02/24/2010 01:00 PM House JUDICIARY
| Audio | Topic |
|---|---|
| Start | |
| HB314 | |
| HB71 | |
| HB331 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 314 | TELECONFERENCED | |
| + | HB 71 | TELECONFERENCED | |
| *+ | HB 331 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE JUDICIARY STANDING COMMITTEE
February 24, 2010
1:08 p.m.
MEMBERS PRESENT
Representative Jay Ramras, Chair
Representative Bob Herron
Representative Bob Lynn
Representative Max Gruenberg
Representative Lindsey Holmes
MEMBERS ABSENT
Representative Nancy Dahlstrom, Vice Chair
Representative Carl Gatto
OTHER LEGISLATORS PRESENT
Representative Kurt Olson
COMMITTEE CALENDAR
HOUSE BILL NO. 314
"An Act relating to fees and charges for medical treatment or
services, the crime of unsworn falsification, investigations,
and penalties as they relate to workers' compensation; and
providing for an effective date."
- HEARD & HELD
HOUSE BILL NO. 71
"An Act relating to a registry for advance health care
directives."
- HEARD & HELD
HOUSE BILL NO. 331
"An Act relating to funding for youth courts; and relating to
accounting for criminal fines."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 314
SHORT TITLE: WORKERS' COMPENSATION
SPONSOR(S): LABOR & COMMERCE
01/27/10 (H) READ THE FIRST TIME - REFERRALS
01/27/10 (H) L&C, JUD
02/03/10 (H) L&C AT 3:15 PM BARNES 124
02/03/10 (H) Moved Out of Committee
02/03/10 (H) MINUTE(L&C)
02/05/10 (H) L&C RPT 2DP 3NR
02/05/10 (H) DP: BUCH, OLSON
02/05/10 (H) NR: LYNN, HOLMES, T.WILSON
02/05/10 (H) FIN REFERRAL ADDED AFTER JUD
02/18/10 (H) JUD AT 1:00 PM CAPITOL 120
02/18/10 (H) -- MEETING CANCELED --
02/24/10 (H) JUD AT 1:00 PM CAPITOL 120
BILL: HB 71
SHORT TITLE: ADVANCE HEALTH CARE DIRECTIVES REGISTRY
SPONSOR(S): HOLMES, DAHLSTROM, MILLETT, KAWASAKI
01/20/09 (H) PREFILE RELEASED 1/16/09
01/20/09 (H) READ THE FIRST TIME - REFERRALS
01/20/09 (H) HSS, JUD
03/31/09 (H) HSS AT 3:00 PM CAPITOL 106
03/31/09 (H) Heard & Held
03/31/09 (H) MINUTE(HSS)
04/14/09 (H) HSS AT 3:00 PM CAPITOL 106
04/14/09 (H) Moved CSHB 71(HSS) Out of Committee
04/14/09 (H) MINUTE(HSS)
04/15/09 (H) HSS RPT CS(HSS) 3DP 3NR
04/15/09 (H) DP: HOLMES, SEATON, CISSNA
04/15/09 (H) NR: LYNN, KELLER, HERRON
02/19/10 (H) JUD AT 1:00 PM CAPITOL 120
02/19/10 (H) -- MEETING CANCELED --
02/24/10 (H) JUD AT 1:00 PM CAPITOL 120
BILL: HB 331
SHORT TITLE: YOUTH COURTS AND CRIMINAL FINES
SPONSOR(S): MUNOZ
02/08/10 (H) READ THE FIRST TIME - REFERRALS
02/08/10 (H) JUD, FIN
02/24/10 (H) JUD AT 1:00 PM CAPITOL 120
WITNESS REGISTER
KONRAD JACKSON, Staff
Representative Kurt Olson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 314 on behalf of the sponsor,
the House Labor and Commerce Standing Committee, which is
chaired by Representative Olson.
LINDA HALL, Director
Division of Insurance
Department of Commerce, Community, & Economic Development
(DCCED)
Anchorage, Alaska
POSITION STATEMENT: Provided comments and responded to
questions during discussion of HB 314 and Amendment 1.
ERIN POHLAND, Assistant Attorney General
Labor and State Affairs Section
Civil Division (Anchorage)
Department of Law (DOL)
Anchorage, Alaska
POSITION STATEMENT: Responded to questions during discussion of
HB 314 and Amendment 1.
DON ETHERIDGE, Lobbyist
Alaska American Federation of Laborers - Congress of Industrial
Organizations (Alaska AFL-CIO)
Juneau, Alaska
POSITION STATEMENT: Provided comments during discussion of
HB 314 and Amendment 1.
KENTON BRINE, Assistant Vice President
State Government Relations
Property Casualty Insurers Association of America (PCIAA)
Olympia, Washington
POSITION STATEMENT: Testified in support of HB 314.
STACY ALLAN, Officer
Laborers' Local 341
Anchorage, Alaska
POSITION STATEMENT: Provided comments during discussion of
HB 341 and Amendment 1.
