ARIZONA HOUSE OF REPRESENTATIVES
Forty-eighth Legislature –First Regular Session
Minutes of Meeting
House Hearing Room 4 -- 9:00 a.m.
Chairman Stump called the meeting to order at 9:04 a.m. and attendance was noted by the secretary.
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Mrs. Barto |
Mr. Lopes |
Mr. Murphy, Vice-Chairman |
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Mr. Bradley |
Ms. Lopez |
Mr. Stump, Chairman |
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Ms. Burns J |
Mrs. Mason |
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Mrs. Groe |
Mrs. Saradnik |
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H.B. 2114 – DPA (7-3-0-0) |
H.B. 2125 – DPA (9-0-0-1) |
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H.B. 2134 – DPA (9-0-0-1) |
H.B. 2268 – DP (10-0-0-0) |
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H.B. 2438 – DPA (10-0-0-0) |
H.B. 2439 – DPA (8-2-0-0) |
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H.B. 2515 – DPA (7-0-0-3) |
H.B. 2517 – NO TIME |
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H.B. 2518 – NO TIME |
H.B. 2519 – DISCUSSED AND HELD |
Kristine Stoddard, Majority Research Analyst, Financial Institutions and Insurance Committee
Michelle Bolton, National Federation of Independent Business (NFIB)
Henry Grosjean, Arizona National Association of Insurance and Financial Advisors
Karlene Wenz, Department of Insurance (DOI)
Rebecca McQuade, Majority Research Intern
Persons recognized who did not speak: pages 2, 3, 4, 7, 9, 11, and 12
Danelle Kelling, Hearing Healthcare Providers of Arizona
Ingrid McBride, Arizona Speech and Hearing Association (ArSHA)
Jason Isaak, Arizona Speech and Hearing Association (ArSHA)
Tabitha Buck, representing self
Michele Michaels, Valley Center of the Deaf, and Community Outreach Program for the Deaf
Steve Barclay, Hearing Healthcare Providers of Arizona (HHPA)
Joel Cmiel, Hearing Healthcare Providers of Arizona (HHPA)
Randy Collins, representing self
Barry Aarons, Arizona Association of Chiropractic (AAC)
Debra Brimhall, Arizona Chiropractic Society (ACS)
Dr. Richard Guarino, representing self
Amanda Weaver, Arizona Osteopathic Medical Association (AOMA)
Norris Nordvold, City of Phoenix
Irene Stillwell, representing self
Dan Brown, Majority Research Analyst
Rory Hays, Maricopa County
Philip Keen, M.D., representing self
Don Hughes, Arizona State Board of Pharmacy
Mindy Rasmussen, Arizona Pharmacy Alliance
Representative Marion McClure, Sponsor
Dale Norris, Arizona Police Association (APA)
CONSIDERATION OF BILLS:
H.B. 2134, small business; uniform health questionnaire – DO PASS AMENDED
Vice-Chairman Murphy moved that H.B. 2134 do pass.
Vice-Chairman Murphy moved that the proposed 16-line Stump amendment
dated 2/6/07 be adopted (Attachment 1).
Kristine Stoddard, Majority Research Analyst, Financial Institutions and Insurance Committee, summarized H.B. 2134 and the proposed Stump amendment (Attachment 2).
Michelle Bolton, National
Federation of Independent Business (NFIB), spoke in support of
H.B. 2134. She said the NFIB represents over 10,000 small businesses in Arizona. Ms. Bolton explained the bill would allow the Department of Insurance to assemble
a group of insurance carriers and small business owners for developing a
uniform Health Status Questionnaire. This would allow a small business to
submit one form to multiple carriers to obtain an insurance rate quote.
Mr. Lopes asked if an insurance company could deny coverage based on an applicant’s answers to the questionnaire. Ms. Bolton replied small businesses would not be denied health insurance under an accountable health plan.
Henry Grosjean, Arizona National Association of Insurance and Financial Advisors, spoke in support of H.B. 2134.
Mr. Lopes asked how many accountable health plan carriers there are in Arizona. Mr. Grosjean replied less than fifty.
