Legislature(2015 - 2016)CAPITOL 106

01/22/2015 03:00 PM HEALTH & SOCIAL SERVICES


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Audio Topic
03:04:07 PM Start
03:05:28 PM Overview: Department of Health and Social Services
05:01:55 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Committee Introductions TELECONFERENCED
+ Department Overview: Health & Social Services by TELECONFERENCED
Commissioner Val Davidson, Chief Medical Officer
Dr. Jay Butler & Other Department Personnel
-- Teleconference Listen Only --
-- Testimony <Invitation Only> --
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                        January 22, 2015                                                                                        
                           3:04 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Paul Seaton, Chair                                                                                               
Representative Liz Vazquez, Vice Chair                                                                                          
Representative Neal Foster                                                                                                      
Representative Louise Stutes                                                                                                    
Representative David Talerico                                                                                                   
Representative Geran Tarr                                                                                                       
Representative Adam Wool                                                                                                        
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
OVERVIEW: DEPARTMENT OF HEALTH AND SOCIAL SERVICES                                                                              
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
VALERIE DAVIDSON, Commissioner Designee                                                                                         
Office of the Commissioner                                                                                                      
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented a power point overview of the                                                                  
Department of Health and Social Services.                                                                                       
                                                                                                                                
JAY BUTLER, MD, Chief Medical Officer/Director                                                                                  
Division of Public Health                                                                                                       
Central Office                                                                                                                  
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during the overview of                                                                
Department of Health and Social Services.                                                                                       
                                                                                                                                
JON SHERWOOD, Deputy Commissioner                                                                                               
Medicaid and Health Care Policy                                                                                                 
Office of the Commissioner                                                                                                      
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:     Answered   questions  during   the  DHSS                                                             
overview.                                                                                                                       
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:04:07 PM                                                                                                                    
                                                                                                                                
CHAIR PAUL  SEATON called  the House  Health and  Social Services                                                             
Standing   Committee    meeting   to    order   at    3:04   p.m.                                                               
Representatives Seaton,  Vazquez, Tarr,  Wool, and  Talerico were                                                               
present at the call to  order.  Representatives Foster and Stutes                                                               
arrived as the meeting was in progress.                                                                                         
                                                                                                                                
3:05:28 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced that the  first order of business would be                                                               
for each  committee member  to introduce  themselves and  share a                                                               
brief account  of their interest  for participation on  the House                                                               
Health and Social Services Standing Committee.                                                                                  
                                                                                                                                
REPRESENTATIVE TARR  said that  she was  interested in  Vitamin D                                                               
and improving  health outcomes, as her  interests included mental                                                               
health,  substance  abuse  treatment,   and  child  sexual  abuse                                                               
prevention.                                                                                                                     
                                                                                                                                
REPRESENTATIVE  VAZQUEZ explained  that  she had  a "passion  for                                                               
health care," noting that she had  an MBA in health care services                                                               
administration.  She looked forward  to working on improvement of                                                               
outcomes, and she expressed her support for prevention.                                                                         
                                                                                                                                
REPRESENTATIVE  WOOL reported  that his  family were  all in  the                                                               
health industry, and  that he was a consumer of  health care.  He                                                               
expressed  concern for  the difficulty  in obtaining  health care                                                               
and health care insurance.                                                                                                      
                                                                                                                                
REPRESENTATIVE  FOSTER  shared  his  success  with  his  personal                                                               
health  since regularly  taking Vitamin  D.   He  noted that  his                                                               
primary  interest was  for directing  attention  to the  villages                                                               
across the state.                                                                                                               
                                                                                                                                
REPRESENTATIVE  TALERICO reported  that,  as he  had 43  distinct                                                               
communities in his  district, he had an  interest in telemedicine                                                               
for the delivery of health care services.                                                                                       
                                                                                                                                
CHAIR  SEATON  shared his  interest  for  better health  outcomes                                                               
relative  to   the  expense,  and   that  he  wanted   to  ensure                                                               
improvement to the health of  Alaskans, with a focus on improving                                                               
basic  health.   He  declared  that this  would  have a  positive                                                               
impact on  all budgets.   He pointed  out that the  Department of                                                               
Health and Social Services had  a myriad of responsibilities.  He                                                               
stated that  he would like  to make upstream changes,  instead of                                                               
waiting  until  the  conditions   were  downstream  and  required                                                               
expensive treatments.   He emphasized  that the  committee mantra                                                               
would be prevention.                                                                                                            
                                                                                                                                
REPRESENTATIVE STUTES  said that she  wanted to learn  about ways                                                               
to keep Alaskans  healthy and to participate  in keeping Alaskans                                                               
healthy.                                                                                                                        
                                                                                                                                
^OVERVIEW: DEPARTMENT OF HEALTH AND SOCIAL SERVICES                                                                           
       OVERVIEW: DEPARTMENT OF HEALTH AND SOCIAL SERVICES                                                                   
                                                                                                                                
