Legislature(2023 - 2024)DAVIS 106
03/14/2024 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Board of Direct Entry Midwives | |
| HB363 | |
| HB187 | |
| HB205 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | HB 187 | TELECONFERENCED | |
| *+ | HB 363 | TELECONFERENCED | |
| *+ | HB 205 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 14, 2024
3:03 p.m.
MEMBERS PRESENT
Representative Mike Prax, Chair
Representative Justin Ruffridge, Vice Chair
Representative CJ McCormick
Representative Dan Saddler
Representative Jesse Sumner (via teleconference)
Representative Zack Fields
Representative Genevieve Mina
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
CONFIRMATION HEARING(S):
Board of Certified Direct-Entry Midwives
Bethel Belisle-Anchorage
- CONFIRMATION(S) ADVANCED
HOUSE BILL NO. 363
"An Act relating to the placement of foster children in
psychiatric hospitals."
- HEARD & HELD
HOUSE BILL NO. 187
"An Act relating to utilization review entities; exempting
certain health care providers from making preauthorization
requests for certain services; and providing for an effective
date."
- HEARD & HELD
HOUSE BILL NO. 205
"An Act interpreting the right to privacy under art. I, sec. 22,
Constitution of the State of Alaska; defining 'abortion,'
'birth,' 'child,' 'conception,' 'natural person,' and 'preborn
child'; relating to civil actions and liability under the Act;
relating to murder of a child; repealing abortion procedures;
amending the definition of 'person' for crimes against a person;
repealing murder of an unborn child and penalties and provisions
related to that crime; relating to the powers of guardians;
relating to powers of attorney for health care decisions;
relating to regulation of abortion; relating to medical
treatment for minors; relating to relocation of a child;
relating to the office of public advocacy; repealing medical
assistance payment for abortions; relating to duties of the
attorney general; relating to the limitation on the use of
assets; and providing for an effective date."
- HEARD & HELD - ASSIGNED TO SUBCOMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 363
SHORT TITLE: FOSTER CHILDREN PSYCHIATRIC TREATMENT
SPONSOR(s): REPRESENTATIVE(s) GRAY
02/20/24 (H) READ THE FIRST TIME - REFERRALS
02/20/24 (H) HSS
03/14/24 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 187
SHORT TITLE: PRIOR AUTH EXEMPT FOR HEALTH PROVIDERS
SPONSOR(s): REPRESENTATIVE(s) SUMNER
05/03/23 (H) READ THE FIRST TIME - REFERRALS
05/03/23 (H) HSS, L&C
02/15/24 (H) HSS AT 3:00 PM DAVIS 106
02/15/24 (H) Heard & Held
02/15/24 (H) MINUTE(HSS)
03/14/24 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 205
SHORT TITLE: CRIMINALIZE ABORTION; PRIVACY; COURTS
SPONSOR(s): REPRESENTATIVE(s) EASTMAN
05/16/23 (H) READ THE FIRST TIME - REFERRALS
05/16/23 (H) HSS, JUD, FIN
05/16/23 (H) HSS RPT RECD W/CS AWAIT TRANSMITTAL NXT
03/14/24 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
BETHEL BELISLE, Appointee
Board of Certified Direct Entry Midwives
Anchorage, Alaska
POSITION STATEMENT: Testified as an appointee to the Board of
Certified Direct Entry Midwives.
REPRESENTATIVE ANDREW GRAY
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As prime sponsor, gave the sponsor
statement for Version S of HB 363.
MATTHEW TURNER, Staff
Representative Andrew Gray
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: On behalf of Representative Gray, prime
sponsor, explained the changes made in the proposed committee
substitute to HB 363.
MATEO JAMIE
Anchorage, Alaska
POSITION STATEMENT: As a foster care child, gave invited
testimony on HB 363, Version S.
SARAH LEWIS
Anchorage, Alaska
POSITION STATEMENT: As a foster care child, gave invited
testimony on HB 363, Version S.
NANCY MEADE, General Counsel
Alaska Court System
Anchorage, Alaska
POSITION STATEMENT: Answered committee questions relating to HB
363, Version S.
KIM SWISHER, Deputy Director
Office of Children's Services
Department of Family & Community Services
Anchorage, Alaska
POSITION STATEMENT: Gave invited testimony on HB 363, Version
S.
JEANNIE MONK, Senior Vice President
Alaska State Hospital & Healthcare Association
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 187.
REPRESENTATIVE JESSE SUMNER
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As prime sponsor, answered committee
questions on HB 187.
TAMMY THIEL, Executive Director
Denali Oncology Group
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 187.
PAM VENTGEN, Executive Director
Alaska State Medical Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 187.
MARC REECE, Director of Public Policy
AETNA
Denver, Colorado
POSITION STATEMENT: Testified in opposition to HB 187.
PREET KLAUR, Policy & Legislative Manger
Premera Blue Cross Blue Shield of Alaska
Seattle, Washington
POSITION STATEMENT: Testified in opposition to HB 187.
STEVE RAMOS, Acting Chief Health Administrator
Division of Retirement & Benefits
Department of Administration
Juneau, Alaska
POSITION STATEMENT: Answered committee members' questions
during the hearing on HB 187.
REPRESENTATIVE DAVID EASTMAN
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As prime sponsor, introduced HB 205.
PAT MARTIN, Outreach Director
Alaska Right to Life
Anchorage, Alaska
POSITION STATEMENT: Gave invited testimony on HB 205.
RICHARD CLAYTON TROTTER, General Counsel
Justice Foundation
Eagle River, Alaska
POSITION STATEMENT: Testified in support of HB 205.
