ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                        January 31, 2018                                                                                        
                           1:30 p.m.                                                                                            
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator Natasha von Imhof, Vice Chair                                                                                           
Senator Cathy Giessel                                                                                                           
Senator Peter Micciche                                                                                                          
Senator Tom Begich                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
PRESENTATION: GOVERNOR'S COUNCIL ON DISABILITIES AND SPECIAL                                                                    
EDUCATION                                                                                                                       
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
SENATE BILL NO. 128                                                                                                             
"An Act establishing the marijuana  education and treatment fund;                                                               
and  relating to  the  duties  of the  Department  of Health  and                                                               
Social  Services  to  administer a  comprehensive  marijuana  use                                                               
education and treatment program."                                                                                               
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: SB 128                                                                                                                  
SHORT TITLE: MARIJUANA EDU/TREATMENT FUND/PROGRAM                                                                               
SPONSOR(s): SENATOR(s) GIESSEL                                                                                                  
                                                                                                                                
01/16/18       (S)       PREFILE RELEASED 1/8/18                                                                                
01/16/18       (S)       READ THE FIRST TIME - REFERRALS                                                                        
01/16/18       (S)       HSS, FIN                                                                                               
01/31/18       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
PATRICK REINHART, Executive Director                                                                                            
Governor's Council on Disabilities and Special Education                                                                        
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:  Presented  on  the  Governor's  Council  on                                                             
Disabilities and Special Education.                                                                                             
                                                                                                                                
MAGGIE WINSTON, Chair                                                                                                           
Governor's Council on Disabilities and Special Education                                                                        
Kenai, Alaska                                                                                                                   
POSITION  STATEMENT:  Presented  on  the  Governor's  Council  on                                                             
Disabilities and Special Education.                                                                                             
                                                                                                                                
JEANNE GERHARDT-CYRUS, Chair                                                                                                    
FASD Working Group                                                                                                              
Governor's Council on Disabilities and Special Education                                                                        
Kiana, Alaska                                                                                                                   
POSITION  STATEMENT:  Presented  on  the  Governor's  Council  on                                                             
Disabilities and Special Education.                                                                                             
                                                                                                                                
JANE CONWAY, Staff                                                                                                              
Senator Giessel                                                                                                                 
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Presented the sectional analysis of SB 128.                                                               
                                                                                                                                
JAY BUTLER, M.D., Chief Medical Officer/Director                                                                                
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Presented information on SB 128.                                                                          
                                                                                                                                
TREVOR STORRS, Executive Director                                                                                               
Alaska Children's Trust                                                                                                         
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Suggested changes to SB 128.                                                                              
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:30:26 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting to order at  1:30 p.m.  Present at the                                                               
call  to order  were  Senators Giessel,  von  Imhof, Begich,  and                                                               
Micciche, and Chair Wilson.                                                                                                     
                                                                                                                                
^Presentation:  Governor's Council  on  Disabilities and  Special                                                               
Education                                                                                                                       
  PRESENTATION: GOVERNOR'S COUNCIL ON DISABILITIES AND SPECIAL                                                              
                           EDUCATION                                                                                        
                                                                                                                                
1:30:53 PM                                                                                                                    
CHAIR WILSON announced the presentation by the Governor's                                                                       
Council on Disabilities and Special Education.                                                                                  
                                                                                                                                
1:31:36 PM                                                                                                                    
PATRICK  REINHART,  Executive  Director,  Governor's  Council  on                                                               
Disabilities and  Special Education, presented on  the Governor's                                                               
Council  on  Disabilities  and Special  Education.  He  said  the                                                               
council addresses  three federal  responsibilities and  two state                                                               
ones in one group with a 25-member board:                                                                                       
                                                                                                                                
      Developmental Disabilities Council (large amount of                                                                       
     federal funding is received for this purpose)                                                                              
        Interagency Coordinating Council for Infants and                                                                        
      Toddlers with Disabilities (required by the federal                                                                       
     Individuals with Disabilities Education Act (IDEA)                                                                         
     Beneficiary Advisory Board to the Alaska Mental Health                                                                     
     Trust Authority                                                                                                            
         Special Education Advisory Panel (also an IDEA                                                                         
     requirement)                                                                                                               
     Governing Body of the Special Education Service Agency                                                                     
                                                                                                                                
MR. REINHART said the council just completed its five-year plan.                                                                
Its priorities are:                                                                                                             
                                                                                                                                
     Empowered to live and thrive in communities                                                                                
     Competitively employed in integrated setting                                                                               
     Skills for education success and independence                                                                              
     Receive appropriate services and support                                                                                   
     Improved quality of life                                                                                                   
                                                                                                                                
1:34:28 PM                                                                                                                    
MAGGIE WINSTON, Chair, Governor's Council on Disabilities and                                                                   
Special Education, presented on the Governor's Council on                                                                       
Disabilities and Special Education. She shared the council's                                                                    
vision statement:                                                                                                               
     Alaskans share a vision of a flexible system in which                                                                      
     each person directs their own supports, based on their                                                                     
     strengths and abilities, toward a meaningful life in                                                                       
     their home, their job and their community. Our vision                                                                      
     includes supported families, professional staff and                                                                        
     services available throughout the state now and into                                                                       
     the future.                                                                                                                
                                                                                                                                
