy and at least one                   
  based on a managed care approach would be reviewed by the                    
  commission.                                                                  
                                                                               
  CHAIR BUNDE said, "I would just observe for the record that                  
  this amendment does not indicate the single payer as the                     
  program that would have the priority."                                       
                                                                               
  COMMISSIONER USERA said that is correct.                                     
                                                                               
  REP. B. DAVIS made a motion to adopt Amendment A.2.                          
                                                                               
  CHAIR BUNDE, hearing no objections, said the amendment was                   
  so moved.  He indicated that there were witnesses on                         
  teleconference that wanted to testify on the legislation in                  
  general.  He further indicated that there was a person on                    
  teleconference from Seattle, Washington.                                     
                                                                               
  Number 430                                                                   
                                                                               
  STEVE LEBRAUN, Account Manager, Aetna Health Plan, testified                 
  via offnet in support of HB 414.  He stated that Aetna                       
  carries the largest share of health insurance in Alaska                      
  concentrated in benefits for larger employers in the public                  
  and private sector.  He said Aetna supports the general                      
  direction of HB 414 because it provides for immediate and                    
  achievable steps towards health care reform along with more                  
  thorough analysis of structure, costs, and alternatives of                   
  universal care.  He stated that the alternative legislation                  
  dismantles and throws out much of the current system and                     
  leaves tremendous power to an appointed commission.  He said                 
  the federal health care plan is likely to pass congress and                  
  many of the provisions would be mandatory in all states.                     
  Individual employers should have the opportunity to review                   
  and evaluate the most important details of health care                       
  reform, costs, benefit level, impact on quality, and impact                  
  on choice before having to decide whether to afford major                    
  changes in the Alaska delivery system.  He maintained that                   
  many details of the proposals, both federal and state, are                   
  not available and said there is no consensus on the best way                 
  to change the current system to allow for universal and more                 
  affordable health care.                                                      
                                                                               
  MR. LEBRAUN further stated that he supported the requirement                 
  for a single payer form and the creation of voluntary                        
  purchasing pools for small employers and individuals.  He                    
  said the use of purchasing pools would address the                           
  portability problems under the current system.  He also                      
  recommended purchasing pools be used for people in between                   
  employment.  He further recommended the use of electronic                    
  filing systems and electronic medical records and billing                    
  systems to reduce the "hassle factor" for consumers and to                   
  improve data collection capabilities.                                        
                                                                               
  MR. LEBRAUN stated that the disclosure of provider rates                     
  would better inform the consumer and would facilitate better                 
  coordination of public health programs with emphasis on                      
  preventive care.  He indicated that the long term objective                  
  for the commission would be to provide the simplest and most                 
  cost effective means of providing universal care by                          
  directing alternate benefit plans, ranging from catastrophic                 
  care to comprehensive.  The commission should estimate the                   
  cost of each alternative and suggest the most appropriate                    
  way to administer the plans.  Mr. Lebraun suggested that if                  
  federal health care acts pass this year, the commission                      
  could also determine whether Alaska should take action.  He                  
  indicated that there are provisions within HB 414 regarding                  
  the proposed form of rate regulation and the arbitration                     
  section and Aetna was concerned about those issues.  He said                 
  that further commentary would be sent in writing upon                        
  request to the committee regarding those issues.                             
                                                                               
  Number 587                                                                   
                                                                               
  CHAIR BUNDE asked for the written commentary.  He then asked                 
  for teleconference testimony from BONNIE NELSON.  There was                  
  no response from teleconference.  He then said that                          
  Administration Amendment 3 (A.3) was before the committee.                   
                                                                               
  REP. OLBERG made a motion to adopt Administration Amendment                  
  3 and also pointed out that there are three proposed                         
  amendments regarding page 5, line 6, and they are                            
  conflicting.  He indicated that he had carefully reviewed                    
  the page and line references of all the amendments and                       
  sorted out any conflicts.                                                    
                                                                               
  CHAIR BUNDE asked Commissioner Usera to clarify a technical                  
  amendment to her amendment.                                                  
                                                                               
  COMMISSIONER USERA said the amendment is a list of what the                  
  commission shall do and would add a new Section 7 after the                  
  adoption of the first amendment and would be renumbered                      
  accordingly.                                                                 
                                                                               
