HOUSE COMMITTEE ON HEALTH AND HUMAN SERVICES

 

March 7, 2003 Hearing Room D

9:00 A.M. Tapes 45 – 48

 

MEMBERS PRESENT:            Rep. Jeff Kruse, Chair

Rep. Billy Dalto, Vice-Chair

Rep. Carolyn Tomei, Vice-Chair

Rep. Gordon Anderson

Rep. Jeff Barker

Rep. Laurie Monnes Anderson

Rep. Ben Westlund

 

STAFF PRESENT:                  Sandy Thiele-Cirka, Committee Administrator

Mara McGraw, Committee Assistant

 

ISSUES HEARD:                     HB 2631 – Public Hearing

                                                Informational Meeting

·         Prescription Patient Assistance Programs—

Community Perspective

 

These minutes are in compliance with Senate and House Rules.  Only text enclosed in quotation marks reports a speaker’s exact words.  For complete contents, please refer to the tapes.

 

TAPE/#

Speaker

Comments

TAPE 45, A

004

Chair Kruse

Calls meeting to order at 9:10 A.M. and opens public hearing on HB 2631.

HB 2631 – PUBLIC HEARING

006

Rep. Bob Jenson

Rep. Bob Jenson, House District 58. Submits written testimony in support of HB 2631 (EXHIBIT A). Offers background on bill. Presents impact of bill on patient access to health records. Relates personal story regarding inability to obtain personal lab results. 

125

Rep. Bob Jenson

Continues presentation on HB 2631. Refers to the Health Insurance Portability and Accountability Act (HIPAA), Clinical Lab Improvement Amendment (CLIA) and Oregon statute. Summarizes purpose and intent of -1 amendment (EXHIBIT B). 

208

Rep. Monnes Anderson

Inquires on laboratory input and logistics of delivering lab results to patients.

215

Rep. Jenson

Explains volume of requests to rural and urban labs.

230

Rep. Anderson

Comments on HIPAA regulations.

260

Catherine Otto

Chair, Government Affairs Committee, Oregon Association of Clinical Laboratory Science. Offers written testimony in support of bill (EXHIBIT C). Explains process for patient access to lab results. Addresses increase in lab result requests.   

302

Elizabeth Smith

Laboratory technologist, Oregon Association of Laboratory Science. Requests -1 amendment reflect traditional explanation of laboratory medicine relating to maintenance of health and well being, monitoring of treatment or evidence of disease. 

333

Chair Kruse

Comments on language. Inquires on HIPAA.

345

Otto

Reports no issue with HIPPA.

348

Mike Spiels

Director, State Public Health Laboratory (SPHL), Department of Human Services (DHS). Reports SPHL is neutral on HB 2631. Speaks to laboratory “indirect care relationship” defined by HIPAA. Reads from HIPPA privacy rule guidelines.

394

Chair Kruse

 Speaks to the intent of HIPAA.

400

Spiels

Comments on eliminating barriers to patient access.

404

Rep. Anderson

Points out HIPAA issues related to mailing lab results.

TAPE 46, A

002

Rep. Monnes Anderson

Questions the financial impact to public lab and clinical lab access.

012

Spiels

Reports on the inability to predict number of results that will be requested. Notes clinical labs may get more requests than public labs. 

032

Chair Kruse

Calls recess. Reconvenes (NOTE: Tape does not reflect reconvening of meeting).

033

Tim Martinez

Representing Oregon Medical Association (OMA). Reports on potential consequences to patients if lab results are released directly to patient. Submits and explains proposed amendment language (EXHIBIT D). 

088

Chair Kruse

Inquires on definition of “materially detrimental.”

089

Martinez

Reports this term is in the physician’s professional medical opinion. 

097

Chair Kruse

Comments language implies physician’s need to assess patient’s state of mind.

104

Rep. Barker

Inquires on cost to implement.

111

Martinez

Reports release of medical records as part of a routine.