ROBERT M. BIRD, Past President
Alaska Right to Life
Kenai, Alaska
POSITION STATEMENT: Spoke in support of HB 205.
ACTION NARRATIVE
3:03:58 PM
CHAIR PRAX called the House Health and Social Services Standing
Committee meeting to order at 3:03 p.m. Representatives
McCormick, Saddler, Fields, Sumner, and Prax were present at the
call to order. Representatives Ruffridge and Mina arrived as
the meeting was in progress.
^CONFIRMATION HEARING(S):
CONFIRMATION HEARING(S):
^Board of Direct Entry Midwives
Board of Direct Entry Midwives
3:06:07 PM
BETHEL BELISLE, Appointee, Board of Certified Direct Entry
Midwives, reviewed her qualifications for her appointment to the
Board of Certified Direct Entry Midwives.
3:07:47 PM
MS. BELISLE, in response to questions from Representative
Saddler, said two issues that need to be addressed are
regulatory "clean-up" to make sure regulations and statutes are
in alignment and staying fiscally responsible so as to meet the
terms of a legislative audit. She said that the 2022
legislative audit highlighted what the board was missing. She
said that concerns with hiring practices were brought about and
stressed that the board itself does the hiring for the Division
of Corporations, Business, and Professional Licensing, not the
division itself. Regarding recruitment, she said it has been
difficult to fill every spot on the board. She said there are
several direct-entry midwives who are ready to apply should HB
175 come up with any new amendments that require three direct-
entry midwives. She said the Midwife Association of Alaska
(MAA) has been working with doctors and families to encourage
more direct-entry midwives to apply to the board.
3:12:54 PM
MS. BELISLE, in response to a question from Representative
Fields regarding outcomes of regulations, noted that there was
one particular outcome with a patient under the care of a
midwife, an obstetrician gynecologist, and a family doctor
regarding a particularly difficult delivery. She said that the
patient wouldn't have delivered if not for the presence of a
midwife, whom Ms. Belisle credited with saving the patient's
life.
MS. BELISLE gave her final statement on her appointment and
thanked the committee for the opportunity to present her
application to the board.
3:17:02 PM
CHAIR PRAX opened public testimony on the appointment of Ms.
Belisle to the Board of Certified Direct-Entry Midwives. After
ascertaining that there was no one who wished to testify, he
closed public testimony.
3:18:06 PM
CHAIR PRAX stated that the House Health and Social Services
Standing Committee has reviewed the qualifications of the
governor's appointees and recommends that the following name be
forwarded to a joint session for consideration: Bethel Belisle,
Board of Certified Direct Entry Midwives. He said that signing
the report regarding appointments to boards and commissions in
no way reflects an individual member's approval or disapproval
of the appointee, and the nomination is merely forwarded to the
full legislature for confirmation or rejection.
3:18:34 PM
The committee took an at-ease from 3:18 p.m. to 3:21 p.m.
HB 363-FOSTER CHILDREN PSYCHIATRIC TREATMENT
3:21:11 PM
CHAIR PRAX announced that the next order of business would be
HOUSE BILL NO. 363, "An Act relating to the placement of foster
children in psychiatric hospitals."
REPRESENTATIVE ANDREW GRAY, Alaska State Legislature, as prime
sponsor, introduced HB 363. He encouraged the committee to
adopt the proposed committee substitute.
3:23:08 PM
REPRESENTATIVE RUFFRIDGE moved to adopt the proposed committee
substitute (CS) for HB 363, Version 33-LS1049\S, Bergerud,
3/13/24, as the working document.
REPRESENTATIVE SADDLER objected for the purpose of discussion.
3:23:45 PM
MATTHEW TURNER, Staff, Representative Andrew Gray, Alaska State
Legislature, on behalf of Representative Gray, prime sponsor of
HB 363, explained the summary of changes from the original bill
version to Version S {included in the committee packet], which
read as follows [original punctuation provided]:
Title Change
Add: and amending Rule 12.1(b), Alaska Child in Need
of Aid Rules Procedure
Eliminate Section
Eliminate section 1 from version A.
Section 1
Amends AS 47.10.087(b) to conform to subsequent
changes.
Section 2
Adds two definitions to this section: "acute
psychiatric hospital" and "contemporaneous two-way
video conference".
Section 3
Adds new rules specifically for how the Department of
Family and Youth Services may place a child into an
acute psychiatric hospital, how the Department must
immediately begin search for a less restrictive
placement for when the child is released from the
acute psychiatric hospital, rules for assuring a
timely initial court hearing to review the placement
of the child, and for establishing regular ongoing
hearings to assure the child does not remain in the
acute psychiatric hospital for longer than necessary.
3:25:10 PM
The committee took a brief at-ease at 3:25 p.m.
3:25:36 PM
REPRESENTATIVE GRAY gave the sponsor statement for Version S of
HB 363 [included in the committee packet]. He explained that HB
363 aims to require children in the custody of the Office of
Children's Services (OCS), also known as foster children, to
receive a hearing in front of a judge in a timely manner to
ensure that they meet the criteria to be placed under the care
of a psychiatric hospital. He cited Native Village of Quinhagak
vs State of Alaska, heard in the Alaska Supreme Court, and
highlighted the judge's opinion that "there is no doubt that
children in OCS custody are at substantial risk of being
hospitalized for longer than they need" and the statement made
that "clarifying the legal protections for a vulnerable
population of children in state custody is of utmost public
importance." He said the Alaska Supreme Court determined that
the current 46-day wait between a child's first admission and
court hearing is far too long to satisfy due process. When a
young person is hospitalized in a psychiatric institution, that
person has limitations placed on their rights and freedoms that
are not placed onto others. He said the chance that a foster
child's rights could be restricted are much higher than that of
other children. He said that often, one of the greatest traumas
experienced by foster children is the process of admission to a
psychiatric institution; it is akin to a form of incarceration.
