Legislature(2019 - 2020)CAPITOL 106
03/28/2019 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Presentation(s): Alaska Children's Justice Act Task Force | |
| HB22 | |
| HB29 | |
| HB97 | |
| HB86 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | HB 22 | TELECONFERENCED | |
| += | HB 29 | TELECONFERENCED | |
| += | HB 97 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| *+ | HB 86 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 28, 2019
3:02 p.m.
MEMBERS PRESENT
Representative Ivy Spohnholz, Co-Chair
Representative Matt Claman
Representative Harriet Drummond
Representative Geran Tarr
Representative Lance Pruitt
MEMBERS ABSENT
Representative Tiffany Zulkosky, Co-Chair
Representative Sharon Jackson
OTHER LEGISLATORS PRESENT
Representative Andy Josephson
COMMITTEE CALENDAR
PRESENTATION(S): ALASKA CHILDREN'S JUSTICE ACT TASK FORCE
- HEARD
HOUSE BILL NO. 22
"An Act extending the termination date of the Statewide Suicide
Prevention Council; and providing for an effective date."
- MOVED HB 22 OUT OF COMMITTEE
HOUSE BILL NO. 29
"An Act relating to insurance coverage for benefits provided
through telehealth; and providing for an effective date."
- MOVED HB 29 OUT OF COMMITTEE
HOUSE BILL NO. 97
"An Act relating to the prescription of drugs by a physician
assistant without physical examination."
- MOVED CSHB 97(HSS) OUT OF COMMITTEE
HOUSE BILL NO. 86
"An Act relating to a state-owned inpatient mental health
treatment hospital; and providing for an effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 22
SHORT TITLE: EXTEND SUICIDE PREVENTION COUNCIL
SPONSOR(s): REPRESENTATIVE(s) TARR
02/20/19 (H) PREFILE RELEASED 1/7/19
02/20/19 (H) READ THE FIRST TIME - REFERRALS
02/20/19 (H) HSS, FIN
03/26/19 (H) HSS AT 3:00 PM CAPITOL 106
03/26/19 (H) Heard & Held
03/26/19 (H) MINUTE(HSS)
03/28/19 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 29
SHORT TITLE: INSURANCE COVERAGE FOR TELEHEALTH
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ
02/20/19 (H) PREFILE RELEASED 1/11/19
02/20/19 (H) READ THE FIRST TIME - REFERRALS
02/20/19 (H) HSS, L&C
03/26/19 (H) HSS AT 3:00 PM CAPITOL 106
03/26/19 (H) Heard & Held
03/26/19 (H) MINUTE(HSS)
03/28/19 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 97
SHORT TITLE: TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS
SPONSOR(s): REPRESENTATIVE(s) KREISS-TOMKINS
03/15/19 (H) READ THE FIRST TIME - REFERRALS
03/15/19 (H) HSS, L&C
03/26/19 (H) HSS AT 3:00 PM CAPITOL 106
03/26/19 (H) Heard & Held
03/26/19 (H) MINUTE(HSS)
03/28/19 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 86
SHORT TITLE: MENTAL HEALTH HOSPITAL: CONTRACTS/BIDS
SPONSOR(s): REPRESENTATIVE(s) FIELDS
03/06/19 (H) READ THE FIRST TIME - REFERRALS
03/06/19 (H) HSS, L&C
03/26/19 (H) HSS AT 3:00 PM CAPITOL 106
03/26/19 (H) <Bill Hearing Rescheduled to 3/28/19>
03/28/19 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
CATHY BALDWIN-JOHNSON, MD
Medical Director
Alaska CARES
The Children's Hospital at Providence
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint titled "Child Abuse
in Alaska: 2019 Update."
JARED PARRISH, PhD
Senior Epidemiologist, MCH-Epi
Division of Public Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint titled "Child Abuse
in Alaska: 2019 Update."
MIKE HOPPER, PhD
Child & Adolescent Psychologist
Fairbanks, Alaska
POSITION STATEMENT: Testified during the presentation by Alaska
Children's Justice Act Task Force.
BERNICE NESBITT, Staff
Representative Ivy Spohnholz
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Reviewed HB 29 on behalf of the bill
sponsor, Representative Spohnholz.
REID HARRIS, Staff
Representative Jonathan Kreiss-Tomkins
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Reviewed HB 97 on behalf of the bill
sponsor, Representative Kreiss-Tomkins.
DEBORAH STOVERN, Executive Administrator
State Medical Board
Division of Corporations, Business, and Professional Licensing
Department of Commerce, Community & Economic Development
Anchorage, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
97.
REPRESENTATIVE ZACK FIELDS
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HB 86 as the sponsor of the
bill.
TRISTAN WALSH, Staff
Representative Zack Fields
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis and the
committee substitute for HB 86.
ACTION NARRATIVE
3:02:25 PM
CO-CHAIR IVY SPOHNHOLZ called the House Health and Social
Services Standing Committee meeting to order at 3:02 p.m.
Representatives Spohnholz, Drummond, Tarr, and Claman were
present at the call to order. Representative Pruitt arrived as
the meeting was in progress. Also in attendance was
Representative Josephson.
^PRESENTATION(S): ALASKA CHILDREN'S JUSTICE ACT TASK FORCE
PRESENTATION(S): ALASKA CHILDREN'S JUSTICE ACT TASK FORCE
3:03:00 PM
CO-CHAIR SPOHNHOLZ announced that the first order of business
would be a presentation by the Alaska Children's Justice Act
Task Force.
3:03:54 PM
CATHY BALDWIN-JOHNSON, MD, Medical Director, Alaska CARES, The
Children's Hospital at Providence, acknowledged the Task Force
members in the audience. She presented a PowerPoint titled
"Child Abuse in Alaska: 2019 Update," and paraphrased slide 1,
"Introduction to the Alaska CIATF," which read:
Federally mandated and funded
Mission: Identify areas where improvement is needed in
the statewide response to child maltreatment,
particularly child sexual abuse, make recommendations
and take action to improve the system.
Statewide, multidisciplinary membership
Legislation to improve protection & justice for
children (starvation, serious physical abuse, privacy)
Focus on education: child abuse in Alaska, mandatory
reporting, & best practices for the multidisciplinary
response to child abuse
DR. BALDWIN-JOHNSON moved on to paraphrase slide 2, "Key
Points," which read:
What's happening with child abuse and neglect in
Alaska?
