SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE April 30, 1994 2:30 p.m. MEMBERS PRESENT Senator Steve Rieger, Chairman Senator Bert Sharp, Vice-Chairman Senator Loren Leman Senator Mike Miller Senator Jim Duncan MEMBERS ABSENT Senator Johnny Ellis Senator Judy Salo COMMITTEE CALENDAR CS FOR HOUSE BILL NO. 409(FIN) am(efd fld) "An Act relating to the maximum amount of assistance that may be granted under the adult public assistance program and the program of aid to families with dependent children; proposing a special demonstration project within the program of aid to families with dependent children and directing the Department of Health and Social Services to seek waivers from the federal government to implement the project." HOUSE JOINT RESOLUTION NO. 47 am Relating to schools on military installations. CS FOR HOUSE BILL NO. 506(FIN) am "An Act relating to student loans; to sanctions for defaulting on a student loan, including denial of a state occupational license; and providing for an effective date." SENATE BILL NO. 346 "An Act requiring that charitable gaming permittees, operators, and vendors may not turn over a pull tab or bingo prize of $50 or more to a person entitled to that prize unless the person provides certain information to the permittee, operator, or vendor and signs a receipt for the prize; requiring the reporting of winners of prizes of $50 or more to the Department of Health and Social Services to ensure that recipients of services provided by the Department of Health and Social Services are reporting charitable gaming winnings and are eligible for those services." HOUSE BILL NO. 472 "An Act relating to referrals involving dental services." CS FOR HOUSE BILL NO. 478(HES) am "An Act relating to the authority of mobile intensive care paramedics, physician assistants, and emergency medical technicians to pronounce death under certain circumstances." CS FOR HOUSE BILL NO. 507(FIN) "An Act relating to licensure by the State Medical Board and temporary permits for certain optometrists." SPONSOR SUBSTITUTE FOR HOUSE JOINT RESOLUTION NO. 54 Relating to medical savings account legislation. HOUSE JOINT RESOLUTION NO. 52 Urging the Congress to amend the Social Security Act so that the higher cost of living in Alaska is reflected when the per capita income of the state is used as a factor in determining the federal share of Medicaid costs. HOUSE BILL NO. 324 "An Act extending the termination date of the Board of Dental Examiners; and providing for an effective date." PREVIOUS SENATE COMMITTEE ACTION HB 409 - See Health, Education & Social Services minutes dated 4/18/94. HJR 47 - No previous action to record. HB 506 - See Health, Education & Social Services minutes dated 4/25/94. SB 346 - See Labor & Commerce minutes dated 3/31/94 and Health, Education & Social Services minutes dated 4/15/94, 4/18/94 and 4/25/94. HB 472 - See Health, Education & Social Services minutes dated 4/15/94, 4/18/94 and 4/25/94. HB 478 - See Health, Education & Social Services minutes dated 4/25/94. HB 507 - See Health, Education & Social Services minutes dated 4/25/94. HJR 54 - See Health, Education & Social Services minutes dated 4/15/94, 4/18/94 and 4/25/94. HJR 52 - No previous action to record. HB 324 - No previous action to record. WITNESS REGISTER Michelle Toohey, Legislative Assistant Representative Hanley State Capitol Juneau, Alaska 99801-1182 POSITION STATEMENT: Not opposed to the HESS CS. Curt Lomas, Division of Public Assistance Department of Health & Social Services P.O. Box 110640 Juneau, Alaska 99811-0640 POSITION STATEMENT: Expressed concerns with section 7 and 8 of HB 409. Representative Eldon Mulder Prime Sponsor State Capitol Juneau, Alaska 99801-1182 POSITION STATEMENT: Reviewed HJR 47. Dennis Porter, Executive Officer Task Force Member 1700 7th Street Unit B Elmendorf AFB, Alaska 99506 POSITION STATEMENT: Reviewed HJR 47. Representative Gary Davis Prime Sponsor State Capitol Juneau, Alaska 99801-1182 POSITION STATEMENT: Reviewed HB 472. Eric Forrer, Member University of Alaska Board of Regents Post Secondary Education Commission Juneau, Alaska POSITION STATEMENT: Urged passage of HB 506. Joe McCormick, ACPE 3030 Vintage Boulevard Juneau, Alaska 99801 POSITION STATEMENT: Supports HB 506 