  Number 643                                                                   
                                                                               
  REP. BRICE said he did not see where his amendment and                       
  Commissioner Usera's amendment were conflicting.                             
                                                                               
  REP. OLBERG said that Administration Amendment 1 establishes                 
  a public health advisory committee and Rep. Brice's                          
  amendment establishes a public health improvement plan                       
  advisory committee.  He asked if the two were synonymous.                    
                                                                               
  Number 657                                                                   
                                                                               
  REP. BRICE suggested that may be the same.                                   
                                                                               
  CHAIR BUNDE asked the members to address Amendment A.3.                      
                                                                               
  REP. OLBERG stated that Amendment A.3 adds Section 7 to page                 
  5 after line 6; but Amendment A.1 and Rep. Brice's amendment                 
  conflict because they both establish a public health                         
  improvement plan advisory committee.                                         
                                                                               
  COMMISSIONER USERA said Rep. Brice's amendment is not on the                 
  table for discussion.                                                        
                                                                               
  CHAIR BUNDE indicated that Amendment A.1 has been adopted                    
  and asked for Rep. Brice to address his amendment.                           
                                                                               
  REP. BRICE asserted that if his amendment was adopted it                     
  would be Section 8.                                                          
                                                                               
  REP. OLBERG maintained that all Amendment A.3 does is add                    
  Section 7 to page 5, line 6.                                                 
  COMMISSIONER USERA indicated that it is the DOA's intention                  
  for the commission to collect information in aggregate from                  
  providers who would by regulation be required to provide the                 
  information in that form.  She also said that the state                      
  would need federal waivers because of some of the                            
  confidentiality provisions in federal programs needed to                     
  collect necessary information.  She indicated that a fiscal                  
  note of approximately $100,000 is associated with the                        
  amendment, because to travel to Washington, D.C., costs                      
  time, money and lawyers.  She said the estimate came from                    
  the Division of Insurance as what they felt it would cost to                 
  obtain federal waivers.                                                      
                                                                               
  Number 712                                                                   
                                                                               
  CHAIR BUNDE said, "We're looking at a program now that                       
  costs... let's just round that off to $1 million."                           
                                                                               
  REP. G. DAVIS asked Commission Usera if there is anything in                 
  the federal health care proposals that might reduce or                       
  eliminate the waivers.                                                       
                                                                               
  COMMISSIONER USERA said she would defer to Deputy Commission                 
  Jay Livey on that question.                                                  
                                                                               
  Number 720                                                                   
                                                                               
  JAY LIVEY, Deputy Commissioner, Department of Health and                     
  Social Services, testified on HB 414.  He stated that the                    
  federal waivers are ERISA (Employee Retirement Security Act)                 
  waivers that state that states do not have the authority to                  
  regulate people who self-insure.  The amendment would allow                  
  the state to obtain waivers so the proper information could                  
  be obtained for those who are self-insuring.  He was not                     
  sure if this was relative to all the bills that address                      
  comprehensive health care.                                                   
                                                                               
  Number 740                                                                   
                                                                               
  REP. G. DAVIS said that federal legislation would amend                      
  ERISA.                                                                       
                                                                               
  COMMISSIONER LIVEY agreed.                                                   
                                                                               
  CHAIR BUNDE asked for further testimony or discussion on                     
  Amendment A.3.                                                               
                                                                               
  REP. B. DAVIS made a motion to adopt Amendment A.3.                          
                                                                               
  CHAIR BUNDE, hearing no objections, said Amendment A.3 was                   
  so moved.  He then brought Administration Amendment 4 to the                 
  table.                                                                       
                                                                               
  REP. OLBERG made a motion to adopt Amendment A.4 and                         
  explained that it would add verbiage to four different                       
  pages.                                                                       
                                                                               
  Number 764                                                                   
                                                                               
  COMMISSIONER USERA stated that pooling to provide insurance                  
  coverage for children needed to be addressed and the                         
  amendment addresses that concern.                                            
                                                                               
