ALASKA STATE LEGISLATURE  HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  April 16, 2024 3:04 p.m. MEMBERS PRESENT Representative Mike Prax, Chair Representative Justin Ruffridge, Vice Chair Representative CJ McCormick Representative Jesse Sumner Representative Zack Fields Representative Genevieve Mina MEMBERS ABSENT  Representative Dan Saddler COMMITTEE CALENDAR  HOUSE BILL NO. 285 "An Act relating to insurance; relating to mammograms; and providing for an effective date." - MOVED HB 285 OUT OF COMMITTEE HOUSE BILL NO. 336 "An Act relating to athletic trainers; and providing for an effective date." - MOVED HB 336 OUT OF COMMITTEE CS FOR SENATE BILL NO. 24(FIN) "An Act relating to mental health education; and providing for an effective date." - MOVED CSSB 24(FIN) OUT OF COMMITTEE PREVIOUS COMMITTEE ACTION  BILL: HB 285 SHORT TITLE: MAMMOGRAMS: INSURANCE COVERAGE SPONSOR(s): REPRESENTATIVE(s) FIELDS 01/22/24 (H) READ THE FIRST TIME - REFERRALS 01/22/24 (H) HSS, FIN 01/29/24 (H) L&C REFERRAL ADDED AFTER HSS 01/29/24 (H) BILL REPRINTED 02/14/24 (H) HSS REFERRAL MOVED TO AFTER L&C 02/21/24 (H) L&C AT 3:15 PM BARNES 124 02/21/24 (H) -- MEETING CANCELED -- 02/28/24 (H) L&C AT 3:15 PM BARNES 124 02/28/24 (H) -- MEETING CANCELED -- 03/04/24 (H) L&C AT 3:15 PM BARNES 124 03/04/24 (H) Heard & Held 03/04/24 (H) MINUTE(L&C) 03/13/24 (H) L&C AT 3:15 PM BARNES 124 03/13/24 (H) Heard & Held 03/13/24 (H) MINUTE(L&C) 03/20/24 (H) L&C AT 3:15 PM BARNES 124 03/20/24 (H) Moved HB 285 Out of Committee 03/20/24 (H) MINUTE(L&C) 03/21/24 (H) L&C RPT 3DP 4NR 03/21/24 (H) DP: FIELDS, CARRICK, SUMNER 03/21/24 (H) NR: RUFFRIDGE, WRIGHT, PRAX, SADDLER 04/09/24 (H) HSS AT 3:00 PM DAVIS 106 04/09/24 (H) -- MEETING CANCELED -- 04/16/24 (H) HSS AT 3:00 PM DAVIS 106 BILL: HB 336 SHORT TITLE: ATHLETIC TRAINER SCOPE OF PRACTICE SPONSOR(s): REPRESENTATIVE(s) FIELDS 02/20/24 (H) READ THE FIRST TIME - REFERRALS 02/20/24 (H) HSS, L&C 04/16/24 (H) HSS AT 3:00 PM DAVIS 106 BILL: SB 24 SHORT TITLE: PUBLIC SCHOOLS: MENTAL HEALTH EDUCATION SPONSOR(s): SENATOR(s) GRAY-JACKSON 01/18/23 (S) PREFILE RELEASED 1/9/23 01/18/23 (S) READ THE FIRST TIME - REFERRALS 01/18/23 (S) EDC, HSS, FIN 02/22/23 (S) EDC AT 3:30 PM BELTZ 105 (TSBldg) 02/22/23 (S) Heard & Held 02/22/23 (S) MINUTE(EDC) 03/06/23 (S) EDC AT 3:30 PM BELTZ 105 (TSBldg) 03/06/23 (S) Moved SB 24 Out of Committee 03/06/23 (S) MINUTE(EDC) 03/08/23 (S) EDC RPT 4DP 1NR 03/08/23 (S) DP: TOBIN, GRAY-JACKSON, STEVENS, KIEHL 03/08/23 (S) NR: BJORKMAN 03/23/23 (S) HSS AT 3:30 PM BUTROVICH 205 03/23/23 (S) Heard & Held 03/23/23 (S) MINUTE(HSS) 04/11/23 (S) HSS AT 3:30 PM BUTROVICH 205 04/11/23 (S) Heard & Held 04/11/23 (S) MINUTE(HSS) 04/13/23 (S) HSS AT 3:30 PM BUTROVICH 205 04/13/23 (S) Moved CSSB 24(HSS) Out of Committee 04/13/23 (S) MINUTE(HSS) 04/14/23 (S) HSS RPT CS 3DP 2NR SAME TITLE 04/14/23 (S) NR: WILSON, KAUFMAN 04/14/23 (S) DP: TOBIN, DUNBAR, GIESSEL 02/07/24 (S) FIN AT 9:00 AM SENATE FINANCE 532 02/07/24 (S) Heard & Held 02/07/24 (S) MINUTE(FIN) 02/15/24 (S) FIN AT 1:30 PM SENATE FINANCE 532 02/15/24 (S) Moved CSSB 24(FIN) Out of Committee 02/15/24 (S) MINUTE(FIN) 02/19/24 (S) FIN RPT CS 4DP SAME TITLE 02/19/24 (S) DP: HOFFMAN, OLSON, KIEHL, BISHOP 03/06/24 (S) TRANSMITTED TO (H) 03/06/24 (S) VERSION: CSSB 24(FIN) 03/11/24 (H) READ THE FIRST TIME - REFERRALS 03/11/24 (H) HSS, EDC, FIN 04/11/24 (H) HSS AT 3:00 PM DAVIS 106 04/11/24 (H) Heard & Held 04/11/24 (H) MINUTE(HSS) 04/16/24 (H) HSS AT 3:00 PM DAVIS 106 WITNESS REGISTER REPRESENTATIVE ZACK FIELDS Alaska State Legislature Juneau, Alaska POSITION STATEMENT: As prime sponsor, presented HB 285. COURTNEY OWENS, Staff Representative Zack Fields Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Gave the sectional analysis for HB 285 on behalf of Representative Fields, prime sponsor. REBECCA BIRCH, Director State Policy & Advocacy Susan G. Komen Dallas, Texas POSITION STATEMENT: Gave invited testimony in support of HB 285. BEVERLY WOOLEY, representing self Big Lake, Alaska POSITION STATEMENT: Testified in support of HB 185. LISA PEABODY FORCE - Facing Our Risk of Cancer Empowered, Inc. Bethesda Maryland POSITION STATEMENT: Testified in support of HB 285. KELLEY MARRE, representing self Kasilof, Alaska POSITION STATEMENT: Testified in support of HB 285. EMILY NENON Alaska Government Relations Director American Cancer Society Cancer Action Network Anchorage, Alaska POSITION STATEMENT: Testified in support of HB 285. ZACK FIELDS Alaska State Legislature Juneau, Alaska POSITION STATEMENT: As prime sponsor, presented HB 336. COURTNEY OWENS, Staff Representative Zach Fields Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Gave the sectional analysis for HB 336 on behalf of Representative Fields, prime sponsor. LYNNE YOUNG, Head Athletic Trainer Orthopedic Physicians Alaska Anchorage, Alaska POSITION STATEMENT: Gave invited testimony in support of HB 336. CARY KELLER, MD, representing self Fairbanks, Alaska POSITION STATEMENT: Testified during the hearing on HB 336. TINA MCLEAN, Chair Alaska Physical Therapy and Occupational Therapy Board Sterling, Alaska POSITION STATEMENT: Testified in opposition to HB 336. SENATOR ELVI GRAY-JACKSON Alaska State Legislature Juneau, Alaska POSITION STATEMENT: As prime sponsor, presented SB 24. BESSE ODOM, Staff Senator Elvi Gray-Jackson Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Provided definitions during the hearing on SB 24 on behalf of Senator Gray-Jackson, prime sponsor. ACTION NARRATIVE 3:04:35 PM CHAIR PRAX called the House Health and Social Services Standing Committee meeting to order at 3:04 p.m. Representatives McCormick, Sumner, Fields, Mina, and Prax were present at the call to order. Representative Ruffridge arrived as the meeting was in progress. HB 285-MAMMOGRAMS: INSURANCE COVERAGE  3:06:22 PM CHAIR PRAX announced that the first order of business would be HOUSE BILL NO. 285, "An Act relating to insurance; relating to mammograms; and providing for an effective date." 3:06:43 PM REPRESENTATIVE ZACK FIELDS, Alaska State Legislature, as prime sponsor, introduced HB 285. He noted that the bill came as a suggestion from Susan G. Komen, the organization that did the research on the bill. He stressed that of the different types of mammograms, many Alaskan women cannot afford diagnostic imaging exams. He said that the Affordable Care Act (ACA) does not cover diagnostic screenings; therefore, high risk women who are not wealthy struggle to pay for these mammograms. He said that when cancer is detected early, it is less expensive to treat; the bill would require an up-front cost which pales in comparison to the cost of delaying detection. He went through the number of detections in Alaska as well as the rest of the U.S. He further related impacts in detection in regard to a woman's race. He drew attention to a slide [hard copy included in the committee packet], which went over cost comparisons. He noted many states have enacted this type of legislation and he welcomed questions from committee members. 3:12:05 PM COURTNEY OWENS, Staff, Representative Zack Fields, Alaska State Legislature, on behalf of Representative Fields, prime sponsor, gave the sectional analysis for HB 285 [included in the committee packet], which read as follows [original punctuation provided]: Section 1: Amends AS 21.42.375(e) to define "diagnostic breast examination" and "supplemental breast examination" and offers guidelines for the basis of additional testing. Section 2: Adds a new subsection to AS 21.42.375 guaranteeing that mammography screening, diagnostic breast examinations, and supplemental breast examinations are covered by applicable insurance plans, with the exception of high deductible health plans that are eligible for a health savings account tax deduction. Section 3: Amends the law of the State of Alaska by applying Sec. 1 and Sec. 2 to an insurance policy or contract on or after the effective date of the law. Section 4: Amends the law of the State of Alaska to allow the Division of Insurance to adopt regulations necessary to implement this act under AS 44.62. Section 5: Section 4 take effect immediately under AS 01.10.070(c). Section 6: This Act takes effect January 1, 2025. 