Roxanne Rohweder, Staff to Representative Jim Nordlund State Capitol Juneau, AK 99801-1182 POSITION STATEMENT: Offered information on HJR 52 Jack Phelps, Staff to Representative Pete Kott State Capitol Juneau, AK 99801-1182 POSITION STATEMENT: Offered information on SSHJR 54 Representative Gene Therriault State Capitol Juneau, AK 99801-1182 POSITION STATEMENT: Prime Sponsor of HB 478 Mark Johnson, Chief, Emergency Medical Services Division of Public Health Department of Health & Social Services P.O. Box 110616 Juneau, AK 99811-0616 POSITION STATEMENT: Testified in support of HB 478 ACTION NARRATIVE TAPE 94-35, SIDE A Number 003 CHAIRMAN RIEGER called the Senate Health, Education and Social Services (HESS) Committee to order at 2:30 p.m. He introduced HB 409 (AFDC DEMO PROJECT AND DECREASE) as the first order of business. He noted that there was a proposed HESS CS which would delete the statutory reductions in AFDC and APA and incorporates other minor changes. SENATOR MILLER moved to adopt the HESS CS, the 8-LS1211\S version, in lieu of the original bill. Hearing no objections, the CS was adopted. MICHELLE TOOHEY, Legislative Assistant to Representative Hanley, stated that they did not have any opposition to the CS. CURT LOMAS, Division of Public Assistance in the Department of Health and Social Services, said that he was representing Jan Hansen. He addressed Sections 7 and 8 which would cap the amount of payments in AFDC and APA at the levels in effect in 1992. He stated that there was a problem with the language tying benefit levels to January of 1992 because of the restructuring of the standards in last years bill. He did not believe that Sections 7 and 8 were necessary. CHAIRMAN RIEGER explained that those sections were present in order to conform to the title. He asked if Mr. Lomas had conforming language to offer. CURT LOMAS suggested that they change the dates in sections 7 and 8 to October 1993 which would eliminate the technical problem. Number 085 SENATOR MILLER moved to adopt the amendment changing the date from "January 1992" to "October 1993." Hearing no objections, it was adopted. CURT LOMAS pointed out another issue with Section 8. He explained that existing language under HB 67 makes cost of living awards contingent upon specific appropriations by the Legislature for that purpose. Section 8 appears to conflict with that provision which seems to indicate a potential problem. CHAIRMAN RIEGER asked if Mr. Lomas had suggested language to address that problem. Chairman Rieger asked if Mr. Lomas was in doubt to the possibility of a problem regarding this issue. CURT LOMAS said that he was not certain that there was a problem, but he thought that he could propose some language if given some time. CHAIRMAN RIEGER set HB 409 aside in order to give Mr. Lomas time to come up with language to speak to this problem in Section 8. Number 127 CHAIRMAN RIEGER introduced HJR 47 (FUNDS TO UPGRADE MILITARY BASE SCHOOLS) as the next order of business before the committee. REPRESENTATIVE ELDON MULDER, Prime Sponsor, said that the Military Schools Task Force evaluated the problem of lack of repairs and repair funding for the school base schools. There is approximately a $52 million backload of work needed to bring these schools up to minimal standards. He explained that the municipalities within which the schools reside are not allowed to bond for the upgrades of these schools since they do not own the schools while the school districts are hesitant to transfer or accept ownership of the schools until they are upgraded. HJR 47 along with a $26 million appropriation bill would attempt to cooperatively reach an agreement between the state and the federal government in order to address this problem. He pointed out that they would propose a 50- 50 match between the state and federal government. The federal government has allocated $10 million towards these type schools nation wide. HJR 47 and some funding from the budget would work towards securing the funds needed to upgrade these schools. DENNIS PORTER, Executive Officer to General Ralston and member of the Task Force, said that this resolution would be used to lobby the federal government in order to free up funds from them. He pointed out that the current Deputy