It's COMMON
What is the impact?
Adverse Childhood Experiences (ACE) Studies
Alaska ACEs and their costs
What can we do to change the trajectory for our kids?
HOPE!
A real-life look at trauma
3:06:45 PM
DR. BALDWIN-JOHNSON shared slide 4, "Adverse Childhood
Experiences (ACE)," and explained that this was a huge
collaborative study between the Centers for Disease Control and
Prevention (CDC) researchers and Kaiser Permanente, a health
maintenance organization in California. She reported that there
were more than 17,000 participants, mostly middle-aged Caucasian
with at least some college education. She reported that they
were asked about events which may have happened to them prior to
18 years of age, which included physical, sexual, and emotional
abuse, as well as physical and emotional neglect. She added
that there were also five questions about family dysfunction,
whether a parent or caregiver suffered from mental illness, if
someone in the family had gone to jail or prison, did they see
their mother being treated violently, was there substance abuse
in the home, or was there divorce or separation. The
researchers were surprised at how common it was for this history
of child maltreatment, with a significant correlation between
this history and the most common causes of disease and early
death. She directed attention to slide 5, "34%," and noted that
more than one-third of Alaskan adults reported a history of
physical or sexual abuse, or physical or emotional neglect.
3:08:55 PM
DR. BALDWIN-JOHNSON moved on to slide 6, "Alaska ACEs snapshot,"
which listed issues as reported by Alaskan adults. She stated
that people who had sustained at least four or more of these
categories of abuse, neglect, or family dysfunction were much
more likely to be unemployed, unable to work, or to report poor
health.
3:09:24 PM
DR. BALDWIN-JOHNSON indicated slide 7, a graph of abuse and
dysfunction with the relative percentage of co-occurrence with
other exposures. She pointed out that these exposures tended to
occur in clusters in families.
3:10:06 PM
DR. BALDWIN-JOHNSON presented slide 8, "Adverse Childhood
Experiences (ACE)," and emphasized that the more ACEs
documented, the higher the risk for developing health and social
problems. She reported that childhood trauma modified
development and impacted genetics. She moved on to slide 9,
"Impacts Start Prior to Birth," and paraphrased the slide, which
read:
Prenatal exposures and experiences can have an impact
on both vulnerability as well as resiliency
Impacts on brain development and genetics
Examples: FASD ? Asthma hospitalization risk
3:11:42 PM
DR. BALDWIN-JOHNSON shared slide 10, "The Developing Brain:
Macro View," comparing photos which revealed the difference
between infant and adult brains. She said that the baby brain
was meant to grow and develop in response to the things
experienced after birth. She moved on to slide 11, "Rapid
Growth of Neuron Development," declaring that this was a micro
view of the brain. She noted that, at birth, there were not a
lot of nerve cells and connections, but that after 6 years the
brain was filling with information. She reported that, in the
teen years, the brain went "through a time of pruning;" when a
skill was not used, it was pruned, and new connections were
developed.
3:12:52 PM
DR. BALDWIN-JOHNSON paraphrased slide 12 "Key Concepts," which
read:
Neurons are designed to change in response to external
signals
The undifferentiated developing brain is critically
dependent on environmental cues
Disruption, or lack of critical cues, can result in
compromised brain function
Development of brain areas occur in a certain order:
"Building Blocks"
DR. BALDWIN-JOHNSON shared slide 13, "Key Concepts, Continued,"
which read:
Children learn to form relationships and respond to
stress - just as they learn to see, hear, walk, talk
Relationships children have with caregivers play
critical roles in regulating stress hormone production
during early years of life
Toxic stressors in childhood create measurable changes
to the brain
3:14:12 PM
DR. BALDWIN-JOHNSON paraphrased slide 14, "The Brain: Targets of
Stress," which read:
Cerebral cortex EEG changes smaller callosum
Limbic system neuronal changes decreased size
Brainstem/ Cerebellum altered transmitters
DR. BALDWIN-JOHNSON moved on to slide 15, "Two Roads to Travel,"
and stated that there were two roads for kids to travel when
they were born. She paraphrased from the slide, which read:
Safe and Nurturing
Have a stable foundation from which to explore their
world
Spend more time in the upper blocks (bonding, talking,
interpersonal relationships)
Child feels calm and safe and can focus their energy
on learning
Trauma and Chaos
When a child is unsafe/threatened, they spend more
time in the lower blocks, focusing only on survival
Fight, Flight or Freeze neural pathways become
"hardwired"
3:15:23 PM
DR. BALDWIN-JOHNSON concluded with slide 16, "Life course
perspective," and stated that there were things that could push
a child's trajectory, noting that well-educated parents who were
able to meet their kids emotional needs, read to their kids,
provide appropriate discipline, get the necessary health care,
and have an adequate education which starts early will push the
life trajectory upward for a better start.
3:16:11 PM
JARED PARRISH, PhD, Senior Epidemiologist, MCH-Epi, Division of
Public Health, Department of Health and Social Services,
presented slide 17 "New emerging data resources" and stated that
the "Alaska Longitudinal Child Abuse and Neglect Linkage Project
(ALCANLink)" was a novel data source that no other state had
currently. He explained that they had taken their limited
resources and maximized them to turn a cross sectional study
into a longitudinal study to allow them to follow people over
time, and accurately estimate risk. He pointed to the Alaska
Pregnancy Risk Assessment Monitoring System (Alaska PRAMS), a
survey conducted in nearly all 50 states, which was offered to
new mothers shortly after birth with questions related to the
pre-birth, birth, and after delivery experiences. That
information was integrated with administrative data sources and
child welfare records to track the population in Alaska and
estimate the risk. He added that a goal was to integrate with
as many administrative data sources as possible. He noted that
PRAMS was weighted for population, so every birth need not be
linked, but instead the data from the survey response was used.
3:18:30 PM
DR. PARRISH addressed slide 18 "Risk (incidence) among children"
and noted that each year they were including an additional year
in age. He reported that 37 percent of children born in Alaska
would be reported to child welfare before the age of nine years.
He declared that this was a large proportion and was an issue
for the Division of Public Health to address. He continued with
slide 19, "Maltreatment burden," and explained that the
prevalence estimate for maltreatment was for 10 percent of the
child population, ages 0 to 17 years, to have contact with child
welfare in an annual year. He reported that the adult
prevalence indicated that 34 percent of adults reported
experiencing some form of abuse or neglect during their
childhood, which he called a proxy for the risk or lifetime
burden for a child. He said that as they measured the
cumulative incidents, it was expected for the estimate to
closely match or exceed that 34 percent as it was the
measurement of actual events as they occurred.
