SENATE BILL NO. 87 "An Act requiring screening of newborns for congenital heart defects; and providing for an effective date." Senator Micciche introduced the legislation. He related a story from personal experience. His niece was born in Japan where newborns were routinely tested for congenital heart disease. A significant defect was discovered that required surgery. He detailed that one in one hundred babies were born in Alaska each year with congenital heart disease; the number one killer of infants with birth defects. The United States was "moving toward" adopting Japan's testing measures. Twenty states were in the process of considering similar legislation and eight states adopted pilot programs. The testing was accessible in several major health facilities in the state. The screening was capable of finding 75 percent of all congenital heart defects, as well as other life threatening conditions. He commented that the test cost $10 and was covered by most health insurance plans and Medicaid. The cost of early detection and treatment was much lower than the cost of late diagnosis and treatment. He furthered that the legislation required the low cost pulse oximetry testing beginning in January 2014. Birthing centers, smaller hospitals, and midwives with fewer than twenty births per year had until January 2016 to purchase the screening equipment. Parents could opt out of the screening. He spoke to the zero fiscal note (FN 1 (DHSS)). He explained that the Department of Health and Social Services (DHSS) was only required to manage basic data on the program. He shared that he wanted to keep impacts from the bill minimal. He offered that no health care organization or association opposed the legislation. Co-Chair Meyer asked how many infants per year were born with heart disease. Senator Micciche restated that one in one hundred babies were born with heart defects each year. Co-Chair Meyer inquired why the effective date was not until January 1, 2014. Senator Micciche replied that he wanted to avoid over burdening healthcare facilities required to purchase the equipment. Vice-Chair Fairclough noted that many of the hospitals had the oximetry equipment on its premises. She inquired what the cost was to purchase the equipment. Senator Micciche responded that he did not know the exact cost. Vice-Chair Fairclough asked how the screening worked. Senator Micciche answered that a device clipped onto the newborn's finger. The screening was not painful or invasive. 9:39:52 AM JILL LEWIS, DEPUTY DIRECTOR, DIVISION OF PUBLIC HEALTH, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, responded that she did not know the cost of the screening equipment. Vice-Chair Fairclough supported the legislation but wanted to know the cost of the equipment to determine the burden placed on smaller health care facilities. She asked DHSS to confirm the cost of the test. Ms. Lewis understood that the cost of the test was the amount stated by the sponsor. Senator Bishop concurred with Vice-Chair Fairclough and wanted to know the cost of the equipment. He wondered whether grant money was available to help purchase the equipment. Ms. Lewis responded that she was not aware of any specific grant program, but that the department would examine grant options and provide assistance if available. Senator Olson remarked that oximetry was a huge advance in non-invasive testing. He queried what provisions were available for healthcare facilities in rural areas where a delay in care could cause harm. STEPHANIE WRIGHTSMAN-BIRCH, DIVISION OF PUBLIC HEALTH, DEPARTMENT OF HEALTH AND SOCIAL SERVICES (via teleconference), reported that the cost of the equipment was approximately $500 to $1000. Some hospitals use more sophisticated and more expensive equipment. She clarified that the screening was administered through probes attached by a Band-Aid applied to the right hand and the left foot and read oxygen levels through the skin. She explained that the division set up an advisory committee comprised of pediatricians, pediatric cardiologists, a direct entry nurse-midwife, and hospital personnel. The division and advisory committee were already working with the hospitals to develop a testing algorithm that would become the standard for all health care facilities across the state as recommended by the American Academy of Pediatrics and the American Academy of Pediatric Cardiologists. She expounded that Alaska had five pediatric cardiologists who travelled around the state to cover rural areas as part of their private practices. The algorithm included guidance to a rural healthcare provider whether transport was required. She responded that the screening was for early identification and intervention measures would be applied if appropriate. Senator Olson noted that the test measured the difference between the oxygenated blood between the hand and the foot. Ms. Wrightsman-Birch confirmed. She indicated that the test was rigorously studied for "a number" of years. She stated that based on data, approximately 200 infants would screen positive. Approximately twenty to thirty of the positive infants would require additional intervention. 9:48:01 AM Senator Olson asked whether the test detected both Atrial Septal defects (ASD) and Ventral [ventricular] Septal defects (VSD). Ms. Wrightsman-Birch answered in the affirmative. She reported that the state had a high number of VSD cases and noted that VSD often resolved without treatment. She stated that the chairman of the advisory committee, Dr. Christiansen, a pediatric cardiologist reported that the screening also identified Tetralogy of Fallot and malformation of the heart at much earlier stages and allowed for treatment before a disease advanced. Senator Olson wondered what happened with a false negative screening result. Ms. Wrightsman-Birch answered that the screening algorithm addressed a positive result by re- screening up to three times. A pediatric cardiologist was contacted after a second positive screening result. Simpler additional testing typically take place before more costly sophisticated tests were warranted. Senator Olson commented that he fully supported the legislation. Co-Chair Meyer cited analysis from the fiscal note that required the department "to establish procedures for submitting reports" for screening. He queried whether DHSS could accomplish the data collection without additional appropriations. Ms. Lewis replied that the department was able to accomplish the requirements with existing resources. Senator Olson asked for clarification regarding Section 2 of the legislation. Ms. Lewis explained that Section 2 delayed implementation of the bill for smaller providers which allowed more time to prepare for the requirements of the bill. Co-Chair Meyer OPENED public testimony. JAMIE MORGAN, AMERICAN HEART ASSOCIATION, SACRAMENTO (via teleconference), expressed the American Heart Association's support of SB 87. She communicated that critical congenital heart defects left untreated can cause death. Research had proven that expanded use of oximetry screening could detect 90 percent of all defects. Early screening reduced congenital heart defect hospital costs that amounted to $2.5 billion each year. She remarked that screening would save Alaskan babies lives born with congenital heart defects. Co-Chair Meyer CLOSED public testimony. Vice-Chair Fairclough MOVED to REPORT SB 87 out of committee with individual recommendations and the accompanying fiscal note. CSSB 87(HSS) was REPORTED out of committee with a "do pass" recommendation and with previously published zero fiscal note: FN1 (DHS). 9:54:26 AM AT EASE 9:58:02 AM RECONVENED