117

Chair Kruse

Requests opinion from OMA’s Health Insurance Portability and Accountability Act (HIPAA) expert.

126

Martinez

Reports amendment drafted by outside counsel.

135

Rep. Jenson

Responds to OMA comments. Speaks to current applicability of statue. Comments on timeline to access primary care physician. Continues explanation of personal experience and notes concern with the changes in health care.   

230

Rep. Dalto

Inquires on ability of patients to interpret and understand lab results. 

246

Rep. Jenson

Reports patients can understand their lab results.

252

Chair Kruse

Reports need for clarification on amendments and HIPAA before moving bill. 

260

Rep. Monnes Anderson

Requests amendments clarify handling of false positives and other critical issues with lab results. 

280

Rep. Jenson

Offers closing remarks.

282

Chair Kruse

Closes public hearing on HB 2631and opens informational meeting.

INFORMATIONAL MEETING

297

Delina Porter

Consumer. Submits written testimony (EXHIBIT E). Comments on testimony of Pfizer representative from 03/03/03 meeting. Relates personal experiences with patient drug assistance programs. 

TAPE 45, B

011

Porter

Continues presentation on community perspective. Describes challenges such as required tax returns, varying rules and regulation from doctor offices and pharmaceutical companies, access to FAX machines, transportation issues and other barriers for mental health consumer access to assistance programs. Comments on financial coverage of prescriptions by assistance programs.

100

Ellen Pinney

Executive Director, Oregon Health Action Campaign. Relates barriers and issues with current prescription assistance programs. Presents suggestions to increase patient accessibility. Comments on SB 9 and the lack of implementation of the toll free access number. Relates results of lack of access to prescriptions. Discusses Medically Needy Program (EXHIBIT F-green page). References the Families U.S.A. report (EXHIBIT F).   

223

Tim Miller

Helpline Coordinator, Oregon Health Access Project. Submits written testimony (EXHIBIT G). Discusses indigent programs and notes they do not fill the current demand. States assistance programs are not a comprehensive solution. Explains hotline center.

257

Vice-Chair Tomei

Inquires on difference between documented calls and undocumented calls.

268

Miller

Explains helpline process for answering and documented calls. Relates process for accessing assistance programs. Reports some clinics charge clients for assistance through assistance program application process.  Continues testimony.   

337

Rep. Barker

Inquires on poverty level formula.

338

Pinney

Unable to answer question.

351

Rep. Anderson

Inquires on funds raised via community partners.

363

Pinney

Reports coalition members donate to advocacy efforts. Notes that foundations are interested in assisting.

381

Vice-Chair Tomei

Comments on documented calls to helpline.

385

Miller

Speaks to marketing, capacity and training of volunteers to expand helpline.

392

Pinney

Speaks to minimal advertising due to current inability to assist volume of callers. 

411

Rep. Dalto

Comments on volume of calls to Governors Ombudsman Office.

424

Pinney

Notes process and assistance provided by Ombudsman Office. Speaks to need for current information.

TAPE 46, B

011

Rob Wheaton

Consumer. Speaks to process involved in completing paperwork to access patient assistance programs. Notes extended timeline in assistance programs response to application request.

035

Don Golden

Consumer. Relates personal experience in accessing patient assistance programs. Reports option to travel out of the country to obtain medications. Provides personal medical history, financial means and required prescriptions. 

076

Rep. Dalto

Inquires on drugs related to transplant rejection.

078

Wheaton

Explains required medication immediately after transplant and on-going prescription needs. Discusses coverage of immunosuppressant and Medicare policies.

098

Nannette Ringering

Submits written testimony (EXHIBIT H). Relates challenges in accessing patient assistance programs in regard to vulnerable populations. Speaks to frequent changes in pharmaceutical company management and subsequent patient assistance programs.