  CHAIR BUNDE asked for questions or objections.  Hearing                      
  none, Chair Bunde stated that Amendment A.4 had been                         
  accepted.  He then brought Administration Amendment 5 to the                 
  table.                                                                       
                                                                               
  REP. OLBERG made a motion to adopt Amendment A.5.                            
                                                                               
  Number 794                                                                   
                                                                               
  COMMISSIONER USERA addressed the amendment.  She said there                  
  is a need to ensure greater consumer participation in the                    
  health care process and the intent of the amendment would                    
  require providers to have a rate sheet for standard                          
  procedures.  Additionally, it requires, upon request of the                  
  consumer, that a specific estimate be provided for the costs                 
  based on an evaluation of the consumer's physical condition.                 
  She said if the provider fails to comply and a complaint is                  
  filed, an annual penalty of $500 would be charged to the                     
  provider.  She then said that once a penalty had been                        
  enforced in a calendar year, the provider would not be                       
  assessed any additional penalties.  She maintained that                      
  currently most providers have rate sheets, and only                          
  penalizing one time for a considerable dollar amount would                   
  help curtail providers from engaging in the appeal process.                  
                                                                               
  TAPE 94-42, SIDE A                                                           
  Number 000                                                                   
                                                                               
  CHAIR BUNDE asked if it would be the provider's                              
  responsibility to inform the consumer that there is a rate                   
  sheet.                                                                       
                                                                               
  COMMISSIONER USERA explained that there is a provision                       
  within HB 414 that requires the provider to disclose to the                  
  consumer that they are entitled to the rate sheet and                        
  estimate information.  It must either be posted or it must                   
  be contained in some type of a disclosure form.                              
                                                                               
  CHAIR BUNDE said it was his hope that people could look                      
  after themselves.                                                            
                                                                               
  COMMISSIONER USERA indicated that the amendment would read,                  
  "A provider shall place the following statement either on a                  
  form to be signed by the patient or in a conspicuous                         
  location on an easily readable sign:  You are entitled to a                  
  charge estimate for a medical procedure before the procedure                 
  is performed by your health provider."                                       
                                                                               
  Number 057                                                                   
                                                                               
  REP. TOOHEY said she would prefer to see a sign displayed at                 
  the front reception area of a doctor's office.  She said                     
  there should also be a list of charges posted to make the                    
  consumers aware of their choices.                                            
                                                                               
  REP. BRICE suggested that perhaps provider's rates could be                  
  included in their advertising as well.                                       
                                                                               
  REP. OLBERG indicated that there are four references to page                 
  7, line 22, interspersed among the submitted amendments.  He                 
  said two of the amendments are similar and two are not.  He                  
  suggested that if Amendment A.5 were adopted, then it could                  
  be fine tuned with Rep. Toohey's Amendment 3, then Rep.                      
  Brice's and Toohey's Amendment 4 could be included as                        
  friendly amendments.                                                         
                                                                               
  CHAIR BUNDE thanked Rep. Olberg for his guidance.                            
                                                                               
  REP. B. DAVIS proposed an amendment to the amendment and                     
  indicated that the language specifies up to $500, not a flat                 
  $500 penalty.  She said she would like the penalty to be up                  
  to $1000.                                                                    
                                                                               
  COMMISSIONER USERA said she would consider it a friendly                     
  amendment.                                                                   
                                                                               
  CHAIR BUNDE asked Rep. B. Davis to move the amendment.                       
                                                                               
  REP. B. DAVIS made a motion to amend Amendment A.5 to change                 
  the penalty to "up to $1000."  She then specified the line                   
  change in the amendment.                                                     
                                                                               
  CHAIR BUNDE asked for questions, discussion, or objections.                  
  Hearing none, Chair Bunde stated that the amendment to                       
  Amendment A.5 was so moved.  He then asked Rep. Toohey if                    
  she would like to propose an amendment.                                      
                                                                               
  REP. TOOHEY stated that she would like to amend Amendment                    
  A.5 to include a provision that would require the mandatory                  
  posting of rates and estimates in the providers front                        
  reception area.                                                              
                                                                               
