HOUSE BILL NO. 308 "An Act relating to dementia awareness." 10:35:04 AM Co-Chair Merrick indicated Representative Stutes's staff was available to introduce HB 308. FATE PUTMAN, STAFF, REPRESENTATIVE LOUISE STUTES, introduced the bill. The purpose of the bill was to draw awareness to dementia and Alzheimer's. He explained the bill was designed to create a public awareness campaign to educate Alaskans about the issue of Alzheimer's. He relayed there were currently no known cures for Alzheimer's or the dementia diseases; however, education and early detection could help to manage the disease and avoid medical intervention including long-term institutionalization or hospitalization. He detailed that fewer than half of Americans living with Alzheimer's disease receive a diagnosis. Additionally, due to Alaska's lack of public health infrastructure for dementia, a lower rate of Alaskans with dementia received a formal diagnosis. The bill was intended to improve the rate of diagnosis for dementia through the production and dissemination of educational material to the public. Mr. Putman relayed that Alzheimer's was one of the ten most common types of dementia. He reported there were about 12,500 people experiencing dementia in Alaska and about 8,500 of the total were Alzheimer's patients. He stated Alaska needed to be prepared for the coming years of the "Alzheimer's tsunami" and delay the onset of dementia to help reduce the disease impacts on patients, families, and the healthcare system. The sponsor's office was working with the Department of Health and Social Services (DHSS) on the legislation to represent the interest of those suffering from Alzheimer's and dementia. He highlighted intent to change the legislation to ensure it complied with an expanded intent to look at the workforce as well as the problem. He noted there would be a fiscal note coming from DHSS. Additionally, there was a new committee substitute (CS). He noted there were individuals online to answer questions. 10:37:38 AM Representative Rasmussen asked about the 12,500 cases of dementia including 8,500 cases of Alzheimer's in Alaska. She asked if the number reflected known cases. She thought the number was probably low. Mr. Putman replied that the problem with Alzheimer's is that people with the disease may not realize they have it. The number reflected the current diagnosed cases in Alaska. Vice-Chair Ortiz MOVED to ADOPT the proposed committee substitute for HB 308, Work Draft 32-LS1397\I (Foote, 3/14/22). Co-Chair Merrick OBJECTED for discussion. Mr. Putman explained the changes in the CS. The CS added the words "and healthcare capacity" to the bill title. He explained the bill would look at the healthcare capacity for Alzheimer's and dementia patients in the state. There was a statutory reference to include the words "and healthcare capacity." Additionally, the word "program" had been removed and replaced with the word "campaign." In the body of the statute, the words "develop, implement" would be replaced with the word "build." After the word "dementia" the word "public" had been inserted. The reference to the [federal] BOLD Act was removed because the funds could be accessed without being referenced in statute. Sections 1 through 6 were removed and replaced with new language. Section 7 had been added to require a biannual report to the legislature about the barriers and problems with dementia preparation. He relayed an eight- year sunset had been added, which would enable the legislature to opt not to renew the program if it was deemed unnecessary. Additionally, the CS included an immediate effective date. Co-Chair Merrick noted that Mr. Putman had been working with stakeholders, which had resulted in some of the changes. She WITHDREW her OBJECTION to the adoption of the CS. There being NO further OBJECTION, Work Draft 32-LS1397\I was ADOPTED. Representative LeBon asked if there was an opportunity for federal funding in the future. Mr. Putman replied affirmatively. He highlighted the federal Building Our Largest Dementia and Alzheimer's (BOLD) Act and relayed that $15 million had been appropriated from Congress in 2021 for informational educational purposes related to Alzheimer's awareness. There were two levels of funding including a $350,000 grant and a $500,000 grant depending on the level of activity of the applying agencies. 10:41:03 AM Representative LeBon asked if the state's funding level enabled leveraging of the federal dollars. He asked if the federal dollars required a level of state support. He asked if there was a relationship the state could take advantage of with state dollars. Mr. Putman replied affirmatively. There was a level of funding required from the state in order to apply for the federal funds. Additionally, a program needed to be up and running in order for the federal government to decide whether the level of funding would be $350,000 or $500,000. Co-Chair Merrick asked to hear from invited testimony. PAMELA KELLEY, EXECUTIVE DIRECTOR, ALZHEIMER'S RESOURCE OF ALASKA, ANCHORAGE (via teleconference), relayed that Alzheimer's Resource of Alaska was the largest dementia services organization operating in Alaska with offices in Fairbanks, Juneau, Mat-Su, and Anchorage. She was also the chair of the Alaska Dementia Action Collaborative, a workgroup comprised of more than 35 stakeholders including public, private, tribal, and nonprofit entities. She shared that the organization had assisted tens of thousands of Alaskans impacted by dementia over the past 38 years. She elaborated that individuals came to the organization after they or a family member had begun to experience memory problems or another symptom of concern. She explained at that point it was typically too late for prevention activities. The organization worked with individuals to help slow the rate of cognitive decline and to help them plan and adapt for the future. Ms. Kelley was certain the state should be building greater awareness about the disease and brain health to reach those whose risks could be reduced well before the worrying symptoms appeared. The work was needed in order to reduce the grim forecasted numbers. She referenced the 12,500 individuals currently diagnosed with dementia in Alaska. She reported that by 2030 the number was projected to be 23,000. She emphasized that paying attention to a person's modifiable risk factors in her 30s, 40s, or 50s could have an impact; however, in reality, most individuals were not aware of dementia during those years. Ms. Kelley did not want to give the indication there was no public awareness work being done in Alaska. She relayed there was work being done, but at what she called the retail level including health fairs, community events, VFW halls, and through speaking engagements. The bill would a population level campaign over time, allowing dementia awareness to be taken wholesale. She communicated that messages about early lifestyle choices and the value of early detection were needed to reduce risk. The messages needed to be provided in many languages to reach those with the greatest risk. She supported the bill because she wanted to see Alaska develop better data around the extent of dementia in the state. She noted the state's prevalence rates were only estimates. She knew the Division of Public Health had the experience to operate a dementia campaign with impact and she knew there were federal dollars available to help achieve the effort. She thanked the committee. 