MS. WINSTON  said she was disabled  at 21 by a  rare neurological                                                               
disorder. At  the time she  had twin one-year-olds. She  was able                                                               
to navigate  the system to acquire  a Medicaid waiver to  stay in                                                               
her own  home to receive services.  She got her own  home through                                                               
RurAL CAP  (Rural Alaska Community  Action Program). She  went to                                                               
college and will  be working on a master's in  psychology. All of                                                               
this was and is possible because  of services she receives in her                                                               
own home. She  has a job as a systems  advocate with the Soldotna                                                               
Independent Living Center.  The state budget is tight,  but it is                                                               
essential that these services are  available in the community and                                                               
in   people's  homes.   Otherwise,   the  option   would  be   an                                                               
institutional setting.                                                                                                          
                                                                                                                                
She said  she is in  a large battle  with the division  about her                                                               
services. She  had been  receiving 24-hour  services in  her home                                                               
but that has been cut to 35  hours a week. If she doesn't receive                                                               
services at  home, then she will  be in a nursing  home where she                                                               
cannot be a mom  and have a job. They are  asking for support for                                                               
the shared  vision of developmental  disabilities services  to be                                                               
received in an integrated community setting.                                                                                    
                                                                                                                                
1:38:43 PM                                                                                                                    
SENATOR MICCICHE asked  whether the council has  tried to educate                                                               
legislators  about  the  codes  or  specific  services  used  for                                                               
disabilities. Legislators  are intending  to keep  the Department                                                               
of  Health  and  Social  Services' (DHSS)  budget  flat,  but  he                                                               
believes  government is  here to  help people  who simply  cannot                                                               
afford to provide that care themselves.                                                                                         
                                                                                                                                
MR. REINHART said  the council gets involved  when the Department                                                               
of Education and Early Development  and DHSS issue regulations or                                                               
policies  related  to  services.  A  Medicaid  ad  hoc  committee                                                               
provides  comments.  Changes   are  happening  rapidly,  probably                                                               
because  of  SB  74.  The council  could  provide  the  council's                                                               
comments on various services.                                                                                                   
                                                                                                                                
SENATOR   MICCICHE  said   waiting  for   regulations  from   the                                                               
departments is late  for the legislature. The  legislature is the                                                               
appropriating  body and  they need  to prioritize  spending. They                                                               
have never questioned  the cost of Medicaid for  the disabled and                                                               
associated  services.  He  suggested that  perhaps  Mr.  Reinhart                                                               
could be available for the subcommittee process                                                                                 
                                                                                                                                
1:41:53 PM                                                                                                                    
MR.  REINHART  presented  a   graph,  "Moving  Forward  Together:                                                               
Alaska's  Developmental Disabilities  System," to  illustrate the                                                               
state's evolving system. In  1997 Harborview Developmental Center                                                               
closed. The cost for delivering  services in communities is about                                                               
a third of what it would  cost if Harborview were open today. The                                                               
waivers are worthwhile. They are  the most important thing in the                                                               
whole developmental  disabilities (DD) system. They  allow people                                                               
to  live independently  in the  community. The  vision is  toward                                                               
more meaningful lives, more employment,  more opportunities to be                                                               
involved in communities.                                                                                                        
                                                                                                                                
MR. REINHART  thanked Senator Micciche for  planning to originate                                                               
the  Developmental Disabilities  Shared Vision  Bill so  that the                                                               
lens of home-based services will always be in statute.                                                                          
                                                                                                                                
MR. REINHART  said shared this  definition of  Supported Decision                                                               
Making (SDM):                                                                                                                   
                                                                                                                                
     Supported  Decision Making  (SDM) can  be best  defined                                                                    
     as:   relationships,   practices,   arrangements,   and                                                                    
     agreements  of more  or  less  formality and  intensity                                                                    
     that  are  designed  to assist  an  individual  with  a                                                                    
     disability   to  make   and   communicate  to   others,                                                                    
     decisions about the individual's life.                                                                                     
                                                                                                                                
Alaska has  an overabundance of  full guardianships.  The council                                                               
wants a mechanism for something  less severe with more individual                                                               
input. Supported Decision  Making is a new movement.  It may take                                                               
some burden from the the Office of Public Advocacy                                                                              
                                                                                                                                
MR.  REINHART said  the council  is  working with  Representative                                                               
Millett  on  a  Supported  Decision  Making  Bill  modeled  after                                                               
similar legislation in  Texas, Delaware, and other  states. It is                                                               
a  civil rights  issue. It  allows people  to decide  what issues                                                               
they want help with and what issues they don't.                                                                                 
                                                                                                                                
