HOUSE FINANCE COMMITTEE March 31, 2022 9:08 a.m. 9:08:29 AM CALL TO ORDER Co-Chair Merrick called the House Finance Committee meeting to order at 9:08 a.m. MEMBERS PRESENT Representative Neal Foster, Co-Chair (via teleconference) Representative Kelly Merrick, Co-Chair Representative Dan Ortiz, Vice-Chair Representative Bryce Edgmon Representative DeLena Johnson Representative Andy Josephson Representative Bart LeBon Representative Sara Rasmussen Representative Steve Thompson Representative Adam Wool MEMBERS ABSENT Representative Ben Carpenter ALSO PRESENT Representative Andi Story, Sponsor; Sara Chambers, Director, Division of Corporations, Business and Professional Licensing, Department of Commerce, Community and Economic Development; Representative Matt Claman, Sponsor. SUMMARY HB 306 EXTEND BOARD OF PHARMACY HB 306 was REPORTED out of committee with three "do pass" recommendations and six "no recommendation" recommendations and with one previously published fiscal impact note: FN1 (CED). HB 60 PUBLIC SCHOOLS: MENTAL HEALTH EDUCATION HB 60 was HEARD and HELD in committee for further consideration. Co-Chair Merrick reviewed the agenda for the morning meeting. HOUSE BILL NO. 306 "An Act extending the termination date of the Board of Pharmacy; and providing for an effective date." 9:08:55 AM REPRESENTATIVE ANDI STORY, SPONSOR, thanked the committee for hearing the bill. She stated that the Board of Pharmacy must be extended for the critical work of licensing and regulation of the profession. She agreed with the auditor's recommendation of extending the board for six years. She remarked that legislators all shared a concern about the Prescription Drug Monitoring Program (PDMP). She believed fixing the PDMP was a separate issue from the extension of the board. She clarified that the PDMP was housed under the Board of Pharmacy; however, the board only had enforcement power and regulatory oversight over pharmacists. She highlighted that the Medical Board, Board of Nursing, Board of Dental Examiners, Board of Examiners and Optometry, and Board of Veterinarian Examiners all participated in the PDMP. She relayed that the chairs of the boards met twice a month solely about the PDMP. She shared that her staff had been working closely with the Department of Commerce, Community and Economic Development (DCCED) and Sara Chambers [Director, Division of Corporations, Business and Professional Licensing, DCCED] and they all felt strongly about how to make some progress in the PDMP. She requested to hear from Ms. Chambers. 9:11:10 AM AT EASE 9:11:37 AM RECONVENED SARA CHAMBERS, DIRECTOR, DIVISION OF CORPORATIONS, BUSINESS AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT, appreciated the members' desire for a solution to ensure the PDMP was doing what the legislature had set forth for the program to do and to ensure it was doing it well. In addition to that, everyone understood and agreed on the expectations of the PDMP. She appreciated the bill sponsor's desire to find some solutions. She communicated that since the last bill hearing, the department had been working with the board chairs and some members of the House Finance Committee to identify existing funding sources that could help the department locate a contractor, consultant, or individual with PDMP expertise who could take a holistic view of how the PDMP fit into the state's opioid crisis management. Additionally, the individual could help determine whether legislation could be recommended in a subsequent report to the legislature to address changes ranging from small to large, what the department, boards, and administration could be doing differently, looking at other states, and providing technical assistance. Ms. Chambers stated the resources were out there and they were working to connect the dots, especially with the department's limited resources. She elaborated that they had been working with the Division of Public Health to identify some grant funding. They believed it may provide an option to move forward on a report and analysis in a way that would edify the concerns. 9:13:52 AM Representative Edgmon relayed that he had been one to raise concerns about the PDMP. He appreciated the information, and it satisfied his concern. He was ready to support the legislation. Representative LeBon MOVED to ADOPT Amendment 1, 32- LS1434\A.2 (Ambrose, 3/16/22) [by Representative Carpenter] (copy on file): Page 1, line 5 Delete "2028" Insert "2026" Representative Edgmon OBJECTED. Representative LeBon explained the amendment. He stated that the committee had heard from the legislative auditor there were some issues with board governance and the working relationship between the Board of Pharmacy and the agency. He thought the legislature would want to see progress towards improving the work of the board. He supported a reduction in the extension of the board from 2028 to 2026. Representative Edgmon MAINTAINED his OBJECTION. A roll call vote was taken on the motion. IN FAVOR: Johnson, Josephson, LeBon, Thompson OPPOSED: Ortiz, Wool, Edgmon, Merrick, Foster The MOTION to adopt Amendment 1 FAILED (4/5). 