3:12:12 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced  that the next order of  business would be                                                               
an overview by the Department of Health and Social Services.                                                                    
                                                                                                                                
3:14:02 PM                                                                                                                    
                                                                                                                                
VALERIE   DAVIDSON,   Commissioner   Designee,  Office   of   the                                                               
Commissioner, Department  of Health  and Social  Services (DHSS),                                                               
shared  that she  had been  an  early childhood  teacher and  she                                                               
believed strongly  in early childhood opportunities.   She stated                                                               
that the  sooner there were  good relationships  between children                                                               
and health  care providers, the  better the experiences  later in                                                               
life.  She reported that she had  worked for the past 15 years in                                                               
the Alaska Tribal Health system,  including the past 8 years with                                                               
the  Alaska Native  Tribal Health  Consortium (ANTHC),  which was                                                               
statewide.     She   shared  that   the  Yukon-Kuskokwim   Health                                                               
Corporation in  Bethel was very  innovative for  providing health                                                               
care services.  She offered  an overview of the department, slide                                                               
2, "Alaska Department of Health  and Social Services Organization                                                               
Chart."  She moved on to  slides 3 and 4, "Executive Leadership,"                                                               
and introduced those in attendance.                                                                                             
                                                                                                                                
COMMISSIONER  DAVIDSON,  in   response  to  Representative  Tarr,                                                               
explained that the Division of  Behavioral Health was now aligned                                                               
with the Division of Public Assistance.                                                                                         
                                                                                                                                
3:22:37 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  DAVIDSON  directed attention  to  slides  5 and  6,                                                               
"Health & Social Services," noting  that Department of Health and                                                               
Social  Services  had  eight  divisions.    She  introduced  each                                                               
division and its director.                                                                                                      
                                                                                                                                
3:25:31 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON, referencing the Divisions  of Public Assistance and                                                               
Senior  and   Disability  Services,  asked  which   division  was                                                               
responsible for public assistance to seniors.                                                                                   
                                                                                                                                
COMMISSIONER   DAVIDSON  replied   that  all   public  assistance                                                               
programs were housed under the Division of Public Assistance.                                                                   
                                                                                                                                
3:26:04 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  DAVIDSON,  addressing  slide  7,  stated  that  the                                                               
vision   for  the   department   was  to   ensure  that   "Alaska                                                               
individuals, families,  and communities really are  safe and they                                                               
are  as  healthy  as  possible."    She  listed  the  three  main                                                               
priorities of  the department:   health  and wellness  across the                                                               
life span; health care access,  delivery, and value; and safe and                                                               
responsible individuals,  families, and communities.   She stated                                                               
that this  focus for priorities  included core services,  and she                                                               
acknowledged  that  the  budget   was  linked  to  results  based                                                               
accountability.   She reported that  the former  commissioner had                                                               
done  a good  job  ensuring  that the  budgets  aligned with  the                                                               
departmental priorities, which  she opined was not  an easy task.                                                               
She  stated that  data  was  still incoming  and  there would  be                                                               
further alignment.                                                                                                              
                                                                                                                                
3:27:29 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON asked  if there  were plans  for accomplishing  the                                                               
priorities  and the  goals,  as the  committee  wanted to  ensure                                                               
there was  a "mechanism to  accomplish each one of  those goals."                                                               
He stated that the current position  of health care in Alaska did                                                               
not have an enviable ranking in the US.                                                                                         
                                                                                                                                
COMMISSIONER DAVIDSON, in response,  directed attention to slides                                                               
8 -  11, "Areas of  primary focus (4)."   She explained  that the                                                               
first focus  was to provide  access to health care  for Alaskans,                                                               
which included a commitment to  Medicaid expansion, as there were                                                               
more than 40,000 Alaskans who did  not have access to health care                                                               
and would be eligible.  She  declared that, in the short term, it                                                               
was important  to get individuals  as healthy as  possible during                                                               
this period  when the  federal government  offered a  100 percent                                                               
match  to Medicaid.   She  explained  that the  longer term  goal                                                               
recognized  that there  were changes  necessary  to the  Medicaid                                                               
program, both the  current and expanded recipients,  in order for                                                               
its delivery  to be as  efficient as possible.   She acknowledged                                                               
that  there   were  significant  systems  challenges   to  enroll                                                               
individuals in  the Medicaid expansion.   She referenced  the two                                                               
system  conversions, which  included the  eligibility information                                                               
system  for Medicaid  and other  public assistance,  which was  a                                                               
year late in coming on line  and was experiencing a backlog.  She                                                               
explained that the other major  system change was to the Medicaid                                                               
payment system,  now called  the Medicaid  Management Information                                                               
System  (MMIS).     She  reported  that  this   system  also  had                                                               
significant  challenges for  accuracy  and  timeliness of  claims                                                               
payments  to  providers.    Noting  that,  in  order  to  proceed                                                               
responsibly, it was necessary to  ensure the systems were running                                                               
sufficiently, she shared  her anticipation for a  July start date                                                               
to  Medicaid expansion,  even as  this could  mean an  aggressive                                                               
push to meet this goal.                                                                                                         
                                                                                                                                