1:46:51 PM                                                                                                                    
JEANNE  GERHARDT-CYRUS,  Chair,  FASD Working  Group,  Governor's                                                               
Council on  Disabilities and Special Education,  presented on the                                                               
Governor's  Council on  Disabilities and  Special Education.  She                                                               
shared that  she is a  parent of multiple children  with prenatal                                                               
exposure  to  alcohol.  She  said   the  Fetal  Alcohol  Spectrum                                                               
Disorders' (FASDs) work group finalized their vision:                                                                           
                                                                                                                                
     The  prevalence  of  Fetal Alcohol  Spectrum  Disorders                                                                    
     (FASDs)  is  reduced  and  individuals  who  experience                                                                    
     FASDs  and  their  caregivers are  empowered  to  reach                                                                    
     their  unique and  full  potential. Through  education,                                                                    
     prevention,   and   provision  of   quality,   relevant                                                                    
       supports and services, Alaska is a FASDs-informed                                                                        
     state.                                                                                                                     
                                                                                                                                
MS.  GERHARDT-CYRUS  said  many  people  do  not  know  that  the                                                               
majority  of people  with  prenatal exposure  to  alcohol do  not                                                               
qualify for developmental disabilities services.                                                                                
                                                                                                                                
MS. GERHARDT-CYRUS shared the work  group's goals from its 5-year                                                               
plan.                                                                                                                           
                                                                                                                                
   1. Raise   awareness    of     FASDs,    a    range    of                                                                    
     neurodevelopmental (brain-based) disabilities that can                                                                     
     affect any person exposed to alcohol before birth.                                                                         
   2. Reduce the incidence of alcohol-exposed pregnancies.                                                                      
   3. Address the stigma associated with FASDs by educating                                                                     
         Alaskans to understand the complexities of the                                                                         
     disability in a way that honors the strengths of those                                                                     
     impacted, to promote an inclusive, accepting culture.                                                                      
   4. Reduce the co-occurrence of childhood trauma and FASDs                                                                    
         by increasing supports for high-risk families,                                                                         
     building resilience, and improving access to treatment                                                                     
     for early childhood trauma.                                                                                                
                                                                                                                                
   5. Define and promote FASDs-informed care in Alaska.                                                                         
   6. Advocate for fully funded appropriate services, supports                                                                  
     and  education for  individuals and  families with  FASDs to                                                               
     increase self-advocacy,  prevent crises, and  reduce adverse                                                               
     outcomes,  such  as  substance  misuse,  incarceration,  and                                                               
     suicide.                                                                                                                   
                                                                                                                                
1:51:37 PM                                                                                                                    
SENATOR BEGICH  said he served  on the juvenile  justice advisory                                                               
committee and  asked what kind  of coordination the  council does                                                               
with  the  Division  of  Juvenile  Justice  (DJJ).  He  said  the                                                               
estimates of youth affected by FAS  in the system vary from 20 to                                                               
60 percent.                                                                                                                     
                                                                                                                                
MS. GERHARDT-CYRUS recognized Shannon Cross  for her work in DJJ.                                                               
The work group has representation  from many groups, although she                                                               
could not recall at the moment  whether anyone from DJJ is on the                                                               
work group.                                                                                                                     
                                                                                                                                
SENATOR VON  IMHOF asked about  the law that put  pregnancy tests                                                               
in bars.                                                                                                                        
                                                                                                                                
MS. GERHARDT-CYRUS said she did  not know much about the effects,                                                               
although she had heard it was successful in some cases.                                                                         
                                                                                                                                
1:54:33 PM                                                                                                                    
SENATOR  GIESSEL said  there  had  been a  report  on that  bill,                                                               
perhaps two  years ago. Five  women had sent notes  thanking DHSS                                                               
for the  pregnancy tests and  stating their behavior  had changed                                                               
as a result of the tests.                                                                                                       
                                                                                                                                
MS.  GERHARDT-CYRUS said  that  showed that  the  women had  some                                                               
knowledge about the effects of prenatal alcohol exposure.                                                                       
                                                                                                                                
She said  that five  work groups will  meet quarterly  to develop                                                               
action plans. Most of the work group is composed of volunteers.                                                                 
                                                                                                                                
MR. REINHART said the Governor's  Council also includes an ad hoc                                                               
autism group that accomplished these goals:                                                                                     
                                                                                                                                
        • Last year the group was focused on the fact that                                                                      
          the state  was losing the  only neurodevelopmental                                                                    
          specialist.   Now  there   will  be   a  pediatric                                                                    
          neurodevelopmental  specialist  at Providence  and                                                                    
          at Alaska Native Health Tribal Consortium.                                                                            
        • Rural outreach clinics traveled to 11 different                                                                       
          communities.                                                                                                          
        • Alaska ECHO Autism is an opportunity for                                                                              
          providers from around the state to video                                                                              
          teleconference with experts from across the                                                                           
          country.                                                                                                              
                                                                                                                                
1:58:25 PM                                                                                                                    
MR.  REINHART said  the legislature  approved Applied  Behavioral                                                               
Analysis  (ABA)   as  a  treatment  for   people  with  difficult                                                               
behaviors. Paying  for ABA has been  an issue so the  Division of                                                               
Behavioral  Health  drafted  regulations.   The  ad  hoc  group's                                                               
comments are noted in the information below.                                                                                    
                                                                                                                                
