Legislature(2017 - 2018)SENATE FINANCE 532

03/29/2018 09:00 AM FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ SB 122 OCS CITIZEN REVIEW PANEL TELECONFERENCED
<Bill Hearing Canceled>
+ Bills Previously Heard/Scheduled: TELECONFERENCED
+= SB 104 EDUCATION CURRICULUM TELECONFERENCED
Heard & Held
+= SB 105 MARITAL & FAMILY THERAPY LIC. & SERVICES TELECONFERENCED
Moved CSSB 105(FIN) Out of Committee
SENATE BILL NO. 105                                                                                                           
                                                                                                                                
     "An  Act  relating  to the  licensure  of  marital  and                                                                    
     family therapists;  relating to  professional liability                                                                    
     insurance for  marital and family  therapists; relating                                                                    
     to medical  assistance for  marital and  family therapy                                                                    
     services; and providing for an effective date."                                                                            
                                                                                                                                
9:04:53 AM                                                                                                                    
                                                                                                                                
Co-Chair MacKinnon  discussed a  brief history of  the bill.                                                                    
The  committee opened  and closed  public  testimony on  the                                                                    
bill on  February 27, 2018.  The committee had  been working                                                                    
on  compromise language  to satisfy  the concerns  raised by                                                                    
members as well as the general public.                                                                                          
                                                                                                                                
Vice-Chair   Bishop  MOVED   to  ADOPT   proposed  committee                                                                    
substitute  for SB  105,  Work  Draft 30-LS0442\N  (Radford,                                                                    
3/28/18).                                                                                                                       
                                                                                                                                
Co-Chair MacKinnon OBJECTED for discussion.                                                                                     
                                                                                                                                
SENATOR DAVID  WILSON, SPONSOR, deferred  to his  staff, Mr.                                                                    
Zepp, to review the committee substitute changes.                                                                               
                                                                                                                                
GARY  ZEPP,  STAFF,  SENATOR   DAVID  WILSON,  reviewed  the                                                                    
Summary of Changes document (copy on file):                                                                                     
                                                                                                                                
     Version J to Version N                                                                                                     
                                                                                                                                
     Section 1Amended                                                                                                           
      Page 2,  lines  16-24:  The required  total  number  of                                                                   
      hours for the supervision  of an Associate Marital  and                                                                   
      Family Therapist was corrected to 1,700 hours.                                                                            
                                                                                                                                
      The previous version incorrectly reflected 1,500  hours                                                                   
      as the required total hours.                                                                                              
                                                                                                                                
      Version R also clarifies  that 100 hours of  individual                                                                   
      supervision  and   100  hours   of  group   supervision                                                                   
      conducted one or  more supervisors  is included in  the                                                                   
      1,700 hours.                                                                                                              
                                                                                                                                
      Section 1 - Deleted                                                                                                       
      Page 2,  lines 29-31:  The requirement  for $30,000  of                                                                   
      professional liability insurance was deleted.                                                                             
                                                                                                                                
      Insurance to  cover state  investigative  costs is  not                                                                   
      currently available as  envisioned. A national  company                                                                   
      does offer  professional liability  insurance, but  the                                                                   
      coverage  would  reimburse   the  licensee  for   their                                                                   
      investigative costs  and  not  the  state  investigator                                                                   
      costs. The  idea  of professional  liability  insurance                                                                   
      was to  pay  for  state investigative  costs  and  keep                                                                   
      downward pressure on the  state investigative costs  so                                                                   
      that the  costs wouldn't be  allocated amongst  current                                                                   
      licensees and increase their existing license fees.                                                                       
                                                                                                                                
 Mr. Zepp continued to read the summary of changes:                                                                             
                                                                                                                                
      Section 2  Amended                                                                                                        
      Page 3, lines 5  -13: Properly re-state the titles  for                                                                   
      the healthcare professions  listed that are  authorized                                                                   
      to provide  group supervision of  an Associate  Marital                                                                   
      and Family Therapist while in training.                                                                                   
                                                                                                                                