3:33:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE STUTES asked whether  the Department of Health and                                                               
Social Services (DHSS)  was going to work with  the Department of                                                               
Corrections  (DOC) for  mental health  evaluation to  inmates as,                                                               
she  opined, there  was a  disconnect between  the two  services.                                                               
She  suggested  this could  alleviate  the  burden on  the  penal                                                               
system.                                                                                                                         
                                                                                                                                
COMMISSIONER DAVIDSON  in response, expressed her  agreement with                                                               
early  intervention   opportunities  in   order  to   forego  the                                                               
construction of  another prison.   She reported that there  was a                                                               
recidivism  effort which  included both  departments, as  well as                                                               
the Alaska Court  System and local communities.   She stated that                                                               
the correction  system was  filled with  people "who  wouldn't be                                                               
there if  we provided adequate  alcohol or other  substance abuse                                                               
treatment," declaring  that these  were resources that  were very                                                               
well  spent.   She  compared  that  this  was  the same  as  with                                                               
Medicaid expansion,  as behavioral health services  were covered.                                                               
She pointed  out that, as  the Patient Protection  and Affordable                                                               
Care  Act   required  behavioral  health  parity,   this  was  an                                                               
opportunity  to interrupt  that  cycle in  corrections and  child                                                               
welfare issues.   She  opined that  too often  the focus  was too                                                               
late and  that earlier  intervention could stop  the cycle.   She                                                               
reported  that there  would be  savings for  DOC as  inmates were                                                               
eligible under  Medicaid expansion for health  care costs outside                                                               
the facility.   She declared  that the challenge was  for timing,                                                               
to ensure  that people  could be  enrolled and  receive services.                                                               
She  pointed out  that there  were also  some short  term savings                                                               
with Medicaid  expansion, including catastrophic  coverage, which                                                               
was currently  paid out of the  general fund.  For  a longer term                                                               
strategy,  as Medicaid  was $1.7  billion of  the DHSS  budget of                                                               
$2.7 billion,  she offered  her belief that  it was  necessary to                                                               
review  the use  of  Medicaid  services in  Alaska  and design  a                                                               
program that worked for Alaska.                                                                                                 
                                                                                                                                
3:38:12 PM                                                                                                                    
                                                                                                                                
COMMISSIONER   DAVIDSON   shared    that   there   were   current                                                               
opportunities to realize savings,  including funding projects for                                                               
long  term care  facilities  and skilled  nursing facilities,  so                                                               
care for elders  could be provided closer to home.   She reported                                                               
that there was  a 100 percent match for these  services, if three                                                               
requirements  were   met:    an   Indian  Health   Service  (IHS)                                                               
beneficiary, an  Alaska Native, or  a Medicaid beneficiary  at an                                                               
IHS facility.  She clarified  that this was already available and                                                               
would  continue under  the Medicaid  expansion.   She  referenced                                                               
Senate  Bill 61  which  looked  at the  prospects  for Alaska  to                                                               
leverage opportunities  and partnerships  with the  tribal health                                                               
system  to recognize  savings.   She  listed the  long term  care                                                               
services and  behavioral health  services for  residential, home,                                                               
and community, as two of  these opportunities.  She mentioned the                                                               
super  utilizer program,  which focuses  on reducing  the use  of                                                               
emergency  departments.   Although  Medicaid beneficiaries  often                                                               
made use  of emergency departments,  DHSS was working  with these                                                               
recipients to  better manage  their care  through a  primary care                                                               
provider.   She acknowledged that  the emergency room  had become                                                               
the first  resort for people without  medical coverage, resulting                                                               
in  a significant  bill for  uncompensated care.   She  suggested                                                               
that Medicaid expansion could teach  people more appropriate ways                                                               
to  access health  care.    She allowed  that  DHSS  was open  to                                                               
suggestions for  change, and she  was looking at  the experiences                                                               
of other states for best practice models.                                                                                       
                                                                                                                                
3:44:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FOSTER  asked whether there were  any transitional                                                               
costs to the state during  the Medicaid expansion and its initial                                                               
100 percent payment by the federal government.                                                                                  
                                                                                                                                
COMMISSIONER DAVIDSON  explained that Medicaid  expansion allowed                                                               
states to  be reimbursed  at 100 percent  during 2014,  2015, and                                                               
2016.  For  the next three calendar years, 2017,  2018, and 2019,                                                               
the  federal  match  would  transition from  95  percent,  to  94                                                               
percent, and then to 93 percent.   In 2020, this would transition                                                               
to a 90 percent federal match,  where it would remain.  Directing                                                               
attention to  the transition costs  for Alaska, she  informed the                                                               
committee that there  was an administrative match  for 50 percent                                                               
of cost,  as well as a  90 percent match for  systems improvement                                                               
and changes.                                                                                                                    
                                                                                                                                