He advised that children have suffered from admissions that were
too long and unnecessary, which is what HB 363 Version S aims to
solve. He opined that the priority should not be on the child,
not on making the legal process surrounding foster childcare and
custody more convenient for the adults involved.
3:31:27 PM
MR. TURNER began the associated PowerPoint presentation to HB
363, Version S [hardcopy included in committee packet]. He
started on slide 1, which explained the purpose of HB 363,
Version S, by giving context with an article of the Constitution
of the State of Alaska. He moved through slides 3-4, which gave
context to the reality of the situation faced by acute
psychiatric care facilities across Alaska. He continued to
slide 5, which touched on the Alaska Supreme Court ruling that
OCS children are at risk of being hospitalized longer than is
necessary. He moved forward to slide 6, which explained the
authority that OCS has with regard to the placement of foster
children in psychiatric care. He continued to slide 7, which
showed a graph of OCS youth placements into acute psychiatric
care from 2017-2022. Finally, he moved through slides 8-9,
which explained what HB 363, Version S, would do if put into law
to solve the issues surrounding OCS childcare in Alaska.
3:36:33 PM
MR. TURNER offered the sectional analysis for HB 363, Version S
[included in committee packet], which read as follows [original
punctuation provided]:
Section 1
AS 47.10.087 Placement in secure residential
psychiatric treatment centers.
Amends AS 47.10.087(b) to conform to subsequent
changes.
Section 2
AS 47.10.087(d) Definitions
Adds two definitions to AS 47.10.087(d) and renumbers
the section to conform to these changes.
The first defines an "acute psychiatric hospital" as a
facility that primarily provides diagnosis and short-
term treatment of mental, emotional, and behavioral
disorders.
The second defines a "contemporaneous two-way video
conference".
Section 3
AS 47.10.087 Child in need of aid procedures
Adds new subsections to AS 47.10.087 that do the
following:
(e) Allows OCS to place a child in its custody into an
acute psychiatric hospital if it is the least
restrictive placement available, and the person in
charge of admittance to the facility finds that acute
psychiatric care is the best course of action for the
child.
(f) Within 24 hours after placing a child in an acute
psychiatric hospital under OCS shall notify the court,
the child's parents, and any other parties to an
ongoing child-in-need-of-aid case involving the child
of the placement.
(g) A court shall review a placement made under (e) of
this section within 48 hours after receiving
notification of the child's placement in an acute
psychiatric hospital. The court shall notify the
child, the child's attorney, the child's parents, the
department, and any parties to a child-in-need-of aid
case involving the child of the time and place of the
hearing once the hearing is scheduled.
Additional language defines the 48-hour period to
allow for weekends and holidays, and allows the court
an additional two day continuance if the concerned
parties cannot meet earlier. To make the hearing
easier, it may be held via teleconference.
The hearing will determine whether continued placement
in an acute psychiatric hospital is in the best
interest of the child. If the child remains in the
acute psychiatric hospital, there will be review
hearings held every 30 days or at the request of the
child or another party after showing good cause.
3:39:34 PM
MATEO JAMIE, as a foster child, gave invited testimony on HB
363, Version S. He described his experience being placed in a
psychiatric facility and said when he was admitted, all of his
belongings were taken from him and he was forced to wear medical
scrubs, all of which were distressing. He said he was placed in
a psychiatric facility because there were no available foster
homes, which the doctor at the facility acknowledged was common
practice. He said that during his two-month stay at the
facility, his OCS worker visited him only twice to determine if
the facility was the correct placement or not. He described
situations where staff physically attacked the youth staying at
the facility and police were called in to maintain order, and he
cited these situations as causes for post-traumatic stress
disorder (PTSD). He said that if they didn't obey every
command, children at the psychiatric facility would receive a
chemical sedative via injection, which further contributed to
the trauma and humiliation of being admitted to a psychiatric
institution. He explained that he felt "like a zombie" for the
two months he was admitted to the institution and had no say
over anything in his life. He emphasized that psychiatric care
should not be used as a substitute for proper placement in a
foster home and said that foster youth deserve placement
decisions within three days of admittance to OCS.
3:42:48 PM
REPRESENTATIVE MINA gave her thanks to Mr. Jamie for sharing his
experience in the foster care system in Alaska.
REPRESENTATIVE PRAX speculated that just being at the
psychiatric facility was enough to cause trauma.
MR. JAMIE confirmed that is correct; he still has PTSD attacks
to this day.
3:43:51 PM
SARAH LEWIS, as a foster care child, gave invited testimony on
HB 363, Version S. She described her own experience in the
foster care system, saying she was in the system until she aged
out when she turned 21. She said foster youth are being placed
in psychiatric hospitals even though the public has been made
aware of the fact that these institutions are not the right
place for many of them. She shared a story of her younger
brother and sister's experience in the foster care system, in
which they were made to wait 29 days in a psychiatric facility
after being removed from a previous foster home. She emphasized
how traumatizing this process was for both her and her siblings
and said that the child has no say in their placement of foster
care. She recounted a visit to a psychiatric hospital that her
youngest sister was placed in where a nurse was taunting a
foster child and threatening them with an injected chemical
sedative. She described her visit to her younger sister as
heartbreaking, saying it was as though she was a zombie due to
the heavy volume of sedative medication they were giving her at
the institution. She said that OCS has created this trauma and
done nothing to remedy it, all the while the foster child has no
say in their placements in the system.