BARBARA HUFF TUCKNESS, Director
Governmental and Legislative Affairs
Teamsters Local 959
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 314 and provided
a comment regarding Amendment 1.
KEVIN B. DOUGHERTY, General Counsel
Alaska District Council of Laborers
Anchorage, Alaska
POSITION STATEMENT: Provided comments during discussion of
HB 314 and Amendment 1.
JAMES WALDO, Staff
Representative Lindsey Holmes
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Assisted with the presentation of HB 71 on
behalf of Representative Holmes, one of the bill's joint prime
sponsors.
WARD B. HURLBURT, M.D., Director and Chief Medical Officer
Central Office
Division of Public Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Provided comments and responded to
questions during discussion of HB 71.
MARIE DARLIN, Coordinator
AARP Capital City Task Force
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 71 and responded
to questions.
LORILYN SWANSON, Manager
Fireweed Place
Tlingit-Haida Regional Housing Authority (THRHA)
Juneau, Alaska
POSITION STATEMENT: During discussion of HB 71, testified in
support of an advance health care directive registry.
EMILY NENON, Director
Alaska Government Relations
American Cancer Society Cancer Action Network (ACS CAN)
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 71.
T. TERRY HARVEY, Staff
Representative Cathy Munoz
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 331 on behalf of the sponsor,
Representative Munoz.
ACTION NARRATIVE
1:08:12 PM
CHAIR JAY RAMRAS called the House Judiciary Standing Committee
meeting to order at 1:08 p.m. Representatives Ramras, Herron,
Lynn, and Holmes were present at the call to order.
Representative Gruenberg arrived as the meeting was in progress.
Representative Gatto was excused. Representative Olson was also
in attendance.
HB 314 - WORKERS' COMPENSATION
1:08:25 PM
CHAIR RAMRAS announced that the first order of business would be
HOUSE BILL NO. 314, "An Act relating to fees and charges for
medical treatment or services, the crime of unsworn
falsification, investigations, and penalties as they relate to
workers' compensation; and providing for an effective date."
1:09:09 PM
KONRAD JACKSON, Staff, Representative Kurt Olson, Alaska State
Legislature - on behalf of the sponsor, the House Labor and
Commerce Standing Committee, which is chaired by Representative
Olson - offered his understanding that HB 314 addresses the
issue of fraud and a small portion of the recommendations
outlined in a report produced by the Medical Services Review
Committee (MSRC) as it pertains to the medical services fee
schedule; and that a forthcoming amendment also addresses the
issue of fraud.
1:11:12 PM
CHAIR RAMRAS made a motion to adopt Amendment 1, labeled 26-
LS1354\A.3, Bailey, 2/17/10, which read:
Page 1, lines 1 - 2:
Delete "the crime of unsworn falsification"
Insert "civil damages"
Page 1, lines 5 - 9:
Delete all material.
Page 1, line 10:
Delete "Sec. 2"
Insert "Section 1"
Renumber the following bill sections accordingly.
Page 2, lines 15 - 16:
Delete "usual, customary, and reasonable"
Page 2, lines 17 - 21:
Delete "include the most recent Current
Procedural Terminology codes for both category I and
category II medical treatment or other services
published by the American Medical Association;
notwithstanding AS 44.62.010 - 44.62.290, the board
shall update the schedule annually by order"
Insert "be based on statistically credible data,
including charges for the most recent category I, II,
and III medical services maintained by the American
Medical Association and the Health Care Procedure
Coding System for medical supplies, injections,
emergency transportation, and other medically related
services, and must result in a schedule that (i)
reflects the cost in the geographical area where
services are provided; and (ii) is at the 90th
percentile"
Page 2, line 26, through page 3, line 2:
Delete all material and insert:
"* Sec. 2. AS 23.30.250(a) is amended to read:
(a) A person who (1) knowingly makes a false or
misleading statement, representation, or submission
related to a benefit under this chapter; (2) knowingly
assists, abets, solicits, or conspires in making a
false or misleading submission affecting the payment,
coverage, or other benefit under this chapter; (3)
knowingly misclassifies employees or engages in
deceptive leasing practices for the purpose of evading
full payment of workers' compensation insurance
premiums; or (4) employs or contracts with a person or
firm to coerce or encourage an individual to file a
fraudulent compensation claim is guilty of workers'
compensation fraud, which may be punished under
AS 11.46.120 - 11.46.150, and may also be guilty of
perjury and related offenses under AS 11.56.200 -
11.56.230 [CIVILLY LIABLE TO A PERSON ADVERSELY
AFFECTED BY THE CONDUCT, IS GUILTY OF THEFT BY
DECEPTION AS DEFINED IN AS 11.46.180, AND MAY BE
PUNISHED AS PROVIDED BY AS 11.46.120 - 11.46.150].
