Legislature(2009 - 2010)BELTZ 105 (TSBldg)

03/10/2010 01:30 PM Senate HEALTH & SOCIAL SERVICES

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01:31:05 PM Start
01:33:47 PM Confirmation Hearings
02:11:08 PM SB46
02:26:28 PM SB172
03:04:50 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Location Change --
Confirmation of Governor's Appointments
Moved CSSB 46(HSS) Out of Committee
Heard & Held
<Note: Above previously heard bill has
been added back onto the Agenda>
Bills Previously Heard/Scheduled
              SB 172-ALASKA HEALTH CARE COMMISSION                                                                          
2:26:28 PM                                                                                                                    
CHAIR  DAVIS announced  consideration  of SB  172.  It was  heard                                                               
SENATOR DONALD OLSON, sponsor of SB  172 said the bill relates to                                                               
the  authorization of  the Alaska  Health  Care Commission.  This                                                               
will be a permanent commission  to address health care issues and                                                               
rising  health care  costs. He  noted that  a proposed  committee                                                               
substitute (CS) was distributed to members.                                                                                     
CHAIR   DAVIS  asked   Mr.  Obermeyer   to  review   the  changes                                                               
represented in the proposed CS.                                                                                                 
2:28:17 PM                                                                                                                    
TOM OBERMEYER, staff to Senator  Davis, said the only substantive                                                               
difference between  the proposed CS  and the original bill  is on                                                               
page 3,  line 6,  relating to the  composition and  membership of                                                               
the commission  under Sec. 18.09.020.  Version S  designates that                                                               
there will be 12 commission  members; nine voting members will be                                                               
appointed by  the governor, including the  state medical director                                                               
as chair, and three nonvoting  members will be ex officio members                                                               
from  the House,  the Senate,  and  Office of  the Governor.  The                                                               
original bill designated a 10 member commission.                                                                                
2:30:51 PM                                                                                                                    
SENATOR PASKVAN  moved to  adopt the  work draft  CS for  SB 172,                                                               
labeled  26-LS0790\S, as  the working  document.  There being  no                                                               
objection, version S was before the committee.                                                                                  
CHAIR  DAVIS  pointed out  that  the  CS designates  the  medical                                                               
examiner  as chair  but it  doesn't  identify who  will fill  the                                                               
other  seats. A  separate handout  proposes the  organizations or                                                               
groups they  might represent, but  the designations will  be made                                                               
following committee  discussion and  public testimony.  She noted                                                               
that  the commissioner  of the  Department of  Health and  Social                                                               
Services (DHSS)  wrote to  ask that  the commission  remain small                                                               
and to suggest  that if the membership is increased  that the new                                                               
members  should  represent  [primary   care  physicians  and  the                                                               
behavioral  health provider  community.] It  was the  sponsor who                                                               
recommended adding two members for a total of 12, she said.                                                                     
SENATOR  DYSON observed  that  this seems  to be  a  good way  to                                                               
handle it.                                                                                                                      
2:34:28 PM                                                                                                                    
JAMES  J.  JORDAN,  Executive   Director,  Alaska  State  Medical                                                               
Association, said  ASMA represents physicians statewide  and they                                                               
support creating  the Alaska Health  Care Commission  in statute.                                                               
However,  they would  like the  committee  to consider  physician                                                               
representation  on this  commission,  both general  practitioners                                                               
and general  surgeons. He  opined that physicians  need to  be at                                                               
the  table  helping   develop  Alaska's  comprehensive  statewide                                                               
health care policy and helping  the commission fulfill its duties                                                               
in developing the  strategies necessary to improve  the health of                                                               
all Alaskans.                                                                                                                   
SENATOR  DYSON asked  if one  of the  voting members  should have                                                               
significant experience  in rural Alaska  or does he  believe that                                                               
the  physician  representation   he  suggested  would  adequately                                                               
represent the medical delivery teams in rural Alaska.                                                                           
MR. JORDAN said  he believes that the  general practitioner could                                                               
represent  the health  care professionals  that are  part of  the                                                               
healthcare delivery team, particularly with telemedicine.                                                                       
2:38:02 PM                                                                                                                    
SENATOR  PASKVAN observed  that  the proposed  position number  8                                                               
designates a primary  care physician who is  licensed to practice                                                               
in  the  state  and  is   board  certified.  He  asked  if  board                                                               
certification  is a  meaningful  requirement and  if  ASMA has  a                                                               
position on that.                                                                                                               
MR. JORDAN  replied it's becoming  uncommon to find  primary care                                                               
physicians who  are not board  certified in Alaska.  He described                                                               
the requirement  as forward looking  in light of the  movement to                                                               
require   board   certification   and  continuing   renewals   in                                                               
licensures and certifications of competence.                                                                                    
CHAIR DAVIS said  she'd like the administration to  speak to that                                                               
because it was their recommendation.                                                                                            
