Legislature(2005 - 2006)CAPITOL 106

04/07/2005 03:30 PM HEALTH, EDUCATION & SOCIAL SERVICES


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Audio Topic
03:36:09 PM Start
03:37:41 PM HB193
04:53:54 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Continuation of Tues. 4/5/05 Mtg --
+= HB 193 LICENSING MEDICAL OR CARE FACILITIES TELECONFERENCED
Heard & Held
+= HB 13 SCHOOL CONSTRUCTION BOND REIMBURSEMENT TELECONFERENCED
<Bill Hearing Postponed>
+ Confirmation Hearing: Teaching Practices TELECONFERENCED
Commission
<Hearing Postponed>
Bills Previously Heard/Scheduled
 HB 193-LICENSING MEDICAL OR CARE FACILITIES                                                                                  
                                                                                                                                
 CHAIR WILSON announced that the first order of business  would be                                                              
 HOUSE  BILL  NO.   193  "An  Act   relating  to  the   licensing,                                                              
 regulation,  enforcement,   and  appeal   rights  of   ambulatory                                                              
 surgical centers, assisted living  homes, child care  facilities,                                                              
 child  placement  agencies,  foster  homes,  free-standing  birth                                                              
 centers, home  health agencies,  hospices or  agencies  providing                                                              
 hospice services,  hospitals,  intermediate care  facilities  for                                                              
 the  mentally  retarded,  maternity  homes,  nursing  facilities,                                                              
 residential  child  care   facilities,  residential   psychiatric                                                              
 treatment  centers,  and  rural   health  clinics;  relating   to                                                              
 criminal history requirements, and a registry, regarding  certain                                                              
 licenses, certifications,  approvals, and  authorizations by  the                                                              
 Department of  Health  and  Social  Services;  making  conforming                                                              
 amendments; and providing for an effective date."                                                                              
                                                                                                                                
3:37:41 PM                                                                                                                    
                                                                                                                                
RICHARD MANDSAGER, M.D., Director, Division of Public Health,                                                                   
Department   of  Health   and   Social  Services,   (Department),                                                               
explained that  HB 193 is a  governor's bill and that  there will                                                               
be an emphasis  to make necessary amendments and  move it forward                                                               
before the end  of the legislative session.  He  said that he has                                                               
received comments  of support and  ideas for  possible amendments                                                               
for HB 193 from eight or nine [human service] organizations.                                                                    
                                                                                                                                
DR. MANDSAGER pointed  out that there are  written amendments for                                                               
HB  193 included  in the  committee packet.   He  added that  the                                                               
intent  of HB  193 is  to consolidate  the various  licensing and                                                               
certification  activities of  the Department  including licensing                                                               
hospitals  and  assisted  living  homes.     HB  193  mandates  a                                                               
background  check   process  to   industries  regulated   by  the                                                               
Department and an  employee misconduct registry, he  related.  He                                                               
said:                                                                                                                           
                                                                                                                                
     [A  centralized registry]  exists today  with certified                                                                    
     nurse  aids, presently  administered  by  the Board  of                                                                    
     Nursing and  the registry concept  that's in  this bill                                                                    
     is  modeled  very  heavily on  what  exists  today  for                                                                    
     certified  nurse  aids   ...  the  employee  misconduct                                                                    
     registry deals  with civil issues of  abuse, neglect or                                                                    
     exploitation  and the  criminal background  check deals                                                                    
     with  criminal  activities  a   person  may  have  been                                                                    
     involved in  ... the complexity  that has  developed in                                                                    
     statute  and   regulation  ...  that  these   types  of                                                                    
     industries  have developed  ...  [have]  grown up  with                                                                    
     some   mixture   of    statute   and   regulation   all                                                                    
     individually developed.   [The] Department of  Law gets                                                                    
     to try and interpret this  every time we have an appeal                                                                    
     or administrative  hearing and has to  figure out where                                                                    
     this activity  fits and the organizations  that do more                                                                    
     than  one  type of  work  ...  they may  have  assisted                                                                    
     living  homes,  they  may  have  psychiatric  treatment                                                                    
     centers, they may have  other social service functions,                                                                    
     some  organizations might  have  hospitals and  nursing                                                                    
     homes;  they  have  to  keep  track  of  all  of  these                                                                    
     different  state rules  for  their  different parts  of                                                                    
     work.   ... the reason  for the bill  is to try  to put                                                                    
     into one  statute the various  rules ... and  then have                                                                    
     regulations that  are as much  similar as  possible ...                                                                    
     then regulations  can be adapted  to problems as  we go                                                                    
     forward over time  ... that's why we are  here today on                                                                    
     this journey that is going to be somewhat laborious.                                                                       
                                                                                                                                