COMMISSIONER  DAVIDSON,  in  response to  Representative  Foster,                                                               
said  that  the  budget,  including transition  costs,  would  be                                                               
provided soon  after the governor's budget  statement, though she                                                               
opined that this would be less than anticipated.                                                                                
                                                                                                                                
3:47:53 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON asked for more  information regarding the enrollment                                                               
system.                                                                                                                         
                                                                                                                                
COMMISSIONER  DAVIDSON   said  that   the  first  phase   of  the                                                               
enrollment system,  the Medicaid determination, had  been delayed                                                               
a year.   She  noted that the  second phase,  including Temporary                                                               
Assistance to  Needy Families (TANF)  and food  assistance, would                                                               
go  live   after  that.     She  said  that   mandatory  overtime                                                               
requirements  were  about  to  be   implemented  to  ensure  that                                                               
individuals  would  be  enrolled  and to  diminish  some  of  the                                                               
backlogs.  She offered that more  progress had been made with the                                                               
enrollment   system  than   the  payment   system,  noting   that                                                               
litigation had begun against Xerox  by the former administration.                                                               
She   reported  that   the  contract   with  Xerox   required  an                                                               
administrative   hearing,   which   would    be   heard   by   an                                                               
administrative  law judge  in February.   She  reported that  the                                                               
state had hired  an independent consultant to review  the work by                                                               
Xerox and write  an independent assessment for the  program.  She                                                               
noted that  Xerox had submitted  a performance  improvement plan,                                                               
which  was being  reviewed.    She offered  her  belief that  the                                                               
situation was  direr than she  had realized, and  that Department                                                               
of  Health   and  Social  Services  would   be  more  transparent                                                               
regarding the problems  with these systems.  She  opined that the                                                               
public  deserved  to  be  more  aware  of  the  backlog  and  the                                                               
situation,  and that  the department  should  be accountable  for                                                               
fixing  the  systems.    She reported  that  the  providers  were                                                               
working with the health care  services to ensure that workarounds                                                               
were in place to guarantee payment.                                                                                             
                                                                                                                                
CHAIR SEATON expressed his disappointment  in the rollout for the                                                               
program, and for  the lack of dual accounting.   He said that his                                                               
office had contacted the State  of Massachusetts when researching                                                               
the problems with Xerox, as  that state had incorporated the same                                                               
system.   He reported that  Massachusetts had the  same problems.                                                               
He asked if the problems in Massachusetts had been resolved.                                                                    
                                                                                                                                
COMMISSIONER   DAVIDSON  acknowledged   that  other   states  had                                                               
contracts with Xerox, although, she  opined, as other states were                                                               
managed care states, it was  not necessary to have the capability                                                               
to  process as  many claims  as Alaska.   She  stated that  other                                                               
states were also in litigation with  Xerox.  She pointed out that                                                               
the systems  in other states  were designed to do  very different                                                               
things.                                                                                                                         
                                                                                                                                
3:54:35 PM                                                                                                                    
                                                                                                                                
COMMISSIONER DAVIDSON,  directing attention back to  the areas of                                                               
primary  focus,  slide  9, "Child  welfare/keeping  our  children                                                               
safe," and reported that more  than 2400 Alaskan children were in                                                               
out of  home placements,  more than  at any  previous time.   She                                                               
expressed concern for  the resources and the  programs to prevent                                                               
this.                                                                                                                           
                                                                                                                                
COMMISSIONER  DAVIDSON moved  on  to the  third  area of  primary                                                               
focus, slide 10,  "Tribal and Federal Partnerships."   She stated                                                               
that  it was  necessary  to have  this out  front  and center  to                                                               
enhance  the State  of  Alaska's  relationships and  partnerships                                                               
with tribal  organizations and the federal  government, including                                                               
the  federal  Departments  of  Interior   and  Health  and  Human                                                               
Services, to  make sure that  barriers which are standing  in the                                                               
way of progress are removed.   She pointed out that Alaska Native                                                               
children  comprised  between  17  -   20  percent  of  the  state                                                               
population, but  comprised 60 percent  of the children in  out of                                                               
home placements.   She  declared that, as  neither the  state nor                                                               
the federal agencies could solve  this problem alone, it was time                                                               
for the  focus to change  from who  was providing the  service to                                                               
what was  being done for the  children, and who could  do what to                                                               
help  get there.   She  acknowledged the  work between  Office of                                                               
Children's  Services and  the  tribal  organizations, but  opined                                                               
that it was necessary to  be more aggressive for leveraging these                                                               
partnerships  and  opportunities.     She  declared  that  tribal                                                               
organizations  had been  ready for  this for  a long  time.   She                                                               
offered her belief that the  commitment to the children should be                                                               
the focus beyond those ideas  for the right solution, noting that                                                               
trust building only happened over time.                                                                                         
                                                                                                                                
3:59:28 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON asked whether there  were particular barriers to the                                                               
legislature  or   to  the  administration  in   working  on  this                                                               
partnership.                                                                                                                    
                                                                                                                                
