Legislature(1997 - 1998)
04/08/1997 01:43 PM L&C
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
SENATE LABOR AND COMMERCE COMMITTEE April 8, 1997 1:43 P.M. MEMBERS PRESENT Senator Loren Leman, Chairman Senator Jerry Mackie, Vice Chairman Senator Mike Miller Senator Tim Kelly MEMBERS ABSENT Senator Lyman Hoffman COMMITTEE CALENDAR Confirmation Hearing: Board of Psychologist and Psychological Associate Examiners Susan L. Baxter E. Ben Crawford Gail C. Shortell - Anchorage David J. Sperbeck - Anchorage Board of Certified Real Estate Appraisers Eileen R. Bechtol - Homer Susan K. Crosson - Anchorage Jon B. Wolfe - Douglas Alaska Public Utilities Commission (APUC) James M. Posey - Anchorage Board of Barbers and Hairdressers Sheryl Sutton - Juneau Robert Pearson - Juneau Board of Public Accountancy Kathleen Grimes - Palmer SENATE BILL NO. 122 "An Act relating to unfair discrimination under a group health insurance policy for services provided by marital and family therapists; and providing for an effective date." - MOVED CSSB 122(L&C) OUT OF COMMITTEE CS FOR HOUSE BILL NO. 30(FIN) "An Act relating to civil liability for certain skating and cycling activities; and providing for an effective date." - MOVED SCSHB 30 (L&C) OUT OF COMMITTEE PREVIOUS SENATE COMMITTEE ACTION SB 122 - No previous action to consider. HB 30 - No previous action to consider. WITNESS REGISTER Ms. Rachael Moreland, Aide Senator Leman State Capitol Bldg. Juneau, AK 99801-1182 POSITION STATEMENT: Aide to sponsor of SB 122. Ms. Beverly Lindell, President Alaska Association for Marriage and Family Therapy P.O. Box 32481 Juneau, AK 99803 POSITION STATEMENT: Supported SB 122. Ms. Marci Wolff Licensed Marital and Family Therapist 110 W 15th Ave. Anchorage, Ak POSITION STATEMENT: Supported SB 122. Ms. Tima Priess Licensed Marriage and Family Therapist P.O. Box 213 Ester, AK 99725 POSITION STATEMENT: Supported SB 122. Ms. Marianne Burke, Director Division of Insurance Department of Commerce and Economic Development P.O. Box 110805 Juneau, AK 99811-0805 POSITION STATEMENT: Supported SB 122. Mr. Jerry Reinwand Blue Cross 2 Marine Way, Suite 219 Juneau, AK 99801-1182 POSITION STATEMENT: Supported CSSB 122(L&C). Mr. Tim Sullivan, Staff Representative Eldon Mulder State Capitol Bldg. Juneau, Ak 99801-1182 POSITION STATEMENT: Staff to sponsor of HB 30. Mr. Kevin Ritchie Alaska Municipal League 217 2nd Street Juneau, Ak 99801 POSITION STATEMENT: Supported HB 30. Mr. Jay Saunder Ms. Melissa Walker Skate Park Committee Juneau, AK 99801 POSITION STATEMENT: Supported HB 30. Mr. Kevin Smith Alaska Municipal League Joint Insurance Association 217 2nd Street Juneau, Ak 99801 POSITION STATEMENT: Commented on HB 30. Ms. Nancy Robb Parks and Recreation P.O. Box 1296 Valdez, AK 99686 POSITION STATEMENT: Supported HB 30. Mr. Bill Musson, Director Petersburg Parks and Recreation P.O. Box 329 Petersburg, AK 99833 POSITION STATEMENT: Supported HB 30. Ms. Marnie Isaacs Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 POSITION STATEMENT: Supported HB 30. ACTION NARRATIVE TAPE 97-16, SIDE A Number 001 CHAIRMAN LEMAN called the Senate Labor and Commerce Committee meeting to order at 1:43 p.m. and said they would review the Board nominees for confirmation. MS. SHERYL SUTTON , Board of Barbers and Hairdressers, thanked everyone for their consideration of her qualifications for appointment to the board and apologized for being unable to attend a previous hearing where her confirmation was taken up. MR. ROBERT PEARSON , Board of Barbers and Hairdressers, said he lived in Juneau for the last 10 years and is a full-time student at the University of Alaska Southeast and studies government. He is employed by the Alaska Council of School Administrators and works putting on teacher training and continuing education. He said he heard of the position from Ms. Sutton and he wanted to get the experience and learn something pursuant to his studies. He also feels he has the time to be attentive to the issues and do a good job. CHAIRMAN LEMAN said they would take up their confirmations in a joint session and announced the Board of Psychologists and Psychological Associate Examiners. MR. BEN CRAWFORD said his family has been in Alaska about 100 years and he is trained specifically as a psychologist in relationships and issues relevant to our lifestyle like substance abuse and crisis debriefing. He was encouraged as President of the Alaska Psychological Association to put his name in as an applicant for this position. CHAIRMAN LEMAN thanked him for his willingness to serve. Number 134 MS. SUSAN BAXTER said she has lived in Alaska since 1969 and received her degree in Psychological Counseling in 1991 and has been very active in professional issues. She was encouraged by professionals in her community to offer her services to the Board and is willing to do that because she is concerned with issues that have to do with protection of the public and facilitating the licensing of professionals. CHAIRMAN LEMAN thanked her for her willingness to serve. MS. GAIL SHORTELL said she moved to Alaska in 1970 and she is currently an attorney in solo practice. She is interested in serving on the Board because she has a sound background in public social services. CHAIRMAN LEMAN asked her if there