* Sec. 3. AS 23.30.250(c) is repealed and reenacted
to read:
(c) In addition to criminal penalties under this
section, a person who violates this chapter is liable
in a civil action brought by or on behalf of a person
who suffers economic damages as a result of the
violation for an award of three times the amount of
compensatory damages resulting from the violation,
subject to adjustment under AS 09.17, and an award of
reasonable attorney fees."
Renumber the following bill sections accordingly.
Page 3, line 19:
Delete all material.
Renumber the following bill section accordingly.
REPRESENTATIVE HOLMES objected for the purpose of discussion.
1:13:19 PM
LINDA HALL, Director, Division of Insurance, Department of
Commerce, Community, & Economic Development (DCCED), indicated
that HB 314 would address some concerns that have arisen [with
regard to current statute]. She recounted that in 2005, the
legislature amended the Alaska Workers' Compensation Act, but in
so doing inadvertently deleted the basis for the Workers'
Compensation Board to adopt a fee schedule, though there was an
expectation at the time that the stakeholders would propose
legislation before August 1, 2007, to address that issue. When
that didn't occur, medical fees were frozen until August 1,
2007, and the division subsequently provided for two Consumer
Price Index (CPI) increases - one in 2006 and one in 2009 - with
the existing extension due to expire on December 31, 2010,
though the medical fee schedule is currently missing
approximately 2,000 procedure codes. Once that last extension
expires, there will be no cap of any kind on medical fees
[related to workers' compensation].
MS. HALL noted that a chart in members' packets illustrates that
in 2008, medical expenses made up 58 percent of the workers'
compensation benefit system in all states for which National
Council on Compensation Insurance, Inc. (NCCI), provides
ratemaking services. Another chart illustrates that in Alaska,
in 2008, medical expenses made up 72 percent of the workers'
compensation benefit system, though in 1988 and 1998, it made up
only 52 percent and 63 percent respectively. In response to
questions, she surmised that the entire cost of Alaska's
workers' compensation benefit system has probably grown due to
Alaska having a larger premium base - though the actual incident
rate has decreased substantially - and it is the aforementioned
growth in medical expenses which illustrates the importance of
implementing a new medical fee schedule, as HB 314 is proposing
to do.
MS. HALL noted that yet another chart illustrates the average
yearly medical cost per case in Alaska - from 2004 through 2008
- versus the average yearly medical cost per case in the rest of
the country; for example, in the rest of the country, the
average yearly medical cost per case is $26,000, whereas in
Alaska, it's $40,000 - substantially higher. Members' packets
also include a handout illustrating workers' compensation
premium rate rankings for all 50 states plus the District of
Columbia; Alaska, for example, is ranked number one with an
index rate of 3.97. Costs drive premiums, and the major costs
of Alaska's workers' compensation benefit system are those
pertaining to medical care. For these reasons, she remarked,
"We need this fee schedule to be in place."
1:19:48 PM
MS. HALL acknowledged, however, that HB 314 is not a fix for
Alaska's workers' compensation system, and won't lower premiums.
Instead, HB 314 would provide for a sustainable fee schedule
that could be renewed each year using data collected from
individual vendors that collect "bill/charge" data. A fee
schedule based on the CPI is simply not sustainable, whereas the
methodology that was in place in 2004 - which HB 314 proposes to
revert back to - is. She then noted that in addition to the
provisions that address Alaska's workers' compensation fee
schedule, other provisions of HB 314 would update the statutes
pertaining to the prosecution of workers' compensation fraud,
which, obviously, adds costs to the system. In the
aforementioned 2005 legislation, authority to investigate and
prosecute workers' compensation fraud was granted, but recent
experience has shown that clarification of those statutes is
warranted in order for the State to successfully prosecute such
fraud.
MS. HALL explained that by changing the title and deleting the
bill's proposed change to AS 11.56.205(a) - existing Section 1 -
Amendment 1 would remove from the bill language regarding the
crime of unsworn falsification. Amendment 1 would also provide
more specificity to proposed AS 23.30.097(a)(1)(D) such that the
fee schedule must be based on statistically credible data and
must result in a schedule that reflects the cost in the
geographical area where the services are provided, and is at the
90th percentile. She predicted that Amendment 1's proposed
change to AS 23.30.097(a)(1)(D) would provide for a more
accurate fee schedule. In response to a question, she said that
passage of Amendment 1 wouldn't lower medical costs or workers'
compensation insurance premiums; passage of Amendment 1 would,
instead, merely provide a methodology for establishing a fee
schedule, a methodology that could stay in place until an
alternative is developed.
MS. HALL, in response to another question, noted that
establishing a more permanent fee schedule is dependent upon the
will of the legislature, and is clearly a policy call.
1:27:11 PM
CHAIR RAMRAS questioned what would occur with regard to injured
workers, workers' compensation insurance premiums, and employers
if Amendment 1 is adopted but a permanent solution is not then
forthcoming.