In response to query from Mr. Lopes, Mr. Grosjean explained the questionnaire would be a convenience for both the small employer and for the accountable health plan.
Persons recognized as to H.B. 2134 who did not speak:
Support
David Childers, America’s Health Insurance Plans
Steve Barclay, CIGNA HealthCare of Arizona
Don Isaacson, Golden Rule Insurance
Todd Sanders, Greater Phoenix Chamber of Commerce
Jessica Pacheco, Arizona Chamber of Commerce
Emilie Isaacs, Arizona Small Business Association
Charles Bassett, Blue Cross/Blue Shield of Arizona
Eileen Klein, United Healthcare
Kelsey Lundy, United Healthcare
Eileen Sigmund, Arizona Small Business Association
Neutral:
Kevin B. DeMenna, AETNA
Mr. Lopes asked how many people are currently covered.
Karlene Wenz, Department of Insurance (DOI), replied there are over one million covered employees.
Mr. Lopes asked if H.B. 2134 would lead to an increase in health coverage by small business owners. Ms. Wenz replied no.
Question was called on the motion that the proposed 16-line Stump
amendment dated 2/6/07 be adopted (Attachment 1). The motion
carried.
Vice-Chairman Murphy moved that H.B. 2134 as amended do pass.
The motion carried by a roll call vote of 9-0-0-1 (Attachment 3).
H.B. 2515, hearing aid dispensers; continuing education – DO PASS AMENDED
Vice-Chairman Murphy moved that H.B. 2515 do pass.
Rebecca McQuade, Majority Research Intern, summarized H.B. 2515 (Attachment 4).
Vice-Chairman Murphy moved that the proposed 13-line Murphy
amendment dated 2/6/07 be adopted (Attachment 5).
Ms. McQuade explained the proposed Murphy amendment makes changes in continuing education requirements.
Danelle Kelling, Hearing Healthcare Providers of Arizona, spoke in support of H.B. 2515.
Persons recognized as to H.B. 2515 who did not speak:
Support
Robert Baber, Hearing Healthcare Providers of Arizona
Steve Barclay, Hearing Healthcare Providers of Arizona
Joel Cmiel, Hearing Healthcare Providers of Arizona
Neutral
Pete Wertheim, Department of Health Services
Henry Grosjean, Arizona Association of Insurance and Financial Advisors, spoke in opposition to H.B. 2515. He said the insurance industry does not require continuing education for agents licensed in Arizona, but only for agents who are licensed out of state.
Question was called on the motion that the proposed 13-line Murphy
amendment dated 2/6/07 be adopted (Attachment 5). The motion carried.
Vice-Chairman Murphy moved H.B. 2515 as amended do pass. The motion
carried by a roll call vote of 7-0-0-3 (Attachment 6).
H.B. 2439, dispensers; audiologists; speech-language pathologists – DO PASS AMENDED
Vice-Chairman Murphy moved that H.B. 2439 do pass.
Rebecca McQuade, Majority Research Intern, summarized H.B. 2439 (Attachment 7).
Persons recognized as to H.B. 2439 who did not speak:
Support
Jason Isaak, Arizona Speech and Hearing Association (ArSHA)
Virginia Clark-Wright, representing self
George J. Roberts, representing self
Robert Wolter, representing self
Bill Schafer, representing self
Brian Mathieson, representing self
Amit Gosalia, representing self
Gabrielle Sadowsky, representing self
Debra Venkatesh, representing self
Wanda Barrett, representing self
Robin Scoins, Arizona Family Rights Advocacy Institute
Troy Hale, representing self
Bob Scharber, representing self
Melanie Orourke, representing self
Aileen Fuller, representing self
Opposed
Randy Collins, representing self
Robert Baber, Hearing Healthcare Providers of Arizona
Lloyd Musselman, representing self
Neutral
Pete Wertheim, Department of Health Services
Ingrid McBride, Arizona Speech and Hearing Association (ArSHA), spoke in support of
H.B. 2439. She said the bill provides the necessary language to prevent misrepresentation
to consumers of the qualifications of an audiologist or hearing aid dispenser.
