Bill Summary – FastDemocracy

State of Alaska
                                                            Fiscal Note
                                                                                               Bill Version:                     CSSSHB 54(HSS)
 2018 Legislative Session
                                                                                               Fiscal Note Number:               2
                                                                                               (H) Publish Date:                 2/2/2018
 Identifier:       HB054SS-DHSS-BVS-1-25-18                                      Department:       Department of Health and Social Services
 Title:            TERMINALLY ILL: ENDING LIFE OPTION                            Appropriation: Public Health
 Sponsor:          DRUMMOND                                                      Allocation:       Bureau of Vital Statistics
 Requester: House HSS                                                            OMB Component Number:              961
 Expenditures/Revenues
 Note: Amounts do not include inflation unless otherwise noted below.                                                                  (Thousands of Dollars)
                                                 Included in
                                    FY2019       Governor's
                                Appropriation      FY2019                                             Out-Year Cost Estimates
                                  Requested       Request
 OPERATING EXPENDITURES               FY 2019        FY 2019       FY 2020                       FY 2021           FY 2022             FY 2023         FY 2024
 Personal Services
 Travel                                     1.8                        1.8
 Services                                   5.0                       40.4                           36.4                 37.5             37.5             37.5
 Commodities
 Capital Outlay
 Grants & Benefits
 Miscellaneous
 Total Operating                            6.8           0.0         42.2                           36.4                 37.5             37.5             37.5
 Fund Source (Operating Only)
 1004 Gen Fund (UGF)                             6.8                               42.2              36.4                 37.5             37.5             37.5
 Total                                           6.8                0.0            42.2              36.4                 37.5             37.5             37.5
 Positions
 Full-time
 Part-time
 Temporary
 Change in Revenues
 None
 Total                                           0.0                0.0                 0.0            0.0                 0.0              0.0              0.0
 Estimated SUPPLEMENTAL (FY2018) cost:            0.0                      (separate supplemental appropriation required)
 (discuss reasons and fund source(s) in analysis section)
 Estimated CAPITAL (FY2019) cost:                 140.0                    (separate capital appropriation required)
 (discuss reasons and fund source(s) in analysis section)
 ASSOCIATED REGULATIONS
 Does the bill direct, or will the bill result in, regulation changes adopted by your agency?                  yes
 If yes, by what date are the regulations to be adopted, amended or repealed?                                  01/01/20
 Why this fiscal note differs from previous version/comments:
 Not applicable; initial version.
 Prepared By:            Jay C. Butler, MD, Chief Medical Officer                                                    Phone:          (907)269-6680
 Division:               Public Health                                                                               Date:           01/25/2018
 Approved By:            Shawnda O'Brien, Asst. Commissioner                                                         Date:           01/25/18
 Agency:                 Health and Social Services
Printed 2/2/2018                                                          Page 1 of 2                                                         Control Code: fnXwk
                                                                                                        CSSSHB 54(HSS) - Fiscal Note 2
                                                  FISCAL NOTE ANALYSIS
STATE OF ALASKA                                                                    BILL NO. SSHB054
2018 LEGISLATIVE SESSION
Analysis
   HB54 version O adds a new statutory chapter, Sec. 13.55, Voluntary termination of life (effective January 1, 2019) that
   allows terminally ill Alaska residents age 18 or older to request and use prescribed medications to voluntarily terminate
   their own life. Under current Alaska law, it is illegal to intentionally aid another person in committing suicide. The bill
   requires a health care provider to file with the Department of Health and Social Services a copy of the record of dispensing
   the medication.
   Given passage of this bill, Alaska would join six states and the District of Columbia in allowing voluntary termination of life
   for residents: Oregon, Washington, Vermont, Montana, California, and Colorado. As is true in these other states, this bill
   requires the Department to:
   -Annually review a sample of the records required under this chapter.
   -Develop and adopt regulations to facilitate the collection of information about compliance with this chapter.
   -Develop and distribute the forms necessary to implement the new law.
   -Collect and track the forms required by the new law.
   -Generate a statistical report of the information collected under this chapter.