 DR.  MANDSAGER referred  to  HB  193  [Version  24-GH1016\A]  and                                                              
 addressed  page  27,  line  26  where  [Section   47.05.330]  the                                                              
 centralized  registry   is  defined.     He   related  that   the                                                              
 centralized registry is based on the current certified  nurse aid                                                              
 registry but expands  it to  all employees.   He explained,  "The                                                              
 purpose is  to get  at people  who  have committed  exploitation,                                                              
 abuse or  neglect and  then, as  we develop  this registry,  this                                                              
 then becomes a barrier to their employment in  another industry."                                                              
 He said that he has received calls from two  different executives                                                              
 from  different   organizations  who  have   retold  stories   of                                                              
 employees that  they  fired for  Medicaid  fraud, who  were  then                                                              
 rehired  by sister  organizations  that  were  unaware  of  their                                                              
 [criminal] history.  He pointed out that the  employee misconduct                                                              
 registry would be public and available to executives  or employee                                                              
 organizations.                                                                                                                 
                                                                                                                                
 CHAIR WILSON  inquired as  to  who has  access to  [the  proposed                                                              
 employee misconduct registry].                                                                                                 
                                                                                                                                
 DR. MANDSAGER explained  that the state  would be providing  that                                                              
 information  to  the  employer.    He  said  that   the  criminal                                                              
 information [registry] is available  [to the public] through  the                                                              
 court system.                                                                                                                  
                                                                                                                                
 3:47:11 PM                                                                                                                   
                                                                                                                                
 REPRESENTATIVE  SEATON   inquired  as  to   the  registry   being                                                              
 available to the general public.                                                                                               
                                                                                                                                
 DR. MANDSAGER  said  that  the employee  misconduct  registry  is                                                              
 modeled on  the current certified  nurse aid  registry, which  is                                                              
 available to  the  public.    He added  that  the  Department  is                                                              
 looking for advice  from the House  Health, Education and  Social                                                              
 Services Standing Committee in  terms of the availability of  the                                                              
 [employee misconduct] registry.                                                                                                
                                                                                                                                
 3:48:00 PM                                                                                                                   
                                                                                                                                
 REPRESENTATIVE SEATON  inquired as to  what will  be included  on                                                              
 the [employee  misconduct] registry.   He  specifically asked  if                                                              
 offenses that are not proven will be included.                                                                                 
                                                                                                                                
 3:48:57 PM                                                                                                                   
                                                                                                                                
 DR. MANDSAGER stated  that what  is envisioned is  a registry  in                                                              
 which the employers would  make reports but the Department  would                                                              
have  to have  findings to  which an  employee would  be able  to                                                               
contest  and  have  administrative hearings,  before  their  name                                                               
would go  in some kind of  an activity that doesn't  have a court                                                               
action.  He referred  to page 28, line 5 of HB  193 and said that                                                               
there are  orders, judgments and adjudications  that the employee                                                               
has  committed  abuse,  neglect, or  exploitation  under  certain                                                               
statutes and they are listed.                                                                                                   
                                                                                                                                
CHAIR  WILSON  commented that  HB  193  will  pass in  the  House                                                               
Judiciary Standing Committee  next, and said that  she would like                                                               
this  section to  be looked  at closely  by the  members of  that                                                               
committee.                                                                                                                      
                                                                                                                                
3:50:19 PM                                                                                                                    
                                                                                                                                
VIRGINIA  STONKUS, Acting  Chief, Division  of Certification  and                                                               
Licensing, Division  of Public Health,  Department of  Health and                                                               
Social Services, clarified that  the employee misconduct registry                                                               
is based only  on action taken that has been  through a decision,                                                               
an  adjudication,  or  a  hearing and  proven  that  someone  has                                                               
abused, neglected,  or exploited  someone in  that field  that is                                                               
not necessarily of a criminal nature.  She explained:                                                                           
                                                                                                                                