3:49:37 PM
REPRESENTATIVE RUFFRIDGE asked Ms. Lewis to expound on why her
role as a placement caregiver in the foster care system wasn't
the first option in a foster youth's journey.
MS. LEWIS said she did not know why OCS chose not to give her
immediate custody of her younger siblings; she only won custody
after she obtained an attorney.
3:52:09 PM
REPRESENTATIVE FIELDS said he was baffled by the accusation
pertaining to NorthStar Psychiatry and asked how those
grievances could have occurred.
NANCY MEADE, General Counsel, Alaska Court System, answered
committee questions relating to HB 363, Version S, deferred the
question to OCS.
REPRESENTATIVE FIELDS asked what mechanism beside making an
appeal would be available if OCS doesn't help in regard to an
alleged abuse at NorthStar Psychiatry.
MS. MEADE answered that she is not aware of litigation
surrounding NorthStar Psychiatry but would investigate it.
3:53:51 PM
KIM SWISHER, Deputy Director, Office of Children's Services,
Department of Family & Community Services, gave invited
testimony on HB 363, Version S. She said she isn't able to
speak to ongoing litigation relating to NorthStar Psychiatry,
but she said that there are very few acute psychiatric hospital
settings in Alaska where OCS is able to give urgent care to
foster youth experiencing urgent mental health needs.
REPRESENTATIVE FIELDS asked what it would take for OCS to find
an alternative to NorthStar Psychiatry after years of documented
abuse.
MS. SWISHER responded that she has seen the number of children
who need to use NorthStar decline and added that OCS is working
with NorthStar to remedy complaints that are put forward.
REPRESENTATIVE FIELDS asked if OCS has worked with nonprofit or
tribal health providers to establish other options for foster
care placement.
MS. SWISHER replied that she would have to get back to
Representative Fields later.
3:56:50 PM
CHAIR PRAX asked how OCS makes the choice for which psychiatric
facility to use and how OCS verifies that the care being
provided is adequate.
MS. SWISHER answered that often, acute care settings are chosen
when OCS is awaiting evaluation of a foster child's evaluation,
which she emphasized is performed by a qualified mental health
professional.
3:58:58 PM
REPRESENTATIVE RUFFRIDGE asked if there is a potential to have a
position within OCS whose sole job is to evaluate foster
children for placement options.
MS. SWISHER answered that OCS utilizes acute care settings when
a foster child meets the criteria for that need. She said that
OCS doesn't have an in-house mental health professional to
evaluate foster children but does partner with outside
providers, and she said she would follow up with more
information later.
4:01:20 PM
REPRESENTATIVE MINA asked Ms. Meade to compare the standard
timelines for court hearings of an adult and a child being
considered for psychiatric facility.
MS. MEADE responded that in the comparable scenario for an
adult, a court hearing is required within 72 hours of a
placement in a psychiatric facility. She said that with regard
to children's psychiatric placement, there is no timeline under
current statute, which is what HB 363, Version S, aims to
address. She said if a court determines that an adult who is
being considered during the 72-hour hearing does not meet the
criteria of acute care, the adult is released; whereas a child
isn't just let go and must be sent somewhere, psychiatric
institutions often being the only least-restricting alternative.
She acknowledged that it does take longer for a child to get a
hearing than an adult because of the number of people and
entities involved in the process. She said that 3 days might be
too short but agreed that anything over 14 days is too long.
She advised that it is up to the legislature to set the adequate
timeline that the courts must follow.
4:07:15 PM
REPRESENTATIVE MINA echoed her understanding that there is
currently no requirement to have a court hearing unless it is
requested by someone.
MS. MEADE answered that the current statute that governs OCS
childcare says a court hearing must be granted within 30 days of
the child being taken into care, and said that statute would be
amended by HB 363, Version S.
4:09:07 PM
CHAIR PRAX asked whether a foster child has an advocate beside
OCS. He clarified the timeline of a foster child's court
hearing and gave a hypothetical scenario of a child under OCS
care to clarify his understanding of how the OCS childcare
system currently functions.
MS. MEADE responded that the intent of HB 363, Version S, is to
shorten the timelines of court case hearings for foster
children. She clarified that HB 363, Version S, would address
foster children who are already in state custody, not children
who are in need of emergency assistance by OCS.
CHAIR PRAX gave another hypothetical scenario to clarify his
understanding of the OCS childcare system.
MS. SWISHER confirmed that Chair Prax' understanding is correct:
a qualified mental health professional evaluates a foster child,
and then OCS works with a care provider to find the least-
restrictive option for the child. In response to a series of
follow-up questions from Representative Prax, said that
sometimes foster children are evaluated and immediately sent
back to lower levels of care but the challenge in Alaska is
locating safe, appropriate step-down care services. She added
that OCS has recently been doing safety checks and takes direct
consultation with foster children.
4:18:09 PM
REPRESENTATIVE GRAY gave context to the proposed 72-hour figure
as written in HB 363, Version S. He said he asked the
Department of Law and spoke with OCS about the proposed 72-hour
figure and acknowledged that the Native Village of Quinhagak vs
State of Alaska, Office of Children's Services case recognizes
that the 72-hour figure might be too tight of a timeline, but
said it is incumbent upon the legislature to select the absolute
[maximum time in which foster child must be placed].
4:19:49 PM
REPRESENTATIVE MINA asked how many court hearings have
teleconference or hybrid hearing capabilities.
MS. MEADE answered that OCS has a robust video presence and
hybrid court options are viable for most who can't make it to
the hearing.
