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Health and Human Services Interim Committee

MINUTES OF THE

HEALTH AND HUMAN SERVICES INTERIM COMMITTEE

July 15, 1998 - 2:00 p.m. -- Room 405 State Capitol



Members Present:    
    Sen. Nathan C. Tanner, Senate Chair
    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. Bryan D. Holladay
    Rep. Carl R. Saunders
    Rep. Raymond W. Short



    
Members Absent:

    Sen. Craig L. Taylor
    Rep. Margaret Dayton
    Rep. J. W. "Bill" Hickman
    Rep. Robert H.M. Killpack

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 June 17, 1998 Minutes -- Chair Tanner called the meeting to order at 2:10 p.m. and welcomed the members of the committee.

     MOTION: Rep. Davis moved to approve the minutes of the June 17, 1998 meeting. The motion passed unanimously. Sen. Montgomery was absent for the vote.

2.    Genetic Testing Privacy Act
    Mr. Gary Thorup, representing Pharmaceutical Research and Manufacturers of America ("PhRMA"), read the following statement by PhRMA in opposition to 1998 H.B. 271, Genetic Testing Privacy Act. "PhRMA strongly opposes, as originally written, Utah House Bill 271, which would regulate access to and use of genetic information of an individual. PhRMA applauds and supports the intent of the legislation to protect the confidentiality of individual patient information, but also believes that any legislation on this issue must protect the continued viability of research that promotes improved health care for all patients." Mr. Thorup urged the the Legislature to take care that any legislation designed to better protect privacy also ensures that medical research can continue to yield new remedies and better ways of caring for patients. In response to a question, Mr. Thorup said that he would provide a written response to the committee from the industry on the issue of using a gatekeeper to ensure confidentiality rather than stripping individual identifiers from genetic information.

    Mr. Chet Loftis highlighted information from the handout Testimony on Genetic Testing Privacy summarizing testimony presented to the committee from the following perspectives: (1) clinical, Dr. Stephanie Hallam; (2) general policy, Mr. Mark Rothstein; (3) life insurance, Dr. Steven Zimmerman; (4) health insurance, Mr. L. Carl Volpe; and (5) research, Dr. David Viskochil. Mr. Loftis also made the committee aware of additional information used in drafting this legislation from other sources and provided preliminary observations.

    Chair Stephens, sponsor of the legislation, commented that genetic testing privacy issues need to be dealt with on the state level. She stated that the interim study has been very productive in resolving concerns with the 1998 bill.

3.    Children's Health Insurance Program Update
    
Mr. Chad Westover, Children's Health Insurance Program of Utah (CHIP), updated the committee on the implementation of the new CHIP created in 1998 by H.B. 137. Mr. Westover explained that Utah will deliver the insurance through a public/private partnership that will provide coverage through several private managed care health plans and will be funded with funds received from Utah's hospitals. He reported that the Utah State Health Plan was submitted to the U.S. Department of Health and Human Services on April 1, approval of the Health Plan was awarded on July 10, and CHIP will begin on August 3, 1998. He noted that the only change required to the Health Plan was the addition of the definition of "access to other coverage" which states that if an employer contributes 50 percent or more to the premium, there is reasonable access to insurance. Rep. Short asked about the authority to define "access to other coverage." Mr. Westover responded that broad rulemaking authority was given to the Department in implementing the program.

     Mr. Westover then distributed and reviewed Attachment C, Covered Services, Limitations and Co-Payment Requirements and Title Plan XXI Plan Submission and Approval. He said phase one of the promotion of CHIP will include public service announcements, eligibility workers at over 100 sites statewide, hospitals, schools, community-based organizations, and a hotline for inquiries. If enrollment is not sufficient, phase two will be more aggressive.