     If you  are applying for  a job  in this field  for the                                                                    
     first  time, there  would be  no reason  to ever  be on                                                                    
     that registry.   If you are in that field  and there is                                                                    
     a  finding  ... reported  by  an  assisted living  home                                                                    
     provider, or  through the course  of an  inspection ...                                                                    
     and it  does go  through a hearing  or process  that we                                                                    
     can, in fact, substantiate,  that's when ... [it could]                                                                    
     go on  the registry.   The other  issues right  now, in                                                                    
     terms  of  what would  go  on  the registry,  would  be                                                                    
     enough information only to  identify the person through                                                                    
     name and,  perhaps, birthdate, and some  indication ...                                                                    
     that  there  was, in  fact,  something  found and  that                                                                    
     would be  the only information that  would be available                                                                    
     on that registry.                                                                                                          
                                                                                                                                
3:51:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GARDNER  inquired  as  to  the  adjudication  and                                                               
whether  issues  such  as  this   would  be  dealt  with  by  the                                                               
Department or in court.                                                                                                         
                                                                                                                                
MS. STONKUS  said, "Whether it has  to go through a  full, formal                                                               
hearing process or ... the hearing  would have to be initiated by                                                               
the  Department, through  the process  that we  would explore  if                                                               
 someone chose ... to challenge that, and want to have  a hearing,                                                              
 then we would do that."                                                                                                        
                                                                                                                                
 3:52:53 PM                                                                                                                   
                                                                                                                                
 REPRESENTATIVE CISSNA inquired as to how the Department  plans to                                                              
 deal with "problem" employees that possibly have  charges against                                                              
 them or that have had cases cleared out of court, but  are likely                                                              
 to "offend" again.                                                                                                             
                                                                                                                                
 DR. MANDSAGER pointed out  that the provider's responsibility  is                                                              
 to report a  concern, a suspicion,  or a  known activity and  the                                                              
 Department's responsibility  is to investigate  and conduct  some                                                              
 kind of a process to reach a finding.                                                                                          
                                                                                                                                
 3:54:49 PM                                                                                                                   
                                                                                                                                
 REPRESENTATIVE  CISSNA stated  that  the  concern  of  the  House                                                              
 Health, Education  and  Social  Services  Standing  Committee  is                                                              
 focused on the  quality of  health services.   She remarked  that                                                              
 [HB  193] can  offer  better  enforcement  of  quality  care  for                                                              
 children and adults that  are in vulnerable situations in  Alaska                                                              
 and through licensure the private sector can be affected.                                                                      
                                                                                                                                
 DR. MANDSAGER  stated that  the [Alaska  State Legislature]  will                                                              
 have to define the statute related to these issues.                                                                            
                                                                                                                                
 3:56:43 PM                                                                                                                   
                                                                                                                                
 REPRESENTATIVE CISSNA expressed her  concern in letting the  next                                                              
 committee of  reference deal  with  HB 193  when there  are  many                                                              
 issues of health and social welfare that are not yet resolved.                                                                 
                                                                                                                                
 CHAIR WILSON  stated that  she is  open to  adding any  necessary                                                              
 amendments and encouraged Representative  Cissna to make  changes                                                              
 to HB 193.                                                                                                                     
                                                                                                                                
 REPRESENTATIVE CISSNA  said that  she would  like  to spend  more                                                              
 time discussing HB 193 in the House Health, Education  and Social                                                              
 Services  Standing   Committee.    She   offered  that   [future]                                                              
 amendments could include defining the "screening" process.                                                                     
                                                                                                                                
 DR. MANDSAGER  referred  to  page  28,  line 23  of  HB  193  and                                                              
 explained that  the  information  contained in  the  registry  is                                                              
 available to the public.                                                                                                       
                                                                                                                                
REPRESENTATIVE  CISSNA  said  "[if] you're  talking  about  doing                                                               
something  else that  isn't in  here, that  ought to  be left  to                                                               
another bill."                                                                                                                  
                                                                                                                                
DR. MANDSAGER  addressed Representative  Cissna and said  that he                                                               
wanted to  clarify his statement,  in case he  didn't effectively                                                               
make his point.  He said:                                                                                                       
                                                                                                                                