COMMISSIONER  DAVIDSON  replied  that although  there  were  some                                                               
agreements with the Tanana Chiefs  Conference for better tribal -                                                               
state  partnership,  there  were   challenges  for  getting  them                                                               
information, especially  about child welfare cases.   She allowed                                                               
that there  would be some administrative  discretion although the                                                               
governor had agreed  to work across departments  to address these                                                               
issues.  She  suggested that it was necessary for  clarity in the                                                               
statutes to  help remove  any of  the barriers.   She  offered to                                                               
relay more  in-depth information.   She concluded with  slide 11,                                                               
"Improving  the health  status of  Alaskans,"  and declared  that                                                               
this was the focus.                                                                                                             
                                                                                                                                
4:01:43 PM                                                                                                                    
                                                                                                                                
JAY  BUTLER,  MD,  Chief Medical  Officer/Director,  Division  of                                                               
Public Health,  Central Office, Department  of Health  and Social                                                               
Services,  shared his  background in  public health  care, noting                                                               
that  he had  worked  for the  past five  years  with the  Alaska                                                               
Native  Tribal Health  Consortium.   Directing attention  back to                                                               
slide 11, "Improving the health  status of Alaskans," he reported                                                               
that  28 percent  of Alaskan  adults and  17 percent  of children                                                               
were obese,  defined as having a  body mass index (BMI)  over 30.                                                               
He pointed out that obesity was  most likely a primary driver for                                                               
the increased rates  of Type 2 diabetes, which  affected almost 5                                                               
percent of  Alaskans.  He noted  that the teenagers were  the age                                                               
group with the biggest increase in  obesity in the past 15 years.                                                               
He shared that  diabetes could be managed, as  well as prevented,                                                               
through  healthy behaviors  such  as weight  control and  healthy                                                               
diet.   He suggested that  healthy behaviors could  be influenced                                                               
by making  the healthy choice  the easy  choice.  He  pointed out                                                               
that preventive maintenance  was very necessary.   He stated that                                                               
education was also an important  influence on behaviors, and that                                                               
the power  of education  was profound.   He  noted that  the only                                                               
eradication  of  a  disease  had  been  for  small  pox,  through                                                               
vaccination, and he offered an  anecdote of a current educational                                                               
campaign to eradicate another disease.                                                                                          
                                                                                                                                
4:09:50 PM                                                                                                                    
                                                                                                                                
DR. BUTLER  discussed the reduction  of tobacco use,  noting that                                                               
use was down to 20 percent  in Alaska, with huge progress for the                                                               
prevention  of smoking.   He  suggested  that this  change was  a                                                               
result of both education and a change of the social norms.                                                                      
                                                                                                                                
REPRESENTATIVE TARR asked about any focus on e-cigarette use.                                                                   
                                                                                                                                
DR. BUTLER replied that there  was great interest, although there                                                               
was a lot  that was still not  known.  He noted  that tobacco use                                                               
overlapped with e-cigarette and marijuana  use.  He reported that                                                               
e-cigarettes  had  been  touted  as  nicotine  prevention  tools,                                                               
although  they were  not currently  FDA  approved for  overcoming                                                               
nicotine addiction.   He expressed his concerns  with the flavors                                                               
and the marketing of e-cigarettes,  comparing it to the smokeless                                                               
products.                                                                                                                       
                                                                                                                                
CHAIR  SEATON  asked  if  the Department  of  Health  and  Social                                                               
Services  was letting  it  be  known that  the  sale of  nicotine                                                               
delivery products to minors was illegal.                                                                                        
                                                                                                                                
DR.  BUTLER  replied  that  the   legislation  was  an  important                                                               
deterrent,  although he  was not  aware of  the enforcement.   He                                                               
reported  that  the  illegal  sale of  tobacco  products  was  an                                                               
educational issue.   In response to Chair Seaton,  he agreed that                                                               
the illegal  sale of nicotine  delivery systems to  minors should                                                               
also be part of the educational curriculum.                                                                                     
                                                                                                                                
4:16:07 PM                                                                                                                    
                                                                                                                                
DR. BUTLER  announced that the  department desired to  reduce the                                                               
abuse  of alcohol  and  other  drugs, as  25  percent of  Alaskan                                                               
adults  reported  binge  drinking.    He  declared  that  it  was                                                               
important to  realize that  this was not  just a  personal health                                                               
decision,  but  that  impairment  also  affected  the  health  of                                                               
others.  He offered examples  of injuries from motor vehicles, as                                                               
well  as  injuries  to  the fetus  from  fetal  alcohol  spectrum                                                               
disorder.   He moved  on to  address opioid  drug abuse  with the                                                               
increase  of opioid  prescriptions,  possibly due  to  a lack  of                                                               
understanding for pain  management.  He declared  that this would                                                               
be a  priority for the  Alaska Health Care Commission  during the                                                               
upcoming year.                                                                                                                  
                                                                                                                                
REPRESENTATIVE  WOOL  asked about  a  centralized  data base  for                                                               
opioid prescriptions.                                                                                                           
                                                                                                                                