        • Early Periodic Screening Detection and Treatment                                                                      
          (EPSDT)   requires   Medicaid   autism   treatment                                                                    
          coverage for children under 21                                                                                        
        • Final regulations in March or April                                                                                   
        • 8.2 Million fiscal note                                                                                               
        • Council gave these comments:                                                                                          
             o Needs supervision coverage                                                                                       
             o Remove "fail first" requirement                                                                                  
             o Rates are low                                                                                                    
             o Recommended working with Alaska Association                                                                      
               for Behavior Analysis (AKABA)                                                                                    
                                                                                                                                
SENATOR  VON IMHOF  asked whether  the $8.2  million fiscal  note                                                               
would be an additional cost to the state.                                                                                       
                                                                                                                                
MR. REINHART said  that was the fiscal note then,  but he doesn't                                                               
know the present fiscal note.                                                                                                   
                                                                                                                                
SENATOR  VON   IMHOF  asked  if   the  amount  would   come  from                                                               
undesignated general funds.                                                                                                     
                                                                                                                                
MR.  REINHART said  it would  be  Medicaid funding,  so half  and                                                               
half.                                                                                                                           
                                                                                                                                
SENATOR  VON IMHOF  said  that former  Senator  Bill Stoltze  had                                                               
spoken about  an autistic charter  school. She asked  whether the                                                               
council had considered something like this.                                                                                     
                                                                                                                                
2:02:09 PM                                                                                                                    
MR. REINHART  said the Alaska  Mental Health Trust  invested some                                                               
funding  into a  pilot school  in  Anchorage that  has four  very                                                               
young students  with challenging behaviors  that is in  its first                                                               
month of operation.                                                                                                             
                                                                                                                                
SENATOR  MICCICHE asked  whether  the state  is  getting the  100                                                               
percent  Medicaid  match from  IHS  [Indian  Health Service]  for                                                               
services for the Alaska Native Community.                                                                                       
                                                                                                                                
MR REINHART said he did not know.                                                                                               
                                                                                                                                
MR.  REINHART   said  the  council   is  focusing   on  universal                                                               
development screening.                                                                                                          
                                                                                                                                
       Goal: to develop and implement a sustainable, cost                                                                       
     effective, efficient method of universal screening                                                                         
        • One in four children ages 0-5 years is at risk                                                                        
          for a developmental delay                                                                                             
        • Only 32 percent of Alaskan parents report having                                                                      
          any standardized developmental screening                                                                              
        • Council convened a Universal Screening Task Force                                                                     
          Midwest Academy with multiple partners                                                                                
             o Public and Tribal Health                                                                                         
             o Head Start                                                                                                       
             o Child Care                                                                                                       
        • House efforts in one place (Help Me Grow)                                                                             
             o Streamline data collection                                                                                       
             o Maximize impact                                                                                                  
                                                                                                                                
MR.  REINHART gave  an  update on  ABLE  accounts. ABLE  accounts                                                               
allow  people  to save  money  in  special accounts,  similar  to                                                               
college  529 savings  accounts, for  disability-related expenses.                                                               
Currently Alaska has 94 ABLE  accounts with $395,771 in funds. He                                                               
thanked Senator Giessel for helping  to get the ABLE bill passed.                                                               
ABLE accounts enable people to help  themselves and to get out of                                                               
poverty. It  is a vicious cycle  to be dependent on  benefits all                                                               
the time. With  federal tax changes, college 529  accounts can be                                                               
changed to ABLE accounts.                                                                                                       
                                                                                                                                
2:07:52 PM                                                                                                                    
MR.  REINHART said  Alaska is  an Employment  First state,  which                                                               
focuses  on programs  providing services  to focus  on work,  and                                                               
gave the following update:                                                                                                      
                                                                                                                                
        • Repeal of subminimum wage in Alaska (DOLWD)                                                                           
        • Transition handbook launched (DHSS)                                                                                   
        • MOU with Employment First Philosophy (DHSS &                                                                          
          DOLWD)                                                                                                                
        • Employment First Job Fair entering 4th year (DHSS                                                                     
          & DOLWD)                                                                                                              
        • Business  Employment   Services    Team   (BEST)                                                                      
          continued joint employer engagement efforts                                                                           
          (DOLWD & DHSS)                                                                                                        
        • Increased focus on transition through Jobz Clubs,                                                                     
          Transition Camps, and summer work experiences                                                                         
          (DOLWD & DEED)                                                                                                        
        • Regulation changes-including employment first                                                                         
          language of "employment and work in competitive,                                                                      
          integrated settings" (DHSS)                                                                                           
                                                                                                                                
SENATOR MICCICHE asked  if someone is disabled, is  there a limit                                                               
on income in order not to lose services.                                                                                        
                                                                                                                                
MR.  REINHART  said  there  are   income  requirements  for  most                                                               
services. Up  to $15,000 a  year can  be put into  ABLE accounts.                                                               
Some programs  are just about  providing services for  a specific                                                               
disability.                                                                                                                     
                                                                                                                                