9:15:58 AM AT EASE 9:16:08 AM RECONVENED Vice-Chair Ortiz MOVED to REPORT HB 306 out of committee with individual recommendations and the accompanying fiscal note. Representative Johnson OBJECTED for discussion. She remarked that she put a reminder in her calendar to bring up the topic the following session. She wanted to ensure the legislature was doing its do diligence. She had some concerns about the length [of the board extension] because some issues had been identified. She remarked that going forward with the next year's budget, it was easy to let things go by the wayside. She remarked there may be an opportunity in the future to talk about boards and commissions, which she believed would likely be healthy for some of the state's boards. She was not interested in shutting the board down or in spending a substantial amount of money on another audit to come back to the committee to report that the same thing was still happening. She stated that somehow the legislature needed to figure out how to get a report that may not be 100 percent or exactly what the legislature wanted to vote on. The legislature would need to determine how to deal with it. Representative Johnson WITHDREW her OBJECTION. There being NO further OBJECTION, HB 306 was REPORTED out of committee with three "do pass" recommendations and six "no recommendation" recommendations and with one previously published fiscal impact note: FN1 (CED). 9:17:59 AM AT EASE 9:20:02 AM RECONVENED HOUSE BILL NO. 60 "An Act relating to mental health education." 9:20:04 AM Co-Chair Merrick noted the bill had been tabled the previous day. Representative Rasmussen MOVED HB 60 be taken up from the table. Representative Thompson OBJECTED. He thought hearing the bill had the potential of being a waste of the committee's time. He believed the committee had better things it needed to get done. He thought hearing the bill was the wrong thing to do currently. He stated the Senate version of the bill would come to the House floor. He believed the committee would rehash the topic a second time over the next couple of weeks. Co-Chair Merrick noted that any amendments made in the committee could be rolled into a committee substitute. Representative Thompson MAINTAINED his OBJECTION. 9:21:20 AM AT EASE 9:21:31 AM RECONVENED Co-Chair Merrick asked to clear the previous roll call. A roll call vote was taken on the motion. IN FAVOR: Josephson, Ortiz, Rasmussen, Wool, Merrick, Foster OPPOSED: LeBon, Thompson, Edgmon, Johnson The MOTION PASSED (6/4). There being NO further OBJECTION, HB 60 was back before the committee. 9:22:18 AM Representative Thompson MOVED to ADJOURN the meeting. A roll call vote was taken on the motion. IN FAVOR: LeBon, Rasmussen, Thompson, Johnson OPPOSED: Ortiz, Wool, Edgmon, Josephson, Merrick, Foster The MOTION to adjourn FAILED (4/6). 9:23:34 AM Co-Chair Merrick asked if the bill sponsor had an opening statement. REPRESENTATIVE MATT CLAMAN, SPONSOR, replied that he did not have opening remarks and was happy to discuss the amendments as needed throughout the process. Representative Johnson MOVED to ADOPT Amendment 1, 32- LS0261\B.17 (Marx, 3/4/22) (copy on file): Page 2, following line 17: Insert a new bill section to read: "* Sec. 4. AS 14.30.360 is amended by adding a new subsection to read: (e) A district shall, before instructing students in mental health as part of a program in health education under (a) of this section, provide notice to parents and guardians of students participating in the program that (1) describes the mental health components of the program; (2) identifies the time and place of the mental health instruction; and (3) informs parents or guardians how to, under AS 14.03.016, object to and withdraw the student from the program." Renumber the following bill section accordingly Representative Josephson OBJECTED. Representative Johnson explained that the amendment would add transparency and parental involvement. She shared that many of her constituents were concerned about schools overlapping with parents when it came to raising kids. The amendment would require notices to be provided to parents about any mental health program including a description of the program and instruction. Additionally, the amendment would give parents the right to opt out of the program. She stated that schools used the process for other topics including sex education. She believed the mental health program should be no different. Vice-Chair Ortiz opposed the amendment. He highlighted that the bill provided for an optional opportunity for districts to adopt guidelines that would come forward from the state. He elaborated it would be optional for districts to adopt any form of a mental health program within their curriculum. He stated the amendment would reach into local board control and mandate what a local board may or may not do. He believed most of the legislature was in support of local control of schools. He stated it was the whole foundation of the school board system. He believed the amendment went against the basic principle. Representative Rasmussen supported the amendment. She stated that the most local control possible involved a parent and their child. She agreed that districts should have some flexibility; however, she believed the amendment would help ensure parents were involved and informed about the curriculum being taught to their children. 