      The titles  of  certain healthcare  professionals  were                                                                   
      verified by the State Medical Board.                                                                                      
                                                                                                                                
      Section 4 and 5 - Deleted                                                                                                 
      Page 4, lines  8    Page 5,  line 1: Sections  4 and  5                                                                   
      were deleted  because  SB  169, which  has  passed  the                                                                   
      Senate and  is  in  the  other body,  amends  the  same                                                                   
      statutes  (AS   47.07.030)  previously   contained   in                                                                   
      sections 4 and 5 of SB 105.                                                                                               
                                                                                                                                
      SB 169 amends statute by replacing a  psychiatrist with                                                                   
      a physician, to expand the direct supervisory  capacity                                                                   
     in  providing  behavioral  health clinic  services.  As                                                                    
     well  as removing  the 30%  on -  site requirement  and                                                                    
     replacing that  by requiring a  physician in  person or                                                                    
     available via a communication device.                                                                                      
                                                                                                                                
     SB 105, as amended, is fully supported by the Board of                                                                     
     Marital and Family Therapists. Please see the two                                                                          
     letters of support from the Board.                                                                                         
                                                                                                                                
9:09:42 AM                                                                                                                    
                                                                                                                                
Co-Chair MacKinnon  WITHDREW her  OBJECTION. There  being NO                                                                    
further OBJECTION,  it was so  ordered. She  invited Senator                                                                    
Wilson to comment on the bill.                                                                                                  
                                                                                                                                
Senator  Wilson discussed  the bill.  He explained  the main                                                                    
purpose  of the  bill  was  to add  the  marital and  family                                                                    
licensed therapist to  the list of providers  that were able                                                                    
to bill Medicaid allowing more  access to services. The bill                                                                    
would  enhance behavioral  health  capacity for  underserved                                                                    
Alaskans who were  on long waitlists to  access services. He                                                                    
stated that  the bill would offer  opportunities for clinics                                                                    
to provide services at a  lower cost. He elaborated that the                                                                    
way  in which  recruitment happened  currently for  licensed                                                                    
social workers  with a  Master of  Social Work  (MSW) degree                                                                    
took  a significant  amount of  time,  about 1  year or  1.5                                                                    
years,   to  recruit.   For  some   clinics,  the   cost  of                                                                    
recruitment was  over $100,000. The  bill would result  in a                                                                    
more  abundant   source  of  providers  that   were  equally                                                                    
qualified to provide behavioral  health services at a lesser                                                                    
cost with easier access.                                                                                                        
                                                                                                                                
Senator Micciche  asked the sponsor  to explain  the benefit                                                                    
of the  bill and identify how  much money would be  saved in                                                                    
the  long run.  Senator Wilson  replied that  without having                                                                    
access  to psychiatric  services  and providers  at a  lower                                                                    
cost, patients  were going to  the emergency room  (ER). The                                                                    
cost for  treatment at an ER  often cost the state  10 times                                                                    
more  than providing  the services  through local  community                                                                    
clinics.  He  noted  previous testimony  by  representatives                                                                    
from  some of  the  community health  centers who  confirmed                                                                    
their  facilities could  provide behavioral  health services                                                                    
at a  lower cost  than an ER.  The Mat-Su  Health Foundation                                                                    
reported the number  of people accessing their  ER and their                                                                    
inability to  meet the needs  of patients because of  a lack                                                                    
of  capacity.  He  also  noted  hearing  testimony  from  85                                                                    
licensed psychiatrists  in the  State of Alaska.  The Mental                                                                    
 Health Working  Group confirmed  that their  studies  stated                                                                   
 that Alaska needed  an additional  106 to 184  psychiatrists                                                                   
 to meet the national  average and to  cover the need in  the                                                                   
 state. He  was  hoping  that patients  could  address  their                                                                   
 issues through a lower acuity of care instead of  them being                                                                   
 escalated  to a  higher  acuity  of  care,  which  was  more                                                                   
 devastating to the individual and costlier to the state.                                                                       
                                                                                                                                