4.    "Date Rape" Drugs
    Mr. Mark Andrews briefed the committee on the abuse and control of drugs often referred to as "date rape" drugs with the intent that the committee decide if any action needs to be taken. Mr. Andrews identified flunitrazepam, gamma hydroxybutyrate (GHB), and ketamine as drugs abused for purposes of sexual assault. He reported regarding the effects of these drugs, the prevalence of their distribution and abuse, available tools to deter and prosecute distribution and use, and policy options for Utah. He explained that flunitrazepam is a sedative that is obtained by diversion from countries where it is legally distributed, is ten times as strong as Valium, and physically and psychologically incapacitates women for sexual assault. GHB is a

central nervous system depressant that is readily obtainable by mail order in ready-to-mix kits from sources on the Internet, may be made from materials that are readily available, and may result in drowsiness, unconsciousness, coma, and death. Ketamine is an anesthetic used mainly for veterinary purposes and causes delirium and inability to remember what occurred while under its influence.

    Mr. Andrews informed the committee that Congress passed federal legislation H.R. 4137, The Drug-Induced Rape Prevention and Punishment Act of 1996 in response to this problem. He reviewed policy options the Legislature may consider including enhancing penalties in the sexual offense statutes, placing GHB and ketamine on the state controlled substances schedule, improving and standardizing protocols for testing, and providing education for avoidance and reporting.

     MOTION: Sen. Montgomery moved that staff draft legislation enhancing the penalty for use of drugs in committing a rape. The vote passed unanimously. Rep. Holladay was absent for the vote.

    Mr. Val Bateman, Utah Medical Association, recommended using general language such as "the use of illegal drugs" rather than naming specific drugs.

5.    Mental Health Authority and Administration Reform
    Chair Tanner explained that because H.B. 352, Mental Health Authority and Administration Reform, did not pass in the 1998 General Session, the committee will consider a revised version of the bill. Ms. Hancock highlighted the following revisions to 1998 H.B. 352 found in the 1999 draft legislation: (1) clarifies that policy is set by the state Board of Mental Health, not by the division or department; (2) governs only the use of public funds, and redefines "public funds"; (3) does not require that the local mental health authority ensure that its contract provider not violate the law, only that the mental health authority require its contract provider not to violate the law or contract provisions; (4) only requires the local mental health authority to take timely (not immediate) corrective action; (5) provides that the local mental health authority is not responsible for the state's cost of enforcement, only for repayment of actual public funds that were used or expended in violation of the statute; (6) allows the local mental health authority to recover any funds that it has to repay the state from the private provider; (7) provides that the local mental health authority's "certification" that its private provider is in compliance with the law only needs to be based on receipt and review of the independent audit and a formal interview with the provider's executive officers; and (8) no longer requires the Division of Mental Health to have a certified list of auditors, but only to verify that the auditor chosen by the local mental health is truly independent.

    Chair Tanner explained that this revised legislation is necessary to protect public funds and individuals who rely on mental health services. He invited Commissioner Carol Page, Davis

County Commission, and Mr. John Tanner, Utah Behavioral Information Network, to address the committee regarding this legislation.

    Commissioner Page expressed concerns with the bill including: (1) contract services between the county and the private provider should be drafted to hold private providers accountable and responsible; (2) legislative consideration needs to be given to the concept, scope, and definition of local mental health authorities; and (3) contract providers, as the ultimate implementation agency, should also be given commensurate levels of responsibility and liability. Ms. Hancock explained how the legislation addresses these concerns. Commissioner Page also pointed out that the proposed legislation addresses mental health authorities but not substance abuse authorities and suggested that perhaps the two should be treated similarly.

    Mr. Tanner raised questions concerning the revised legislation. He stated that if the responsibilities of private providers increase, funds should also increase. He also requested that a reference be included regarding rules for expenditures of funds. Ms. Robin Arnold-Williams, Department of Human Services, responded that the state guidelines are found in the state finance policy and are readily available. Mr. Tanner discussed the responsibilities for oversight provided in the bill and argued that local authorities may not be able to meet the requirement to assure that the conditions listed in the bill are complied with.

6.    Other Business - No other business was discussed.

7.    Adjournment--

     MOTION: Rep. Carlson moved to adjourn the meeting at 4:25 p.m. The motion passed unanimously.


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