were any issues the legislature should know about. She replied no. SENATOR LEMAN wished her the best. MR. DAVID SPERBECK, a clinical and forensic psychologist born in Anchorage, said he has served the Board for about 10 years as a consultant on issues related to ethics in complaints. CHAIRMAN LEMAN thanked him for his willingness to serve and announced the Board of Certified Real Estate Appraisers. Number 200 MS. SUSAN CROSSON said she has been a real estate appraiser for about 18 years and owns her own business. She said this board has been in existence for only about 4 years and prior to that time they were not licensed. She said she served under Governor Hickel and has been invited to reapply. Number 241 MR. JON WOLFE said he has been a resident of Juneau and Douglas for about 15 years. He said he is interested in serving because he has a background in regulations and could benefit this new board. He has been appraising in Juneau for about seven years. CHAIRMAN LEMAN asked in an effort to come up with an equitable system of paying for the cost of education across the State of Alaska in the REAA areas, there has been a suggestion to use property taxes and someone said that would cost more to appraise than they would collect, if that is a valid assessment. MR. WOLFE said he didn't have an opinion on that. CHAIRMAN LEMAN thanked him for his willingness to serve and said they would next take up the Alaska Public Utilities Commission. MR. JAMES POSEY, 18-year Alaskan resident, said he has had a number of jobs here. He brings his experience in management, technology, and problem solving to the Board. CHAIRMAN LEMAN asked if he could see any particular challenges coming our way with the federal government mandating deregulation. MR. POSEY replied that with deregulation as instituted from the East Coast, one must always look at rural areas and areas that are disconnected as being special circumstances and if Congress, in its wisdom, provides the state utility commissions with the support and regulatory devices that would allow local circumstances to fall under the local commission, he thought they could successfully negotiate deregulation. That is what is currently happening in the area of telecommunications. He said a special situation is that we are not connected to the grid. We are like an island and there could be some market failure situations. CHAIRMAN LEMAN asked if he thought competition in the Alaska market place in telecommunications has been a success so far. MR. POSEY replied that it is being instituted successfully because of how the Act works and also because of the expertise within the various competing utilities, considering its complexity and new technology. CHAIRMAN LEMAN thanked him for his willingness to serve and announced they would next take up the Board of Public Accountancy. Number 354 MS. KATHLEEN GRIMES said she had been in Alaska since 1974 and although she is not a CPA, she has an extensive accounting background of about 15 years. She has an accounting degree and a master's in governmental and nonprofit finance. She said she has volunteered her time locally and is ready to volunteer at a state- wide level. CHAIRMAN LEMAN asked if the construction projects she worked with were in rural Alaska. MS. GRIMES said the majority of them were during the Project 80s when all the schools in Anchorage were being built. CHAIRMAN LEMAN asked her to help the legislature with her suggestions for a better government and thanked her for her willingness to serve. He then announced he would notify the Senate of their hearings. Number 450 SB 122 INS.COVERAGE:MARRIAGE & FAMILY THERAPIST CHAIRMAN LEMAN announced SB 122 to be up for consideration. MS. RACHAEL MORELAND , Aide to Senator Leman, said that SB 122 was requested by the Alaska Association for Marriage and Family Therapy. It adds marital and family therapists to the list of providers against whom insurers may not discriminate. It does not mandate insurers to add coverage of marital and family therapists where the coverage currently is not provided. It merely requires that insurers treat marital and family therapists on equal footing with other licensed mental health providers and extend the same opportunities for coverage that the insurer offers these licensed providers. Currently health insurers offering mental health services may not discriminate against licensed psychologists, psychological associates, or clinical social workers. SB 122 would allow those insured with mental health coverage to choose treatment from a licensed marital and family therapist. MS. MORELAND said she wanted to correct a phrase on sponsor statement at the end of paragraph two. It is incorrect where it says the insurance company offers the same as in other states. It should read, "It merely requires that insurers treat marital and family therapists on equal footing with other licensed providers in their field. She said marital and family therapists are licensed or certified in 37 states and are recognized by the U.S. Department of Health and Human Services as one of the five core mental health disciplines in the U.S. CHAIRMAN LEMAN asked if it was correct that if an insurance policy provides for mental health services, then the insurer cannot discriminate against marriage