DR. BUTLER replied that that  was a recognized best practice, and                                                               
it was used in Alaska.                                                                                                          
                                                                                                                                
REPRESENTATIVE  TARR  offered her  belief  that  the funding  was                                                               
scheduled  to  cease  last  year,  and there  had  not  been  any                                                               
legislation to extend the funding.                                                                                              
                                                                                                                                
COMMISSIONER DAVIDSON  expressed agreement that funding  had been                                                               
discontinued  but  that,  as  the  department  had  felt  it  was                                                               
"sufficiently important  for the health  of Alaska, it  was being                                                               
continued through an agreement with another department.                                                                         
                                                                                                                                
REPRESENTATIVE  VAZQUEZ asked  if  this data  base was  different                                                               
than  the  data base  for  the  over-utilization of  prescription                                                               
drugs.                                                                                                                          
                                                                                                                                
4:20:41 PM                                                                                                                    
                                                                                                                                
JON  SHERWOOD,  Deputy  Commissioner, Medicaid  and  Health  Care                                                               
Policy,  Office of  the Commissioner,  Department  of Health  and                                                               
Social  Services, in  response  to  Representative Vazquez,  said                                                               
that this  was a different  program, was available to  all health                                                               
care providers and pharmacies, and was not limited to Medicaid.                                                                 
                                                                                                                                
REPRESENTATIVE  TARR asked  for clarification  that the  provider                                                               
had to  access the  information from the  data base,  and whether                                                               
any of the  program management had changed, especially  as it was                                                               
not on a real time basis.                                                                                                       
                                                                                                                                
MR.  SHERWOOD  explained  that  the program  was  now  under  the                                                               
Department  of Commerce,  Community &  Economic Development.   As                                                               
administration   of  the   data  base   was  not   in  the   DHSS                                                               
responsibility, he was not aware of the specifics.                                                                              
                                                                                                                                
REPRESENTATIVE VAZQUEZ  asked if  the prescription data  base was                                                               
used by DHSS.                                                                                                                   
                                                                                                                                
MR. SHERWOOD  opined that DHSS  did not  have access to  the data                                                               
base, although  he was not  absolutely certain.  He  relayed that                                                               
it was intended for use by providers when prescribing.                                                                          
                                                                                                                                
REPRESENTATIVE VAZQUEZ asked  if this lack of  access was because                                                               
of statutory restraints.                                                                                                        
                                                                                                                                
MR.  SHERWOOD  offered  his  belief  that  the  statute  did  not                                                               
identify DHSS as a user of  the data base, although he would like                                                               
to confirm this.                                                                                                                
                                                                                                                                
CHAIR SEATON asked  that Mr. Sherwood provide that  answer to the                                                               
committee.                                                                                                                      
                                                                                                                                
REPRESENTATIVE  VAZQUEZ asked  how many  individuals were  in the                                                               
Lock-In program,  and how its  use had constrained  expenses over                                                               
the  past five  years.   She  asked whether  the settlement  with                                                               
legal  services  regarding  the  Lock-In  program  was  still  in                                                               
effect.                                                                                                                         
                                                                                                                                
MR. SHERWOOD  replied that  he would research  that and  send the                                                               
information to the committee.                                                                                                   
                                                                                                                                
CHAIR SEATON asked  for a status update, specifically  to how the                                                               
system was working.                                                                                                             
                                                                                                                                
REPRESENTATIVE VAZQUEZ requested a  copy of the legal settlement.                                                               
She opined  that Lock-In was  a good cost containment  measure as                                                               
it prevented over utilization by recipients.                                                                                    
                                                                                                                                
CHAIR SEATON asked for an outline of the Lock-In program.                                                                       
                                                                                                                                
REPRESENTATIVE WOOL asked if the  data base tracked the physician                                                               
or provider as well as the recipient.                                                                                           
                                                                                                                                
MR. SHERWOOD  replied that he  was unsure  and agreed to  get the                                                               
information back to the committee.                                                                                              
                                                                                                                                
CHAIR SEATON  asked for a  more comprehensive description  of the                                                               
prescription data base program, as well.                                                                                        
                                                                                                                                
4:27:43 PM                                                                                                                    
                                                                                                                                
DR. BUTLER  directed attention  back to  slide 11,  and discussed                                                               
the now legal  use of marijuana.  He stated  that the Division of                                                               
Public Health  wanted to reduce  any adverse health  effects from                                                               
this legalization,  and do what was  best for Alaska.   He stated                                                               
that DHSS would learn lessons  from legalization in other states.                                                               
He  listed  some  of  the   short  term  effects  from  marijuana                                                               
legalization  to include  an increase  in Colorado  for emergency                                                               
room visits  by children from  THC ingestion, and an  increase in                                                               
burns during  extraction of THC.   He expressed concern  with the                                                               
medical literature  on long term effects,  particularly for heavy                                                               
use in adolescents.  He  shared that the department was reviewing                                                               
regulations with marijuana.  He  allowed that the bigger question                                                               
for all  drug use  was why  people needed  to self-medicate.   He                                                               
mentioned  the data  on adverse  childhood experiences  and those                                                               
effects on health  in later life.  He reported  that research was                                                               
working  to reduce  these later  health  effects.   He said  that                                                               
almost  25  percent  of  hospitalization  injuries  were  alcohol                                                               
based.                                                                                                                          
                                                                                                                                