 9:13:47 AM                                                                                                                   
                                                                                                                                
 Senator Olson asked if  the sponsor had checked with  health                                                                   
 corporations regarding  the  changes  to the  bill.  Senator                                                                   
 Wilson asked if  Senator Olson was  referring to the  native                                                                   
 health  corporations  or  some  of  the   larger  providers.                                                                   
 Senator Olson  wondered,  if he  called up  Maniilaq  Health                                                                   
 Center, whether they would be able to confirm that  the bill                                                                   
 sponsor had reached out  to them about the proposed  changes                                                                   
 in the  bill.  Senator Wilson  stated that  Maniilaq  Health                                                                   
 Center was a member  of the Alaska Primary Care  Association                                                                   
 (APCA), who  was  in full  support  of the  legislation.  He                                                                   
 hoped Maniilaq Health Center would support the bill  being a                                                                   
 member of APCA. He relayed that half of the members  of APCA                                                                   
 were tribal  entities  that  operated the  community  health                                                                   
 centers. The trade association  was in full support and  had                                                                   
 been lobbying to help support the bill.                                                                                        
                                                                                                                                
 Senator Olson referenced  the name change  in Section 4  and                                                                   
 5. He  asked  if the  Senator had  talked  with any  of  the                                                                   
 physician  groups   such  as   the  Alaska   State   Medical                                                                   
 Association about the changes  moving from psychiatrists  to                                                                   
 physicians. Senator  Wilson responded in  the negative.  His                                                                   
 office had worked  with the department  on the  legislation.                                                                   
 They were in  full support of  the change from  psychiatrist                                                                   
 to physician  to meet more  of the  federal definitions  and                                                                   
 guidelines with conforming language.                                                                                           
                                                                                                                                
 Senator  Olson  asked  who   "they"  were.  Senator   Wilson                                                                   
 specified Director  Burns of  the Department  of Health  and                                                                   
 Social Services (DHSS).                                                                                                        
                                                                                                                                
 Co-Chair MacKinnon  stated that  the committee  had  removed                                                                   
 from the  bill  another bill  that  was carried  by  another                                                                   
 sponsor, Senator  Giessel,  regarding  supervision  and  the                                                                   
 definition Senator  Olson referred to.  Currently in  Alaska                                                                   
 state statute, in any  individual medical provider's  office                                                                   
 a psychiatrist  was required  30 percent  of  the time.  She                                                                   
 conveyed  her   point  that   there  were   two  pieces   of                                                                   
legislation that  would affect the same  portion of statute.                                                                    
With that  in mind, she  had a concern that  the legislature                                                                    
would  be dependent  on  two pieces  of  legislation by  two                                                                    
different legislators  ending across the finish  line at the                                                                    
same  time  to accomplish  what  the  legislature wanted  to                                                                    
accomplish. Senator  Wilson's bill  allowed the  billing and                                                                    
was not speaking  directly to supervision. She  asked if she                                                                    
was  correct.   Senator  Wilson  clarified  that   the  bill                                                                    
addressed both supervision and the  expansion of MSW's being                                                                    
able to bill Medicaid.                                                                                                          
                                                                                                                                
Co-Chair    MacKinnon   directed    her   question    around                                                                    
supervision.  She asked  about supervision  in terms  of the                                                                    
bill the committee  had heard previously and  whether it had                                                                    
to do with  30 hours. Mr. Zepp answered  in the affirmative.                                                                    
He noted that  the previous version of the  bill in Sections                                                                    
4 and 5 fell into the  Medicaid billion section of the bill.                                                                    
In thinking of  SB 105 there were two silos.  The first silo                                                                    
was the training  issue for an associate which  was what the                                                                    
senator as trying to streamline  and expand. The second silo                                                                    
was  under  the Medicaid  billing  to  provided marital  and                                                                    
family therapists  under the optional Medicaid  services, so                                                                    
they could bill and  seek reimbursement. The Senator removed                                                                    
Sections 4  and 5 because  Senator Giessel's  bill clarified                                                                    
direct   supervision   from   a   physician   with   certain                                                                    
guidelines.                                                                                                                     
                                                                                                                                