2:40:10 PM                                                                                                                    
DEBORAH   ERICKSON,  Executive   Director,  Alaska   Health  Care                                                               
Commission  (AHCC),  said  she works  within  the  Department  of                                                               
Health and  Social Services (DHSS)  and she is speaking  today on                                                               
behalf of both  DHSS and AHCC. She confirmed  that DHSS suggested                                                               
the language  related to the  additional seat for a  primary care                                                               
physician who  practices family  medicine, primary  care internal                                                               
medicine, or pediatric  medicine in the state.  Because it's very                                                               
rare  now for  somebody  to be  practicing  and licensed  without                                                               
having board  certification in  any of  these fields,  DHSS would                                                               
have  no  objection  to  adding   clarifying  language  that  the                                                               
individual  practicing  would  also  be required  to  have  board                                                               
certification in that particular field.                                                                                         
2:42:02 PM                                                                                                                    
SENATOR PASKVAN  asked if she  said the department  wouldn't mind                                                               
if the board certification requirement were removed.                                                                            
MS.  ERICKSON replied  DHSS doesn't  have a  concern with  either                                                               
adding   or   leaving   out   the   provision   requiring   board                                                               
CHAIR  DAVIS said  the  committee  needs to  discuss  and make  a                                                               
decision on  that matter. She  asked if  she's seen the  list the                                                               
committee is considering.                                                                                                       
MS. ERICKSON answered no.                                                                                                       
CHAIR DAVIS  said it was her  intention to take testimony  on the                                                               
proposed  list of  commission members  before  making a  decision                                                               
about what to put in the final CS.                                                                                              
MS.  ERICKSON  said  she'd  like  to  first  speak  to  the  AHCC                                                               
recommendation  about  the  size  of  the  commission.  The  AHCC                                                               
January  report   included  a  recommendation  for   a  permanent                                                               
commission   established   in   statute   and   responsible   for                                                               
comprehensive,  sustained,  accountable, and  transparent  health                                                               
system  improvement planning  for  the  state. They  specifically                                                               
recommended  that the  commission  remain the  same  size as  the                                                               
existing commission, which  is seven voting and  three ex officio                                                               
members.  AHCC   made  that  recommendation  with   the  specific                                                               
understanding that there was some  support for a larger body. The                                                               
concern  is  that  a  larger   commission  would  not  facilitate                                                               
communication  and decision  making  and that  it  might in  fact                                                               
function  more  as  an  advocacy   body.  Thus,  for  reasons  of                                                               
efficiency and  the function of  the group, AHCC wanted  to state                                                               
on the record that the existing body worked well.                                                                               
2:45:30 PM                                                                                                                    
MS. ERICKSON  said the Department  of Health and  Social Services                                                               
also believes  that the commission  should maintain  a relatively                                                               
small size, but the two  additional seats would be acceptable. If                                                               
these are  added, DHSS recommends  that they be designated  for a                                                               
primary care  physician and a representative  from the behavioral                                                               
health  provider community.  Although they're  somewhat different                                                               
than DHSS suggested, she believes  that the department would find                                                               
the  descriptions   for  the  primary  care   physician  and  the                                                               
behavioral health provider acceptable.                                                                                          
2:46:57 PM                                                                                                                    
JEFF JESSEE,  CEO, Alaska Mental Health  Trust Authority (AMHTA),                                                               
said AMHTA  wants a seat  at the table  too. He is  familiar with                                                               
the struggle  to keep a group  small enough to be  functional and                                                               
still  represent  all  of the  necessary  aspects  adequately  so                                                               
decisions  are fully  informed and  representative of  the issues                                                               
that  need to  be considered.  While he's  pleased that  there is                                                               
interest  in  adding  behavioral  health  representation  to  the                                                               
commission, he  believes that it's  critical to have  someone who                                                               
has   a  system   wide  perspective.   He  confirmed   this  with                                                               
Commissioner  Hogan and  he expected  the DHSS  representative to                                                               
convey that  the department would  support the  behavioral health                                                               
representative   being   a    representative   of   AMHTA.   That                                                               
representative  might be  a provider  or an  administrator of  an                                                               
organization but  they would be  able to represent  the interests                                                               
of the behavioral health system and  have a systemic view of this                                                               
issue. This  would bring  the type  of expertise  and information                                                               
that would be most helpful to the commission, he concluded.                                                                     
SENATOR DYSON asked if the  mental health community would include                                                               
people who deal with substance abuse.                                                                                           
MR.  JESSEE   answered  yes;  the   term  behavioral   health  is                                                               
universally  used  to denote  both  mental  health and  substance                                                               