MS. HALL opined that with regard to injured workers, having a
fee schedule that is reflective of the average fees in a
particular geographical area - and currently there are three
such areas [in Alaska] - would allow injured workers access to
medical care, thus addressing one of the division's primary
concerns, particularly given that adopting "multiples of
Medicare, for example," is not likely to occur in Alaska and, in
any case, would not be in the best interest of injured workers
attempting to access medical care. She surmised that employers,
too, want their injured employees to have access to medical care
so that they can come back to work. Again, the methodology
proposed by Amendment 1 is sustainable and has already been
proven to work, though it won't control costs or premiums.
CHAIR RAMRAS asked whether the cost of medical care is different
for injuries that occur on the job than it is for injuries that
don't occur on the job.
MS. HALL said that the cost of the medical care wouldn't be
different, though what the medical care provider ultimately gets
paid by the person, or his/her health insurance company, or the
workers' compensation benefit system could vary depending on the
situation.
CHAIR RAMRAS questioned what would result if Amendment 1 were to
be amended such that in its change to proposed AS
23.30.097(a)(1)(D), the words, "90th percentile" were replaced
with the words, "70th percentile".
MS. HALL, acknowledging that a 90th percentile is high,
cautioned that in deciding what constitutes an acceptable
reimbursement rate, the committee should keep in mind that
ensuring injured workers have access to medical care is the
primary goal.
1:34:35 PM
MR. JACKSON, in response to a question, offered his
understanding that the words, "90th percentile" came from
regulation.
MS. HALL concurred, adding that the medical fee schedule in the
workers' compensation regulations has been at the 90the
percentile for a significant number of years, and that's why the
division is seeking to include that percentile in statute.
CHAIR RAMRAS expressed dissatisfaction with that rationale, and
questioned whether reducing the percentile to an 80th percentile
would both reduce workers' compensation insurance rates and
ensure that injured workers have access to medical care.
MS. HALL said she is unable to predict whether such a change
would still ensure that injured workers have access to medical
care, surmised that medical care providers would be harmed by
establishing the fee at an 80th percentile, but acknowledged
that such a change might eventually translate into a benefit for
employers because the division bases its premiums on the
historical cost of claims. Various studies, she noted, conflict
with regard to whether changing a fee schedule has resulted in a
significant impact on the states that did so.
CHAIR RAMRAS offered his belief that reducing the percentile
would be of benefit to employers, and said he would be seeking
to amend Amendment 1 to that effect.
MR. JACKSON, in response to questions, said that there have been
two CPI increases to the existing fee schedule, and that the
bill doesn't contain a sunset provision.
REPRESENTATIVE GRUENBERG indicated that he would prefer to see
the percentile increased to a 95th percentile, and would
therefore be opposing a reduction to an 80th percentile.
[Chair Ramras turned the gavel over to Representative Herron.]
MS. HALL, in response to a question, explained that prior to the
statutory change that occurred in 2005, the fee schedule was
updated annually, and that such updates have not occurred since.
REPRESENTATIVE GRUENBERG asked for further information about the
criminal provisions of the bill, of Amendment 1, and of existing
statute.
MS. HALL indicated that the DOL found that the "fraud
prosecution language" of existing AS 23.30.250(a) was
insufficiently clear for prosecuting cases of fraud; that the
language contained in the bill appears to address fraud only
from a civil standpoint and then only as perpetrated by the
employee; and that Amendment 1 would allow all those who commit
fraud to be subject to both criminal and civil prosecution.
[Representative Herron returned the gavel to Chair Ramras.]
REPRESENTATIVE GRUENBERG offered his understanding that in cases
involving fraud, changing current statute [as both the bill and
Amendment 1 propose] would result in less civil damages being
awarded.
MS. HALL concurred with that summation.
1:48:45 PM
ERIN POHLAND, Assistant Attorney General, Labor and State
Affairs Section, Civil Division (Anchorage), Department of Law
(DOL), also concurred.
REPRESENTATIVE GRUENBERG questioned who would benefit by such a
change.
MS. POHLAND indicated that such a change wouldn't benefit anyone
in particular.
1:51:32 PM
DON ETHERIDGE, Lobbyist, Alaska American Federation of Laborers
- Congress of Industrial Organizations (Alaska AFL-CIO), relayed
that although the Alaska AFL-CIO has a concern about the fraud
provisions of HB 314, Amendment 1 would address that concern by
making those provisions applicable to all who commit fraud. In
response to a question, he indicated that at this time, changing
the percentile listed in Amendment 1 won't alter the Alaska AFL-
CIO's position on either the bill or Amendment 1, and that in
addition to having its concern regarding fraud addressed, the
Alaska AFL-CIO simply wants to ensure that injured workers would
still be covered and still have access to medical care.