DR.  BUTLER  relayed that  injuries  were  the leading  cause  of                                                               
premature death  in Alaska, and  the outcome could  be influenced                                                               
during the  golden hour  of field management  and transport  to a                                                               
certified trauma  center.   He reported that  there were  now two                                                               
Level  2 trauma  centers  in Alaska,  as well  as  15-16 Level  4                                                               
centers.                                                                                                                        
                                                                                                                                
4:33:47 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON  asked about  other  strategies  for prevention  of                                                               
injuries.                                                                                                                       
                                                                                                                                
DR.  BUTLER,  in  response,  mentioned  the  "Kids  Don't  Float"                                                               
program,  which   encouraged  the  use  of   personal  floatation                                                               
devices.  He pointed to  the white flotation coats program, which                                                               
were  made to  look  like  a traditional  whaler's  coat, as  the                                                               
whalers were  the traditional leaders  in a community.   He cited                                                               
education and regulations for the  use of seat belts and helmets.                                                               
He  spoke of  the tragic  injuries from  domestic violence,  and,                                                               
although not  a traditional part  of public health, he  deemed it                                                               
was necessary for DHSS to recognize and address this problem.                                                                   
                                                                                                                                
4:35:57 PM                                                                                                                    
                                                                                                                                
DR. BUTLER  stated that immunizations  had made a  big difference                                                               
in the health of Alaskan children  and that Alaska was doing well                                                               
for ensuring vaccinations  for school age children.   However, he                                                               
noted  that some  vaccination rates  lagged,  especially for  the                                                               
immunizations  of  two year  olds.    He  shared that  access  to                                                               
vaccines  was  often a  challenge.    He  noted that  Alaska  was                                                               
looking at models for a  return to the universal vaccine program,                                                               
and he  mentioned the  Alaska vaccine  assessment program.   This                                                               
program would allow the purchase  of vaccines at wholesale prices                                                               
for substantial savings to providers  and third party payers.  He                                                               
offered his  belief that Alaska would  be the tenth state  to use                                                               
this model for vaccine purchases.                                                                                               
                                                                                                                                
CHAIR  SEATON asked  whether the  state  program for  purchasing,                                                               
warehousing, and distributing vaccines was currently in place.                                                                  
                                                                                                                                
DR. BUTLER replied that the  remaining funding allowed to forward                                                               
fund the first year purchases, and  then continue to buy in bulk.                                                               
He  explained that  much of  the country  had direct  to provider                                                               
distribution,  but  that  the state  had  convinced  the  federal                                                               
government   that  Alaska   had   a   better  understanding   for                                                               
distribution logistics in an Arctic environment.                                                                                
                                                                                                                                
4:39:10 PM                                                                                                                    
                                                                                                                                
DR.  BUTLER discussed  the prevention  and control  of infectious                                                               
diseases, noting  that this  health threat  would continue  as it                                                               
dealt with another biologic system  that was able to continuously                                                               
change.   He offered his  belief that there  was not a  high risk                                                               
for Ebola  in Alaska, as  the department monitored the  return of                                                               
the  very small  volume of  travelers  from affected  areas.   He                                                               
noted that DHSS  continued its work with hospitals  in Alaska and                                                               
Washington State  for management planning  in case of Ebola.   He                                                               
mused that  Ebola brought back  the conversation  about readiness                                                               
for serious infectious diseases.                                                                                                
                                                                                                                                
4:41:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  FOSTER asked  about inadequate  sewage and  water                                                               
quality  and  its  role with  infectious  diseases,  and  whether                                                               
Department  of Health  and Social  Services would  have any  role                                                               
with this.                                                                                                                      
                                                                                                                                
COMMISSIONER  DAVIDSON  replied  that  the  Centers  for  Disease                                                               
Control  and the  ANTHC had  reviewed the  impact on  infants and                                                               
communities  without  adequate   sanitation  facilities.    These                                                               
findings indicated  that there were  11 times  greater likelihood                                                               
for hospitalization from respiratory  infections and 5 times more                                                               
likely from  skin infections.   She clarified that  these infants                                                               
required a  medivac from  the rural  community to  the hospitals.                                                               
She  relayed that  this  equated to  hospitalization  for one  in                                                               
three  infants from  the community  in any  year.   She explained                                                               
that the  challenge was for  some public health  benefit programs                                                               
to  continue   in  other  state   departments  during   times  of                                                               
significant  budget   contractions.    She  offered   a  personal                                                               
anecdote of her  daughter's bouts with respiratory  disease.  She                                                               
pointed  out that  adequate sanitation  facilities programs  were                                                               
matched by federal  funding.  She declared that there  was a link                                                               
between adequate sanitation facilities  and public health and the                                                               
health status of communities.                                                                                                   
                                                                                                                                