9:26:14 AM Representative Wool did not support the amendment. He highlighted that the bill provided guidance for developing instructions in mental health. He stated that the language was about a student's physical and mental health. He remarked that a child's health included mental and physical health. He elaborated that if a child was sick, they were not physically well and if they were depressed, they were not mentally well. He did not believe talking about the subject of mental health in a classroom should require parental permission. He disputed the claim that it was like sex education. He remarked that perhaps families discussed mental health at home, but perhaps they did not. He pointed out that no one talked about the need for parental buy-in to discuss nutrition. He thought mental health was akin to that. He noted that many schools included a mental health section in health class. He did not see any problem and had not heard any complaints. He stated the topic had been included in his kids' education since the beginning. He shared that in elementary school kids went to "counselor" to talk about things. He stated the bill was not overly prescriptive and pertained to guidelines. He did not support requiring parental permission or notification. Representative LeBon supported the amendment. He stated that the process would require school board endorsement of whatever came out of the mental health arena through the State Board of Education. He stated that a local school board would have a weigh-in opportunity. He believed the concern was whether a program would come out of the bill or if there would be an embedded expectation or cultural change within each school district's curriculum. For example, if a district chose to develop a mental health class, the amendment would enable parents to opt in or out. 9:28:38 AM Representative Edgmon opposed the amendment for two reasons. He believed the amendment was redundant. He detailed that state law gave school districts autonomy and worked through an organizational structure that included school boards. He stated that schools could already do this [instruct on mental health]. Second, if the amendment went into law, they would be picking up mental health and not having the same application apply towards alcohol, drug abuse, cardiopulmonary resuscitation, early cancer prevention/detection, dental health, family health, environmental health, and all of the rest of the Bree's Law portion. He stated the amendment was highly prescriptive and unnecessary. Co-Chair Merrick asked if the bill sponsor was aware that the concept was included the companion bill, SB 80. Representative Claman answered that he believed there may be parts of the language included in SB 80, but he did not believe it was identical. Representative Wool referenced a statement by Representative LeBon that a class may be offered in mental health. He remarked that there was already a class on psychology offered in high school and likely in junior high. He pointed out the class included the subject of mental health. He had not seen a permission slip for the class. He stated that the bill merely pertained to basic knowledge and talking about the subject of mental health. He stated that no one was advocating for therapy sessions or anything in that realm. He underscored the bill only pertained to guidance for districts. He believed the amendment was far too prescriptive. Representative LeBon responded that psychology had been an elective in the Fairbanks School District when he had served on the school board. He countered that in a sense, parents did have a say whether their child took the course. He asked what the harm would be in allowing parental input one way or the other for psychology or other mental health course. Representative Wool suggested that perhaps the child that needed to hear about mental health had a family that did not want them to hear about the topic and perhaps the child needed the mental health education portion. He was not trying to subvert parental intent, but he emphasized mental health was a very important issue in school. He remarked that some kids were hiding their mental health illness and teen suicide was extremely high. He pointed out that many times the parent of a child who had committed suicide did not know anything had been going on with their child. He believed mental health was an important component of overall holistic health. 