9:18:52 AM                                                                                                                    
                                                                                                                                
Co-Chair MacKinnon  stated that  she was willing  to support                                                                    
the  billing portion  of the  legislation because  of seeing                                                                    
the  results  of an  opioid  epidemic  in Alaska  and  other                                                                    
mental  health needs  that were  being under-represented  in                                                                    
communities  across the  state. She  added that  she thought                                                                    
supervision was  important, and that Senator  Giessel's bill                                                                    
along with  Senator Wilson's bill  both needed to  reach the                                                                    
finish line.                                                                                                                    
                                                                                                                                
Senator  Micciche thought  both bills  being discussed  were                                                                    
advantageous  to  the clients  and  to  the state.  Co-Chair                                                                    
MacKinnon echoed the comments of Senator Micciche.                                                                              
                                                                                                                                
9:20:53 AM                                                                                                                    
                                                                                                                                
RANDALL  BURNS,  DIRECTOR,  DIVISION OF  BEHAVIORAL  HEALTH,                                                                    
DEPARTMENT    OF   HEALTH    AND   SOCIAL    SERVICES   (via                                                                    
teleconference), discussed  fiscal note OMB  component 2660.                                                                    
 The fiscal note  specifically addressed  the portion of  the                                                                   
 bill  related  to  the  addition  of  marriage   and  family                                                                   
 therapists to the optional  Medicaid statutes. The  division                                                                   
 had estimated  what  was thought  to  be  a fair  amount  of                                                                   
 additional costs  to the Medicaid  budget as  the result  of                                                                   
 adding  Marriage  and  Family  therapists  to  the  list  of                                                                   
 professions that could bill Medicaid for their  services. He                                                                   
 found that the bill would only apply to about  633 Medicaid-                                                                   
 eligible recipients in the first year.                                                                                         
                                                                                                                                
 Mr. Burns  continued that most  of the  marriage and  family                                                                   
 therapists worked  in  clinics  and did  not  bill  Medicaid                                                                   
 directly. There  was no  way of  knowing how  many of  those                                                                   
 individuals would  opt  to leave  a  clinic  to start  up  a                                                                   
 practice independently or  start billing independently.  The                                                                   
 division tried to be  conservative in its calculations.  The                                                                   
 division estimated  approximately $1  million. He  continued                                                                   
 that $660,000 of  the amount  would be in  federal match  to                                                                   
 the state's commitment of about $340,000. There was  a small                                                                   
 charge  for FY  19  to  make  the  changes  to  the  state's                                                                   
 Medicaid Management  Information  System to  allow  marriage                                                                   
 and family therapists to bill Medicaid directly.                                                                               
                                                                                                                                
 Co-Chair MacKinnon  stated that  the committee  required  an                                                                   
 updated fiscal note. She  pointed out that the numbers  were                                                                   
 correct but the  narrative on the back  needed to change  to                                                                   
 reflect the new committee  substitute before the  committee.                                                                   
 Mr. Burns stated that he was working on that presently.                                                                        
                                                                                                                                
 Senator  Micciche   thought   the  fiscal   note   addressed                                                                   
 additional costs but did  not capture any consideration  for                                                                   
 cost  avoidance. He  asked  Mr.  Burns  if  he  intended  to                                                                   
 include some evaluation of cost avoidance that  would result                                                                   
 from the passage of the  bill. Mr. Burns stated that he  did                                                                   
 not put cost avoidance  in the fiscal  note of the bill.  He                                                                   
 saw it falling within the  more wholistic approach of SB  74                                                                   
 and the changes being made to the system by the  1115 waiver                                                                   
 and  the   process.  He  thought   estimating  the   savings                                                                   
 resulting from adding marriage and family therapists  to the                                                                   
 list would be difficult.  The division had not  contemplated                                                                   
 making  such a  representation  in  the  fiscal  note  being                                                                   
 reviewed.                                                                                                                      
                                                                                                                                