She said Arizona statute defines the scope of a hearing aid dispenser to
include only the fitting and dispensing of hearing aids.
Chairman Stump said a phrase in the bill states “any variation or synonym of these words or terms” which strikes him as vague. Ms. McBride said the intent of the phrase is that it be solely descriptive of one’s services and profession.
Jason Isaak, Arizona Speech and Hearing Association (ArSHA), said he is aware that the restrictive nature of the phrase will be an issue of discussion.
Ms. Lopez said she has a proposed amendment (Attachment 8) which would address the issue of the vagueness of the phrase “variation or synonym,” and asked if ArSHA would object to her amendment.
Mr. Isaak said ArSHA would not support the proposed Lopez amendment.
Mrs. Barto agreed with Ms. Lopez that the attempt of the bill is to address the higher education standard for audiologists. She said she has received many letters and e-mails from audiologists expressing concern with the terminology aspect of the bill.
Tabitha Buck, representing self, spoke in support of H.B. 2439. She said the bill provides needed updates to the audiology licensure requirements in Arizona. The bill updates language to require the doctoral degree in audiology, which is a clinical degree, and adds the requirement that the doctoral degree must be from an accredited program.
In response to query from Chairman Stump, Ms. Buck said Masters level training in audiology is not available in Arizona, or in other states.
In response to query from Mrs. Saradnik, Ms. Buck replied that doctoral candidates receive extensive training in the practice of fitting hearing aids.
Michele Michaels, Valley Center of the Deaf, and Community Outreach Program for the Deaf, spoke in support of H.B. 2439.
Mrs. Saradnik asked if there is consumer confusion as to the use of the terms audiology, audiologist and hearing aid dispenser. Ms. Michaels replied yes.
Steve Barclay, Hearing Healthcare Providers of Arizona (HHPA), a statewide professional association of licensed hearing aid dispensers, spoke in opposition to H.B. 2439. He said that HHPA views the proposed bill as a competitive move described as consumer protection. He said HHPA objects to the exemption from taking the State Hearing Aid Dispensing Examination for new four-year graduates. He distributed an Examination for License fact sheet (Attachment 9), and a statement against the bill from Burt Schapiro, Audioprosthologist (Attachment 10).
Joel Cmiel, representing self, spoke in opposition to H.B. 2439.
Mrs. Saradnik asked if any audiologist has ever failed the licensing examination. Mr. Cmiel replied yes, and further explained each state has an exam, and that providers are involved in the creation of the examination.
Vice-Chairman Murphy moved that the proposed 23-line Barto amendment
dated 2/5/07 be adopted (Attachment 11).
Ms. McQuade explained the proposed Barto amendment requires the use of words such as audiology, doctor of audiology, audiometry, audio pathologist, and abbreviations and variations in any written communication, not just advertising and signs. The amendment stipulates that courses sponsored by a single hearing aid manufacturer can count for no more than four hours of continuing education towards license renewal requirements.
Randy Collins, representing self, spoke in opposition to H.B. 2439. He said the bill would ensure an increase in the growing shortage of audiologists while preventing a future solution to the problem it will help create. He said hard-of-hearing and deaf consumers would not benefit from H.B 2439. In addition, H.B. 2439 would exempt dispensing audiologists from taking the state hearing aid dispensing exam, when in fact, the state exam needs to be revised and strengthened to reflect the needs of the 450,000 hard-of-hearing and deaf people living in Arizona.
Question was called on the motion that the proposed 23-line Barto amendment
dated 2/5/07 be adopted (Attachment 11). The motion carried.
Ms. Lopez said she would not offer her proposed amendment (Attachment 8), but that she believes it is critical that the parties work out the issue of terminology. Chairman Stump agreed.
Vice-Chairman Murphy moved that H.B. 2439 as amended do pass. The
motion carried by a roll call vote of 8-2-0-0 (Attachment 12).
H.B. 2114, AHCCCS; chiropractic services – DO PASS AMENDED
Vice-Chairman Murphy moved that H.B. 2114 do pass.