3:20:12 PM
CO-CHAIR SPOHNHOLZ asked whether a report of contact with the
Office of Children's Services (OCS) was a report of harm or a
substantiated report.
DR. PARRISH replied that this was a report of harm. In response
to Representative Drummond, he explained that BRFSS was the
behavioral risk factor surveillance system.
3:20:38 PM
DR. PARRISH shared slide 20, "Among children born in Alaska
during 2009-2011," and reported that each was an estimate for a
child under nine years of age: one out of three would have a
report of harm to child welfare; one out of four would have a
report of harm screened in with child welfare; one out of eight
would have a report of harm substantiated with child welfare;
and one out of sixteen would be removed from their home by child
welfare. He moved on to slide 21, "First report by maltreatment
type," which shared the reports for physical abuse, sexual
abuse, mental injury, and neglect. He pointed out that these
were the four classifications used by OCS. He noted that each
of the estimates could be calculated because they were a
cumulative measure during the developmental periods for kids
over their life course trajectory.
3:22:13 PM
DR. PARRISH said that the data "have a ton of information that I
could be providing to you, but usually with information and data
I found that I can give data overload very quickly, as he
presented slide 22, "Pre-birth household dysfunction." He
clarified that this was not ACEs research but was an attempt to
better understand ACEs. He pointed out that abuse and neglect
were suffered directly by a child and the household dysfunction
was the environment in which a child developed. He stated that
household dysfunction could be measured prior to birth which
allowed for the ACE score of a child at birth. He pointed out
that the more household dysfunctions the more likely the child
would have contact with child welfare before the age of nine.
He declared that an accumulation of bad things in life impacted
the ability to appropriately make a safe place for a child to
develop. He moved on to slide 24, "PRAMS Questions used to
quantify pre-birth household dysfunction beyond ACEs only
questions." He listed financial stress, arguments with partner,
homelessness, partner didn't want pregnancy, and partner
threatens or limits activities as additional household
dysfunctions that also were strongly related, independently for
contact with child welfare. He acknowledged that although
dysfunction could occur in every household, if there were three
of these, it was 140 percent more likely for a report to OCS
before the age of 9, and if there were five or more of these
dysfunctions, it was 361 percent more likely. He declared that
the utilization of population-based data helped to predict the
effective placement of resources for prevention, to provide
services adequately to the families, and to identify those who
need these services.
3:25:21 PM
DR. BALDWIN-JOHNSON paraphrased slide 26, "National estimates:"
which read:
In the US ANNUALLY
Lifetime burden
Between $433.7 billion and $2 trillion (2016 USD)
DR. BALDWIN-JOHNSON addressed slide 27, "Alaska estimates:"
which read:
Between $631 million to $10.7 billion ANNUALLY
Alaska research suggests:
Costs for SUBSTANTIATED reports: $82 million for
childhood health care, child welfare, special
education
40.6% adult Medicaid enrollment linked to Adverse
Childhood Experiences (ACEs)
Decreasing ACEs and improving our response to child
maltreatment could save our state ~$92 million
annually in costs related just to: Medicaid, smoking,
diabetes, binge drinking, arthritis, obesity
DR. BALDWIN-JOHNSON addressed slide 29, "What can we do?" which
read:
Reasons for hope:
Healing is possible
Our brains can always learn
We can all help build resilience in children
We can all help protect children
DR. BALDWIN-JOHNSON moved on to slide 30, "Early & effective
intervention," which read:
Child Advocacy Centers
Multidisciplinary response
Child focused
Forensic interview
Medical exam
Mental health services
Support & advocacy
Information sharing
DR. BALDWIN-JOHNSON shared slide 31, "Children seen at Alaska
CACs," pointing out that many hub communities had child advocacy
centers, which had provided service to more than 30,000 children
and their families.
3:27:58 PM
DR. BALDWIN-JOHNSON presented slide 32 "How do we create the
best future for our children's lives?" and slide 33 "Development
influenced by both negative and positive factors." She
expressed a desire for only positive factors, with the
prevention of any negative experience or trauma. She pointed to
slide 34 "Protective Factors: Focus on adults," which listed:
Supportive, nurturing, stable family
Supportive social networks
Caring adults outside family
Household rules, monitoring of child
Parental employment
Adequate housing
Access to health care, other services
Community safety
Community involvement
3:29:11 PM
DR. BALDWIN-JOHNSON addressed slide 35 "Dare to be the one" and
reminded the committee that April was National Child Abuse
Prevention Month and that the motto for this year was "Dare to
be the one." She shared slide 36 and slide 37, "What can you
do?" which read:
Realize this affects ALL of us in Alaska
Break the silence!
Make your decisions using a trauma- informed lens
"It's not what's wrong with you, it's what happened to
you"
Support system-wide approaches to strengthen children
and families
"Strengthening Families" program
"Help me grow"
"Alaska Resilience Initiative
Think big - "Collective Impact"
Support community based initiatives
Examples:
ROCK MatSu (Raising our Children with Kindness)
MAPP (Mobilizing for Action through Planning and
Partnerships)
3:31:18 PM
DR. BALDWIN-JOHNSON shared slide 38, "Our data suggests that:"
which read:
Many Alaskan adults bear the burden of a lifetime
accumulation of family violence and dysfunction
Alaskan children start accumulating these adverse
events early in life
Our economy and our society bear the costs
DR. BALDWIN-JOHNSON concluded with slide 39 "To reduce this
burden we need:" which read:
Prevention
Early recognition
Early, effective, timely intervention
Effective treatment
A focus on supporting healthy, stable , safe and
nurturing families and communities so our children can
be healthy & successful adults
3:32:28 PM
MIKE HOPPER, PhD, Child & Adolescent Psychologist, shared some
of his experiences and paraphrased from a prepared statement,
which read [original punctuation provided]:
I have been tasked with putting a face on the
statistics you just witnessed? I have been a
practicing child/adolescent psychologist for the past
40 years and have been working with abused kids for
that entire time but it took me most of the first
decade to understand that?The faces that come most
readily are the ones I failed to recognize during
those early years.