 Co-Chair MacKinnon  acknowledged that  the number  would  be                                                                   
 difficult to  quantify, as there  was a  mixture of  private                                                                   
 versus government utilization. She  indicated that the  bill                                                                   
 would contribute to an  overall higher cost to the  Medicaid                                                                   
system for  the state. It  was a  new service that  would be                                                                    
provided  and reimbursed  by the  state  with a  significant                                                                    
portion  of  the  reimbursement   coming  from  the  federal                                                                    
government in  an effort  to deploy  the resources  to those                                                                    
needing  help,  to  divert  ER access,  and  to  lower  care                                                                    
access.                                                                                                                         
                                                                                                                                
Co-Chair  MacKinnon reported  that someone  from the  Alaska                                                                    
Board of Marital  Family Therapy had come  online. She asked                                                                    
for the will of the committee.                                                                                                  
                                                                                                                                
9:25:43 AM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
9:27:21 AM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
Co-Chair  MacKinnon  relayed  that the  public  hearing  had                                                                    
closed  on the  bill.  She indicated  the  committee was  in                                                                    
receipt of  her comments.  She asked  Ms. Cunningham  if she                                                                    
had a brief comment she wanted to make to the committee.                                                                        
                                                                                                                                
KAREN  CUNNINGHAM,  ALASKA  BOARD   OF  MARITAL  AND  FAMILY                                                                    
THERAPY,  ANCHORAGE   (via  teleconference),   testified  in                                                                    
support of the bill. She  was a licensed marriage and family                                                                    
therapist (LMFT)and sat  on the Alaska Board  of Marital and                                                                    
Family Therapy. She  reported that the board  met to discuss                                                                    
SB  105  and  unanimously  affirmed their  support  for  the                                                                    
statutory  changes  presented  in   the  bill.  One  of  the                                                                    
responsibilities  of  the  board was  to  establish  minimum                                                                    
requirements for  applicants seeking licensure.  Senate Bill                                                                    
105  called for  clarification that  the hours  required for                                                                    
licensure  were 1700.  The breakdown  of the  hours included                                                                    
1500  face-to-face  clinical hours  and  100  hours each  of                                                                    
individual and group  supervision. Another responsibility of                                                                    
the  board was  to serve  and protect  public interest.  The                                                                    
proposed  legislation worked  towards that  end by  allowing                                                                    
applicants greater options  for supervisors which ultimately                                                                    
would  lead to  a  greater  number of  LMFTs  in the  state.                                                                    
Currently, there  was a limited  number of  LMFT supervisors                                                                    
which made it very difficult  for new graduates applying for                                                                    
associate  licensures  to find  an  individual  and a  group                                                                    
supervisor willing to commit to a minimum of 2 years.                                                                           
                                                                                                                                
Co-Chair MacKinnon  relayed that  the committee  had written                                                                    
comments  from  the  board.  Ms.  Cunningham  did  not  have                                                                    
 anything to add  to the  letter that had  been written.  She                                                                   
 appreciated the opportunity to speak.                                                                                          
                                                                                                                                
 Co-Chair MacKinnon  stated it  was her  intent  to move  the                                                                   
 bill. She had an agreement  from the sponsor and the  boards                                                                   
 that were contacted  in support of the  new language in  the                                                                   
 bill.                                                                                                                          
                                                                                                                                
 Senator Micciche understood  the fiscal  note and the  logic                                                                   
 behind it.  He  was  concerned that  the  department  seemed                                                                   
 unwilling to put  on the record that  there would likely  be                                                                   
 an  offset to  the  costs  of  the  bill.  Not  all  of  the                                                                   
 additional services  in the  state's portfolio  of  Medicaid                                                                   
 billing had panned  out as a cost  saving measure. He  would                                                                   
 have liked to  have heard more from  the department that  it                                                                   
 recognized there would be  an offset rather than a  $340,000                                                                   
 UGF match. He hoped the amount would have been lower  due to                                                                   
 the offset.  With  the  expansion  of  Medicaid,  additional                                                                   
 services, and new waivers  the legislature had not seen  the                                                                   
 savings in  the waivers  that he  would have  liked to  have                                                                   
 seen. He  was  concerned  with UGF  spending  increases.  He                                                                   
 supported the additional services  but was worried that  the                                                                   
 department was not formally recognizing an offset.                                                                             
                                                                                                                                