1:53:31 PM
KENTON BRINE, Assistant Vice President, State Government
Relations, Property Casualty Insurers Association of America
(PCIAA), indicated that the PCIAA supports HB 314, though has
not yet had a chance to review Amendment 1. He noted that
medical expenses are higher in Alaska than in other states, and
constitute a larger percentage of "lost cost" related to
workers' compensation than in other parts of the country. He
said he believes that the fraud provisions of the bill will help
insurers control costs while still providing adequate protection
for injured workers.
1:55:29 PM
STACY ALLAN, Officer, Laborers' Local 341, relayed that
Laborers' Local 341 appreciates Amendment 1, which addresses
concerns regarding the fraud provisions of the bill. She
offered her hope that the legislature would continue to address
the issues pertaining to workers' compensation and the effect
that system has on injured workers. In response to a question,
she indicated that the percentile provided for in Amendment 1 is
not of concern to Laborers' Local 341.
1:57:53 PM
BARBARA HUFF TUCKNESS, Director, Governmental and Legislative
Affairs, Teamsters Local 959, said that Teamsters Local 959
supports HB 314. She indicated, though, that arbitrarily
lowering the percentile currently provided for in Amendment 1
would give Teamsters Local 959 great concern, because such a
change could result in physicians refusing to provide medical
care to injured workers, and could create some of the same
problems that have arisen with regard to Medicare/Medicaid.
2:03:47 PM
KEVIN B. DOUGHERTY, General Counsel, Alaska District Council of
Laborers, noted that 8 A.A.C. 45.082(i)(3) uses the words "90th
percentile"; that that percentile has been in place for at least
20 years; that his organization would have to conduct more
research before it could speak to whether it would support
lowering that number; and that it would be hard to say what
percentile would start to impact service, which would be of
concern. In conclusion, he asked the committee to be cautious
when considering changing the percentile, and suggested that the
issue warrants further study.
CHAIR RAMRAS, after ascertaining that no one else wished to
testify, closed public testimony on HB 314.
2:05:23 PM
CHAIR RAMRAS made a motion to amend Amendment 1 such that in its
proposed change to AS 23.30.097(a)(1)(D), the words, "90th
percentile" would be replaced with the words, "85th percentile".
REPRESENTATIVE GRUENBERG objected.
CHAIR RAMRAS explained that he is interested in striking the
right balance between medical care for the injured worker and
compensation for the medical community, and employer costs.
REPRESENTATIVE GRUENBERG said he opposes the amendment to
Amendment 1, and pointed out that it has not yet been fully
vetted with regard to how it would affect injured workers.
REPRESENTATIVE HOLMES agreed that the amendment to Amendment 1
merits further discussion, and relayed that absent that
discussion, she is reluctant to vote for the amendment to
Amendment 1.
REPRESENTATIVE HERRON questioned whether anyone has ever
considered providing for a different percentile.
MS. HALL indicated that the division's focus has instead been to
get a fee schedule in place to replace the one that's due to
expire at the end of the year, and thereby prevent further
increases in "the system costs (indisc.) premiums for
employers."
CHAIR RAMRAS characterized the amendment to Amendment 1 as a
provocative change, and questioned why the committee shouldn't
adopt it if doing so might lower employer costs.
REPRESENTATIVE LYNN, commenting that the committee has not yet
heard why the percentile is currently set at a 90th percentile,
characterized an 85th percentile as just an arbitrary number
that was picked simply because it sounded good.
REPRESENTATIVE GRUENBERG again expressed a preference for not
adopting the amendment to Amendment 1.
CHAIR RAMRAS withdrew the amendment to Amendment 1.
2:13:46 PM
CHAIR RAMRAS then made a motion to adopt a conceptual amendment
to Amendment 1 such that in its proposed change to AS
23.30.097(a)(1)(D), the words, "is at the 90th percentile" would
be replaced with the words, "the amount paid by the preferred
provider network of insurers is not to exceed the 90th
percentile".
REPRESENTATIVE GRUENBERG objected for the purpose of discussion.
MS. HALL cautioned against using that language, because there
are a lot of preferred provider networks as well as what she
called "rented networks."
CHAIR RAMRAS questioned whether that issue could be resolved by
specifying that it would be the average amount paid by the top
five preferred provider network of insurers. He expressed a
preference for changing the language of Amendment 1 to address
what he called ever-increasing workers' compensation insurance
premiums.
MS. HALL explained that the division only collects information
about billed charges, not paid charges, and surmised, therefore,
that using such information in the calculation would present a
big task.
CHAIR RAMRAS relayed that HB 314 would be set aside with the
motion of whether to adopt the conceptual amendment to
Amendment 1, and the motion of whether to adopt Amendment 1,
left pending.
The committee took an at-ease from 2:20 p.m. to 2:21 p.m.
HB 71 - ADVANCE HEALTH CARE DIRECTIVES REGISTRY
2:21:02 PM
CHAIR RAMRAS announced that the next order of business would be
HOUSE BILL NO. 71, "An Act relating to a registry for advance
health care directives." [Before the committee was CSHB
71(HSS).]