Secretary of Education, Madeline Cunin, will be coming to Alaska to see the problems on school base installation facilities. Hopefully, she will acknowledge the problems, realize the slowness of the funding, recognize that Alaska is trying to satisfy the immediate needs while looking to the long term. He encouraged the committee's support of HJR 47. SENATOR LEMAN inquired as to Representative Mulder's comment regarding funding from the budget this year. He expressed concern with the inability to identify an amount from the $10 million that would be available in Alaska. He said that he did not see references to the military schools task force in HJR 47, and he asked if that is an intentional omission. REPRESENTATIVE MULDER explained that the 50-50 match was not included in HJR 47, the appropriations bill was the 50-50 match. The omission was intentional in order to recognize budgetary constraints, but everything would be done to try to provide that match. He felt that the match was a reasonable alternative. He noted that this problem affects the security of these bases in terms of evaluation. They are trying to push some kind of funding in the House. He mentioned the Aurora school and its problem. SENATOR LEMAN thought that Representative Mulder had mentioned funding this year on the 50-50 match. REPRESENTATIVE MULDER noted the presence of a proposal regarding some school construction money. SENATOR MILLER moved HJR 47 as amended out of committee with individual recommendations. Hearing no objections, it was so ordered. Number 230 CHAIRMAN RIEGER introduced HB 472 (REFERRALS INVOLVING DENTAL SERVICES) as the next order of business before the committee. REPRESENTATIVE GARY DAVIS, Prime Sponsor, explained that HB 472 would deal with the problems encountered in the ethics code of the Alaska Dental Society regarding referrals. HB 472 would add a new section to the statutes regarding the Board of Dental Examiners. He pointed out that the section would merely codify the portion of their ethics code which speaks to referrals. SENATOR LEMAN asked if HB 472 would prevent a dentist who goes on vacation from referring a patient to another dentist if that favor is returned later. REPRESENTATIVE DAVIS stated that HB 472 would only prohibit dentists from receiving compensation for a referral, but it would not eliminate advertising or referrals. SENATOR MILLER moved HB 472 out of committee with individual recommendations. Hearing no objections, it was so ordered. Number 278 CHAIRMAN RIEGER introduced HB 506 (STUDENT LOAN PROGRAM) as the next order of business before the committee. ERIC FORRER, Member of the University of Alaska Board of Regents and Postsecondary Education Commission, explained that HB 506 speaks to the Postsecondary Education Commission's primary responsibility of turning the student loan fund into a revolving fund. This fund is approximately $500 million in state investments which should be self-supporting. He indicated that the commission's goal was vigorous management of this fund. He said that with such high capital, it is easy to lose track of this bad situation. Strict management of this fund is necessary for the long term. Mr. Forrer mentioned that the portion of HB 506 which denies the reissuance of a license by the state to an individual whose student loan was in arrears. He did not believe that discussion was about the correct issue. He felt that it would be more onerous not to require people to be in good standing with their student loan than to require it. That would illustrate the commission's seriousness about rigorous management of the fund. He urged passage of HB 506. CHAIRMAN RIEGER expressed concern with the first section of HB 506 regarding the denial of an occupational license. He did not think that any other lender in Alaska could go to the Department of Commerce and request for denial of an occupational license of a borrower who is in default. He suggested that on page 1, line 12 after "licensee," the following clause be inserted: "and the balance owing on the loan is $100,000." Super agencies with more power than those of the lending community should not be created. He also indicated concerns with the statutory provisions regarding assigning wages for a defaulted loan. Number 363 