2:12:34 PM                                                                                                                    
SENATOR MICCICHE said  that in Finance, a question  came up about                                                               
income limits and penalizing people for earning too much.                                                                       
                                                                                                                                
MR.  REINHART   said  their   goal  is   that  people   look  for                                                               
opportunities to be employed and  be part of society. The council                                                               
has  a web-based  tool,  Benefits  101, that  people  can use  to                                                               
determine  how   income  might  affect   services.  It   is  very                                                               
complicated.  The  council  has  been investing  money  to  train                                                               
people in this area of benefit calculations.                                                                                    
                                                                                                                                
2:14:37 PM                                                                                                                    
SENATOR  BEGICH asked  what  take  away he  wanted  to leave  the                                                               
committee with  as members work  through the  subcommittee budget                                                               
process.                                                                                                                        
                                                                                                                                
MR.  REINHART said  that "home  and  community-based services  is                                                               
good bang for the buck." That is the most important issue.                                                                      
                                                                                                                                
SENATOR VON IMHOF asked how Alaska compared to other states.                                                                    
                                                                                                                                
MR.  REINHART said  Alaska  ranks well  in  state comparisons  of                                                               
home-and-community-based services.  Alaska was  one of  the first                                                               
to get  rid of a  developmental disability institution.  He would                                                               
share those comparisons with the committee.                                                                                     
                                                                                                                                
2:16:56 PM                                                                                                                    
SENATOR VON IMHOF said reports over time would be helpful.                                                                      
                                                                                                                                
2:17:15 PM                                                                                                                    
At ease.                                                                                                                        
                                                                                                                                
          SB 128-MARIJUANA EDU/TREATMENT FUND/PROGRAM                                                                       
                                                                                                                                
2:17:23 PM                                                                                                                    
CHAIR  WILSON announced  the  consideration of  SB  128 with  his                                                               
intention to hear and hold the bill.                                                                                            
                                                                                                                                
2:19:43 PM                                                                                                                    
SENATOR  GIESSEL, Alaska  State Legislature,  sponsor of  SB 128,                                                               
said she  knew many  people would question  the need  for another                                                               
fund. "Well, frankly,  Mr. Chairman, I blame the  hippies from my                                                               
generation of  the 60s and  70s who raised  kids who were  led to                                                               
believe that this Schedule I,  hallucinogenic drug was harmless,"                                                               
she  said. These  people voted  to put  this drug  on the  street                                                               
corners and it is now readily  available. The state needs to deal                                                               
with that.  "Those old hippies'  grandchildren are at  risk," she                                                               
said, as she sees them in school-based clinics.                                                                                 
                                                                                                                                
She  said these  kids  deal with  jaw-dropping  things. She  does                                                               
screening for  depression, suicidal  ideation, and drug  use. She                                                               
needs better tools to talk to  them about marijuana use. She does                                                               
not run across kids who  smoke because the smoking education fund                                                               
has worked.                                                                                                                     
                                                                                                                                
She  said government  should be  involved because  government "is                                                               
taking  a tax  on  this  tapeworm that  is  sucking  life out  of                                                               
people." This  bill takes some of  this money to the  Division of                                                               
Public  Health  to  create materials  for  students  and  adults.                                                               
Grants  will be  available to  private sector  non-profits to  go                                                               
forth  on  education  and  treatment  programs  funded  by  taxes                                                               
collected.                                                                                                                      
                                                                                                                                
2:22:56 PM                                                                                                                    
SENATOR GIESSEL said the bill is  being offered at the request of                                                               
DHSS. The  fund mirrors the  Tobacco Use Education  and Cessation                                                               
Fund. The  bill counters  the message that  legal means  safe and                                                               
harmless, a belief  that many schoolkids are led  to believe, and                                                               
the message that this is a money-maker for staff coffers.                                                                       
                                                                                                                                
She  said the  bill allows  DHSS to  collect data  on the  use of                                                               
marijuana, the public attitude and  knowledge about this drug and                                                               
how to  protect the cognitive  abilities and health of  our youth                                                               
through education, mostly  about side effects. This  will be done                                                               
through grants to local organizations.  The bill does not specify                                                               
organizations because  the government should not  pick winners or                                                               
losers. Many groups are ready to do this work.                                                                                  
                                                                                                                                
2:24:48 PM                                                                                                                    
JANE CONWAY,  Staff, Senator  Giessel, Alaska  State Legislature,                                                               
Juneau, Alaska, presented the sectional analysis of SB 128.                                                                     
                                                                                                                                
     Section 1  AS 43.61.010(d) is technical  and conforming                                                                    
     language that clarifies which  fund is being referenced                                                                    
     in this section that  is about the recidivism reduction                                                                    
     fund.  Since  we  are establishing  another  fund,  the                                                                    
     Marijuana  Education  and  Treatment  Fund  in  another                                                                    
     subsection  to  follow,  Legislative  Legal  wanted  to                                                                    
     correctly  name  which  fund   is  being  addressed  to                                                                    
     prevent any confusion.                                                                                                     
                                                                                                                                