Vice-Chairman Murphy moved that the proposed 22-line Stump amendment
dated 2/5/07 be adopted (Attachment 13).
Rebecca McQuade, Majority Research Intern, summarized H.B. 2114 (Attachment 14). She explained the proposed Stump amendment changes enrollment in the pilot program from one group of 3,000 members to three groups of 500 members.
Barry Aarons, Arizona Association of Chiropractic (AAC), spoke in support of H.B. 2114 with the Stump amendment. Mr. Aarons said the pilot program is subject to legislative appropriation. He said the bill with the amendment is a reasonable approach to a demonstration project that could determine whether the concerns about primary referral in a capitated Arizona Health Care Cost Containment System (AHCCCS) are valid, and if patients who need chiropractic care will benefit from the program.
Mr. Lopes said he is concerned about the role of the primary care provider (PCP). He said he believes AHCCCS is successful because of the gatekeeper concept. The bill does not require that the PCP be involved in referral of a patient to chiropractic services.
Mr. Aarons said AAC believes that AHCCCS understands the system of gatekeeper under managed care better than anyone does. Therefore, AAC suggests that a reasonable compromise is to allow AHCCCS to determine the process.
Debra Brimhall, Arizona Chiropractic Society, spoke in support of H.B. 2114 with the Stump amendment.
Dr. Richard Guarino, representing self, spoke in support of H.B. 2114 with the Stump amendment.
Amanda Weaver, Arizona Osteopathic Medical Association (AOMA), spoke in opposition to H.B. 2114. She noted that when this bill was heard in the Health Committee last week, it was suggested that a stakeholder meeting be held. She said neither the AOMA nor the Arizona Medical Association received an invitation to a stakeholder meeting. Ms. Weaver said the proposed amendment for the chiropractic care program is an intelligent approach. However, it does not address the objections of the physician community. She said the AOMA opposes the 12 visit minimum portion of the pilot program.
Ms. Burns said the amendment removes the 12 visit minimum.
Persons recognized as to H.B. 2114 who did not speak:
Support
Sharon Muggli, representing self
Robin Scoins, Arizona Family Rights Advocacy Institute
Oppose
Genevra Richardson, Health Choice
David Landrith, Arizona Medical Association
Barbara Meaney, Vanguard Health Systems for Phoenix Health Plan
Eileen Klein, APIPA
Laura Hahn, Arizona Academy of Family Physicians
Jake Logan, Mercy Care Health Plan
Kelsey Lundy, APIPA
Neutral
Jennifer Hott, AHCCCS
Todd Sanders, Greater Phoenix Chamber of Commerce
Question was called on the motion that the proposed 22-line Stump amendment
dated 2/5/07 be adopted (Attachment 13). The motion carried.
Ms. Burns moved that H.B. 2114 as amended do pass. The motion carried by a
roll call vote of 7-3-0-0 (Attachment 15).
H.B. 2519, appropriation; senior olympics – DISCUSSED AND HELD
Chairman Stump said H.B. 2519 is an information-only bill.
Vice-Chairman Murphy moved that H.B. 2519 do pass.
Rebecca McQuade, Majority Research Intern, summarized H.B. 2519 (Attachment 16).
Norris Nordvold, City of Phoenix, spoke in support of H.B. 2519.
Irene Stillwell, representing self, spoke in support of H.B. 2519. She said there is a need to do something to help keep seniors well, fit and independent, which is what Senior Olympics is about. She said it is a health program that uses sports as a vehicle for keeping seniors well and happy.
Vice-Chairman Murphy moved to withdraw the motion that H.B. 2419
do pass. The motion carried.
H.B. 2125, county medical examiners - DO PASS AMENDED
Vice-Chairman Murphy moved that H.B. 2125 do pass.
Dan Brown, Majority Research Analyst, summarized H.B. 2125 (Attachment 17).
Vice-Chairman Murphy moved that the proposed 3-page Stump
amendment dated 2/5/07 be adopted (Attachment 18).
Mr. Brown explained the proposed Stump amendment adds a number of definitions and several provisional changes.