  COMMISSIONER USERA indicated that the change would go under                  
  subsection A of the adopted Amendment A.5.  She then                         
  indicated that some practitioners would have to supply "a                    
  blue book" of the costs, citing that they offer so many                      
  different procedures.  She said that the list could be                       
  limited to the top 20 procedures or grouped by diagnosis                     
  related categories.  She then asked Rep. Toohey if it would                  
  be practical.                                                                
                                                                               
  Number 283                                                                   
                                                                               
  REP. TOOHEY agreed that it may not be practical, but there                   
  should be a notice that indicates that prices are available                  
  upon request.                                                                
                                                                               
  COMMISSIONER USERA said that Rep. Toohey's proposed                          
  amendment could be added to subsection C of Amendment A.5.                   
  She said the phrase for a list of standard charges could be                  
  added at the end of the subsection.                                          
                                                                               
  CHAIR BUNDE asserted that the language is redundant because                  
  the consumer would be entitled to a charge estimate and                      
  would also be entitled to a list of procedures.  He asked                    
  how many procedures would a consumer inquire about in one                    
  day.                                                                         
                                                                               
  Number 330                                                                   
                                                                               
  REP. BRICE asked what the cost would be to have a data base                  
  established where a consumer could call a state number, use                  
  a touch-tone phone on a menu system to obtain information on                 
  providers in specific areas, and then be transferred to a                    
  voice mail box of a chosen provider who would then have a                    
  menu system to provide procedural costs.                                     
                                                                               
  COMMISSIONER USERA stated that there is a provision in an                    
  alternative bill that requires the rates to be reported to                   
  the commission.  She said her amendment would not require                    
  that and the fiscal note associated with it would be                         
  astronomical.                                                                
                                                                               
  REP. BRICE said he knows that the system is being used in                    
  other states and that some one in the private sector is                      
  profiting from it.                                                           
                                                                               
  CHAIR BUNDE suggested that the list of rates for common                      
  procedures be provided.                                                      
                                                                               
  REP. TOOHEY said she withdrew her amendment.                                 
                                                                               
  Number 406                                                                   
                                                                               
  CHAIR BUNDE stated that Amendment A.5 was before the                         
  committee and asked for a motion.                                            
                                                                               
  REP. B. DAVIS made a motion to adopt Amendment A.5.                          
                                                                               
  CHAIR BUNDE, hearing no objections, announced that Amendment                 
  A.5 was so moved.                                                            
                                                                               
  REP. B. DAVIS asked if Rep. Brice's amendments were going to                 
  be addressed.                                                                
                                                                               
  REP. BRICE made a motion to adopt his amendment.                             
                                                                               
  Number 421                                                                   
                                                                               
  CHAIR BUNDE asked Rep. Brice to speak to his amendment.  He                  
  then indicated that due to technical difficulties earlier,                   
  teleconference testimony from Anchorage had been postponed                   
  and proceeded to ask for teleconference testimony from                       
  BONNIE NELSON.                                                               
                                                                               
  Number 425                                                                   
                                                                               
  BONNIE NELSON, Representative, Alaska Public Interest                        
  Research Group (AKPIRG), testified via teleconference on HB
  414.  She stated that AKPIRG supports a single payer system                  
  and urged the committee to include the plan.  She also said                  
  that she would like to see the elimination of the                            
  restrictions on preexisting conditions.  She said she also                   
  would like to see that type of discrimination eliminated                     
  from private insurance companies.  She indicated that the                    
  Americans with Disabilities Act requires employers to hire                   
  handicapped persons, but if the person is medically                          
  expensive, their claim affects the businesses' premium rates                 
  and she felt that it was unfair for both large and small                     
  businesses.                                                                  
                                                                               
  MS. NELSON further stated that AKPIRG also recommends that                   
  the commission be comprised of a broad range of consumers.                   
  She said the Clinton proposal indicates that a commission                    
  member may not have any official relations to companies or                   
  providers that pose a conflict of interest, i.e. health care                 
  providers and insurance companies.  She continued to read                    
  from the provisions in the Clinton proposal that specified                   
  the varying types of conflicts of interest.                                  
                                                                               
  Number 604                                                                   
                                                                               
  CHAIR BUNDE stated that the committee had the information                    
  that Ms. Nelson was reading from and thanked her for her                     
  testimony.                                                                   
                                                                               