My first patient, Kenny, I met, sort of, as he raced
sliding on stocking feet down the halls of a locked
th
long-term psychiatric facility on the 8 floor of LA
County Medical Center. He was laughing hysterically at
the staff that chased after him. I wanted him as a
patient on sight. I was told he was an incorrigible
delinquent who had attempted to hang himself after
setting his room at an LA detention center on fire.
Senior staff assured me he had only done so to escape
his correctional consequences. If so, he didn't
succeed. I stayed in touch with Kenny over the course
of the next 20 years he spent incarcerated. He ended
up in the Supermax at Pelican Bay for assaulting an
inmate accused of molesting children. He would be
about 56 y/o today. But he died years ago, 3 weeks
after being let out on a compassionate release. I
never did ask him why he tried to kill himself as a
teenager.
Likewise I didn't ask the crippled 15 year old
prostitute I was asked to visit on an emergency unit 2
floors below Kenny's why she'd jumped off a 4-story
parking structure. I was told she was just depressed.
And I didn't stand up for the 14 y/o pregnant teen in
that same unit who complained that one of the nursing
staff had fondled her. That was quietly swept under
the rug. Nobody bothered to ask her about the father
of her child and so neither did I. We all just assumed
she was a loose woman.
I didn't know to ask these kids the hard but obvious
questions. For a time I accepted the professional
party line: They were disturbed and disturbing kids.
But I couldn't forget them. But it wasn't until I went
to work in the early 80's in the nation's first
residential facility specifically for "abused and
neglected children" in the dry hills near Palm Springs
that I began to understand them. I came to Alaska soon
after and it has been Alaska's children who have
tutored me ever since.
I have come to recognize that it is child abuse, and
especially child sexual abuse, that is indeed
"disturbed and disturbing", not the kids who survive.
But survivors don't easily or typically disclose. They
prefer to "tell" in behaviors that can make you feel
the way many will feel their whole lives: Helplessly
angry, fearful and hopeless. But I have to constantly
remind myself that those feelings are not my own; they
are being shared with me by the kids I work with. And
so I have to tell myself that I am not helpless; I am
not hopeless or fearful. But I am angry. I am angry
that now that we know, now that we can recognize the
survivors we can still turn away from disturbing
children of all ages and not ask the hard questions or
seek the real answers. It is the face of one of those
more recently forgotten children that haunts my nights
from time to time.
You could see her clearly in numerous on-line child
pornography videos the FBI confiscated. She was the 26
y/o woman cheerfully helping very young children
perform horrible sex acts. Over the course of nearly
12 hours of interview in FCC this young woman
patiently explained in the voice and words of a five
year old, that she learned to do so as a
kindergartener caught up in a sado-masochistic child
sex ring in Milwaukee she called "The Play Hous. The
only way she could help the other children not get
hurt was to show them how to please a circle of sick
men with unbelievably sick needs. Abused throughout
her childhood even when eventually taken into the
State of Alaska's custody, she remained most fearful
still of the men of the Play House as a young adult.
She thought she'd found sanctuary with her co-
defendant, an older man who promised he would never
let anyone hurt her. When he turned out be interested
in very young girls and wanted her help photographing
them, well that all seemed normal and she did what she
could to make sure they didn't get hurt.
I explained to her judge at sentencing that hers were
not the acts of a criminal, but acts of a kind of
heroism I have seen before only in the insanely
abusive, secret world of child sexual exploitation. I
will forever be angry and haunted that the judge
turned away from this heroic young lady and sentenced
her to 22 years in federal prison, righteously
insisting "She should have known better".
But in a way he was right: She should have known
better. And it is responsibility of those of us who
have to see that all children in AK know better.
Children like the 36 y/o mother whose two young
children were recently taken into foster care after
she left them alone during a black out drunk. I sat
across from her in a coffee shop along the way to
Anchorage. She couldn't afford the trip in to
Fairbanks. I wanted a little history to help her 5 y/o
son. Her tired eyes were my first clue. She explained
that she never sleeps and suffers from chronic panic
attacks. She even offered that she had been diagnosed
as bipolar and a borderline personality disorder, was
on psychiatric medication and had been in counseling
for 12 years with one therapist in Louisiana before
coming north with her children, where she'd now found
another. But nothing really seemed to help. As a rule
she didn't drink her hated mother was a mean
alcoholic; father, an addict but she'd found that if
occasionally she drank to the point of blackout she
would hit a sort of a "reset button" and could start
over and keep going.
This was all she knew about herself, after years of
mental health support. She'd accepted that she was a
broken person who was periodically under attack from
her own feelings.
She herself had survived a childhood with divorced
parents who fought bitterly over their 3 children.
Both parents partied hard, every night as the children
bounced between a rock and a hard place. Our mother,
the oldest, had no memory from the age of 8 to 13 y/o
except for the fact that during those years she
discovered her love of horses which sustained her to
this day. Her two young siblings eventually both
became psychiatrically disabled. For reasons she could
not fathom her younger brother hated her bitterly.
A loving grandmother gave her shelter growing up, paid
for riding lessons and saved her life. She married
young to a much older man she loved, bred and raised
race horses, and had a son. She left them after 10
years for reasons she couldn't understand; she was
afraid to continue caring for her son.
She hadn't slept for more than a couple hours a night
for as long as she can remember.
This is the face of abuse you so often see with OCS
parents, folks that survive things they can barely
remember and yet constantly fear. This poor woman
wasn't having "panic attacks": She was having
repetitive "daymares" from chronic REM deprivation;
nightmares from an abusive childhood that could find
no safe release and maybe resolution in the privacy of
her sleeping mind and so exploded into her waking life
without context. Why chronic sleep problems? As a
child, she and her sibs were told to remain in their
room no matter what while her parents partied, every
night: alone, unprotected and I am certain prey to all
sorts of predators. Her adult mind could only protect
her so much from the memory of that happened to her
and from what she learned to do. It could not protect
her from the reminders of her own children, and so her
fears worsened; her vigilance remained constant; sleep
unthinkable.
Her tired eyes filled with tears as I assured her of
the strength of her mind and goodness of her heart and
explained her shattered life. She slept 5 hours that
night after crying for three. She now has the
difficult but I am convinced, doable task of putting
together a life that won't repeat her past. She is
what we call a survivor and she should have known
better.