9:32:05 AM Vice-Chair Ortiz underscored that the bill provided an option for districts to adopt guidelines. He believed that prior to a local board adopting any kind of mental health program, there was plenty of opportunity for the public to provide input and express concerns. He stated the school system in Alaska was based on local control. He thought it was likely the case in many places in the U.S. He emphasized the amendment allowed government to tell districts what to do and took away local control. He stressed it was not in the spirit of the basic principle of local control. Representative Claman did not support the amendment. He explained that the entire point of the guidelines was to not force them on any district. He stated that the amendment took away from local control and created an unfunded mandate. He encouraged committee members to vote against the amendment. Co-Chair Merrick asked for verification that the idea included in the amendment could be adopted by the local school board or school district at their discretion. Representative Claman replied affirmatively. Representative Johnson provided wrap up on Amendment 1. She did not find providing a parental opt-out to be overly prescriptive. She believed it was the right thing to do. She referenced a prior example used by a committee member where a child had mental health issues they were hiding or were not talking to parents. She asked about kids who were already in therapy or psychiatric treatment and the parents were involved. She considered what would happen if the child also received mental health curriculum in school that their parents were unaware of. She stated there could be conflicting issues and advice. She believed it could be dangerous and she had concerns about the possibility. She did not see how the amendment would be an unfunded mandate. She agreed it was important to think about mental and physical health. She stated that the bill was wide open. She noted there had been a lot of discussion about suicide prevention, which made sense, but it was not specified in the bill. She noted that the bill did not refer to the diagnostic manual or specify what mental health would mean. She believed parents should be involved. 9:35:40 AM Representative Josephson MAINTAINED his OBJECTION. A roll call vote was taken on the motion. IN FAVOR: Rasmussen, Johnson, LeBon OPPOSED: Ortiz, Wool, Edgmon, Josephson, Merrick, Foster Representative Thompson was absent from the vote. The MOTION to adopt Amendment 1 FAILED (3/6). 9:36:37 AM Representative Johnson MOVED to ADOPT Amendment 2, 32- LS0261\B.18 (Marx, 3/4/22) (copy on file): Page 1, lines 7 - 8: Delete "Department of Health and Social Services, regional tribal health organizations, and representatives of national and state mental health organizations" Insert "Statewide Suicide Prevention Council" Page 2, lines 6 - 8: Delete "Department of Health and Social Services, regional tribal health organizations, and representatives of national and state mental health organizations" Insert "Statewide Suicide Prevention Council" Representative Josephson OBJECTED. Representative Johnson explained that the amendment would remove the Department of Health and Social Services (DHSS) and other organizations from page 2, lines 6 through 8 and inserted the Statewide Suicide Prevention Council. She stated the committee had heard a lot of public testimony about suicide and mental health issues, but the bill did not include the Statewide Suicide Prevention Council, which she believed should be the top entity listed. She believed it made more sense for the council to be the primary source working with other entities. She explained that the organization already worked with state departments, tribal and other health organizations, and local communities. Representative Johnson stated the amendment was not about excluding anyone. She relayed that the council was established in 2001 by statute. The council's duties included community education, informing and advising the governor and legislature, working with the state and local governments, schools, and Native communities on overall wellness. She stated that members of the council included representatives from the Alaska Federation of Natives, DHSS, a survivor, youth, legislators, Alaska Mental Health Trust Authority, and the military. She noted there were also public seats. She thought oversight by the council made much more sense. She added that while the council's name focused on suicide, its mission was holistic and included wellness. 9:37:48 AM Representative Edgmon believed that as with the first amendment, Amendment 2 was well intended; however, he believed it constituted overlap. He looked at language in the bill under the legislative intent section for consultation with DHSS, regional tribal health organizations, and representatives of national and state mental health organizations. He believed the Statewide Suicide Prevention Council fit under the category of state mental health organizations. He explained that listing out specific entities got into a situation under the statutory construct where every single thing included should be itemized. He stated it was overly prescriptive. He did not support the amendment. Representative Wool did not support the amendment. He agreed with Representative Edgmon that the Statewide Suicide Prevention Council fit under the category of state mental health organizations. He thought it was advisable to cast the net as wide as possible. He stated suicide was definitely a problem, but there were other mental health issues as well. He listed other examples such as body image, addiction, substance abuse, and anxiety. He believed narrowing the bill to suicide was too narrow and overly prescriptive. Representative Claman did not support the amendment. He recognized that suicide was a