     Section  2  AS  43.61.010  is  a  new  subsection  that                                                                    
     creates  the  Marijuana  Education and  Treatment  Fund                                                                    
     within the general fund.  After receiving tax collected                                                                    
     from  marijuana  sales,  the  Dept.  of  Administration                                                                    
     shall separately  account for and deposit  25% of those                                                                    
     proceeds  into  the  Fund,   and  the  legislature  may                                                                    
     appropriate  those monies  for the  purpose of  funding                                                                    
     DHSS   programs  for   marijuana   use  education   and                                                                    
     treatment.  This section  specifies that  the money  in                                                                    
     this fund does not lapse.                                                                                                  
                                                                                                                                
MS. CONWAY noted that Section  3 has minor fixes from Legislative                                                               
Legal.                                                                                                                          
                                                                                                                                
     Section  3 AS  44.29.020(a)  contains  two minor  fixes                                                                    
     from  Leg Legal  that adds  the word  "the" to  (11) of                                                                    
     this section, and  also the word "to" to  item (14). It                                                                    
     also  adds to  this section  that DHSS  will administer                                                                    
     the marijuana education and  treatment program by grant                                                                    
     or contract out this  program to other organizations in                                                                    
     Alaska.  This  section  outlines 5  components  of  the                                                                    
     program  that must  be included:  1. A  community-based                                                                    
     marijuana  misuse  prevention  component  2.  Marijuana                                                                    
     public  education  geared  toward prevention  of  youth                                                                    
     initiation of marijuana use,  education re: the effects                                                                    
     of marijuana  use and education  re: marijuana  laws 3.                                                                    
     Survey  of  youth   and  adults  concerning  knowledge,                                                                    
     awareness, attitude  and use  of marijuana  products 4.                                                                    
     Monitoring   of  the   public's   health  relating   to                                                                    
     consequences of marijuana use  5. Provide for substance                                                                    
     abuse  screening,  brief   intervention,  referral  and                                                                    
     treatment                                                                                                                  
                                                                                                                                
SENATOR VON IMHOF  said the sponsor statement has  an estimate of                                                               
$9 million to  be collected in taxes. She asked  if a contingency                                                               
plan is in place if less than 9 million is collected.                                                                           
                                                                                                                                
SENATOR GIESSEL deferred the question to the division.                                                                          
                                                                                                                                
2:27:46 PM                                                                                                                    
SENATOR BEGICH disclosed a conflict  of interest as he works with                                                               
Portland  State University  as a  trainer and  consultant on  the                                                               
Reclaiming Futures Project, which  deals with the substance abuse                                                               
screener  referenced  on  page  3.  lines 24  and  25.  He  could                                                               
financially benefit  from the bill  if Portland  State University                                                               
were to win a grant.                                                                                                            
                                                                                                                                
2:28:40 PM                                                                                                                    
JAY BUTLER,  M.D., Chief Medical Officer/Director,  Department of                                                               
Health and  Social Services (DHSS),  presented information  on SB                                                               
128. He  responded to Senator  Imhoff's question by  stating that                                                               
the health  education component could be  very plastic, depending                                                               
on  the   assessments  of  the   situation,  and  he   asked  for                                                               
flexibility to focus  on "what is rather than what  I think it is                                                               
going to be."                                                                                                                   
                                                                                                                                
DR. BUTLER said the Marijuana  Education and Treatment Fund would                                                               
be similar  to the  Tobacco Use Education  and Cessation  fund in                                                               
terms of  how tax revenues  are used. Twenty-five percent  of the                                                               
marijuana excise tax  would go to the fund.  Currently 50 percent                                                               
goes to the  recidivism fund and 50 percent to  the general fund.                                                               
The bill  would divide the  50 percent  that goes to  the general                                                               
fund between the general fund and the marijuana education fund.                                                                 
                                                                                                                                
He said  the overarching goal  is statewide  coordination between                                                               
youth   prevention,  public   health   and   safety,  and   youth                                                               
prevention.  About   10  percent  of  marijuana   users  will  be                                                               
diagnosed  with  cannabis  use  disorder,  which  is  similar  to                                                               
alcohol-use rates.  The risk is  two-fold when  regular marijuana                                                               
use begins in the  teen years, so an emphasis is  to delay use of                                                               
marijuana  in youth.  The top  public health  and safety  risk is                                                               
driving under the influence of marijuana.                                                                                       
                                                                                                                                
2:33:28 PM                                                                                                                    
DR. BUTLER outlined the five parts to a comprehensive program:                                                                  
                                                                                                                                
        • Community-based marijuana misuse prevention, with                                                                     
          a focus on youth prevention                                                                                           
        • Assessment of knowledge and awareness of laws,                                                                        
          and use of marijuana products                                                                                         
        • Monitoring of population health impact related to                                                                     
          marijuana use and legalization                                                                                        
        • Marijuana education                                                                                                   
        • Substance abuse screening, brief intervention,                                                                        
          referral, and treatment (SBIRT)                                                                                       
                                                                                                                                