4:22:05 PM
REPRESENTATIVE RUFFRIDGE gave his thanks to Representative Gray
for putting HB 363, Version S, forward and suggested that there
be language added to include an obligation to a child being
released should they not meet the criteria for acute psychiatric
care. He asked Ms. Meade to speak to the burden of proof of the
state, and asked Ms. Swisher whether OCS had noticed any of the
complaints brought forward or taken any action to remedy them.
4:25:57 PM
MS. SWISHER, responding to Representative Ruffridge, said that
she has seen changes with NorthStar Psychiatry in working with
its personnel, and OCS takes these complaints seriously and will
continue to investigate them.
MS. MEADE explained that the standard of evidence for admitting
a foster child to acute psychiatric care is "clear and
convincing" evidence that the child is suffering from a mental
illness. She cited page 3, line 9 of HB 363, Version S, which
clarifies that the court can authorize OCS to continue the
placement into acute psychiatric care, but said the presumption
is to not place them into care if not necessary. She said in
child cases, an individual's will is not as important as in
adult cases. She said the decision is based off of a
consideration of all of the evidence presented by all parties
involved in the case and emphasized that there is a statewide
problem with quality mental health facilities and treatment in
Alaska.
4:29:28 PM
CHAIR PRAX expressed interest in how a decision is considered
between adults and children.
REPRESENTATIVE GRAY, in response to Representative Ruffridge,
said that he believes OCS is doing its best to get foster
children the placements and care they need but is inhibited by a
lack of resources. He emphasized that the moment a foster child
says the words, "I'm going to kill myself," a child must be
taken away from their current placement and reevaluated. Making
a statement is sometimes a method used by children in OCS
custody to escape an unhappy placement, whether true or not.
4:31:59 PM
MS. LEWIS added to Representative Gray's testimony, clarifying
that she was referencing her brother, Jeremy Redmond, who passed
away in October 2020 due to a lack of care by OCS. She said
that the job of OCS is to take care of the children in its
custody, but it didn't follow through with that promise. She
said that OCS chose to wait until there was a crisis in her home
with her brother. She recalled going to court to testify
against her brother's foster home placement and said her calls
had been ignored. She said that after placement in this foster
home, her brother was staying with an adult still under OCS care
that she pleaded with the OCS to be removed but was not. She
said this adult under OCS care provided her little brother
drugs, and it was OCS who notified Ms. Lewis of her little
brother's overdose death, even after her pleas to have the
person removed.
CHAIR PRAX asked why Ms. Lewis was disqualified from custody of
her little brother.
MS. LEWIS said that she was disqualified from foster parenthood
because she could not provide her little brother with the
behavioral health services that he was required to be receiving
under OCS care.
4:37:48 PM
A roll call vote was taken. Representatives McCormick,
Ruffridge, Sumner, Fields, Mina, and Prax voted in favor of
adopting the proposed CS for HB 363, Version 33-LS1049\S,
Bergarud, 3/13/24, as a working document. [Representative
Saddler was absent.] Therefore, by a vote of 6-0, Version S was
before the committee.
4:39:14 PM
REPRESENTATIVE FIELDS commented that one of the reasons
institutions with histories of abuse can still exist is because
of the for-profit motive of psychiatric care facilities. He
urged committee members to guide OCS further because what is
happening currently is outrageous.
REPRESENTATIVE MINA added that the Department of Health (DOH)
and the Department of Family and Community Services (DFCS) have
a draft of a youth behavioral health plan that seeks to address
downstream services of the departments. There is a public
comment period open until March 17.
4:41:02 PM
CHAIR PRAX announced that HB 363, Version S, was held over.
4:41:14 PM
The committee took an at-ease from 4:41 p.m. to 4:42 p.m.
HB 187-PRIOR AUTH EXEMPT FOR HEALTH PROVIDERS
4:42:43 PM
CHAIR PRAX announced that the next order of business would be
HOUSE BILL NO. 187, "An Act relating to utilization review
entities; exempting certain health care providers from making
preauthorization requests for certain services; and providing
for an effective date."
4:44:22 PM
CHAIR PRAX opened public testimony on HB 187.
JEANNIE MONK, Senior Vice President, Alaska State Hospital &
Healthcare Association, testified in support of HB 187, saying
it would reduce the wait time for certain healthcare services by
exempting healthcare providers from the preauthorization
process. She said that HB 187 represents a step forward in
ensuring timely access to essential medical care. She said that
prior authorization can be extremely frustrating and stressful
for patients and said the last thing a patient wants to worry
about is whether or not their insurance company will cover their
medical bills. She said for patients in rural areas, the issue
of prior authorization is exacerbated by the remote nature of
rural medical care. She emphasized that the prior authorization
process is extremely time consuming for medical providers as
well. Often a healthcare provider will hire teams of staff just
to manage insurance and prior authorization requests. She said
the proposed legislation would strike a good balance between all
aspects of the prior authorization process, and she urged the
committee to pass HB 187.
4:48:00 PM
REPRESENTATIVE FIELDS asked how many medical conditions exist
where the treatment might be longer than 12 months.
MS. MONK said she would follow up with an answer later.
4:48:37 PM
REPRESENTATIVE RUFFRIDGE asked Representative Fields to clarify
his question as to how it relates to prior authorization.
REPRESENTATIVE FIELDS asked if a hypothetical treatment regime
that would need to be executed for longer than 12 months is
addressed in HB 187.
4:49:36 PM
REPRESENTATIVE JESSE SUMNER, Alaska State Legislature, as prime
sponsor, in response to Representative Fields, cited psoriasis
medication as an ongoing treatment regime and said that the
exemption for prior authorization, as addressed under HB 187, is
for the healthcare provider, not the patient.
