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Health and Human Services Interim Committee

MINUTES OF THE

HEALTH AND HUMAN SERVICES INTERIM COMMITTEE

June 17, 1998 - 2:00 p.m. -- Room 405 State Capitol



Members Present:    
    Rep. Nora B. Stephens, House Chair
    Sen. Robert F. Montgomery
    Sen. Millie M. Peterson
    Sen. Pete Suazo
    Rep. Loretta Baca
    Rep. Mary Carlson
    Rep. Gene Davis
    Rep. Margaret Dayton
    Rep. Bryan D. Holladay
    Rep. Robert H.M. Killpack
    Rep. Carl R. Saunders
    Rep. Raymond W. Short


    
Members Absent:
    Sen. Nathan C. Tanner, Senate Chair
    Sen. Craig L. Taylor
    Rep. J. W. "Bill" Hickman

Staff Present:
    Mr. Mark D. Andrews
     Research Analyst
    Ms. Janetha W. Hancock
     Associate General Counsel
    Mr. R. Chet Loftis
     Associate General Counsel
    Ms. L. Kaye Clark
     Secretary

Note:    A list of others present and a copy of materials distributed in the meeting are on file in the Office of Legislative Research and General Counsel.
    

1.    Call to Order and Approval of Minutes _ Chair Stephens called the meeting to order at 2:10 p.m. and welcomed the members of the committee.

     MOTION: Rep. Carlson moved to approve the minutes of the May 20, 1998 meeting. The motion passed unanimously. Reps. Baca, Davis, Dayton, and Holladay were absent for the vote.
    
2.    Tax Credit for Stay-at-Home Parents
    Chair Stephens explained that Sen. Muhlestein sponsored S.B. 210, Income Tax Credit for Stay-at-home Parents or Guardian, during the 1998 General Session. The bill passed in the Senate but did not have a hearing in the House of Representatives. She noted that this bill was among the issues receiving the highest priority by the committee.

    Sen. Muhlestein presented S.B. 210 and explained that the bill creates a tax credit for a parent or guardian who stays at home and cares for one or more of his or her children under six years old and has an income of $3,000 or less . He pointed out that while there are tax credits for child care, there are no comparable credits for parents who provide care for their children at home. Sen. Muhlestein reported that studies show the importance of early childhood development and said that he considers this bill to be a preventive measure. He noted that the bill has a $17 million fiscal note. He then asked for input from the committee regarding the bill.

    Rep. Killpack urged the committee to support legislation that helps parents stay at home to raise their children. Rep. Carlson suggested a clarification in the bill of the ages of children that may be included in the tax credit. Rep. Davis said it may be advisable to include federal tax forms other than the W-2 and noted that this bill may discriminate against single parents on welfare who do not have the option to stay at home to care for their children. Rep. Dayton spoke in favor of the bill and argued that stay-at-home parents are being taxed to fund federal child care. The committee also discussed concerns that this tax credit may deprive the education system of revenue.

    Chair Stephens encouraged Sen. Muhlestein to present a final version of the bill to the committee at a future meeting.

3.    Portability of Funding
    Chair Stephens informed the committee that during the 1998 General Session the Legislature passed H.B. 372, Portability of Funding for Health and Human Services, requiring the Division of Services for People With Disabilities(DSPD) and the Division of Health Care Financing(DHCF) to conduct a study to identify alternatives for increasing the portability of state and federal funding for services to persons with disabilities. Chair Stephens said that, as required by the bill, the divisions would present a preliminary report. A final report will be presented to the Health and Human Services Interim Committee in October. Rep. Hogue provided background information and reported that there is a steering group in place to sort through the issues of portability.

    Ms. Sue Geary, Director, Services for People with Disabilities, distributed Disability Program Overview and Utah's System of Services for People with Disabilities. She presented information showing the cost of, and the total number of people using, the following programs: home and community based services, private intermediate care facilities for people with mental retardation, the Utah State Developmental Center, residential and day services, and other services. She said the purpose of the portability study is to provide a choice of available programs and support for those making a transition between programs.

    Mr. Michael Deily, Director, Division of Health Care Finance, Department of Health, explained that the current system is a dual system. He said that both systems are at capacity with the available funding which has created problems with portability (the ability to move between the systems). He distributed HB 372 _ Outline of Progress To Date, listing the members of the steering committee, non-voting participants, and the groups represented. Mr. Deily also identified some of the barriers to portability including lack of available resources, a moratorium on building additional facilities, and licensing requirements. He reported that the committee has met with a consultant from Utah State University in the Early Intervention Program and proposed that the study be completed in two parts: (1) a cost study that would provide a description of the differences in services and costs between the systems; and (2) a preference

study. Mr. Deily said the results of these studies will be reported to the committee at the October meeting. Rep. Davis added that an audit in this area will also be available at that time.