2:51:01 PM                                                                                                                    
WAYNE  STEVENS,  President  and  CEO,  Alaska  State  Chamber  of                                                               
Commerce (ASCC),  related that he has  served as a member  of the                                                               
Health  Care  Commission  for  the   past  year.  This  temporary                                                               
commission expires this  year and while it began  to address many                                                               
relevant  issues, it  doesn't have  time to  address them  to the                                                               
degree required. Alaska's health  care system needs adjustment in                                                               
order to provide cost effective,  quality access to residents and                                                               
the best  first step to address  these issues is to  establish in                                                               
statute   the  Alaska   Health  Care   Commission.  Experts   and                                                               
representatives of  key stakeholders appointed to  this body will                                                               
form a  plan to realign the  system. The Alaska State  Chamber of                                                               
Commerce  supports  a  permanent  commission  that  will  provide                                                               
recommendations to the governor  and Legislature that will result                                                               
in  a health  care system  that provides  quality and  affordable                                                               
access to  all Alaskans. The  ASCC also supports  including seats                                                               
on the commission for the state chamber and for primary care.                                                                   
2:53:29 PM                                                                                                                    
SENATOR DYSON asked if he has a specific member to recommend.                                                                   
MR. STEVENS  replied he isn't seeking  a seat for himself  and he                                                               
doesn't have a specific recommendation,  but he does believe that                                                               
the  business  community needs  representation  because  it is  a                                                               
significant contributor to the health  care system. He added that                                                               
he has  an interest in  the health  care community and  served on                                                               
the  Kodiak  hospital  board  for   about  14  years.  And  as  a                                                               
representative of the  business community he has  an interest and                                                               
understanding of how  to control and contain  costs. According to                                                               
testimony the commission received, there  are four basic parts to                                                               
the cost  equation in the drivers  of health care: 50  percent is                                                               
personal responsibility;  20 percent is the  environment in which                                                               
you live; 20  percent is genetics; and 10 percent  is the cost of                                                               
access to  health care.  When you're  not addressing  the largest                                                               
part  of the  problem  it's  not productive  to  argue about  the                                                               
smallest part of the problem, he concluded.                                                                                     
2:56:51 PM                                                                                                                    
SHELLY HUGHES,  Alaska Primary  Care Association  (APCA), thanked                                                               
the committee  for adding  a primary care  position to  the bill.                                                               
She echoed  Mr. Jessee's statement  that a representative  with a                                                               
system perspective would  benefit the commission more  than say a                                                               
solo  practice physician  who is  focused on  patient care.  APCA                                                               
could  provide  this  perspective   for  medical,  basic  dental,                                                               
behavior  health,  and  the  many   primary  care  provider  type                                                               
positions. While  the position  could be  filled by  a physician,                                                               
administrators  sometimes have  a  better overall  sense of  what                                                               
works in  the overall system,  she said. Because primary  care is                                                               
so key  to costs and  prevention, it's important to  have someone                                                               
with this system approach, she concluded.                                                                                       
CHAIR DAVIS  said she would  take direction from the  members and                                                               
the sponsor with respect to  the proposed list of representatives                                                               
before she had a new CS drafted.                                                                                                
2:59:05 PM                                                                                                                    
SENATOR OLSON  said he  agrees that a  large commission  could be                                                               
unwieldy, but busy schedules can  make it difficult to get enough                                                               
people to  a meeting  to get a  fair cross  section, particularly                                                               
with health  care providers.  Referencing the  earlier discussion                                                               
about board certification, he said  he doesn't support that idea.                                                               
Another concern  relates to the governor  making the appointments                                                               
because it  vests too  much power  in that  office. He  asked the                                                               
committee to consider the alternatives.                                                                                         
CHAIR  DAVIS said  she and  the  committee would  take that  into                                                               
consideration,  but  the  governor  wouldn't  have  full  control                                                               
because people  would submit their  application and  the governor                                                               
would have to select from the list.                                                                                             
3:03:12 PM                                                                                                                    
DENISE LICCIOLI,  Staff to Senator  Olson, referenced  an earlier                                                               
statement   that   the   sponsor   asked   for   the   commission                                                               
representatives  listed on  the handout  and said  that's correct                                                               
for  the  first seven  positions  but  not  eight and  nine.  The                                                               
sponsor  clarified that  he doesn't  support the  requirement for                                                               
board certification for position eight  and for position nine the                                                               
sponsor requested  a member from  the Alaska Mental  Health Trust                                                               
CHAIR DAVIS held SB 172 in committee.                                                                                           

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