2:21:11 PM
REPRESENTATIVE HOLMES, speaking as one of the bill's joint prime
sponsors, moved to adopt the proposed committee substitute (CS)
for HB 71, Version 26-LS0289\T, Kurtz/Bannister, 1/21/10, as the
work draft. There being no objection, Version T was before the
committee.
[Chair Ramras turned the gavel over to Representative Herron.]
REPRESENTATIVE HOLMES explained that HB 71 addresses advance
health care directives - commonly known as living wills. A
family member of an acquaintance of hers experienced a medical
emergency while the family was on a trip out of state, and
although the person who took ill did have a living will, it had
been left locked up at home and so was of no use whatsoever.
Representative Holmes said that upon hearing about this
experience, she realized that she, too, could potentially be in
a similar situation someday because although she does have a
living will, she keeps it locked up at her father's house.
House Bill 71 would establish, under the Department of Health
and Social Services (DHSS), a voluntary registry for advance
health care directives; those who choose to do so, could submit
their living will information to the DHSS for inclusion in the
registry - a secure, online database - that could then be
accessed by hospitals and healthcare providers across the state.
2:23:10 PM
JAMES WALDO, Staff, Representative Lindsey Holmes, Alaska State
Legislature - on behalf of Representative Holmes, one of the
bill's joint prime sponsors - added that once entered into the
registry, a person's living will would also be accessible to the
person, his/her agent, guardian, or surrogate, and other types
of healthcare facilities such as nursing homes. In response to
a question, he explained that under Version T, the DHSS would be
allowed to contract with a registry organization to establish
and maintain the State registry - such an organization would be
able to do so at less cost than the DHSS.
REPRESENTATIVE GRUENBERG observed that the DHSS's decreased
fiscal note for Version T reflects that change.
MR. WALDO concurred.
[Representative Herron returned the gavel to Chair Ramras.]
2:26:21 PM
WARD B. HURLBURT, M.D., Director and Chief Medical Officer,
Central Office, Division of Public Health, Department of Health
and Social Services, explained that HB 71 creates a mechanism
for the storage of advance health care directives, and that both
the division and the DHSS have worked with the sponsor and are
in support of the intent to have advance health care directives
made available via the proposed registry. The administration,
however, has taken a neutral position on HB 71 due to the fiscal
note.
REPRESENTATIVE GRUENBERG, mentioning that he strongly supports
HB 71, expressed a desire for national uniformity and interstate
cooperation regarding advance health care directives.
DR. HURLBURT, in response to a question, surmised that the
Association of State and Territorial Health Officials (ASTHO)
could potentially provide a forum to address such issues. He
pointed out that any information submitted to the proposed
registry would be accessible to healthcare providers out of
state. Furthermore, some other states have adopted similar law,
and so could serve as models for Alaska's registry.
CHAIR RAMRAS said he opposes HB 71 due to the fiscal note, and
questioned why the State should pay someone over $100,000 per
year to maintain the proposed registry.
REPRESENTATIVE HOLMES clarified that the bulk of the fiscal note
addresses startup costs, and that the amount required to
maintain the registry after startup would quickly be scaled
back.
DR. HURLBURT concurred.
REPRESENTATIVE GRUENBERG suggested that the issues raised by the
fiscal note would be better addressed by the House Finance
Committee, the bill's next committee of referral.
2:35:01 PM
MARIE DARLIN, Coordinator, AARP Capital City Task Force, noted
that members' packets contain the AARP's letter of support for
HB 71, and that her group is among those that worked very hard,
for four years, to statutorily provide for advance health care
directives, and so views HB 71 as a follow-up piece of
legislation that would allow advance health care directives to
actually be useful and function as intended. The AARP has
worked very hard, and will continue to work very hard, to get
its members to complete their advance health care directives
and, hopefully, carry them with them; most people won't,
however, and so HB 71 would hopefully provide recourse for those
people. She indicated that although the AARP has not yet
calculated the cost of maintaining the proposed registry, the
AARP would like to see some consideration given to low-income
people, perhaps via providing for a very low [registration fee].
With regard to the issue of needing access to the registry when
traveling outside of Alaska, she offered her understanding that
the bill is not yet clear with regard to whether healthcare
professionals in the state a person is traveling in would have
access to Alaska's registry. Regardless that that issue is one
that might still need to be clarified, the AARP still supports
HB 71 and hopes that it will pass.
REPRESENTATIVE HOLMES noted that proposed AS 13.52.310(c)
outlines who could have access to the information in the
registry, and that it specifically provides that a hospital in
another state could obtain information from Alaska's registry if
requested to do so by the individual or his/her agent, guardian,
or surrogate.
MS. DARLIN questioned whether that language is all that's
necessary.
REPRESENTATIVE HOLMES offered her belief that it is, that a
healthcare provider would be able to access information in the
registry regardless of where the healthcare provider and the
person happen to be. That is her intent, she concluded.