   If Alaska experienced about the same rate of participation as Oregon per year, it would be expected that less than 40
   voluntary termination of life applications would be submitted and less than 20 deaths would result. According to the 2015
   Oregon Death with Dignity Act report, there were 218 Death with Dignity Act prescriptions written to requesting
   individuals in Oregon; of those, 125 individuals, or just over half, ingested the prescribed medication and died as
   expected. No individual that ingested the medication regained consciousness nor died first of the terminal condition. For
   Oregon, this corresponds to 38.6 Death with Dignity Act deaths per 10,000 total deaths.
   The Bureau of Vital Statistics would be responsible for implementing the duties of the Department under a voluntary
   termination of life law. The bill allows the Department to adopt regulations after the effective date of January 1, 2018.
   Bureau staff does not have the capacity or expertise required to develop complex regulations and do extensive outreach.
   Therefore, a $5.0 contract for professional services would be needed for the latter half of FY2019 and again in the first
   part of FY2020. Based on Washingtons and Oregons experience with their death with dignity laws, it is expected it will
   take six months to develop the preliminary draft regulations and forms required by this new chapter, followed by a series
   of public meetings to get input from stakeholders, with a target of regulations being in place by January 1, 2020. A small
   amount of travel would be associated with stakeholder meeting facilitation in several areas of the state.
   The Bureau would require a one-time capital appropriation to add a custom module to its existing Electronic Vital Records
   System. Additional funds would be required in the out years to maintain and license the system module as an addition to
   a current, ongoing contract with an automatic 3% increase annually through FY2021. After 2021, the contract must be re-
   negotiated; therefore, FY2022-2024 do not include the 3% increase. The module would store electronic copies, track the
   forms required by this law and produce the statistical report. Although only a small number of applications and deaths are
   anticipated annually, a simple spreadsheet will not be sufficient to collect, track and analyze forms. Washington State
   initially tried implementing their death with dignity act without a data base application, but that turned out to be an
   unwieldy solution.
   Given passage of this bill, the Department would provide training, register forms received by health care providers, and
   prepare the annual report. This training would be provided to funeral homes and health care providers regarding the
   proper completion of death certificates for voluntary termination of life patients to ensure confidentiality is maintained.
   Based off Oregons ongoing FTE estimates, less than 1/10th of one FTE is required to register the forms; the personal
   services costs can be absorbed within the current appropriation.
(Revised 9/26/17 OMB/LFD)                                                                                             Page 2 of 2
HB054SS-DHSS-BVS-1-25-18                                        Page 2 of 2                                                 Control Code: fnXwk
Statutes affected: 
HB0054A, AM HB 54, introduced 01/18/2017: 11.41.115, 11.41.100, 11.41.110, 11.41.120, 13.55.030, 13.55.050, 13.55.060, 47.32.900, 13.55.070, 13.55.090, 13.55.130, 13.55.080, 13.55.100, 13.55.110, 13.55.120, 13.55.140, 13.55.150, 13.55.160, 13.55.170, 08.64.336, 13.55.180, 13.55.190, 13.55.200, 13.55.210, 40.25.100, 13.55.220, 13.55.230, 21.45.250, 13.55.240, 13.55.900, 13.55.010
HB0054B, AM SSHB 54, introduced 03/27/2017: 11.41.115, 11.41.100, 11.41.110, 11.41.120, 13.55.030, 13.55.050, 13.55.070, 13.55.110, 13.55.060, 13.55.080, 13.55.090, 13.55.100, 13.55.120, 13.55.130, 13.55.140, 13.55.150, 13.55.160, 13.55.170, 08.64.336, 13.55.180, 13.55.190, 13.55.200, 13.55.210, 40.25.110, 13.55.220, 13.55.230, 13.55.240, 21.45.250, 13.55.250, 13.55.900, 33.30.901, 13.55.010
HB0054C, AM CSSSHB 54(HSS), introduced 02/02/2018: 11.41.115, 11.41.100, 11.41.110, 11.41.120, 13.56.030, 13.56.050, 13.56.060, 47.32.900, 13.56.070, 13.56.090, 13.56.130, 13.56.080, 13.56.100, 13.56.110, 13.56.120, 13.56.140, 13.56.150, 13.56.160, 13.56.170, 13.56.180, 13.56.190, 08.64.336, 13.56.200, 13.56.210, 13.56.220, 13.56.230, 40.25.110, 13.56.240, 13.56.250, 13.56.260, 21.45.250, 13.56.270, 13.56.290, 33.30.901, 13.56.010