He  said community-based  marijuana  misuse  prevention is  about                                                               
local efforts  to prevent misuse  before it starts  by mitigating                                                               
risk factors  and enhancing existing  programs for  public health                                                               
and education to address substance misuse prevention.                                                                           
                                                                                                                                
He said that  the Youth Risk Behavior Survey showed  that kids in                                                               
afterschool programs  report a lower  frequency of  marijuana use                                                               
and initiation.                                                                                                                 
                                                                                                                                
SENATOR MICCICHE  said he has been  on the board of  the Boys and                                                               
Girls  Club for  25 years.  He  asked what  model programs  would                                                               
cost.  He wondered  if the  bill should  have a  cap on  proposed                                                               
allocations if marijuana revenues continue to increase.                                                                         
                                                                                                                                
DR. BUTLER  responded that may  be a Finance  Committee question.                                                               
He  said that  a robust  afterschool  program may  need a  larger                                                               
proportion than  exists now. The projections  for total marijuana                                                               
tax revenue is $10 million a year.                                                                                              
                                                                                                                                
2:37:08 PM                                                                                                                    
SENATOR  MICCICHE  said he  still  hears  from people  who  think                                                               
marijuana sales will  save the state from its fiscal  gap, but he                                                               
understands that revenue is not expected to grow significantly.                                                                 
                                                                                                                                
SENATOR BEGICH asked  what model programs and  robustness mean to                                                               
the department.                                                                                                                 
                                                                                                                                
DR. BUTLER  said robust programs have  data to show less  use. He                                                               
noted  the interest  shown to  the Iceland  model, in  which teen                                                               
substance use has  declined dramatically over the  last 20 years.                                                               
The press has  simplified the solution to  afterschool and sports                                                               
programs. There also has been a  shift in social norms of what is                                                               
good parenting, as well as  regulation. Curfew hours are enforced                                                               
and alcohol store hours are limited.                                                                                            
                                                                                                                                
SENATOR BEGICH said  he wanted to focus  on afterschool programs.                                                               
He asked  if DHSS  would have  strict requirements  for efficient                                                               
programs. He does not want to  divert money to programs that have                                                               
no effect.                                                                                                                      
                                                                                                                                
DR.  BUTLER   said  that  would   be  a  Request   for  Proposals                                                               
requirement.                                                                                                                    
                                                                                                                                
CHAIR  WILSON   said  he  thought   the  initial   percentage  of                                                               
allocations by  DHSS was lower than  25 percent and asked  why it                                                               
is higher now.                                                                                                                  
                                                                                                                                
2:41:41 PM                                                                                                                    
DR. BUTLER said  that the proposal is not small.  The proposal is                                                               
not as ambitious  as in some states, such as  Colorado, which has                                                               
a yearly expert  panel on the effect of  legalization. DHSS wants                                                               
to maximize the ability to provide  a good public health model to                                                               
regulate legal, retail marijuana.                                                                                               
                                                                                                                                
He said the second component  is assessment and monitoring of the                                                               
following:                                                                                                                      
                                                                                                                                
    Assessment   of   trends   in   knowledge,   awareness,                                                                     
     attitudes, and behaviors to address misperceptions and                                                                     
     knowledge gaps                                                                                                             
      Monitoring health status and use trends to identify                                                                       
     any health or health system effects of legalization                                                                        
     Some questions that require answers:                                                                                       
                                                                                                                                
        • Do youth perceive marijuana as a less harmful                                                                         
          substance due to legalization?                                                                                        
        • Do youth and adults see driving under the                                                                             
          influence of marijuana as dangerous?                                                                                  
        • How has marijuana legalization affected Alaskans'                                                                     
          health and safety?                                                                                                    
                                                                                                                                
2:44:28 PM                                                                                                                    
DR. BUTLER said the last question may take time to answer.                                                                      
                                                                                                                                
SENATOR  VON IMHOF  asked if  DHSS is  working with  Colorado and                                                               
Oregon to  compare data, such as  the rate of car  accident under                                                               
the influence.                                                                                                                  
                                                                                                                                
DR. BUTLER said states have  frequent phone contact and meetings,                                                               
when  possible,  with surveillance  gurus  from  the Centers  for                                                               
Disease   Control  about   how   to  do   these  assessments   in                                                               
standardized ways. States look to each other for leadership.                                                                    
                                                                                                                                
SENATOR GIESSEL said she has  been very interested in the subject                                                               
of marijuana-impaired driving  and in a meeting a  month ago, the                                                               
Anchorage  Police Department  said they  had documented  25 fatal                                                               
car  accidents attributable  to  marijuana-impaired driving.  She                                                               
suggested he be in contact with them to get the data.                                                                           
                                                                                                                                
DR.  BUTLER said  marijuana education  seemed  to be  a big  void                                                               
after  legalization. Materials  will be  designed to  communicate                                                               
messages to                                                                                                                     
                                                                                                                                