MS. DARLIN, in response to a question, said that she does not
know how many people would take advantage of the registry, nor
how many people even have an advance health care directive in
place yet, nor how such could be estimated.
DR. HURLBURT, in response to a question, surmised that although
the details still need to be worked out, there would be various
options for submitting advance health care directives to the
registry; that they could be submitted in person, by mail, or
electronically; that there would be a central location for such
submissions; and that the intent is for a private firm to
administer the registry and provide training to Alaska's
hospitals and healthcare providers. In response to a further
question, he explained that the DHSS staff the fiscal note
references would be responsible for monitoring the procurement
and selection processes, and help with statewide logistics. In
response to a comment, he said he is unable to address the
amount of the salary listed in the fiscal note.
CHAIR RAMRAS questioned how large of a registration fee would be
required in order to pay for that staff position.
2:44:37 PM
DR. HURLBURT suggested that a registration fee, even a modest
one, could prove to be a disincentive for people who might wish
to use the registry. The intent of the bill is to facilitate
the use of advance health care directives.
CHAIR RAMRAS remarked that regardless of the public good the
bill would accomplish, it still puts a burden on the State and
creates another job in State government.
REPRESENTATIVE HOLMES, in response to a question, explained that
the department has worked very hard to reduce the fiscal note,
thus illustrating the importance being placed on establishing an
advance health care directive registry; under Version T, only
one employee would be needed for the first year, with personal
services costs being scaled back in subsequent years. In
response to a question, she indicated that there is a lot of
concern among those she's heard from that a registration fee
would be required.
CHAIR RAMRAS said he is opposed to creating another job. He
noted that the language of proposed AS 13.52.310(h) says in
part, "The department may charge a fee to file a directive in
the registry", and suggested that the word, "may" be changed to
the word "shall" in order to offset the estimated personnel
costs.
DR. HURLBURT remarked that if such a change were made, then the
committee should also consider having the bill provide an
exemption from the fee for those who are indigent.
REPRESENTATIVE LYNN said he could envision even someone with
just less income also being unable to afford a registration fee.
In response to a comment, he said that if having an advance
health care directive is a good thing, then it logically follows
that a registry for such directives would also be a good thing
because then people could actually make use of their directives.
It would be nice, therefore, if everyone, regardless of income,
could get their directives added to the registry.
2:52:47 PM
LORILYN SWANSON, Manager, Fireweed Place, Tlingit-Haida Regional
Housing Authority (THRHA) - after mentioning that in addition to
managing an independent-living senior complex, she also serves
on the Juneau Commission on Aging (JCOA) - indicated that she is
advocating for the adoption of HB 71, and is in favor of the
State of Alaska establishing and maintaining an advance health
care directive registry, which would hopefully be incorporated
into a national advance health care directive registry. She
went on to say:
I support this for several reasons. Many of us have
advance directives, and they are filed away in our
home files. ... Yes, we know they are there, but I ask
you, how many family members know where it is or how
to access the information - especially in an
emergency. We live in the age of world travel. ...
For those having an advance directive, they probably
do not carry it with them; I know I don't, and I
imagine that many of you do not as well.
I also see firsthand the confusion that can be created
by medical emergencies. I manage an apartment
building for an aging senior population. A 911 call
leads to the emergency personnel being called to the
building, and one of the first questions that I am
usually asked, if it is a life threatening emergency,
is, "Do you know if this person has an advance
directive in place?" I may know, but unless it is
lying on the table or in plain sight in the apartment,
I do not feel comfortable answering that question
unless the tenant has specifically instructed me to do
so in case of an emergency, and then I am still not
comfortable with it.
In both of these cases, should there be a State
registry, with coordination to a national registry,
any emergency personnel or institution would have
computer access to this information immediately. This
is why we all have an advance directive in place, so
that it can be acted upon per our own personal wishes
and instructions. I would like to say, however, that
I do not feel there should be a filing fee for
registering. I feel that this would be a ...
detriment for the many who are on low income, and they
would not file. We worked hard, for four years, to
get the advance directive here, in the state of
Alaska, and now it is time to make it work by
establishing this State registry. Thank you.
REPRESENTATIVE GRUENBERG asked how many people in Alaska would
be eligible for inclusion in the proposed registry if the bill
passes.
MS. SWANSON offered her belief that anyone who has an advance
health care directive would be eligible for inclusion. She,
too, relayed that she doesn't know how many people have an
advance health care directive in place, though as an advocate
for senior issues, she encourages everyone, not just seniors, to
have one. In response to a question, she surmised that
mandating a registration fee would probably not be popular with
lower-income Alaskans.