JOE MCCORMICK explained that the Alaska student loan program is a non-collateralized loan. He pointed out that this section speaks to the renewal of a license not the initial license. The section is more like a concept, a reminder. He noted that reminding an individual that their Alaska student loan is in arrears when they renew their occupational license is common practice in many other states. That would send a message to the borrower that the state of Alaska is serious about the repayment of student loans. SENATOR MILLER inquired as to the ability of pursuing an individual whose loan is in arrears through legal procedures. JOE MCCORMICK said that eventually that could happen. A judgement or garnishment of wages of the borrower could occur. Mr. McCormick reiterated the importance of sending the message to the bond market and the borrower that the state of Alaska does expect a borrower to repay their loan. SENATOR MILLER felt that the majority of non-payers are individuals living outside of the state. JOE MCCORMICK said that was not necessarily the case. The percentage of individuals with occupational licenses who have delinquent loans are less than 10 percent. Mr. McCormick explained that this would not be a mechanism in which to collect money. He added that he was not advocating this provision because he thinks it is going to collect a lot of money for the Alaska Student Loan Program. He is advocating as simply sending a message to the borrower, as well as sending the message to the people that they receive their bonds from, that they really are serious about making this a viable program and having sound financial integrity. Number 418 CHAIRMAN RIEGER asked if the names of the delinquent borrowers are published in the newspapers and JOE MCCORMICK acknowledged that they are published. Also, they have the power to garnish wages, but that power is much more difficult for self-employed individuals. CHAIRMAN RIEGER requested Mr. McCormick's comments on an amendment that he was proposing which provides if the balance owing on a loan is in excess of $100,000, it would trigger the denial of the occupational license. JOE MCCORMICK responded that the important thing is to get the legislation passed, and while he does not particularly favor the amendment, he believes it is important to get it passed in some form. Number 441 SENATOR SHARP commented that he has extreme difficulty with the amendment, and he wants to enhance the lowest cost method possible to collect delinquent student loans. To go through the court system is not cheap. Number 451 CHAIRMAN RIEGER moved the adoption of his proposed amendment. Senators Miller and Rieger voted "Yea" and Senators Sharp, Leman and Duncan voted "Nay." The motion failed. Number 453 SENATOR MILLER moved that CSHB 506(FIN) am be passed out of committee with individual recommendations. Hearing no objection, it was so ordered. Number 458 CHAIRMAN RIEGER introduced CSHB 409(FIN) am(efd fld) (PUBLIC ASSIST. DEMO PROJECT & DECREASE) as the next order of business. He asked for Mr. Lomas' comments on a change to Section 8 in SCS CSHB 409(HES) which was adopted by the committee on 4/18/94. CURTIS LOMAS, Division of Public Assistance, Department of Health and Social Services, said he has discussed a proposed change to Section 8 with the bill drafter who agrees that it will take care of the problem. The amendment would delete the language "Notwithstanding AS 47.25.430 - 47.25.615" on page 5, line 16 and replace it with "Except as provided in AS 47.25.430(b)." He explained that is the section that provides for awarding of cost- of-living increases, subject to appropriation for that purpose by the Legislature. Number 470 SENATOR MILLER moved the adoption of Amendment No. 2 to page 5, line 16 of SCS CSHB 409(HES). Hearing no objection, the Chairman stated the amendment was adopted. Number 480 SENATOR MILLER moved that SCS CSHB 409(HES), as amended, be passed out of committee with individual recommendations. Hearing no objection, it was so ordered. Number 482 CHAIRMAN RIEGER brought HJR 52 (DETERMINING FEDERAL SHARE OF MEDICAID) before the committee as the next order of business. ROXANNE ROHWHEDER, staff to Representative Jim Nordlund, said currently, the federal government sets its medical