and family therapists because they practice in that area. MS. MORELAND said that was correct for certain services. Since there was a quorum present, SENATOR MACKIE moved and asked unanimous consent that the individuals they listened to for confirmation for the various boards be submitted to the joint session for confirmation. There were no objections and it was so ordered. MS. BEVERLY LINDELL , President, Alaska Association for Marriage and Family Therapy, supported SB 122 saying it's very simple. They are just being asked to be added to the list of providers that cannot be discriminated against by insurers. It's not a mandate for coverage; it's not any willing provider language. MS. LINDELL thought this bill is important because it provides fairness as marriage and family therapists are one of the five core mental health professions as identified by the National Institute of Mental Health. The others are already in this legislation. They are not asking for special treatment. She said the second issue is cost, the argument being that it will increase insurance costs. An opinion from the Division of Insurance on this question a few years ago came back stating they could find no evidence of that happening and there is some suggestion that it could actually decrease costs. MS. LINDELL stated that there is considerable evidence that the treatment of mental and emotional disorders is not unproductive. She said a report prepared by the Mental Health Liaison Group out of Washington D. C. estimated on a national basis over $1 billion could be saved with appropriate mental health treatment. Another study by the Harvard Community Health Plan involved patients whose symptoms may have still included psycho-social problems and when group therapy was added, there was a reduction by 50% of doctor visits. She said there is now considerable evidence that licensed marriage and family therapists can complete treatment in fewer sessions than individual treatment which translates into reduced costs for consumers and insurers. The third issue has to do with the rights of consumers, and allowing freedom of choice of qualified providers is fair. In a 1993 survey of consumers, the American Psychologists found that marriage and family therapists were the type of therapist most often recommended by consumers to family and friends. Finally, she said they have heard a lot about how the American family is in a lot of trouble. They are the profession that has special expertise in the treatment and care of families and they would like the opportunity to do that. CHAIRMAN LEMAN asked if she supported Senator Mackie's proposed amendment that would insert a new section on page 2, line 11 saying, "(2) "unfair discrimination" does not include requirements imposed by an insurer for purposes of utilization review, cost containment, or standards of clinically appropriate health care services". MS. LINDELL deferred to the Division of Insurance. Number 500 CHAIRMAN LEMAN asked what the core mental health groups were. MS. LINDELL replied the other groups are psychiatrists, psychologist or psych-associates, social workers and professional nurses. CHAIRMAN LEMAN noted that they are not in this legislation, but are in the statute. CHAIRMAN LEMAN said in a letter of support from Dr. Pollick that insurers do not compensate licensed marriage and family therapists equally. He asked if the intent was to mean that they did not have equal access to insurance coverage. MS. LINDELL said that is correct and agreed that they do not intend to make compensation equal to that of a medical doctor. MS. MARCI WOLFF , licensed marriage and family therapist, supported SB 122. She has specific training for family therapy rather than a focus on other areas of psychology such as research or social policy making. She recited an extensive list of credentials and said she is currently in private practice and regularly receives referral from doctors, psychologists, social workers, and other family therapists, attorneys, military sources, and community agencies. She receives these referrals because she's effective in providing quality therapy in a brief cost effective manner. She said marriage and family therapists need to be recognized and supported legislatively in providing the services for which they are uniquely qualified to provide. CHAIRMAN LEMAN asked if any of her services are currently being paid by insurance. She replied that many are. Number 540 MS. TIMA PRIESS said she is a licensed marriage and family therapist. She said she has been accepted as a provider by several insurance companies including the Veterans Administration. She has had the experience of being turned down by insurance companies, including a company that had certified her under their managed care program, but would not certify her independently for clients who use their insurance without the managed care which doesn't make much sense to her. MS. PRIESS pointed out under section 47.17.020, the Alaska Child Protection Statute, professionals who are required to report child abuse include practitioners of the healing arts. These professionals are defined in section 47.17.290 (13) as including marital and family therapists. In addition 47.24.010, the statute that defines who is required to report