2:57:02 PM
EMILY NENON, Director, Alaska Government Relations, American
Cancer Society Cancer Action Network (ACS CAN), said that the
ACS CAN supports HB 71. She recounted that in his later years,
her father developed severe dementia, and spent the last four
years of his live in a nursing home. During the last six months
of his life, his advance health care directive was overlooked
three separate times. On one occasion, when he was still living
in the nursing home, her mother was called to meet the ambulance
staff taking him from the nursing home to the hospital, and when
she got there, she found that the ambulance staff had managed to
resuscitate him, and the attending physician was mortified upon
learning that her father had had an advance health care
directive but the nursing home had not sent it over with the
ambulance staff. In conclusion, she said she doesn't want to
see anyone else go through the same agony her family went
through.
[HB 71, Version T, was held over.]
HB 331 - YOUTH COURTS AND CRIMINAL FINES
2:58:40 PM
CHAIR RAMRAS announced that the final order of business would be
HOUSE BILL NO. 331, "An Act relating to funding for youth
courts; and relating to accounting for criminal fines."
CHAIR RAMRAS turned the gavel over to Representative Herron.
2:59:21 PM
T. TERRY HARVEY, Staff, Representative Cathy Munoz, Alaska State
Legislature, on behalf of the sponsor, Representative Munoz,
explained that HB 331 would provide a funding mechanism for
Alaska's youth courts, which are an alternative venue for youth
offenders and which have been a great success in Alaska for over
20 years; under the bill, funding would come from a portion of
the criminal fines imposed by the Alaska Court System.
[HB 331 was held over.]
3:01:02 PM
ADJOURNMENT
There being no further business before the committee, the House
Judiciary Standing Committee meeting was adjourned at 3:01 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| 01 HB314 Sponsor Statement ver A.pdf |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
HB 314 |
| 02 HB314 Bill v. A.pdf |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
HB 314 |
| 03 HB314 Sectional Analysis ver A.pdf |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
HB 314 |
| 04 HB314 Amendment A 3.pdf |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
HB 314 |
| 05 HB314-Law-Crim-02-11-10.pdf |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
HB 314 |
| 06 HB314 - DOLWD-WC-01-28-10.pdf |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
HB 314 |
| 07 HB314 Letter AK Spine Institute 2-2-10.pdf |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
HB 314 |
| 08 HB314 Letter NFIB 1-31-10.pdf |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
HB 314 |
| 09 HB314 NCCI AK Medical Cost Comparison.pdf |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
HB 314 |
| 10 HB314 NCCI AK vs Countrywide Medical Cost per Case.pdf |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
HB 314 |
| 11 HB314 NCCI All States Medical Cost Comparison.pdf |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
HB 314 |
| 12 HB314 Letter ASMA 1-1-10.pdf |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
HB 314 |
| 13 HB314 Suggested changes ASMA 1-1-10.pdf |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
HB 314 |
| 14 HB314 Workers' Compensation Premium Rate Ranking cy 2008.pdf |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
HB 314 |
| 15 HB314 8 AAC 45 082 Medical Treatment.pdf |
HJUD 2/24/2010 1:00:00 PM |
HB 314 |
| 01 HB71 propsed Bill CS v.T .pdf |
HJUD 2/24/2010 1:00:00 PM |
HB 71 |
| 02 HB71 Sponsor Statement.pdf |
HJUD 2/24/2010 1:00:00 PM |
HB 71 |
| 03 HB71 Sectional.pdf |
HJUD 2/24/2010 1:00:00 PM |
HB 71 |
| 04 HB71 Changes to v. C.pdf |
HJUD 2/24/2010 1:00:00 PM |
HB 71 |
| 05 HB71(HSS) Bill v. C.pdf |
HJUD 2/24/2010 1:00:00 PM |
HB 71 |
| 06 HB71 Bill v. E.pdf |
HJUD 2/24/2010 1:00:00 PM |
HB 71 |
| 07 HB071CS(JUD)-DHSS-IPEMS-2-15-10.pdf |
HJUD 2/24/2010 1:00:00 PM |
HB 71 |
| 08 HB71CS(HSS) - DHSS FN 4-15-09.pdf |
HJUD 2/24/2010 1:00:00 PM |
HB 71 |
| 09 HB71 AARP Support Ltr.pdf |
HJUD 2/24/2010 1:00:00 PM |
HB 71 |
| 10 HB71 Relevant Statutes.pdf |
HJUD 2/24/2010 1:00:00 PM |
HB 71 |
| 01 HB331 Sponsor Statement.pdf |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
hb 331 |
| 02 HB331 Bill v. R.pdf |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
|
| 03 HB331-DHSS-YC-2-22-10.pdf |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
hb 331 |
| 04 HB331 AK Court Fines & Forfeitures Annual.htm |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
HB 331 |
| 06 HB331 FAQs.pdf |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
hb 331 |
| 05 HB331-UYCA FactBrief.docx |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
HB 331 |
| 07 HB331 Fines in Statute.pdf |
HJUD 2/24/2010 1:00:00 PM HJUD 2/25/2010 1:00:00 PM |
hb 331 |
| 08 HB331 Support Letters.pdf |
HJUD 2/24/2010 1:00:00 PM |
HB 331 |