state and national issue. He would not want anyone with a mental health issue to be suicidal. He believed the amendment narrowed the bill's focus. He agreed with the past two speakers that Statewide Suicide Prevention Council fit under the category of state mental health organizations that could participate. Representative Josephson MAINTAINED his OBJECTION. Representative Johnson provided wrap up. She continued to have concerns about the erosion of parental rights. She liked the idea of including sideboards on the legislation. She noted that suicide prevention dealt with wellness across a spectrum. She stated that the amendment was not prescriptive and recognized one of the largest problems in Alaska. She emphasized the problem was not getting any better. A roll call vote was taken on the motion. IN FAVOR: Johnson, LeBon, Rasmussen OPPOSED: Edgmon, Josephson, Ortiz, Wool, Merrick, Foster Representative Thompson was absent from the vote. The MOTION to adopt Amendment 2 FAILED (3/6). 9:41:35 AM Representative LeBon MOVED to ADOPT Amendment 3, 32- LS0261\B.13 (Marx, 2/26/22) (copy on file): Page 2, line 8, following "organizations.": Insert "The guidelines must provide that an instructor who is not a mental health professional may provide only information within the guidelines, and that the instructor must, before providing instruction in mental health, provide a verbal disclaimer stating that the instructor is not a mental health professional and may provide only information within the guidelines for instruction in mental health established by the state board." 7 Page 2, line 17, following "provided.": Insert "In this subsection, "mental health professional" has the meaning given in AS 47.30.915." Vice-Chair Ortiz OBJECTED. Representative LeBon explained the amendment applied whether mental health became a program within a school district or was simply embedded into the health curriculum. The amendment proposed that prior to instruction on mental health, an educator would be required to read a verbal disclaimer that they were not a mental health professional, and they may only provide information with the guidelines for instruction on mental health established by the state board. He included the local board of education in the description as well. He believed the change was necessary because it acknowledges the complexity of mental health as a topic. He detailed that licensed mental healthcare providers had years of education requiring a master's or doctorate degree and thousands of hours of internship and training. He stated that scope of practice was about staying in one's lane of expertise. He did not feel it was the intent of the bill to place a teacher in a role that was outside of their lane. The amendment would remind the teacher and students of the limited intention to provide mental health information in classrooms. Representative Josephson opposed the amendment. He believed the amendment would lead to a stilted class atmosphere. He shared that his wife is a second grade teacher and she told him often that her seven-year-old students were reflecting some struggles with mental health, mostly through self esteem concerns and lack of feeling of personal worth. He thought requiring a teacher to tell a class of seven-year- olds that they were not a mental health professional was beyond awkward and seemed to prevent a conversation about how to handle sadness or loss into story time. He did not believe the amendment was necessary. 9:44:22 AM Representative Edgmon stated his understanding that a school board could already do what the amendment called for at the local level. He struggled with the fact that the amendment would apply higher standards to one component of AS 14.30.360 (a). He highlighted child abuse, child abduction, neglect, sexual abuse, domestic violence and stated the items were not in law under the standards included in the amendment. He stated the amendment did not meet the disparity test for him. He opposed the amendment. Representative Wool opposed the amendment. He highlighted that during public testimony, a teacher had said something akin to what Representative Josephson had said. The testifier had discussed that teachers and students had a mentor/mentee relationship and often a student went to a teacher to talk about "whatever." He stated that teachers did not provide disclaimers they could not provide advice because they were not healthcare professionals. He clarified he did not think teachers were doing mental health therapy sessions. He believed the idea further stigmatized mental health, which he did not support. Representative Claman did not support the amendment. He pointed out that the amendment took authority away from the local board. He explained if a local board chose to include mental and physical health aspects in a curriculum adopted through a robust public process that were not part of the guidelines, the amendment would not allow the districts to teach the items. Under the amendment, districts would be limited to the guidelines adopted by the state board. He pointed out that that the document for the current board guidelines for health was only two pages without substantial detail. He expected some school districts to have a much more robust program. He believed the amendment would limit the local authority he was aiming to encourage. 