     What  we  are  talking  about  is  ...  in  regulation,                                                                    
     defining this,  because it's clearly  going to  have to                                                                    
     be  much better  defined  ... but,  if the  Legislature                                                                    
     wants  more detail  and  more in  statute  ... that  is                                                                    
     possible.  We, currently,  are working on language that                                                                    
     could either  be in statute,  if the  Legislature wants                                                                    
     it that  way, or could  be in regulation to  define how                                                                    
     this process will work.                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON inquired  as to the intent  of the registry                                                               
and if it serves as  a preliminary background check for employers                                                               
to utilize.                                                                                                                     
                                                                                                                                
4:00:30 PM                                                                                                                    
                                                                                                                                
DR. MANDSAGER said:                                                                                                             
                                                                                                                                
     What I  envision that  an employee  misconduct registry                                                                    
     does is  if I am  an employer, [an applicant]  comes in                                                                    
     and wants  to apply for  work, I can quickly  type into                                                                    
     my computer,  [to] see if  Joe Smith has  committed any                                                                    
     of these activities ... if  so, I don't need to receive                                                                    
     an  employment  application  from Joe  Smith  ...  most                                                                    
     people won't  be on this  registry, because  they won't                                                                    
     have  committed these  activities  ...  [if] Joe  Smith                                                                    
     does  apply  [and isn't  listed  on  the registry]  ...                                                                    
     then, we  go through  the process  of doing  a criminal                                                                    
     background  check ...  by the  time they  are employed,                                                                    
     both parts of their past are known.                                                                                        
                                                                                                                                
4:01:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON opined that  there is an expense associated                                                               
to having the registry when  it is only listing adjudicated items                                                               
and the full background check is  required when a new employee is                                                               
hired.   He said he  is concerned  with Section 47.05.330  [of HB
193, Version  24-GH1016\A], Subsection (e).   He stated  that the                                                               
liability of putting in information  that hasn't been adjudicated                                                               
 as a barrier to employment, could be [a huge liability] for the                                                                
 State of Alaska.                                                                                                               
                                                                                                                                
 4:03:03 PM                                                                                                                   
                                                                                                                                
 DR. MANDSAGER  clarified that  the  employee misconduct  registry                                                              
 deals with civil issues  and the criminal background check  deals                                                              
 with  criminal  issues.    He  said  that  information   that  is                                                              
 unverified,  unsubstantiated,  or  unadjudicated  should  not  be                                                              
 incorporated into an applicant's record.                                                                                       
                                                                                                                                
 4:03:57 PM                                                                                                                   
                                                                                                                                
 REPRESENTATIVE SEATON clarified that the [employee misconduct                                                                  
 registry] will include civil cases.                                                                                            
                                                                                                                                
 4:04:34 PM                                                                                                                   
                                                                                                                                
 REPRESENTATIVE GARDNER said:                                                                                                   
                                                                                                                                
      I have a constituent who  brought this issue to me  ...                                                                   
      [he] has ... [a] large [business], he employs a  lot of                                                                   
      people who provide services  to frail adults,  elderly,                                                                   
      disabled people  ...  in their  homes.   He  has,  over                                                                   
      time, had a lot of  situations in which he had to  fire                                                                   
      an employee, for mistreatment  of any sort, for  fraud,                                                                   
      where  they've  billed  for  hours  that   they  didn't                                                                   
      actually work  ... as  an employer,  not  only does  he                                                                   
      fire  the  person  but  he  is  also   responsible  for                                                                   
      repaying that  money, and so,  he has  a liability  ...                                                                   
      then, he would find ... these people that he  fired for                                                                   
      whatever reason, were now working for  another provider                                                                   
      down the street ... there  was no legal way for him  to                                                                   
      tell them [to watch out for misconduct] ...                                                                               
                                                                                                                                
 REPRESENTATIVE GARDNER continued:                                                                                              
                                                                                                                                