So we are here to make sure you know better. Know that
1/3 of the children of Alaska come to the attention of
OCS by the time they are 8 y/o. That is a large silent
constituency that needs your voice and understanding
in any budgetary discussion. And they need the can-do
genius of Alaska's frontier if we are ever to make a
dent in that startling statistic. Thank you.
3:44:23 PM
REPRESENTATIVE DRUMMOND shared her support for the questioning
of young mothers for their pre-natal and pre-pregnancy lives.
3:45:45 PM
DR. HOPPER shared that there was a world of expertise available
for help in any aspect.
3:46:13 PM
CO-CHAIR SPOHNHOLZ noted that the data created an opportunity
for Alaska to ensure that service and support went to the right
people. She asked about the next steps to address the necessary
support.
3:47:07 PM
DR. PARRISH stated that the initial part about having any new
data was for educating yourself and understanding the context of
the situation before there can be any targeting for prevention.
He emphasized that the Division of Public Health was addressing
the issue because it related to all the health effects which
they were attempting to prevent. He shared that he had learned
that the data was not real until he could, as a member of the
community, contextualize them into his life. He reported that,
as many children were reported as neglected, if there were a
system to help with support for the families early on, these may
never require any use of resources from OCS. He reported on the
use of this program with other states and the pooling of data.
3:49:17 PM
DR. BALDWIN-JOHNSON acknowledged that there were several models
for targeting high risk families. She added that the data would
help ensure the targeting of the right intervention for the
right people and to try to find targeted alternatives with less
expensive interventions.
3:50:09 PM
DR. HOPPER shared that there were great opportunities for
information and learning from the boys in the youth centers. He
pointed out that much of the chronic mental illness was really
"unbelievable stories of massive abuse and neglect" and "hiding
from those histories."
3:52:48 PM
CO-CHAIR SPOHNHOLZ offered her belief that this underscored the
need for appropriate response and support for young people that
have been hurt and incarcerated. She stated that it was also
necessary to look "upstream" to help prevent the incidences.
She said that the child welfare system begins with a report of
harm and then being drawn into the system creates more trauma,
whereas creative approaches to support at-risk families could
prevent this. She pointed to work being done with at-risk
families in the Matanuska-Susitna area and the appropriate use
of information sharing to help with the necessary supports and
services.
HB22-EXTEND SUICIDE PREVENTION COUNCIL
3:55:39 PM
CO-CHAIR SPOHNHOLZ announced that the next order of business
would be HOUSE BILL NO. 22, "An Act extending the termination
date of the Statewide Suicide Prevention Council; and providing
for an effective date."
The committee took a brief at-ease.
3:56:39 PM
REPRESENTATIVE TARR said that she did not have any additional
information but that she was available for any questions.
3:57:00 PM
REPRESENTATIVE DRUMMOND moved to report HB 22 out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, HB 22 was moved from the House
Health and Social Services Standing Committee.
3:57:33 PM
The committee took an at-ease from 3:57 p.m. to 4:00 p.m.
HB 29-INSURANCE COVERAGE FOR TELEHEALTH
4:00:53 PM
CO-CHAIR SPOHNHOLZ announced that the next order of business
would be HOUSE BILL NO. 29, "An Act relating to insurance
coverage for benefits provided through telehealth; and providing
for an effective date."
4:00:58 PM
BERNICE NESBITT, Staff, Representative Ivy Spohnholz, Alaska
State Legislature, paraphrased from the Sectional Analysis for
HB 29 [Included in members' packets], which read:
Section 1.
AS 21.42.422 has been amended to require insurance
coverage for health benefits provided through
telehealth technology.
Section 2.
AS 21.42.422 is a new subsection that defines health
care insurer as a person transacting the business of
health care insurance except for a nonfederal
governmental plan. It also adds the definition of
telehealth under 47.05.270(e) as the practice of
health care delivery, evaluation, diagnosis,
consultation, or treatment, using the transfer of
health care data through audio, visual, or data
communications, performed over two or more locations
between providers who are physically separated from
the recipient or from each other or between a provider
and a recipient who are physically separated from each
other.
Section 3
The changes to Section 1 of this bill applies to
health care insurance plans that are offered, issued,
delivered, or renewed on or after the effective date.
Section 4
The effective date is July 1, 2020. As a preliminary
matter, note that a sectional summary of a bill should
not be considered an authoritative interpretation of
the bill -- the bill itself is the best statement of
its contents.
4:01:55 PM
REPRESENTATIVE DRUMMOND moved to report HB 29 out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, HB 29 was moved from the House
Health and Social Services Standing Committee.
4:02:20 PM
The committee took a brief at-ease.
HB 97-TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS
4:03:52 PM
CO-CHAIR SPOHNHOLZ announced that the next order of business
would be HOUSE BILL NO. 97, "An Act relating to the prescription
of drugs by a physician assistant without physical examination."
4:04:02 PM
REID HARRIS, Staff, Representative Jonathan Kreiss-Tomkins,
Alaska State Legislature, paraphrased from the Sponsor Statement
[Included in members' packets], which read:
The 2016 Medicaid Reform Bill (SB 74) provided for the
use of telehealth, revising Alaska statutes to require
the Alaska State Medical Board to adopt regulations
and guidelines for physicians rendering a diagnosis;
providing treatment; or prescribing, dispensing, or
administering a prescription drug to a person without
first conducting a physical examination under AS
08.64.364.
However, SB 74 only addressed physicians and the
Board's interpretation was that the bill's provisions
should not apply to physician assistants (PA's). This
effectively barred PA's from practicing telemedicine,
requiring them to first conduct in-person
examinations.
House Bill 97 aligns statute with the intent of the
Medicaid Reform Bill, clarifying that PA's can provide
telemedicine in collaboration with and under the
oversight of physicians. Under HB97, PA's are subject
to the same statutory oversight as physicians
regarding the practice of telemedicine, as well as the
same disciplinary sanctions when appropriate.
Alaska, with its vast geographical challenges and
limited access to vital healthcare, stands to benefit
from this legislation. HB 97 will increase patient
access to care, extending the reach of medicine to
medically underserved areas.
4:05:58 PM
REPRESENTATIVE PRUITT asked for clarification that this bill was
necessary because the State Medical Board had interpreted Senate
Bill 74 as to not include physician assistants. He asked if Ms.
Stovern believed that the intent of Senate Bill 74 was to
include physician assistants.