CHAIR PRAX asked Ms. Monk how often prior authorization requests
are denied and how long payment would take if a request were
approved.
MS. MONK replied that it varies greatly, but there is no data
set on it. She said there are hundreds of procedures all over
Alaska that have to be authorized every day.
4:52:05 PM
TAMMY THIEL, Executive Director, Denali Oncology Group,
testified in support of HB 187. She gave context to the primary
role of the Denali Oncology Group (DOG) and explained how the
current prior authorization process is negatively affecting
medical care in Alaska. She said HB 187 prescribes a solution
for these issues by introducing the concept of a "gold card"
that grants exemption to healthcare providers who consistently
follow evidence-based medicine and achieve an 80 percent
approval rating on prior authorization requests. She said this
could greatly streamline the process of prior authorization and
urged the committee's support for HB 187.
4:55:11 PM
PAM VENTGEN, Executive Director, Alaska State Medical
Association, testified in support of HB 187. She said that
prior authorization is a process that serves a purpose but can
often inhibit timely and quality healthcare. She said the "gold
card" provision of HB 187 is sensical and would make the process
of prior authorization smoother for all parties involved. She
gave a note on statistics surrounding prior authorization
approval/disapproval rates, along with patient outcomes
depending on the approval or disapproval of the prior
authorization. She cited a survey from the American Medical
Association (AMA) that found that prior authorization
requirements delay necessary treatment and care in 94 percent of
cases. She said the physical, emotional, and financial impact
to patients from delays caused by prior authorization are
significant and devastating, and change should be made. She
said that HB 187 makes sound and logical changes to these
problems and urged the committee's support of HB 187.
4:59:48 PM
MARC REECE, Director of Public Policy, AETNA, testified in
opposition to HB 187. He said that HB 187 is not a good
solution to the ailments that currently exist in the prior
authorization system. He explained that the purpose of prior
authorization is to ensure that healthcare is paid for and
administered as soon as possible and said that HB 187 doesn't
help with that purpose. He said that the bill sponsor doesn't
recognize the impact of the proposed legislations' proposed
"gold card" exemption program. The 80 percent threshold is far
lower than every other state that has tried to implement an
exemption program.
5:03:06 PM
REPRESENTATIVE MINA asked what mechanisms are currently in place
that insurance companies can pursue to reduce the wait time for
prior authorization.
MR. REECE responded that AETNA is actively trying to reduce the
prior authorization approval process by removing certain
services from prior authorization and by automating the approval
process through clinical standards that must be met.
5:05:14 PM
PREET KLAUR, Policy & Legislative Manger, Premera Blue Cross
Blue Shield of Alaska, testified in opposition to HB 187. She
said the proposed bill would be costly and confusing for
insurance companies and their members. She warned that HB 187
would increase the risk for adverse medical events, citing an
unnamed study that found that over 10 percent of authorization
reviews prevented adverse drug events and medical errors. She
emphasized that prior authorization is a critical tool in
ensuring that healthcare is cost-effective and safe, and added
that all prior authorization requests are resolved within 5
days, or within 24 hours if it is an emergency request. She
explained an existing support structure for medical providers
that allows for a reevaluation process if there were wrongful
disapproval of a prior authorization request.
REPRESENTATIVE MINA asked what mechanisms Premera Blue Cross
Blue Shield of Alaska was pursuing to reduce prior authorization
approval times.
MS. KLAUR answered that Premera Blue Cross Blue Shield of Alaska
has created a reevaluation process for a denied approval and
implemented an electronic portal online for easier access to
information regarding its prior authorization approval.
5:10:18 PM
REPRESENTATIVE MINA asked whether HB 187 applies to the
healthcare plans utilized by the State of Alaska.
STEVE RAMOS, Acting Chief Health Administrator, Division of
Retirement & Benefits, Department of Administration, answered
that HB 187 is housed under Title 21 under Alaska Statute, and
the Alaska Care plans as administered by the Division of
Retirement and Benefits are not insurance plans, so they are
subject to Title 39 under Alaska Statute.
REPRESENTATIVE MINA asked Representative Sumner, "Is your intent
to also cover the state plan and [Employee Retirement Income
Security Act] (ERISA) plans or are you only sticking to Title
21?"
REPRESENTATIVE SUMNER answered that is correct.
5:11:56 PM
CHAIR PRAX, after ascertaining there was no one else who wished
to testify, closed public testimony on HB 187.
CHAIR PRAX announced that HB 187 was held over.
HB 205-CRIMINALIZE ABORTION; PRIVACY; COURTS
5:12:35 PM
CHAIR PRAX announced that the final order of business would be
HOUSE BILL NO. 205, "An Act interpreting the right to privacy
under art. I, sec. 22, Constitution of the State of Alaska;
defining 'abortion,' 'birth,' 'child,' 'conception,' 'natural
person,' and 'preborn child'; relating to civil actions and
liability under the Act; relating to murder of a child;
repealing abortion procedures; amending the definition of
'person' for crimes against a person; repealing murder of an
unborn child and penalties and provisions related to that crime;
relating to the powers of guardians; relating to powers of
attorney for health care decisions; relating to regulation of
abortion; relating to medical treatment for minors; relating to
relocation of a child; relating to the office of public
advocacy; repealing medical assistance payment for abortions;
relating to duties of the attorney general; relating to the
limitation on the use of assets; and providing for an effective
date."
5:13:10 PM
The committee took an at-ease from 5:13 p.m. to 5:16 p.m.