3:13:08 PM REPRESENTATIVE MINA asked what the average cost share of diagnostic imaging was. REPRESENTATIVE FIELDS answered that he heard in public testimony there was a range of rates including hundreds of dollars, but he did not know if that was the average. 3:13:54 PM REPRESENTATIVE PRAX offered his belief that diagnostic screening followed the regular screening. REPRESENTATIVE FIELDS confirmed that was correct. For the high- risk group, which he noted in Alaska is 12,000 people, it was recommended by doctors that they have the diagnostic screening. REPRESENTATIVE PRAX questioned whether the diagnostic screening would need pre-authorization and why the insurance company wouldn't pay it. REPRESENTATIVE FIELDS answered that the issue is that ACA required no cost share for a standard mammogram, but the diagnostic would need a co-pay. He went over scenarios where people may not be able to pay the costs. 3:16:08 PM REPRESENTATIVE RUFFRIDGE asked for clarity whether high deductible plans would be exempt under the proposed legislation. REPRESENTATIVE FIELDS explained the differences between deductibles and delays in care. REPRESENTATIVE RUFFRIDGE sought confirmation that the bill would cover people covered under private insurance and would not affect Medicaid or Medicare. Further, he inquired whether a person with a high deductible plan would not be mandated to cost-share under the bill. REPRESENTATIVE FIELDS responded that's correct. 3:17:47 PM REPRESENTATIVE PRAX welcomed invited testifiers. 3:17:59 PM REBECCA BIRCH, Director, State Policy & Advocacy, Susan G. Komen, said she strongly supported HB 285 and shared a story about a patient who was "barely making ends meet" who had to take out a loan to take the diagnostic test and the costs that ensued because of late detection. She commented about a study on cost averages and said high deductible plans are eliminated with the health savings accounts. 3:21:29 PM REPRESENTATIVE PRAX opened public testimony on HB 285. 3:22:11 PM BEVERLY WOOLEY, representing self, testified in support of HB 285. She described her history with breast cancer and how her ultrasound finally found a tumor. She said she was an example of how the cost savings can be realized through early detection, and the bill would provide an increase to much needed access. She noted because of delayed diagnosis, 20 years out she was still paying for follow-up care. She opined that HB 285 would save lives and encouraged the committee to pass it without delay. 3:25:13 PM LISA PEABODY, FORCE - Facing Our Risk of Cancer Empowered, Inc., said she represented a high-risk community and testified in support of HB 285. She further discussed high risk individuals with a predisposition that the average person does not have. This high-risk community, according to national guidelines, needed their mammograms to start at age 25. In addition to mammograms, this group may also need a breast ultrasound or MRI every year, even when it costs hundreds of dollars, and she opined that the proposed bill would close the gap for the high- risk individuals. 3:27:57 PM KELLEY MARRE, representing self, testified in support of HB 285 and shared that she was an oncology social worker. She offered statistics on annual diagnoses and noted that men also get breast cancer. She discussed costs and delays in diagnosis due to the lack of affordability. She stressed that no one should have to choose between basic needs or health care and asked the committee to pass HB 285 so individuals would not be charged for high-risk screening and diagnostic imaging. 