4:06:51 PM
DEBORAH STOVERN, Executive Administrator, State Medical Board,
Division of Corporations, Business, and Professional Licensing,
Department of Commerce, Community & Economic Development,
offered her belief that the State Medical Board could not
determine the legislative intent regarding physician assistants
so other stakeholders asked that the proposed bill clarify that
physician assistants would be covered under the statute.
4:07:58 PM
REPRESENTATIVE PRUITT asked if the State Medical Board covered
physicians assistants as well as physicians.
MS. STOVERN replied "yes, they do."
REPRESENTATIVE PRUITT shared his concern that, as more people
were allowed the opportunity to prescribe up to Schedule II
drugs, there may be a challenge as physicians assistants would
no longer have to interact with a patient for these controlled
substances.
MS. STOVERN, in response, stated that part of the statute
required the board to adopt the nationally published American
Medical Association guidelines for practicing telehealth by
physician assistants. She added that the collaborative plan
with the supervising physician determined the scope of practice
by the physician assistant and included the type of prescriptive
authority.
4:11:49 PM
CO-CHAIR SPOHNHOLZ asked for confirmation that physician
assistants had to utilize the Prescription Drug Monitoring
Database (PDMP).
MS. STOVERN said that anyone prescribing controlled substances
was required to use the PDMP and this would include physician
assistants engaging in prescriptions through telehealth.
4:12:45 PM
CO-CHAIR SPOHNHOLZ closed public testimony.
4:12:58 PM
REPRESENTATIVE DRUMMOND moved to report CSHB 97, Version 31-
LS0695\M, Marx, 3/21/19, from committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, CSHB97(HSS) was moved from the House Health and
Social Services Standing Committee.
4:13:23 PM
The committee took an at-ease from 4:13 p.m. to 4:16 p.m.
HB 86-MENTAL HEALTH HOSPITAL: CONTRACTS/BIDS
4:16:17 PM
CO-CHAIR SPOHNHOLZ announced that the final order of business
would be HOUSE BILL NO. 86, "An Act relating to a state-owned
inpatient mental health treatment hospital; and providing for an
effective date."
4:16:45 PM
REPRESENTATIVE DRUMMOND moved to adopt the proposed committee
substitute (CS) for HB 86, labeled 31-LS0623\U, Marx, 3/26/19,
as the working draft.
4:17:04 PM
CO-CHAIR SPOHNHOLZ objected for discussion.
4:17:06 PM
REPRESENTATIVE ZACK FIELDS, Alaska State Legislature, stated
that the proposed bill would prevent wholesale privatization of
Alaska Psychiatric Institute (API), although it would not
prevent partial privatization of individual services or
components within API, some of which already existed. He noted
that there was concern for "a rush to judgement in terms of
contracting with a specific company whose record I'll get to in
a little bit." He shared that public forums in Anchorage had
made clear that workers at API were committed to the public
mission of API and committed to their patients, although they
had lacked the resources and managerial support to do their jobs
safely and to provide for the safety of the residents. He
declared that the purpose of proposed HB 86 was to provide for a
safe environment for both residents and workers at API, which he
opined "requires public management." He stated that the
proposed bill would not undo the temporary contract with
Wellpath, nor would it prevent privatization of individual
components of services which was consistent with the consultant
report on privatization directed by the Alaska State Legislature
under Senate Bill 74. He presented a PowerPoint titled "CS
House Bill 86," and paraphrased slide 3, titled "API:
Background," which read in part:
Opened in 1962 as part of Alaska Mental Health
Enabling Act of 1956.
4:19:13 PM
REPRESENTATIVE FIELDS moved on to slide 4, "Patient Population
and Care," which read:
It is a 24/7 safety net provider of inpatient
psychiatric care
Patients who need acute psychiatric care,
Title 47-involuntary commitment
Title 12-criminal/forensic patients awaiting court
ordered examinations
ADRD (Alzheimer Disease and Related Disorder)
patients, often placed inappropriately because there
is no community placement available
Others are patients who are experiencing
intellectual/developmental disabilities and where
there is no community support
API is key for broader health system reforms and cost
savings
REPRESENTATIVE FIELDS addressed slide 5, "Background Literature
on Privatization," and slide 6, "2017 Legislative Study
recommends against privatization," which read in part:
1999 Praat and Maahs metastudy of 33 cost
effectiveness studies found that private facilities
were no more cost effective than public studies
2016 the US Department of Justice cited lack of cost
savings and lowered delivery of services in private
prisons as reason for cessation of private prison
usage.
Alaska's own Legislature mandated a privatization
study in SB 74, working with the Alaska Mental Health
Trust and Public Consulting Group
Conclusion: Continue state management to attain cost
savings while preserving services
Cost benefit analysis showed that full privatization
carried risks of decreased quality of services, higher
cost over 5 year contract period
REPRESENTATIVE FIELDS emphasized that inadequacy of staffing was
an important safety issue and a threat to workers safety often
had a ripple effect resulting in less patient safety at API.
4:21:38 PM
REPRESENTATIVE FIELDS directed attention to slide 7 "A Brief
Timeline of the GEO Group, Correct Care Solutions, and Wellpath"
and stated that it could get a bit confusing when attempting to
ascertain the relationship between Wellpath and GEO Group and
Correct Care Solutions. He stated that Correct Care Solutions
and Wellpath were largely the same company, and that Wellpath
had been part of the GEO Group going back in the corporate
history. He pointed out that these had been the same companies
at different points in their history.
4:22:14 PM
REPRESENTATIVE FIELDS shared slide 8, "Death on the Wards," and
declared that Wellpath had a "profoundly disturbing" record as
it had been sued about 1400 times. He noted that he had a "full
set of media clippings and some of them are horrifying to read
through." He shared the story of an individual in a Wellpath
facility who contracted a cold, which progressed into pneumonia
with vomiting and bleeding, and was never provided any care
beyond cough drops. The individual died without receiving any
care from Wellpath. He stated that the 1400 lawsuits were
direct results of "a profit model that sacrifices patient safety
for profits."
4:23:11 PM
REPRESENTATIVE FIELDS reviewed slides 9 - 12, "Wellpath's
history of negligence, deaths," and stated that "this is the
record of Wellpath. It is a very consistent, it's a very
troubling record... " He offered his belief that this troubling
record was the reason to pass proposed HB 86.