 9:31:36 AM                                                                                                                   
                                                                                                                                
 Senator von  Imhof relayed that  she sat  on the  Healthcare                                                                   
 Blueprint  Committee.  The  committee  was  in  phase  2  of                                                                   
 identifying areas  of concern.  The committee  was  flushing                                                                   
 out the five areas of concern it identified to  put together                                                                   
 a recommendation  to  create  a systemic  transformation  of                                                                   
 Alaska's  healthcare  system.  One  of  the  five  areas  of                                                                   
 concern was access  to primary  care providers. She  thought                                                                   
 the  bill  addressed  the  issue  by  qualifying  a  marital                                                                   
 therapist  as  a   provider.  She   thought  the  bill   was                                                                   
 consistent with  the direction of  the blueprint  committee.                                                                   
 Although the committee was still in progress,  she supported                                                                   
 the bill because  she believed  it provided greater  access,                                                                   
 particularly in rural Alaska,  by allowing telehealth to  be                                                                   
 part of the solution and  for rural citizens to have  access                                                                   
 to a variety of healthcare providers in numerous  forms. The                                                                   
 intent of the systemic change of Alaska's  healthcare system                                                                   
 was to lower the cost by having more access to a  variety of                                                                   
 healthcare providers  and  through  preventive  care  versus                                                                   
 costly crisis  management.  She thought  the  unquantifiable                                                                   
 downstream savings was a  guess but was consistent with  the                                                                   
 values of the blueprint committee she sat on.                                                                                  
                                                                                                                                
9:33:54 AM                                                                                                                    
                                                                                                                                
Co-Chair MacKinnon agreed with  Senator Micciche and Senator                                                                    
von  Imhof. She  would be  supporting the  bill because  she                                                                    
believed the bill did what  Senator von Imhof had discussed.                                                                    
She  was concerned  with providers  abusing the  system. She                                                                    
looked  at some  abuse in  the dental  field. For  instance,                                                                    
some  dentists performed  unnecessary  extractions on  young                                                                    
children and  billing Medicaid. Another example  were adults                                                                    
having  all of  their teeth  removed without  a particularly                                                                    
good  reason or  back up  materials. She  continued that  as                                                                    
long  as  providers behaved  in  the  best interest  of  the                                                                    
people that were  seeking care from them,  the system should                                                                    
see a decrease.  However, if providers decided to  use it as                                                                    
a funding source for their  individual practices and started                                                                    
billing excessively, the system would break.                                                                                    
                                                                                                                                
Co-Chair MacKinnon continued that  Alaska's heath care costs                                                                    
were  30  percent  higher  than  the  national  average  and                                                                    
America's health  care costs were higher  than anywhere else                                                                    
on the  planet. Alaskans were  faced with a  low demographic                                                                    
and  high  needs.  They  were at  the  mercy  of  hospitals,                                                                    
pharmaceuticals, insurance companies, and  access to care in                                                                    
general. Senate Finance and the  legislature were working to                                                                    
provide lower cost care to Alaskans.  The bill was a step in                                                                    
the  right  direction.  It  required  cooperation  from  the                                                                    
providers to be judicious in  the way they accessed Medicaid                                                                    
funding  which  had  a   federal  match.  Senator  Miccichie                                                                    
suggested by moving it from  an emergency room to a doctor's                                                                    
or provider's  office the cost  would be lower, and  the net                                                                    
of providers would be larger for those seeking services.                                                                        
                                                                                                                                
Co-Chair  MacKinnon  continued  to  discuss  the  bill.  She                                                                    
thought the department  had provided a fiscal  note with the                                                                    
possibility of  an increased cost. The  department had tried                                                                    
to  quantify  it, knowing  that  there  were variables  that                                                                    
could  lower  the overall  cost.  She  appreciated that  the                                                                    
fiscal  note  was  not   indeterminate.  She  preferred  the                                                                    
legislature  striking a  balance  between understanding  the                                                                    
possible   implications   and   how   providers,   insurance                                                                    
companies, hospitals,  and pharmaceuticals  working together                                                                    
could  meet  Alaskans  healthcare needs.  Like  other  small                                                                    
states, Alaska's  legislators struggled  to lower  the costs                                                                    
for their constituents.                                                                                                         
                                                                                                                                