10:45:33 AM NONA SAFRA, MEMBER, ALASKA COMMISSION ON AGING, HOMER (via teleconference), she shared information on her work and shared she was a caregiver of a person with Alzheimer's. She read from prepared remarks: You have all of the data on Alzheimer's as a public health crisis that's devastating to Alaska. Our workforce and our state budget will be impacted by the sheer number of Alaskans who will be diagnosed with dementia in the next decade. So, Alaska needs to address this crisis now. The fiscal note covers one position, which can facilitate federal receipt authority to meet the crisis. So, not passing HB 308 is a missed opportunity for every Alaskan family affected by dementia. This funding gives Alaska better access to focus on issues like increased early detection and diagnosis, risk reduction, prevention, and supporting dementia caregiving. The Alzheimer's Impact Movement shows Medicaid cost of the disease in Alaska is at $76 million in 2020, with $110 million projected in 2025, which is a 44.6 percent increase and that doesn't take into account the latest research published this month in Nature that brain changes due to COVID statistically show a cognitive decline in the population, which adds to our need to have [?] awareness. I speak because my odds for dementia are increased due to a brain injury as well as I am a caregiver and I speak for Alaskans who don't know their increased odds of getting dementia and that they can do things now to change that. I'm also a member of the Brain Injury Taskforce so I'm dealing with people with brain injury. They need HB 308 passed to learn how to avoid or delay the onset and for all the caregivers who need support. So, Alaskans are depending on you, our representatives, to do that. I urge the committee to support HB 308. Ms. Safra noted she was currently in Nome for the finish of the Iditarod. She had been talking with people during her visit and was amazed by the number of families impacted by dementia. She thanked the committee for its time. 10:48:21 AM Co-Chair Merrick asked the Department of Health and Social Services to review the fiscal note. KAROL FINK, SECTION CHIEF, DIVISION OF PUBLIC HEALTH, DEPARTMENT OF HEALTH AND SOCIAL SERVICES (via teleconference), relayed that the CS had changed significantly from the original bill and would change the fiscal note. The amount in the current fiscal note was based on the most basic foundational aspects of creating and implementing a new evidence-based education campaign. She noted that the amount could be scaled. She explained the baseline amount could be reduced if there was additional funding or the state was able to secure the federal grant in the future. She explained the amount shown on the current fiscal note was the minimum required. Representative Carpenter saw the same costs in the out years shown on the note. He asked what scalable meant. Ms. Fink answered that scalable pertained to the reach and frequency of how the messages met individuals. She explained that a smaller budget would mean reaching fewer people with less frequency. Representative Carpenter stated his understanding of the statement. He asked if Ms. Fink meant that if the legislature funded under $777,000, the program would be scaled down. Ms. Fink agreed. 10:50:37 AM Representative LeBon referenced the sunset date of July 1, 2030. He asked if it was because the sponsor hoped to utilize federal participation and the sunset date would be extended if federal funds were received. Alternatively, he wondered if the sunset would occur if the state did not receive federal funding. Mr. Putman answered it was the latter scenario provided by Representative LeBon. He explained the bill was designed to have funding for eight years through undesignated general funds (UGF) if necessary. He noted that the grant could be a one-time grant. He elaborated that if no new federal funds came forward, the eight-year sunset date was designed so the legislature could end the program if there was no funding or if it determined the program was no longer needed. Representative Carpenter asked who would be doing the education of the court system, law enforcement, fire fighters, and other. Mr. Putman answered the initial intent was to have DHSS provide the education. The CS took some of the specific language out, but the intent remained to have the department educate first responders, firefighters, and others about what they were experiencing in dementia situations. Representative Carpenter stated the original intent was for all training to be done by DHSS. He elaborated that the CS specified the state would continue to train. He asked for verification that some of the training would be done by DHSS and the other training would be done by an unidentified party. Mr. Putman clarified that DHSS would be fully responsible for the training. 10:53:04 AM Representative Carpenter looked at the sectional analysis (copy on file) indicating the new statute would require DHSS to maintain a list of state providers who diagnose, evaluate, and manage dementia. He asked what the list enabled DHSS to do. He asked if the information would enable DHSS to target its training. Mr. Putman responded that the list was intended in the original legislation to ensure that people who may have dementia and doctors identifying a person may have dementia, to provide the list to patients in order for the patients to access a doctor. He clarified that the department would prepare the documents and provide them to medical professionals and the medical professionals would hand them out to patients. Co-Chair Merrick thanked Mr. Putman. She set an amendment deadline for Wednesday, March 23 at 6:00 p.m. HB 308 was HEARD and HELD in committee for further consideration.