4:23:35 PM
REPRESENTATIVE TARR asked if most of the lawsuits had been
associated with the Wellpath prison facilities and not with
their mental health facilities, as indicated by Wellpath
testimony.
4:24:31 PM
REPRESENTATIVE FIELDS replied that both facilities had lawsuits,
adding the Geo Group had the prison contracts and Correct Care
had the private mental health hospital contracts. He offered
his belief that both groups had serious problems.
4:25:02 PM
REPRESENTATIVE FIELDS added that there were "voluminous media
reports from locations around the country where Wellpath has
operated these facilities." He declared that it was "troubling"
where there were credible detailed media reports from multiple
facilities about highly specific incidents of negligence and
death as a result of inadequate care. He shared his concern
that there had not been any assurance from Wellpath for staffing
levels or adequacy of care. He pointed to slide 13, "Wellpath
has "no plan," loses key staff," and stated that the news was
consistent with the company's record for not having a plan for
adequate staffing. He emphasized that the history at API had
shown that adequate staffing was essential for safety to both
patients and workers. He declared that he did not have a
fundamental objection to a different management structure at
API, although he had "extreme concerns" about for-profit
management through a company with a long record of negligence
having a flat budget as a significant amount of money would be
siphoned off for profits. He added that the ownership of
Wellpath was a "highly leveraged private equity firm,"
explaining that private equity firms extracted profit by
shortchanging care, driving down costs, and typically flipping
companies.
4:27:43 PM
REPRESENTATIVE FIELDS directed attention to slide 14, "Putting
Alaskan's First," and he highlighted that outsourcing API to a
private equity firm and Wellpath was a bad idea. He pointed to
an earlier study by the Alaska State Legislature for the
potential savings by privatization, which had specifically cited
Wellpath as a reason not to privatize. He read from the
feasibility study: "The expected margin for a for-profit
contractor is eight percent. This estimate is based on
reporting form South Florida State Hospital." He reiterated
that there was a flat funded API budget, and that, as the
Department of Health and Social Services had not put any "side
boards" on the profits for Wellpath in the contract, there was
no guarantee for the amount of money being spent on care versus
profits for the company.
4:29:17 PM
REPRESENTATIVE TARR shared that she was troubled with this cycle
of change with the formation of new companies relative to the
lawsuits.
REPRESENTATIVE FIELDS acknowledged that it was "fairly common."
He emphasized that Correct Care Solutions had a very long and
very troubling history, and that Wellpath was substantially
Correct Care Solutions. He pointed out that the Geo Group also
had a long and troubling history, although it was not currently
associated with Wellpath.
4:30:25 PM
CO-CHAIR SPOHNHOLZ shared her personal concern that a "really
solid company with a great reputation is gonna want to keep
their name the same for a long time because you build brand
equity over time." She said that the level of frequency for re-
branding, acquisition, or sale over the years indicated that
there was not a lot of brand value and they were not building
any brand equity with a good reputation. She stated that this
was a red flag for her.
4:31:07 PM
REPRESENTATIVE FIELDS expressed his agreement and stated that
this was actually "a toxic brand." He noted that legislative
bodies in other parts of the United States had cancelled pending
contracts with Correct Care because it had such toxic history
and was such a toxic brand, and he offered his belief that this
was the reason for the re-naming as Wellpath.
4:31:30 PM
TRISTAN WALSH, Staff, Representative Zach Fields, Alaska State
Legislature, paraphrased from the "Sectional Analysis for HB 86"
[Included in members' packets], which read:
Section 1. This section amends AS 36.30.300 to add a
new subsection (f) that prohibits creation of
contracts relating to the ownership or operation of an
inpatient mental health treatment hospital established
under AS 47.30.660 (c) (see Section 4)
Section 2. This section amends AS 36.30.310, the State
of Alaska's Emergency Procurement Statutes, to
prohibit the use of these statutes to solicit or
obtain private contracts to run an inpatient mental
health treatment hospital established under AS
47.30.660 (c) (See Section 4)
Section 3. This section amends AS 47.30.660 (b) to
correspond with a new subsection in AS 47.30.660 (c),
that is established in Section 4.
Section 4. This section amends AS 47.30.660 to add an
additional subsection, (c), that requires the
Department of Health and Social Services operate and
maintain an "inpatient mental health treatment
hospital" in the State. It prohibits the state from
delegating or contracting for the ownership, operation
or management of such a facility. It also prohibits
the state from using the single source procurement
statutes in AS 36.30.310 to procure supplies or
services for this facility. It also defines "inpatient
mental health treatment hospital" for the purposes of
this section.
Section 5. This section amends the uncodified law of
the State of Alaska to define the applicability of new
subsections established in Section 1, Section 2,
Section 3 and Section 4, to contracts entered into,
extended or renewed after the effective date of this
Act.
Section 6. This section amends the uncodified law of
the State of Alaska to state if this Act takes effect
after March 1st, 2019, it is retroactive to March 1st,
2019.
Section 7. This section provides for an effective
date; it would take effect immediately on passage
under AS 01.10.070 (c)
4:34:10 PM
MR. WALSH paraphrased from the "Summary of Changes: CS for HB
86" [Included in members' packets], which read:
Several changes were made between version M and the
Committee Substitute (Version U) of House Bill 86
(introduced on 3/16/19).
The administration voiced concern that it would be
unable to contract out for various services handled by
local vendors, such as maintenance, security, and
laundry. The Committee Substitute sought to address
those concerns by making the following changes:
Section 1. Deleted "operation" and "maintenance" to
allow the department to continue to use this limited
competition procurement statute for certain aspects of
the operation and maintenance of the hospital.
Section 2. Deleted "operation" and "maintenance" to
allow the department to continue to use this statute
for emergency procurements for certain aspects of the
operation and maintenance of the hospital.
Section 4. Deleted "operat and "maintain" to allow
the department to continue to contract out for certain
aspects of the operation and maintenance of the
hospital. This meant that section 4 (c) was reduced to
one subsection.
Section 6. This change reflects the accurate
retroactive date for Alaska Psychiatric Institute.
4:35:34 PM
CO-CHAIR SPOHNHOLZ removed her objection to the motion to adopt
the proposed committee substitute (CS) for HB 86, labeled 31-
LS0623\U, Marx, 3/26/19, as the working draft. There being no
further objection, Version U was before the committee.
4:36:08 PM
REPRESENTATIVE PRUITT asked if Section 4 of the proposed
committee substitute would prevent any outside management or
ownership of API.