       1. help prevent youth initiation of marijuana use                                                                        
        2. educate the public about the health effects of                                                                       
          marijuana use                                                                                                         
        3. educate the public about marijuana laws                                                                              
                                                                                                                                
2:49:32 PM                                                                                                                    
DR. BUTLER said  part of the education is needed  for health care                                                               
professionals. Health care professionals  may think back to their                                                               
hippie  days when  a  joint was  "half  oregano." Now,  high-tech                                                               
horticulture produces  marijuana breeds  with much  higher levels                                                               
of  THC.  There  are  also  a  wide  variety  of  products:  vape                                                               
solutions, concentrates, edibles, topicals, etc.                                                                                
                                                                                                                                
He  said  providers need  tools  for  substance abuse  screening,                                                               
brief intervention,  referral, and treatment (SBIRT).  Use during                                                               
pregnancy  is a  concern. The  health effects  are unknown.  Some                                                               
providers recommend it for morning sickness.                                                                                    
                                                                                                                                
He said data on youth use shows  that it has been stable over the                                                               
past ten years.                                                                                                                 
                                                                                                                                
He said  adults can help  reduce youth marijuana use.  Youth with                                                               
supportive    teachers,     parent    communication,    community                                                               
connections, and afterschool programs report less marijuana use.                                                                
                                                                                                                                
DR.  BUTLER  said  Alaska  can   join  with  Oregon,  Washington,                                                               
Colorado, and  California to  direct tax  funding towards  a very                                                               
rational way  to regulate retail  marijuana to reduce  the public                                                               
health risk with a minimum of regulation.                                                                                       
                                                                                                                                
2:54:36 PM                                                                                                                    
SENATOR BEGICH asked if any increase  had been shown in adult use                                                               
and why does the Alaska Youth  Risk Behavior Survey show a higher                                                               
use among youth.                                                                                                                
                                                                                                                                
DR. BUTLER said  the adult trend data for Alaska  has been stable                                                               
at around  15-16 percent. He  speculated that  legalization could                                                               
increase  availability and  reduce the  perception of  harm among                                                               
youth.                                                                                                                          
                                                                                                                                
SENATOR BEGICH  said he hoped  DHSS would produce  yearly reports                                                               
about  trend   data  so  the  legislature   could  track  whether                                                               
education programs are effective.                                                                                               
                                                                                                                                
SENATOR GIESSEL  asked if he  knew of  the Office of  Opioids and                                                               
Substance  Abuse   referenced  by   the  Governor's   Council  on                                                               
Disabilities.                                                                                                                   
                                                                                                                                
2:57:46 PM                                                                                                                    
MR BUTLER said it is actually  the Office of Substance Misuse and                                                               
Addiction Prevention, which was  created using existing funds and                                                               
positions from the Division of  Public Health and the Division of                                                               
Behavioral Health.  The office plays  a coordinating role  with a                                                               
focus on opioids and marijuana and prevention.                                                                                  
                                                                                                                                
CHAIR WILSON asked how the fund  is similar to and different than                                                               
the tobacco programs in the state.                                                                                              
                                                                                                                                
DR.  BUTLER   said  it  is   not  significantly   different,  but                                                               
sustainability  is one  issue. A  big proportion  of the  tobacco                                                               
prevention fund came from the  master settlement, and those funds                                                               
are  starting  to decline.  Marijuana  retail  sales would  be  a                                                               
sustainable source of funding for the Marijuana Education Fund.                                                                 
                                                                                                                                
3:00:37 PM                                                                                                                    
CHAIR WILSON opened public testimony on SB 128.                                                                                 
                                                                                                                                
3:00:51 PM                                                                                                                    
TREVOR  STORRS,  Executive  Director,  Alaska  Children's  Trust,                                                               
suggested changes to SB 128. He  said than when Alaska became the                                                               
third state to legalize recreational  marijuana use, it came with                                                               
opportunities and  challenges. The  first priority is  to protect                                                               
Alaska's  youth  because marijuana  use  in  youth effects  their                                                               
brain  development. Four  out of  ten high  school students  have                                                               
used  marijuana.  Alaska  needs specific  youth  prevention  that                                                               
promotes protective  factors. The proposal in  the House utilizes                                                               
the  Alaska   Children's  Trust   and  its  program   the  Alaska                                                               
Afterschool Network to focus on  youth use prevention. The Alaska                                                               
Children's Trust has a proven  grant-making system with a greater                                                               
investment in services.                                                                                                         
                                                                                                                                
3:02:55 PM                                                                                                                    
MR  STORR said  connecting  the funds  to  the Alaska  Children's                                                               
Trust ensures higher standards and  the highest possible outcomes                                                               
for  youth. He  encouraged  the  Senate to  follow  the House  in                                                               
directing another 25 percent to afterschool programs.                                                                           
                                                                                                                                
3:03:41 PM                                                                                                                    
CHAIR WILSON closed public testimony on  SB 128 and held the bill                                                               
in committee.                                                                                                                   
                                                                                                                                
3:05:10 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair  Wilson adjourned  the Senate  Health  and Social  Services                                                               
Standing Committee at 3:05.