abuse of elders and disabled adults also includes marital and family therapists. Number 561 MS. MARIANNE BURKE, Director, Division of Insurance, said this particular section of the code has somehow mutated over time. The original intent, according to her reading of the enacting legislation, was the practice of unfair discrimination was to mean unfairly discriminating against similar professions. For example, if you were an M.D. licensed to perform an appendectomy, an insurance company could pay one doctor and not another. MS. BURKE said regarding cost, that the services provided under an insurance contract is a matter of a contractual arrangement. You contract to have particular services covered at a particular rate or up to a particular cap. As long as there's no expansion of those services by adding another profession, it would not increase the cost. Her only concern is if a profession expanded the scope of services that was provided under the contractual arrangement; for example, expanding marital and family therapists to include priests, rabbis, or ministers - all of whom provide counseling. But this is a licensed group and she does not know their scope. She understand that this is a credible group and has standards of practice and conduct to which they adhere. TAPE 97-16, SIDE B SENATOR MACKIE asked her if she had problems with his proposed amendment. MS. BURKE replied the first portion, "unfair discrimination does not include requirements imposed by an insurer for purposes of utilization review" is perfectly appropriate. She said cost containment is not inappropriate as long as it is not used to dictate that you go to the cheapest available service in town. MR. JERRY REINWAND, Blue Cross, said SB 122 raises an issue bigger than just the issue of family and marital therapists. The proposed bill really talks about unfair discrimination and there is no statutory definition of what is unfair discrimination, nor is there in regulation. While the Division has been a tough, but fair regulator, the legislature is still leaving it up to them to apply their own idea of what constitutes unfair discrimination. They support Senator Mackie's amendment, because it puts, by contract, what terms and conditions would not constitute unfair discrimination which brings clarity to the issue. CHAIRMAN LEMAN asked if he thought the legislature should define unfair discrimination. MR. REINWAND replied that discrimination is an important issue and there have been cases in the past where insurance companies have not always done the right thing regarding discrimination. He thought it would be in everyone's interest and good public policy if you're going to say you can't do it, to define what it is. MS. LINDELL clarified that any licensed group has within its statutes that regulate the profession the scope of practice. Under marriage and family therapists it lists first of all the requirements in terms of formal education, specific courses that are required, time of supervision, practicum experience, etc. In terms of what the practice means, that is also in the statute and includes the diagnosis and treatment of mental and emotional disorders that are referenced in a standard diagnostic nomenclature for marriage and family therapy, whether a cognitive affected behavior within the context of human relationships, particularly marital and family systems. They must also apply the understanding of the dynamics. CHAIRMAN LEMAN noted that some ministers may qualify, but probably very few. MS. LINDELL agreed. SENATOR MACKIE moved to adopt amendment #1. There were no objections and it was so ordered. SENATOR MACKIE moved to pass CSSB 122(L&C) from committee with individual recommendations and $0 fiscal note. There were no objections and it was so ordered. HB 30 CIVIL LIABILITY FOR SKATEBOARDING CHAIRMAN LEMAN announced HB 30 to be up for consideration. MR. TIM SULLIVAN, Staff to Representative Eldon Mulder, sponsor, said HB 30 was requested by the Municipality of Anchorage. They and several other municipalities would like to create skating and cycling parks so skaters and cyclers will have a place to ride rather than using areas designed for pedestrians. The municipalities are willing to develop these areas if they can be insulated from liability for claims arising from claims inherent in skating and cycling. MR. SULLIVAN said the intent of HB 30 is to encourage municipalities to proceed with development of various outdoor recreation without increasing their liability unnecessarily. This bill applies only to municipal skating and cycling parks. It is patterned after legislation passed providing this limited protection to ski areas. This protection from liability relates to inherent dangers and risks of skating and cycling. Municipalities are required to post signs warning of the inherent risks and that the liability rests with the skater and cycler. SENATOR KELLY informed the committee that the sponsor came to him with two amendments. Number 1 on page 1, line 8 after "skating" would delete "and" and insert "or". Amendment number 2 on page 4, line 31 would insert a new paragraph to read the facility "does not include a trail used for skating or cycling." In other words there was some concern that the current definition or lack of definition