3:29:53 PM EMILY NENON, Alaska Government Relations Director, American Cancer Society Cancer Action Network, testified in support of HB 285 and gave a history of coverage for cancer screenings. She spoke to state-regulated plans and how they set the precedence for what other plans do and opined that the bill would be about setting precedence for every plan offered in the state. She shared a story of a woman who needed follow up treatment, who had to set aside money each month for over a year to be able to afford the treatment, and she said the bill would help people like her. She offered to address deductibles and [health] savings accounts, the latter which are specific kinds of accounts that have federal law issues. She said she looked forward to progressing and that she was available for questions. 3:33:43 PM REPRESENTATIVE PRAX, after ascertaining that no one else wished to testify, closed public testimony on HB 285. 3:34:29 PM REPRESENTATIVE RUFFRIDGE moved to report HB 285 out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, HB 285 was reported out of the House Health and Social Services Standing Committee. 3:35:17 PM The committee took an at-ease from 3:35 p.m. to 3:36 p.m. HB 336-ATHLETIC TRAINER SCOPE OF PRACTICE  3:36:32 PM CHAIR PRAX announced that the next order of business would be HOUSE BILL NO. 336, "An Act relating to athletic trainers; and providing for an effective date." 3:38:28 PM ZACK FIELDS, Alaska State Legislature, as prime sponsor, presented HB 336 and summarized that the bill was about resolving an ambiguity in the law related to work that athletic trainers can do. He elaborated on what their training looked like and pointed out that the level of training for an athletic trainer was similar to that of a physical therapist. He noted that invited testifiers could give more real-world examples of trainers in Alaska. 3:41:31 PM COURTNEY OWENS, Staff, Representative Zach Fields, Alaska State Legislature, gave the sectional analysis for HB 336 [included in the committee packet], on behalf of Representative Fields, prime sponsor, which read as follows [original punctuation provided]: Section 1: Amends AS 08.07.030(b) to update the Athletic Trainers Practice Act to reflect the professional education requirements more accurately. Requires that athletic trainers refer patients to medical professionals in the event of condition and/or injury present outside of the scope of their practice: clarifies who they can provide services to. Section 2: Amends AS 08.07.030(c) by clarifying responsibilities of athletic trainers: • Includes individuals who can benefit from athletic training services; and • Permits athletic trainers to clinically diagnose injuries, illnesses, & conditions; and • Allows athletic trainers to treat conditions, in addition to injury and illness. Section 3: AS 08.07.090(4) Amends definition of "athletic training" to permit clinical diagnosis and treatment of conditions. Section 4: Repeals the definitions of "athlete" and "athletic injury or illness." Section 5: Applies an immediate effective date. 3:43:06 PM LYNNE YOUNG, Head Athletic Trainer, Orthopedic Physicians Alaska, clarified that athletic trainers are healthcare professionals who provide services in collaboration with physicians. She expounded on the tasks they perform and the medical-based education they follow, as well as ongoing certifications they must meet. She noted none of the asked changes in the bill would change athletic training but would further explain what the athletic trainers can provide and to whom. 3:48:00 PM REPRESENTATIVE MINA asked whether athletic trainers diagnose conditions. MS. LYNNE answered that they provide a clinical diagnosis, sometimes known as a differential diagnosis. REPRESENTATIVE MINA referenced a letter that expressed concerns that the bill broadens the scope for athletic trainers and asked Ms. Lynne if she wished to address the letter. MS. LYNNE confirmed a trainer's educational background included accredited training and rigorous components including certifications that must be met. 3:51:16 PM REPRESENTATIVE RUFFRIDGE asked for clarity about a phrase in the bill that noted "athlete" to "individual". MS. LYNNE responded that the core of the bill was for an athletic trainer to provide training to individuals. When spectators, for example, fall or get hit with a ball, an athletic trainer may further evaluate these injuries but not go beyond the scope [of their training]. She provided examples of other types of evaluations. She noted the possibility of adding the word "movement" that may help with definitions. 