  REP. TOOHEY asked if Ms. Nelson was recommending that                        
  commission members not be members of the medical community.                  
                                                                               
  MS. NELSON said she was not recommending that they not be                    
  from the medical community and suggested that a retired                      
  doctor could participate as a member.  She said there should                 
  be no monetary conflict of interest.  She felt there should                  
  be persons with expertise, but conflicts of interests should                 
  be avoided.                                                                  
                                                                               
  Number 635                                                                   
                                                                               
  REP. BRICE said, "...possibly on page 2, section B, to                       
  alleviate the concerns of the department maybe we can... on                  
  that line... state... the plan developed by the committee                    
  under A of this section should recognize the need... to                      
  probably take it down a step with a little bit... take it                    
  down a step from shall and to make sure that there's a lot                   
  of concern here to address these questions."                                 
                                                                               
  COMMISSIONER USERA offered language that she felt would                      
  address the concern.  She indicated that Amendment A.1,                      
  subsection A, would be referenced to page 1, section A of                    
  Rep. Brice's amendment.  She said the sentence, "The                         
  commission shall consider public and private health care                     
  professionals, labor organizations, businesses, the                          
  educational system, the Alaska Public Health Association,                    
  the Alaska Mental Health Board, and the Alaska Native Health                 
  Board to serve on the public health advisory committee as                    
  well as recognizing the need for geographic, ethnic, and                     
  cultural diversity..." would be inserted at the end of the                   
  subsection.                                                                  
                                                                               
  REP. BRICE said the language was acceptable to him.                          
                                                                               
  Number 699                                                                   
                                                                               
  CHAIR BUNDE asked if the change was too much to be a                         
  technical amendment or is it an amendment to the amendment?                  
                                                                               
  REP. BRICE suggested that it would be an amendment to the                    
  amendment.                                                                   
                                                                               
  CHAIR BUNDE asked if Rep. Brice would propose that                           
  Amendment A.1 be amended with the aforementioned language.                   
                                                                               
  REP. BRICE said, "So moved."                                                 
                                                                               
  CHAIR BUNDE asked Commissioner Usera to repeat the language.                 
                                                                               
  COMMISSIONER USERA said in Amendment A.1, Section 6,                         
  subsection A, line 3, after the period following the word                    
  commission, the following sentence would be inserted:  "The                  
  commission shall consider public and private health care                     
  professionals... and the Alaska Native Health Board to serve                 
  on the Public Health Advisory Committee as well as recognize                 
  the need for geographic, ethnic, and cultural diversity."                    
                                                                               
  CHAIR BUNDE stated that the motion was before committee.  He                 
  asked for discussion or objections.  Hearing none, Chair                     
  Bunde indicated that the amendment to Amendment A.1 had been                 
  adopted.                                                                     
                                                                               
  Number 732                                                                   
                                                                               
  COMMISSIONER USERA suggested an amendment that would add                     
  subsection C to Amendment A.1.  She said, "...establish a                    
  public health advisory committee which... there would be a                   
  subsection C... may develop a public health implementation                   
  improvement plan... which (1) recognizes the need for...                     
  goes down as is included in Rep. Brice's amendment.  And,                    
  (2) may include... and the rest of that section remains the                  
  same."                                                                       
                                                                               
  REP. BRICE made a motion to adopt the proposed amendment to                  
  Amendment A.1.                                                               
                                                                               
  CHAIR BUNDE, hearing no objections, stated that the                          
  amendment was so moved.  He then said he hoped to see the                    
  revised workdraft before the next meeting and suggested that                 
  the committee would further discuss the bill before passing                  
  it out of committee.                                                         
                                                                               
  COMMISSIONER USERA indicated that the department would                       
  update fiscal notes accordingly to accompany the new                         
  committee substitute (CS).                                                   
                                                                               
  REP. TOOHEY reminded all those present that there would be a                 
  meeting on Saturday, March 12, 1994 to further discuss and                   
  work on HB 414.                                                              
                                                                               
  Seeing no further business before the committee, CHAIR BUNDE                 
  ADJOURNED meeting at 4:43 p.m.                                               

Document Name Date/Time Subjects