of facility would require the municipality of Anchorage and other areas to put warning signs up on trails, like the Tony Knowles Coastal Trail. SENATOR MACKIE clarified that this amendment referred to only those facilities that are built specifically for that. MR. SULLIVAN agreed. SENATOR KELLY moved to adopt amendment 1. There were no objections and it was so ordered. SENATOR KELLY moved to adopt amendment 2. There were no objections and it was so ordered. Number 460 MR. SULLIVAN said there was another amendment, number 3, that they support. He said that several municipalities including Valdez, Petersburg, Sitka, and Seward expressed the idea that they should have the ability to determine what is needed to separate the facility from conflicting uses or hazardous conditions in this situation. On page 3, line 9 it would delete "with fencing or another type of enclosing or surrounding structures." SENATOR MACKIE moved to adopt amendment 3. There were no objections and it was so ordered. SENATOR MACKIE asked if there was a number of municipalities looking at this now. MR. SULLIVAN said there were letters of support from a number of municipalities, including Anchorage, Kodiak, Kenai, Juneau, and Fairbanks. SENATOR MACKIE asked to what degree was the liability a deterrent to building the parks. MR. SULLIVAN said he would prefer the AML address that issue. MR. JAY SAUNDER AND MELISSA WALKER, representing the Juneau Skate Park Committee, testified before the committee. MR. SAUNDER said that it is very difficult and expensive to have someone to cover the insurance of a skate park and this bill would greatly increase the chances of a skate park happening for a large population of youth skaters in Juneau. SENATOR MACKIE asked them if they knew if they go to this park and are doing flips or whatever and break their arm, are they willing to accept that responsibility or should their parents be allowed to sue the CBJ. MR. SAUNDERS replied that they understand and feel that parents shouldn't be able to sue. MR. KEVIN RITCHIE, Alaska Municipal League, said they look at this as another opportunity to provide services for our youth. The frustrating thing now is that kids can get hurt and in most cases wouldn't have anyone to sue. Municipalities are not barred from doing this, but there is a big financial incentive for not putting together a skateboard park because, even though it's safer, there's a much greater risk of loss to the municipal government. This bill just does what ski areas do which is they say if we're negligent in the ski area and you hurt yourself, it's our fault, but if the ski area is well maintained, there are inherent dangers in skiing that you have to accept. In Juneau there has been some negotiation with kids to use an approved facility rather than the street. So it's a lot safer for both pedestrians as well as the kids themselves. SENATOR KELLY asked if there was an approved facility in Juneau now. MR. RITCHIE replied that these young adults are currently working on developing that facility. SENATOR MACKIE asked what it would cost for insurance now to have a facility. MR. RITCHIE replied there is a significant difference in the liability. MR. KEVIN SMITH, Alaska Municipal League Joint Insurance Association, said the coverage for skateboard parks in general has been excluded from most general liability policies available in the State of Alaska. Recently the Board of Trustees of JIA discussed this idea and the needs of municipalities to deal with the issue of getting kids off the streets and into some place. So their association went ahead and included skateboarding as a covered item. This is largely in anticipation of passage of the bill and largely just addressing the needs of the members since it's not actually an insurance company per se. MR. SMITH said that coverage is almost impossible to get now. This bill would help coverage become available at whatever cost. MS. NANCY ROBB, Valdez Parks and Recreation, said the City of Valdez is very supportive of HB 30 and the amendments that will allow municipalities to delineate the boundaries. SENATOR KELLY asked if Valdez was currently planning a skateboard park. She replied that they currently have an in-line hockey rink they constructed last year through some donations and this will assist them with that. In the past 30 days a number of youth have expressed interest in developing a skateboard park. MR. BILL MUSSON, Director, Petersburg Parks and Recreation, supported HB 30. He said this issue is becoming increasingly important in many municipalities around the State in expanding positive recreational opportunities for the youth of communities. He also supported the amendments. Number 347 MS. MARNIE ISAACS, Municipality of Anchorage, said she is also the parent of a skater. She thanked them for considering this for the kids and that resolutions have been passed by the Anchorage Youth Commission and the Anchorage Assembly, and are currently pending before the Anchorage Chamber and the Downtown Anchorage Association, in support of this legislation. SENATOR MACKIE moved to pass SCSHB 30(L&C) from committee with individual recommendations and $0 fiscal note. There were no objections and it was so ordered. CHAIRMAN LEMAN adjourned the meeting at 2:55 p.m.