Rory Hays, Maricopa County, spoke in support of H.B. 2125 with the proposed Stump amendment. She said the most important aspect of the bill is that it intends to organize the statute to provide more clarification and to reflect current practices.
Philip Keen, M.D., representing self, spoke in opposition to H.B. 2125 and the proposed Stump amendment. He said the bill would impose a primarily urban system upon the entire state.
In response to query from Mr. Lopes, Dr. Keen said he was an Associate Medical Examiner in Maricopa County from 1986 through 1992, and Chief Medical Examiner from 1992 through 2005.
Mr. Lopes asked if the current medical examiners in the state agree with Dr. Keen’s position on H.B. 2125.
Dr. Keen replied those medical examiners he has talked with do not believe the law needs to be changed.
Mrs. Groe asked what impact the bill would have on Beaver Dam, Littlefield, and those types of areas.
Dr. Keen replied the biggest expense in administering large geographic areas for death investigation is transportation.
Mrs. Groe asked if transportation expense includes transporting a body from outlying areas to Phoenix or other areas, and what would be the cost to the counties.
Dr. Keen replied the cost per body is about $125 to $140 base, plus fee per mile.
Mrs. Groe clarified there is the expense of transportation, and the expense of hiring additional people to work in each office. Dr. Keen said the costs would be to the counties. He said he is a contractor working in a county office. A medical investigator must go to every death scene.
Mrs. Groe asked if Dr. Keen had an alternative to the bill.
Dr. Keen replied the bill is not necessary. Everything specified in the bill can be done under existing law.
Ms. Hays said that based on Dr.
Keen’s comments there are some things that are not well understood. She said
H.B. 2125 was discussed with various medical examiners and the County
Supervisors’ Association. She said there is nothing in the bill that requires
the medical examiner or a medical examiner representative to be on the scene of
an accident. It allows, but does not require, that medical death investigators
can do some of the things that medical examiners do. She said the bill
clarifies that autopsies are necessary only for certain types of cases. She
said she has worked with small counties to try to establish appropriate
definitions. The practices used in the organ donation area did not reflect
current law. She said she strongly disagrees with
Dr. Keen that no changes are appropriate. She said she has worked with groups
to assure that present practice is reflected in the bill. Ms. Hays said that
transportation is an issue, but she does not believe the bill would create additional
transportation expenses.
Ms. Burns noted the portion of the bill that says, “take charge of the body” is existing law.
Persons recognized as to H.B. 2125 who did not speak:
Support
Todd Madeksza, County Supervisor’s Association
Ray Churay, Maricopa County Sheriff's Office
John Mangum, Sciencecare Anatomical, Inc.
Mark Fischione, Maricopa County Forensic Science Center
Gregory Harris, Donor Network of Arizona
Joseph Abate, Life Legacy Foundation
Neutral
Janet Regner, the Hopi Tribe
Question was called on the motion that the proposed 3-page Stump
amendment dated 2/5/07 be adopted (Attachment 18). The motion
carried.
Vice-Chairman Murphy moved that H.B. 2125 as amended do pass.
The motion carried by a roll call vote of 9-0-0-1 (Attachment 19.)
H.B. 2438, controlled substances; monitoring program – DO PASS AMENDED
Vice-Chairman Murphy moved that H.B. 2438 do pass.
Vice-Chairman Murphy moved that the proposed 2-page Barto amendment
dated 2/6/07 be adopted (Attachment 20.)
Dan Brown, Majority Research Analyst, summarized H.B. 2438 (Attachment 21). He explained the proposed Barto amendment removes the registration fee and replaces the fee with an appropriation from the Arizona State Board of Pharmacy funds in the sum of $395,795.00.
Don Hughes, Arizona State Board of Pharmacy, spoke in support of H.B. 2438. He said the bill creates a centralized database for controlled substances issued to individuals.
Mindy Rasmussen, Arizona Pharmacy Alliance, spoke in support of H.B. 2438. She said 32 states have enacted this type of legislation.
In response to query from Ms. Burns, Ms. Rasmussen explained that due to the issue of security and privacy of patients, the database would only be accessed by a pharmacist.