9:37:33 AM                                                                                                                    
                                                                                                                                
 Vice-Chair Bishop made a comment about the  general services                                                                   
 line of  the fiscal  note for  the  development of  business                                                                   
 rules  and  the   Medicaid  Management  Information   System                                                                   
 detailing the parameters for services and reimbursement.  He                                                                   
 suggested the  department tract  the legislation  to see  if                                                                   
 there was a savings rather than a UGF spend. He  thought the                                                                   
 bill should result in a savings.                                                                                               
                                                                                                                                
 Co-Chair MacKinnon suggested  that Senator Wilson  implement                                                                   
 some tracking  method  for the  particular billing  code  to                                                                   
 look at how providers were using the service.  She suggested                                                                   
 a follow-up. She saw the bill as a benefit to  hospitals and                                                                   
 providers and  she  hoped it  translated into  quality  care                                                                   
 that was  appropriate  and effective  for people  trying  to                                                                   
 access care.                                                                                                                   
                                                                                                                                
 Senator  Wilson  appreciated  the  comments  from  committee                                                                   
 members. He  had hoped  the bill  would  increase access  to                                                                   
 care. His intention was not to increase the  state's burden.                                                                   
 He thanked the committee for hearing the bill.                                                                                 
                                                                                                                                
 Co-Chair  MacKinnon reflected  that  Mr.  Zepp  had  been  a                                                                   
 pleasure to work with in answering questions  from committee                                                                   
 members and from her team.  She was thankful that there  was                                                                   
 an enthusiastic  effort to  meet and  answer questions  that                                                                   
 were difficult to answer.                                                                                                      
                                                                                                                                
 Vice-Chair Bishop  MOVED  to  report CSSB  105(FIN)  out  of                                                                   
 Committee   with   individual   recommendations   and    the                                                                   
 accompanying fiscal notes.                                                                                                     
                                                                                                                                
 There being NO OBJECTION, it was so ordered.                                                                                   
                                                                                                                                
 CSSB 105(FIN)  was  REPORTED out  of  committee with  a  "do                                                                   
 pass" recommendation  and with  one new  forthcoming  fiscal                                                                   
 impact  note  from  the  Department  of  Health  and  Social                                                                   
 Services and one new fiscal impact note from  the Department                                                                   
 of Commerce, Community and Economic Development.                                                                               
                                                                                                                                
 9:42:33 AM                                                                                                                   
 AT EASE                                                                                                                        
                                                                                                                                
 9:46:35 AM                                                                                                                   
 RECONVENED                                                                                                                     
                                                                                                                                

Document Name Date/Time Subjects
CSSB 104 Bill version Y.pdf SFIN 3/29/2018 9:00:00 AM
SB 104
CSSB 104 Sponsor Statement version Y.pdf SFIN 3/29/2018 9:00:00 AM
SB 104
CSSB 104 Sectional Analysis ver Y.pdf SFIN 3/29/2018 9:00:00 AM
SB 104
SB 105 - Senate Finance Q A.pdf SFIN 3/29/2018 9:00:00 AM
SB 105
SB 105 - Letters of Support.pdf SFIN 3/29/2018 9:00:00 AM
SB 105
CS SB 105 FIN wrok draft v N.pdf SFIN 3/29/2018 9:00:00 AM
SB 105
CSSB 105(FIN) - Summary of Changes.pdf SFIN 3/29/2018 9:00:00 AM
SB 105
SB 104 Von Imhof Document ParentRoadmap_ELA_3.pdf SFIN 3/29/2018 9:00:00 AM
SB 104
SB 104 Von Imhof Document - ParentRoadmap_Math_5.pdf SFIN 3/29/2018 9:00:00 AM
SB 104