REPRESENTATIVE FIELDS said that he would consider a friendly
amendment for limited management of API to either a state or a
non-profit operator. This would allow the department to retain
the authority to go through a competitive procurement process
for non-profit management. He offered his belief that this
would address his concerns for patient and worker safety and
allow for partnerships to provide better services.
[HB 86 was held over.]
4:38:19 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:38 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB022 Supporting Document-Letter of Support from American Foundation for Suicide Prevention - Alaska Chapter 03.07.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 22 |
| HB022 Supporting Document-Letter of Support from Suicide Prevention Council 2.25.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 22 |
| HB022 Fiscal Note DHSS-SPC-3.22.2019.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 22 |
| HB022 Supporting Document-Letter of Support from NAMI Alaska 3.6.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 22 |
| HB022 Sponsor Statement 03.15.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 22 |
| HB022 Supporting Document Legislative Audit of Suicide Prevention Council 3.6.2019.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 22 |
| HB022 Supporting Document-Letter of Support from Sally Donaldson 2.25.19.pdf |
HHSS 3/28/2019 3:00:00 PM |
HB 22 |
| HB022 Supporting Document--Letter of Support from ALPHA.pdf |
HHSS 3/28/2019 3:00:00 PM |
HB 22 |
| HB022 Supporting Document-Letter of Support- Governor's Council on Diabilities & Special Education 3.26.19.pdf |
HHSS 3/28/2019 3:00:00 PM |
HB 22 |
| HB022 Supporting Documents-Letter of Support AFN 3.22.19.pdf |
HHSS 3/28/2019 3:00:00 PM |
HB 22 |
| HB029 Sectional Analysis ver A 2.25.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM SHSS 2/14/2020 1:30:00 PM |
HB 29 |
| HB029 Sponsor Statement 2.25.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM SHSS 2/14/2020 1:30:00 PM SHSS 2/19/2020 1:30:00 PM |
HB 29 |
| HB029 Supporting Document-Letter of Support 2.25.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM SHSS 2/14/2020 1:30:00 PM SHSS 2/19/2020 1:30:00 PM |
HB 29 |
| HB029 Fiscal Note DCCED-DOI 3.22.2019.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM SHSS 2/14/2020 1:30:00 PM SHSS 2/19/2020 1:30:00 PM |
HB 29 |
| HB029 Letter of Support Moda Health 03.25.2019.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM SHSS 2/14/2020 1:30:00 PM SHSS 2/19/2020 1:30:00 PM |
HB 29 |
| HB029 Presentation 03.25.2019.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM SHSS 2/14/2020 1:30:00 PM |
HB 29 |
| HB029 Letter of Support ACoA 03.25.2019.pdf |
HHSS 3/28/2019 3:00:00 PM SHSS 2/14/2020 1:30:00 PM SHSS 2/19/2020 1:30:00 PM |
HB 29 |
| HB0097 Supporting Document AK State Medical Bd Roster.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| HB0097 Supporting Document AAPA general overview.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| HB0097 Supporting Document AK State Medical Bd PA scope of practice.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| HB0097 Supporting Document DEA Drug Schedules.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| HB0097 Supporting Document HRSA -HPSA Underserved Primary Care Areas.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| HB0097 Supporting Document Medically Underserved Areas HRSA.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| HB0097 Supporting Document PA guidelines AK State Medical Bd.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| HB0097 Supporting Document PA Prescriptive Authority (AAC).pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| HB097 Draft Proposed Blank CS ver M 3.21.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 97 |
| HB097 Fiscal Note DCCED-CBPL-3.22.19.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 97 |
| HB097 Supporting Document Letters of Support for companion legislation SB44.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM SFIN 4/9/2019 9:00:00 AM |
HB 97 SB 44 |
| HB0097 Sectional.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 97 |
| HB0097 Sponsor Statement.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM |
HB 97 |
| HB0097 Sectional Analysis 3.27.2019.pdf |
HHSS 3/28/2019 3:00:00 PM |
HB 97 |
| HB0097 Sponsor Statement 3.27.2019.pdf |
HHSS 3/28/2019 3:00:00 PM |
HB 97 |
| HB0097 Support Document--Orion BH Emails of Support.pdf |
HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| HB0097 Supporting Document Letter of support from ACOA 3.27.2019.pdf |
HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| HB0097 Supporting Document Letter of support from AK Policy Forum 3.27.2019.pdf |
HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| HB0097 Supporting Document Letter of support from Dietrich (OBHS) 3.27.2019.pdf |
HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM |
HB 97 |
| Childrens Justice Act Task Force Presentation 3.28.2019.pdf |
HHSS 3/28/2019 3:00:00 PM |
Children's Justice Act Task Force |
| HB 86 Supporting Document-ITPI AK Letter for Support HB 86 3.27.19.pdf |
HHSS 3/28/2019 3:00:00 PM |
HB 86 |
| HB086 Draft Proposed Blank CS ver U 3.26.2019.pdf |
HHSS 3/28/2019 3:00:00 PM |
HB 86 |
| HB 86 Sponsor Statement 3.13.19.pdf |
HHSS 3/28/2019 3:00:00 PM |
HB 86 |
| HB 86 Sectional Analysis 3.13.19.pdf |
HHSS 3/28/2019 3:00:00 PM |
HB 86 |
| HB086 Fiscal Note DHSS-API 3.22.2019.pdf |
HHSS 3/28/2019 3:00:00 PM |
HB 86 |
| HB086 Fiscal Note DHSS-MS 3.22.2019.pdf |
HHSS 3/28/2019 3:00:00 PM |
HB 86 |
| HB 86 Sectional Analysis Version U 3.28.19.pdf |
HHSS 3/28/2019 3:00:00 PM |
HB 86 |
| HB 86 Summary of Changes Version M to Version U.pdf |
HHSS 3/28/2019 3:00:00 PM |
HB 86 |
| HB 86 Supporting Document-Letters of Support 3.28.19.pdf |
HHSS 3/28/2019 3:00:00 PM |
HB 86 |
| HB 86 Supporting Document Presentation 3.28.19.pdf |
HHSS 3/28/2019 3:00:00 PM |
HB 86 |
| HB 86 Supporting Documents-News Clips-3.28.19.pdf |
HHSS 3/28/2019 3:00:00 PM |
HB 86 |