Ms. Lopes said there is a theory that people go to other states because of better health benefits. He asked if Ms. Rasmussen would provide him with information as to whether people do cross state lines to take advantage of state laws. Ms. Rasmussen replied she would try to get that information.
Mrs. Groe asked what the cost to implement this program is. She asked if the proposed bill would interfere with a patient who has unmanageable chronic pain.
Ms. Rasmussen replied in many cases patients are going to several physicians and several pharmacies to try to achieve pain control. This bill would provide that by going to one physician for chronic pain, that physician could address patient concerns and get the pain under control.
Mr. Hughes explained the costs of the Controlled Substances Prescription Monitoring Program (CSPMP) relate to creating the computerized database system. The Arizona State Board of Pharmacy will issue a Request for Proposal (RFP). There are certain vendors who currently do this work for pharmacies. He said there are federal grants available so there is no longer a registration fee, which is covered by the proposed Barto amendment.
Persons recognized as to H.B. 2438 who did not speak:
Support
Harlan Wand, Arizona State Board of Pharmacy
Marcus Osborn, representing self
Reed Elesvier, representing self
Teresa Jennings, State Government Affairs
Dean Wright, Arizona State Board of Pharmacy
Bill Everson, Chairman, Fraternal Order of Police, Arizona Labor Council
Bryan Soller, Arizona State Fraternal Order of Police
James Mann, Arizona Fraternal Order of Police
Matthew Taylor, Arizona Fraternal Order of Police
John Ortolano, Arizona Fraternal Order of Police
Janet Elliott, Arizona Community Pharmacy Committee
Neutral
Stuart Goodman, Arizona Medical Board
Question was called on the motion that the proposed 2-page Barto
amendment dated 2/6/07 be adopted (Attachment 20.) The motion
carried.
Vice-Chairman Murphy moved that H.B. 2438 as amended do pass.
The motion carried by a roll call vote of 10-0-0-0 (Attachment 22).
H.B. 2268, cancer insurance; firefighters; peace officers – DO PASS
Vice-Chairman Murphy moved that H.B. 2268 do pass.
Rebecca McQuade, Majority Research Intern, summarized H.B. 2268 (Attachment 23).
Representative Marion McClure, Sponsor, explained that last year cancer insurance was included as a retirement benefit for firefighters. She said H.B. 2268 would extend that insurance to peace officers in the state. She said the insurance is limited to job related cancers.
Dale Norris, Arizona Police Association (APA), spoke in support of H.B. 2268. He said the APA represents 6,500 peace officers. The cancer insurance benefit relates to industrial fires, chemical spills and leaks, and unknown devices that may contain hazardous materials. He said the insurance plan is self-insured. Employers pay premiums that are capped at $180 annually. He said it is likely that when peace officers are added to the plan, the premium will reduce further.
Persons recognized in support of H.B. 2268 who did not speak:
Kelsey Lundy, Arizona Police Association
John Ortolano, Arizona Fraternal Order of Police
Bill Everson, Arizona Fraternal Order of Police, Arizona Labor Council
Bryan Soller, Arizona State Fraternal Order of Police
James Mann, Arizona Fraternal Order of Police
Don Isaacson, Arizona Fraternal Order of Police
Matthew Taylor, Arizona Fraternal Order of Police
Andy Swann, Associated Highway Patrolmen of Arizona
Thomas Van Dorn, Arizona Association of Chiefs of Police and Phoenix Police
David Gore, Professional Fire Fighters of Arizona
Question was called on the motion that H. B. 2268 do pass. The motion
carried by a roll call vote of 10-0-0-0 (Attachment 24).
H.B. 2517, osteopathic board; continuation – NO TIME
H.B. 2518, respiratory care board; continuation – NO TIME
Without objection, the meeting adjourned at 12:00 p.m.
_______________________________
Yvette O’Connor, Committee Secretary
February 7, 2007
(Original minutes, attachments and disc are on file in the Office of the Chief Clerk.)
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COMMITTEE ON HEALTH
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February 7, 2007
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