5:16:09 PM
REPRESENTATIVE DAVID EASTMAN, Alaska State Legislature, as prime
sponsor, introduced HB 205. He explained that the bill is also
referred to as the "Life at Conception Act" and "Preborn Child
Equality Act of 2024" and deals with the constitutional rights
of children.
5:17:10 PM
PAT MARTIN, Outreach Director, Alaska Right to Life, gave
invited testimony in support of HB 205. He began his testimony
by drawing attention to an article in a 1965 issue of Life
Magazine and proffering that the article anticipated Alaska
Right to Life's overarching theory that life begins at
conception. He explained the article was published seven years
before Roe v. Wade, and in the magazine issue "there are
articles which were very publicly published, and these indicate
that in 1965 we had the scientific knowledge that life begins at
conception and, in fact, we had not just the knowledge that life
begins at conception, but we had actual imagery that life begins
at conception."
MR. MARTIN referred to the committee's previous consideration of
a healthcare bill, using that to bolster his major points. He
purported the following [bullet-pointed for clarity]:
• Performing an abortion is murder.
• The act of performing an abortion falls under the
heading of healthcare.
• When an egg and a sperm meet, life begins.
• An individual human being in the womb is alive but
separate from the mother.
• An individual human being is killed during an
abortion, no matter what the stage of gestation.
• Whether the fetus is eight days or six weeks it is an
individual human being that is alive.
• The constitution gives an inherent right to equality
and equal protection under the law.
• Equal right to protection under the law applies to a
fetus.
• The Alaska constitution and Alaska judicial system are
in conflict regarding the right to life of an unborn
child.
• Children in the womb deserve to be protected from
violence.
• We make it legal for doctors to murder a child in the
womb and pay them to do so.
• We pay for abortions because our tax dollars pay for
half of the abortions performed in Alaska.
• In 1969 Senator Rayder moved to Alaska from California
and introduced bills legalizing abortion until one
finally passed and became law after a 2/3 vote by the
legislature to override the governor's veto.
• It has been known for 800 years that abortions kill.
• We ignore science and wantonly legalize killing babies
in the womb.
• Alaska's supreme court has a duty and the authority to
create new constitutional rights.
• Our constitutions are designed to recognize the rights
that are given to us from God.
• The legislature and the people can change the Alaska
constitution to recognize the rights of the unborn.
• Alaska's supreme court has determined that abortion is
a fundamental right, but the court does not have the
authority to make that determination.
• The Alaska courts have said reproductive rights are
unamenable, but they technically lack the authority to
make that determination.
• A child's health is not a concern in abortion
jurisprudence in the state of Alaska.
• We deny the health of the life of a child when we say
a woman can kill him [sic].
• A brutal gruesome brutal death is not good for the
health of a child.
• Anyone advocating for abortion in Alaska does so with
total disregard for the health of the child as well as
disregard for the existence of the child.
• The statute that governs abortion in Alaska doesn't
mention the child; it says the process is a
termination of pregnancy.
• One of the results of the Dobbs decision is that
states can determine abortion policy.
MR. MARTIN, as part of his discourse, proffered as proof that a
being in the womb is alive by purporting that blood
transfusions, open heart surgery, and spinal bifida surgeries
have been performed on children in the womb. He also alleged
that there were active murder cases in Alaska in which men were
being prosecuted for killing babies in the womb. He described
several of these cases, explaining that in one instance the baby
in the womb was murdered by another man when it was 36 weeks.
He added, "In some of these cases, the mothers died in the
process as well." He also drew the committee's attention to the
phrase "reproductive rights," characterizing it as abortion
activism. He claimed that in 1997 abortion advocates and
activists "created out of whole cloth, out of thin air, a right
for a woman to kill her child in total violation of that child's
constitutional rights to life, to equality among persons, and
equal protections under the law."
5:32:03 PM
CHAIR PRAX responded by commenting on the Roe v. Wade and the
Dobbs decision and stated that these were huge matters.
MR. MARTIN asked Chair Prax to enter a set of petitions into the
record, specifying that there were 4,822 signed petitions.
5:36:04 PM
RICHARD CLAYTON TROTTER, General Counsel, Justice Foundation,
gave invited testimony in support of HB 205. He described his
background and how it relates to HB 205, explaining that the
Justice Foundation filed four briefs in the Dobbs decision and
that the foundation has approximately 5,000 related cases. He
explained that he has copies of testimony from Alaska post-
aborted women and women from all over the United States which he
would be happy to provide to the committee. He noted that some
of the stories would bring a person to tears, relating one story
about a woman who terminated a pregnancy and has spent the
subsequent years "lamenting and grieving over" the child she
thought she murdered in her own womb.
MR. TROTTER continued his testimony by describing one of his
briefs which said that a person is a person no matter how small
and quoted Dr. Suess. He described the continuum of conception
to birth, explaining that barring unforeseen circumstances such
as being shot or killed, the child will be born into the world
and become a human being. He went on to tell the story of a
person known as Hannah S, who never occupied her mother's womb
as a baby but instead started life as an egg that came out of
her mother's womb and was placed in a petri dish and frozen for
2 1/2 years and then the egg was fertilized. The fertilized egg
was subsequently stored for 2 1/2 years; thawed out and put in a
woman's womb; and was born "in the regular way" nine months
later. She is now a graduate of Baylor University in the
graduate school of Social Studies, and her goal is to stand up
for in vitro babies. He explained that during the Dobbs
deliberations, she was waving her hands in the air figuratively
saying, "I'm alive! I'm alive! I was alive for two years
frozen."