4.    Genetic Testing Privacy Act
    Chair Stephens announced that the committee would continue it's study of 1998 H.B. 271, Genetic Testing Privacy Act, focusing on health insurance and informed consent.

    Mr. Jeff Gabardi, Health Insurance Association of America (HIAA), introduced Mr. L. Carl Volpe, Vice President, Health Policy and Analysis, Wellpoint Health Networks, and distributed the handout HIAA, Testimony of L. Carl Volpe, PhD. Mr. Volpe said that medical advances have allowed genetic characteristics to be included with age, gender, weight, smoking, occupation, and health status as risk selection and risk classification factors. He said the addition of genetic information as a risk factor has increased fears about the denial of health insurance based on genetic discrimination. Mr. Volpe noted that the health insurance industry has defined genetic tests as those that link specific health conditions to specific genes or gene products.

    Mr. Volpe explained that the Health Insurance Portability and Accountability Act of 1996 (HIPAA) prohibits insurers offering group coverage from using genetic testing information in determining initial eligibility or renewal of coverage. However, insurers may use the information as a basis for raising rates. He said that regarding the individual market, genetic information cannot be used to deny renewal of coverage, however, the rate may be increased. He quoted a recent survey of the members of HIAA which showed that none of its members requires a genetic test as a condition of application for health coverage or renewal. He noted that federal law is silent on the use of genetic information in the initial coverage decision in the individual market because of the issue of risk spreading.

    Mr. Volpe said 30 states have either guarantee issue or specific prohibitions on the use of genetic testing at the individual level. He identified the following provisions in state legislation: (1) the definition of a genetic test is very narrow; and (2) the inclusion of "safe harbors" excluding certain routine tests from the genetic test prohibition. He cautioned that legislation aimed at improving access may increase costs, thereby decreasing access to individuals. He concluded that based on industry practice and current federal and state laws, the industry believes that no additional legislation to limit the use of genetic testing in health insurance risk assessment is necessary.

    Dr. David Viskochil, clinical geneticist, University of Utah, and a member of the Health Department's Genetics Advisory Committee, reported regarding concerns with research issues in H.B. 271. He said the advisory committee is in complete agreement with Section 26-40-112, which contains additional guidelines for research studies. On the other hand, he believes Section 26-40-114 would be difficult to implement because it requires retroactive consent. He explained

that established Institutional Review Boards (IRBs), already cover the guidelines included in the bill.
He recommended that IRBs continue to be used for research. Chair Stephens asked how confidentiality can be protected without retroactive consent. Dr. Viskochil responded that participants are asked to give consent for use of their samples for other purposes in the initial consent. He said another option is to make the samples anonymous. He said the key issue is to enforce the protocols.

5.    Other Business
        
    Report on the advisability of Utah Valley State College leasing Developmental Center land _ Chair Stephens informed the committee that S.B. 177, Review of Lease or Purchase of Utah State Developmental Center Land By Utah Valley State College, requires the Board of Regents to review the advisability of leasing developmental center land by Utah Valley State college and report its findings, conclusions, and recommendations to the Health and Human Services Interim Committee, the Education Interim Committee and the Executive Appropriations Interim Committee by July 1, 1998.

    Mr. Fred Hunsaker, staff to the Board of Regents, reported that the Legislature directed the Board of Regents to prepare a report addressing the following issues: (1) the need for an additional campus of Utah Valley State College; (2) the advisability of acquiring a portion of land associated with the Utah State Developmental Center near American Fork for such a campus; and (3) financial considerations for acquiring this site if it is deemed advisable. He reported that the study determined that there is a need for an additional campus in Utah County and that the developmental center land is a desirable location. Mr. Hunsaker recommended a contract purchase at fair market value and that the interest rate be based on a fair market rate.

    Mr. Doug West, Department of Human Services, reviewed information in the handout Utah Valley State College Land Study. He reported that the DSPD Board, the division director, and the superintendent of the Utah State Developmental Center agreed that the college will not have a negative impact on the developmental center. He believes there is an adequate buffer between the facility and the proposed campus. Mr. West said it is important to establish fair market value and a fair rate of return to ensure the highest possible return to the trust lands. The committee discussed options regarding future use of the property and financing considerations including long-term lease versus purchase.

    Mr. Kent Beirs will forward to the committee a copy of the Department of Facilities Construction and Management's response to this report.

6.    Adjournment--

     MOTION: Rep. Davis moved to adjourn the meeting at 4:40 p.m. The motion passed unanimously.

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