164

Marsha Katz

Consumer. Submits written testimony (EXHIBIT I). Relates personal experience with patient assistance programs. Reports cost of prescriptions and lack of Medicare coverage. Discusses income limitations. Offers suggestions to expand coverage of patient assistance programs. 

236

William Glennen

Consumer. Relates personal experience with mental health issues and patient assistance programs. Speaks to inability to afford both daily expenses and prescriptions. Relates challenge and barriers in accessing patient assistance programs for patients using psychotropic drugs.   

332

Robert Childs

Community Treatment Clinician, Cascadia Behavioral Health Care. Submits written testimony (EXHIBIT J). Relates experiences of client population in living with mental health issues and prescription drugs programs.

394

Vice-Chair Tomei

Inquires on reference to available beds.

395

Childs

Concurs beds are psychiatric. Speaks to issues with patient access to prescription assistance programs. Describes results of current gap in services. 

TAPE 47, A

020

Tim Nesbitt

President, Oregon AFL-CIO. Submits written testimony (EXHIBIT K). Encourages committee to think broadly in considering solutions to the issue of patient access to assistance programs. Speaks to costs of prescription drugs (EXHIBIT K-pages 6-7). Relates need for more affordable prescription drugs. Suggests bulk purchasing by state.    

083

Rose Spears

Chairperson, Oregon Action-Portland and Consumer. Submits written testimony (EXHIBIT L). Testifies on income limitations, prescription costs and personal experiences with accessing patient assistance programs.

132

Vern Smith

Consumer. Submits written testimony (EXHIBIT M). Provides personal experience with accessing patient assistance programs. Reports Social Security Administration (SSA) offered comment on divorce or separation as a financial solution to access services.

186

Catherine Bax

Physician Assistant, Virginia Garcia Clinic. Addresses clinic and indigent patient’s issues regarding the patient assistance programs.  Speaks to frequent changes in assistance programs rules and regulations. Inquires on standardizing programs and/or forms.   

266

Eric Landen

Co-Chair, Client Advisory Board Multnomah County HIV Services Center; Associate Member, HIV Planning Council; Consumer. Relates personal experience living with terminal illness and accessing patient assistance programs. Discusses Ryan White funds, dual diagnosis, and the need for additional revenue.

375

Rep. Westlund

Notes fiscal impact of not providing adequate health care.

389

Bill Hancock

Multnomah County Community Health Council and Consumer. Relates income limitations, prescriptions costs and personal experiences with patient assistance programs.  

TAPE 48, A

005

Bill Hancock

Continues testimony on patient assistance programs. Addresses cost to safety-net clinic. Reports having to go without life saving prescriptions due to lack of coverage through patient assistance programs.

057

Rep. Westlund

Inquires on cost of HIV drugs.

058

Hancock

Reports $1500 per month.

059

Landen

Reports $2000-2200 per month.

060

Rep. Westlund

Clarifies that doe not include witness’ heart medications.

061

Hancock

Concurs.

065

Vice-Chair Tomei

Requests pharmaceutical lobbyists view tape of today’s meeting. Closes informational meeting and adjourns the meeting at 11:28 A.M.

 

EXHIBIT SUMMARY

 

A – HB 2631, written testimony, Rep. Bob Jenson, 2 pp.

B – HB 2631, -1 amendment, staff, 1 p.

C – HB 2631, written testimony, Catherine Otto, 1 p.

D – HB 2631, proposed amendment language, Tim Martinez, 1 p.

E – Informational, written testimony, Delina Porter, 1 p.

F – Informational, packet, Ellen Pinney, 34 pp.

G – Informational, written testimony, Tim Miller, 7 pp.

H – Informational, written testimony, Nannette Ringering, 2 pp.

I – Informational, written testimony, Marsha Katz, 5 pp.

J – Informational, written testimony, Robert Childs, 1 p.

K – Informational, packet, Tim Nesbitt, 7 pp.

L – Informational, written testimony, Rose Spears, 1 p.

M – Informational, written testimony, Vern Smith, 2 pp.