MR. TROTTER opined that modern technology is proving, beyond a
reasonable doubt, that life begins at conception and that every
time an embryo in a petri dish is destroyed, a human being is
murdered or man slaughtered. He touched upon the recent Alabama
statute regarding in vitro fertilization and again emphasized
that life begins at conception. The Dobbs case said that Roe v.
Wade and the Casey decision must be overturned and that abortion
is not a constitutional right. He went on to say the people
elected as representatives of each state must be allowed to
determine their laws on the issue. He emphasized to the
committee that it was up to citizens to persuade one another and
then go vote. It therefore becomes the purview of the committee
and the legislature to make decisions protecting the life of the
unborn. He then reviewed findings of the Dobbs case as it
related to the Alaska court system and the Alaska legislature,
discussing who, in his view, had the authority to make such
judgments.
MR. TROTTER commented that the state recently voted down having
a constitutional convention saying he understood there was a lot
of outside money influencing Alaska voters. He described the
Alaska Supreme Court and the [1997] Valley Hospital case and how
rational basis review was not the standard that should have been
applied. He expressed appreciation to the committee for hearing
his testimony, closing with a final comment about how the
aforementioned Hannah S stands as proof of his primary
hypothesis.
5:51:13 PM
ROBERT M. BIRD, Past President, Alaska Right to Life, gave
invited testimony in support of HB 205. He described his
background as a political candidate, a retired schoolteacher,
and a radio talk show host. He began his testimony by
describing the Alaska Constitution and the Alaska Supreme Court.
He posited that the Supreme Court could make decisions regarding
Alaska cases relevant to the constitution. The courts can then
reverse those decisions regarding the constitution in such a way
that they can say whatever they want about what it means which
basically results in there being no Alaska Constitution at all.
He pointed out that people say the constitution is a living
document, but it is not alive. It is dead. He that the Supreme
Court can do unconstitutional things and opined that the idea of
three co-equal branches of government is nonsense. He referred
to a section of Federalist No. 45, [an essay in the Federalist
Papers series written by James Madison and published in 1788],
which he interpreted as saying the US Supreme Court is of
absolutely no use and their decisions depend entirely on an
executive enforcing its opinion.
MR. BIRD continued by saying that there was a "blatant, obvious,
impeachable offense" that goes way back to Article 1, Section
22, the Right to Privacy, which was added to the state
constitution in 1972. He pointed out the language that gave the
legislature the right to implement or define the right to
privacy. He questioned the limits of the right to privacy,
purporting that the courts "absconded their duty to intercept
the definition of where the right to privacy should be limited,"
and so abortion came to be defined as a privacy right. "As
such, any ability of the legislature to restrict abortion has to
go according to the whims of the judiciary."
5:55:33 PM
CHAIR PRAX reminded Mr. Bird that the House Health and Social
Services Standing Committee was focusing on the health aspects
of the issue and that the House Judiciary Standing Committee
would consider the legal aspects.
MR. BIRD responded that he did not think he was going to be
asked about the health aspects. He went on to point out that if
HB 205 did not have some sort of rider on it saying that "this
statute shall not be reviewable by the judiciary," then the
judiciary would simply fall back on its own established case
law. He quoted Article 4, Section 1, which states that "the
jurisdiction of the courts shall be proscribed by law," which
means that the legislature does, in fact, have the right and the
ability to keep the judiciary's hands off whatever statute
emerges.
5:57:07 PM
REPRESENTATIVE SUMNER asked whether it would prevent enforcement
of the law by the courts if a section was added which said the
law should not be reviewed by the judiciary.
MR. BIRD responded that courts do not enforce laws; the
executives do. He referred again to the Valley Hospital case,
using that to advance his theories concerning the right to
enforce laws pertaining to abortion and how that is the purview
of the executive branch not the courts.
REPRESENTATIVE SUMNER asked for clarification regarding whether
such a section would prevent courts from adjudicating a murder
charge subsequent to the passage of HB 205.
MR. BIRD responded that the courts could adjudicate and pass on
the opinions, but enforcement is up to the executives. He
referred to Abe Lincoln's inaugural address of 1861 when he
spoke out against the Dredd Scott decision having the courts
strike down laws as being unconstitutional. He posited that it
is a false tradition that all court decisions have to be obeyed.
5:59:23 PM
REPRESENTATIVE RUFFRIDGE asked whether Mr. Bird had read through
HB 205, particularly the language in Sections 5 and 6, which
states that "this chapter is not subject to judicial review".
MR. BIRD said he supports that part of the bill. He then stated
that the Alaska Pipeline would never have been built unless in
1972, Congress had placed the construction of the pipeline under
such an override.
6:00:39 PM
REPRESENTATIVE SUMNER asked for further clarification regarding
whether such a section would prevent the court from taking up
the previously mentioned murder prosecutions.
MR. BIRD suggested that such a section in statute would make it
non-reviewable. He cautioned that an executive could choose not
to enforce certain elements of any law he doesn't like;
therefore, it is an imperfect section.
6:02:20 PM
MR. MARTIN brought up Representative Sumner's previous question
and explained that the section in HB 205 on judicial review
would not hinder criminal prosecution. Rather, the language is
to protect against judicial activism, but in the case of someone
who performs an illegal abortion, the prosecution of that person
would be protected.
REPRESENTATIVE SUMNER said that answered his question.
6:03:43 PM
REPRESENTATIVE EASTMAN summarized the points made by the
witnesses and commented that "we have the science, it's
established, and there is very little question about that." He
concluded that the questions from decades ago are now resolved,
thus, he opined, it is time for "our statutes" to catch up with
"our science."
6:04:50 PM
CHAIR PRAX announced that HB 205 was held over.
6:05:03 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 6:05 p.m.