9:47:34 AM Representative LeBon provided wrap up on the amendment. He stated that each of the 53 school boards in the state would have to interpret the guidelines as they saw appropriate. He agreed there would be parental input and a vote up or down by a school board. He referenced a comment made about a seven-year-old showing mental health issues. He considered whether the child could be having a bad day or something wrong at home. He did not know how a classroom teacher would know which was the case. He asked if a classroom teacher would be motivated to write a note home to share they were observing some disturbing behavior and suggest the parent may want to seek a mental health professional to talk with the child. He stated, "I don't know if that is what we want to have happen." He was not intending to downplay the importance of mental health. He merely wanted to ensure there were reasonable sideboards in the legislation and that classroom teachers were not expected to become mental health professionals overnight; the process to obtaining the skills included education and experience. Vice-Chair Ortiz MAINTAINED his OBJECTION. A roll call vote was taken on the motion. IN FAVOR: Rasmussen, Johnson, LeBon OPPOSED: Wool, Edgmon, Josephson, Ortiz, Merrick, Foster Representative Thompson was absent from the vote. The MOTION to adopt Amendment 3 FAILED (3/6). 9:49:55 AM Representative Rasmussen WITHDREW Amendment 4, 32- LS0261\B.12 (Marx, 2/11/22) (copy on file). 9:50:12 AM Representative Edgmon MOVED to ADOPT Amendment 5, 32- LS0261\B.15 (Marx, 2/22/22) (copy on file): Page 2, following line 17: Insert a new bill section to read: "* Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to read: REPORT TO THE LEGISLATURE. Two years after the effective date of this Act, the state Board of Education and Early Development shall submit a report to the senate secretary and chief clerk of the house of representatives and notify the legislature that the report is available. The report must (1) include a copy of the guidelines for developmentally appropriate instruction in mental health developed by the state Board of Education and Early Development as required under AS 14.30.360(b), as amended by sec. 3 of this Act; and (2) describe the process the state Board of Education and Early Development used to develop the guidelines." Renumber the following bill section accordingly. Co-Chair Merrick OBJECTED for discussion. 9:50:22 AM AT EASE 9:50:55 AM RECONVENED Representative Edgmon deferred to the sponsor to explain the amendment. Representative Claman explained the amendment. The amendment called for a report to the legislature after the two-year process establishing the guidelines had been completed by the State Board of Education. The purpose of the amendment was to make certain the legislature was aware of the adopted guidelines. Co-Chair Merrick WITHDREW her OBJECTION. There being NO further OBJECTION, Amendment 5 was ADOPTED. 9:51:58 AM Representative Edgmon MOVED to ADOPT Amendment 6, 32- LS0261\B.14 (Marx, 2/22/22) (copy on file): Page 1, line 15, following "health,": Insert "physical health," Co-Chair Merrick OBJECTED for discussion. Representative Edgmon asked the bill sponsor to explain the amendment. Representative Claman explained that the amendment was in response to debate in the House Finance Committee about whether physical health was also included because it was not specifically stated in the bill. The amendment clarified that the guidelines would address physical and mental health. Co-Chair Merrick WITHDREW her OBJECTION. There being NO further OBJECTION, Amendment 6 was ADOPTED. 9:52:43 AM Representative Edgmon MOVED to ADOPT Amendment 7, 32- LS0261\B.19 (Klein/Marx, 3/25/22) (copy on file): Page 1, line 1, following "education": Insert "; and providing for an effective date" 3 Page 1, line 7: Delete "and Social" Insert ", the Department of Family and Community" 7 Page 2, line 7: Delete "and Social" Insert ", the Department of Family and Community" 11 Page 2, line 11: Delete "and Social Services," Insert ", the Department of Family and Community [AND SOCIAL]" 15 Page 2, following line 22: Insert a new bill section to read: "* Sec. 5. This Act takes effect July 1, 2022." Co-Chair Merrick OBJECTED for discussion. Representative Edgmon deferred to the bill sponsor to explain the amendment. Representative Claman explained the amendment addressed the changes in structure by Executive Order 121 that split DHSS into the Department of Health and the Department of Family and Community Services. He relayed that both departments would be included in the list of parties participating in the guidelines. Co-Chair Merrick WITHDREW her OBJECTION. There being NO further OBJECTION, Amendment 7 was ADOPTED. 9:53:36 AM AT EASE 9:54:29 AM RECONVENED Co-Chair Merrick closed the amendment process. HB 60 was HEARD and HELD in committee for further consideration. Co-Chair Merrick reviewed the schedule for the afternoon meeting. ADJOURNMENT 9:55:05 AM The meeting was adjourned at 9:55 a.m.