DR. BUTLER declared that it  was necessary to consider what could                                                               
realistically be  accomplished for  the 25  percent of  the state                                                               
population  who did  not have  the proper  sanitation facilities.                                                               
He emphasized that it was  important to use engineering models to                                                               
look  for ways  to provide  these  services.   He referenced  the                                                               
diseases associated  with a lack  of running water,  pointing out                                                               
that these were not waterborne  diseases.  He noted the challenge                                                               
to  supply adequate  wash water  for personal  hygiene, comparing                                                               
this to  the absolute minimum World  Health Organization standard                                                               
for refugee  camps.  He  declared the need for  opportunities for                                                               
people to wash in rural Alaska.                                                                                                 
                                                                                                                                
4:48:27 PM                                                                                                                    
                                                                                                                                
DR. BUTLER moved  on to discuss the prevention  of infant deaths,                                                               
reporting that today's  death rates were about  tenfold lower due                                                               
to  immunization, improved  standards  of  living, and  increased                                                               
protection   in  the   first  year   of  life.     He   discussed                                                               
implementation  of the  Healthy Alaskans  2020 action  plan.   He                                                               
said  that it  was  necessary to  programmatically address  these                                                               
health challenges  in order to  make a difference.   He explained                                                               
that  the Healthy  Alaskans program  was a  collaboration between                                                               
the  State  of  Alaska  and   the  Alaska  Native  Tribal  Health                                                               
Consortium  to connect  with communities,  identify  some of  the                                                               
priorities for improving health, determine  what could be done to                                                               
make  those  improvements,  and  then measure  the  impact.    He                                                               
relayed that the plan's outcome  was for 25 measures with useable                                                               
goals  and included  specific outcomes  such  as reducing  cancer                                                               
mortality, reducing  the proportion of Alaskans  living below the                                                               
poverty line, and improving the high school graduation rate.                                                                    
                                                                                                                                
4:51:33 PM                                                                                                                    
                                                                                                                                
DR. BUTLER expressed  his pleasure in hearing of  the interest in                                                               
prevention,  stating that  health  care had  really been  disease                                                               
care.  He enthused that prevention  was an emphasis of the Alaska                                                               
Health Care Commission in defining  how health care was provided.                                                               
He  offered  his  thoughts  on Vitamin  D,  citing  thousands  of                                                               
studies for its health outcomes  which included the prevention of                                                               
falls  and fractures  in the  elderly, as  well as  prevention of                                                               
colon,  breast, and  prostate  cancer,  cardio vascular  disease,                                                               
stroke, diabetes,  and depression.   He  allowed that  there were                                                               
still a  lot of  questions for  the public  health opportunities,                                                               
and that  association did  not necessarily  prove causation.   He                                                               
pointed  out  that there  were  more  than 1500  clinical  trials                                                               
assessing Vitamin D,  and, as he was a pragmatist,  he asked what                                                               
this would  mean for  Alaska.   He shared  that the  vital trial,                                                               
involving  more than  25,000 Americans,  was very  well conducted                                                               
and, because of  its size, offered many analyses.   He lauded the                                                               
potential   for  flu   prevention  with   an  over   the  counter                                                               
supplement.                                                                                                                     
                                                                                                                                
CHAIR SEATON reflected  on some of the earlier  trials which only                                                               
offered once  a week  or once  a month  Vitamin D  dosage, noting                                                               
that recent  research showed that  daily dosage was  necessary to                                                               
affect  soft  tissue.   Other  studies  examining the  effect  on                                                               
cancer  and other  disease had  shown  that Vitamin  D may  prove                                                               
ineffective if dosages were only taken a few times each month.                                                                  
                                                                                                                                
4:58:57 PM                                                                                                                    
                                                                                                                                
COMMISSIONER   DAVIDSON  acknowledged   the  work   of  the   HSS                                                               
transition  team which  brought  together more  than 250  Alaskan                                                               
volunteers  to offer  ideas for  improvement to  the delivery  of                                                               
services,  slide  12, "Looking  to  the  future."   She  directed                                                               
attention to  the five  recommendations listed  on the  slide and                                                               
said   that   these  would   all   be   evaluated  for   possible                                                               
implementation.                                                                                                                 
                                                                                                                                
CHAIR  SEATON stated  that the  committee  would review  Medicaid                                                               
expansion,  including reviews  of  the Arizona  criteria and  the                                                               
Tennessee model for  cost sharing with the  health care providers                                                               
to implement the program.                                                                                                       
                                                                                                                                
5:01:55 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 5:01 p.m.                                                                                                          

Document Name Date/Time Subjects
DHSS House_HSS Committee Powerpoint Intro_2015.01.22.pptx HHSS 1/22/2015 3:00:00 PM
HSS presentation