3:55:24 PM REPRESENTATIVE FIELDS noted that a testifier who could not be present suggested a refinement of the language in the bill. 3:56:24 PM CHAIR PRAX opened public testimony on HB 336. 3:57:10 PM CARY KELLER, MD, representing self, testified during the hearing on HB 336 and provided his medical background as an orthopaedic surgeon, who has worked with athletic trainers. He defined "athlete" as being someone who engages in high-performance activity, but there are also "community athletes" such as walkers or cyclists. He noted it was a mistake to think athletic trainers could only provide to team-based athletes. He focused on Alaska-based athletic trainers in his examples. 3:59:46 PM TINA MCLEAN, Chair, Alaska Physical Therapy and Occupational Therapy Board, spoke in opposition to HB 336 on behalf of the board. She stated there was no argument that athletic trainers are of value to the healthcare system but expressed concern surround the wording in the bill that would allow for any individual to be treated or evaluated by an athletic trainer. She noted their training is not extensive, and even in the master's program, it is not geared towards the general public and all conditions. Additional wording should be inserted for more clarification in the bill, she opined. 4:03:47 PM CHAIR PRAX, after ascertaining no one else wished to testify, closed public testimony on HB 336. 4:04:29 PM REPRESENTATIVE FIELDS noted there could be opportunities to work on the language in the bill. REPRESENTATIVE RUFFRIDGE agreed and expressed concern about language in Section 2, suggesting that "scope of practice" could be limiting. He opined there needed to be further clarification. 4:06:21 PM REPRESENTATIVE RUFFRIDGE moved to report HB 336 out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, HB 336 was reported out of the House Health and Social Services Standing Committee. 4:07:02 PM The committee took an at-ease from 4:07 p.m. to 4:09 p.m. SB 24-PUBLIC SCHOOLS: MENTAL HEALTH EDUCATION  4:09:38 PM CHAIR PRAX announced that the final order of business would be CS FOR SENATE BILL NO. 24(FIN), "An Act relating to mental health education; and providing for an effective date." 4:09:56 PM SENATOR ELVI GRAY-JACKSON, Alaska State Legislature, as prime sponsor, recapped SB 24. She summarized the bill stating that it would add mental health education to the already existing health education for students grades K-12. 4:10:46 PM BESSE ODOM, Staff, Senator Elvi Gray-Jackson, Alaska State Legislature, on behalf of Senator Gray-Jackson, prime sponsor of SB 24, clarified that the definition of "mental health" came from the Center of Disease Control and Prevention (CDC). 4:11:24 PM REPRESENTATIVE MCCORMICK moved to report CSSB 24(FIN) out of committee with individual recommendations and the accompanying fiscal notes. 4:12:06 PM REPRESENTATIVE SUMNER objected. He noted he was contacted by his local school board and that the bill would result in an unfunded mandate. 4:13:08 PM A roll call vote was taken. Representatives Mina, McCormick, Fields, and Prax voted in favor of reporting CSSB 24(FIN) out of committee with individual recommendations and the accompanying fiscal notes. Representatives Ruffridge and Sumner voted against it. Therefore, CSSB 24(FIN) was reported out of the House Health and Social Services Standing Committee by a vote of 4-2. 4:14:21 PM SENATOR GRAY-JACKSON provided closing comments and stated that she would be more than happy to work with school districts and asked for information to be provided to her staff. 4:14:43 PM ADJOURNMENT  There being no further business before the committee, the House Health and Social Services Standing Committee meeting was adjourned at 4:15 p.m.