assistance percentages based on each state's per capita income. Those percentages range from 50 percent to 79 percent, with Alaska's matching rate set at only 50 percent. HJR 52 urges Congress to amend the Social Security Act to take into account Alaska's high cost of living, as well as its higher health costs. Number 503 SENATOR MILLER moved that HJR 52 be passed out of committee with individual recommendations. Hearing no objection, it was so ordered. Number 506 CHAIRMAN RIEGER introduced SSHJR 54 (SUPPORT MEDICAL SAVINGS ACCT LEGISLATION) as the next order of business. JACK PHELPS, staff to Representative Pete Kott, explained that as medical costs nationally and in Alaska continue to rise, the need for innovative approaches to health care cost containment becomes more acute. Medical Savings Accounts (MSAs) offer an approach to reducing health care costs that appeals to market forces and minimizes government intrusion into the market. HJR 52 urges Congress to amend the U.S. Tax Code to make these medical savings accounts work. Number 525 SENATOR MILLER moved that SSHJR 54 be passed out of committee with individual recommendations. Hearing no objection, it was so ordered. Number 527 CHAIRMAN RIEGER brought CSHB 478(HES) am (AUTHORITY TO PRONOUNCE DEATH) before the committee. REPRESENTATIVE GENE THERRIAULT, prime sponsor of HB 478, said the legislation was introduced to allow mobile intensive care paramedics, physician assistants, and emergency medical technicians to determine and pronounce death under certain circumstances. It provides that they may make a determination and pronouncement of death upon determining that a person has suffered irreversible cessation of circulatory and respiratory functions while a physician is not immediately available for consultation by radio or telephone. This will help emergency response teams to better attend to the emergency medical needs of Alaska. Number 557 MARK JOHNSON, Chief, Emergency Medical Services Section, Department of Health and Social Services, stated the department's support for HB 478. He said the bill very clearly defines under what circumstances CPR can be stopped. CHAIRMAN RIEGER noted Craig Lewis of the Alaska EMS Association was present to respond to questions. There being none, he asked for the pleasure of the committee. SENATOR MILLER moved that CSHB 478(HES) am be passed out of committee with individual recommendations. Hearing no objection, it was so ordered. Number 567 CHAIRMAN RIEGER brought CSHB 507(FIN) (LICENSING OF OPTOMETRISTS AND PHYSICIANS) before the committee. He directed attention to a proposed SCS CSHB 507(HES), that is identical to SB 298 which was passed out of committee several weeks before. SENATOR MILLER moved that SCS CSHB 507(HES) be adopted. Hearing no objection, the motion carried. SENATOR MILLER moved that CSHB 507(HES) be passed out of committee with individual recommendations. Hearing no objection, it was so ordered. Number 582 CHAIRMAN RIEGER brought SB 346 (REPORT CHARITABLE GAMING WINNERS) before the committee as the next order of business. TAPE 94-35, SIDE B Number 573 CHAIRMAN RIEGER said during a previous hearing on SB 346, there was testimony asking for verification by photo identification to address a concern that people were claiming prizes under false identification. He then directed attention to a work draft committee substitute which addresses that concern. SENATOR MILLER moved that CSSB 346(HES) be adopted. SENATOR DUNCAN objected. A vote was taken with the following result: Senators Rieger, Miller, Sharp and Leman voted "Yea" and Senator Duncan voted "Nay." The Chairman stated the motion carried. SENATOR MILLER moved that CSSB 346(HES) be passed out of committee with individual recommendations. Hearing no objection, it was so ordered. Number 563 CHAIRMAN RIEGER brought HB 324 (EXTEND BOARD OF DENTAL EXAMINERS) before the committee as the final order of business. There being no witnesses wishing to testify on the legislation, he then asked for the pleasure of the committee. SENATOR MILLER moved that HB 324 be passed out of committee with individual recommendations. Hearing no objection, it was so ordered. There being no further business to come before the committee, the meeting was adjourned at 3:30 p.m.