      What's the threshold of  proof [for this registry]  ...                                                                   
      the state  can't afford  to  have a  trial for  all  of                                                                   
      these  things  ...  one  question  that  is  absolutely                                                                   
      legal, ... is, "Would you hire this person  again?" ...                                                                   
      and  the state  doesn't  have  to  have  any  panel  or                                                                   
      adjudication, nobody's  open  to  lawsuits,  we  simply                                                                   
      say, as  an employer,  "it is  my  responsibility if  I                                                                   
      want to  protect all  of the  people that  I am  caring                                                                   
      for, to  just  call  their previous  employer  and  ask                                                                   
      them."                                                                                                                    
                                                                                                                                
CHAIR WILSON said that there are cases where personalities                                                                      
conflict.  She pointed out that some employers would not rehire                                                                 
someone based on basic personality differences.                                                                                 
                                                                                                                                
4:07:34 PM                                                                                                                    
                                                                                                                                
MS. STONKUS said:                                                                                                               
                                                                                                                                
     As a licensing agency,  we are responsible for assuring                                                                    
     that the programs that we  fund meet the standards that                                                                    
     are set.  The issue of  the registry would be, if there                                                                    
     is a report ... they would  report to us, a concern for                                                                    
     abuse,  neglect, or  exploitation,  but  that would  be                                                                    
     part  of our  investigation  ...  to substantiate,  and                                                                    
     assure, that we found  enough information based on that                                                                    
     investigation to  support a concern ...  the individual                                                                    
     would  be  notified  that  we have  come  up  ...  with                                                                    
     substantial   findings   ...   they   would   have   an                                                                    
     opportunity to  request a full  review ...  making sure                                                                    
     that it  wasn't just  a personality  issue ...  if they                                                                    
     declined  ... then  the decisions  would  be made  that                                                                    
     they would  be eligible  for their  name going  on that                                                                    
     registry.  If they chose to  do the hearing and we went                                                                    
     through that process and that  finding was upheld, then                                                                    
     we have  the adjudication, and  the support ...  to put                                                                    
     that individual's name on the registry.                                                                                    
                                                                                                                                
MS.STONKUS continued:                                                                                                           
                                                                                                                                
     Throughout the  whole process ... [there  would be] ...                                                                    
     the chance  to go back  and challenge that there  was a                                                                    
     finding  that they  thought  was done  in  error ...  I                                                                    
     think our  concern and consideration, here,  is wanting                                                                    
     to  be respectful  of the  folks who  would be  on that                                                                    
     registry  ...  there  are enough  situations  where  we                                                                    
     could  not legally,  or through  the court  process, or                                                                    
     through the  criminal process,  find that  capacity ...                                                                    
     there's legal precedent to have this in place.                                                                             
                                                                                                                                
REPRESENTATIVE SEATON inquired as to  the necessity of making the                                                               
registry public  and available.   He opined that if  the registry                                                               
is public,  the names on it  could be published in  the newspaper                                                               
or made available in a number of ways that could be problematic.                                                                
                                                                                                                                
4:11:27 PM                                                                                                                    
                                                                                                                                
 DR. MANDSAGER  related that  there are  several  options when  it                                                              
 comes to creating the  registry.  The  first option, he said,  is                                                              
 that the  registry is open  to the  public.   The registry  could                                                              
 also be set up  so that employers have  to sign up and  passwords                                                              
 are assigned to qualified individuals to view [the  registry], he                                                              
 explained.   He pointed out  another scenario  where an  employer                                                              
 could call [the Department], and ask a staff member  for registry                                                              
 information.                                                                                                                   
                                                                                                                                
 4:12:31 PM                                                                                                                   
                                                                                                                                
 REPRESENTATIVE CISSNA  remarked that  the [employment  misconduct                                                              
 registry]  seems more  like  a  criminal  background  check  than                                                              
 anything else.    She  inquired  as to  how  the  registry  would                                                              
 function, who would make the decisions as to who was  included on                                                              
 it and  how appeals  would be  managed.   She  asked about  other                                                              
 states  [that   utilize  similar   registry's]   and  how   those                                                              
 registry's function.  She added that to utilize a  registry costs                                                              
 money and takes  time.  She  requested information pertaining  to                                                              
 the attached fiscal note.                                                                                                      
                                                                                                                                
 DR. MANDSAGER  addressed  Representative  Cissna's  concerns  and                                                              
 explained that the more rights that are given to  individuals for                                                              
 appeals will  create  a higher  cost  and  the fiscal  note  will                                                              
 increase.  The amendment process  related to this bill, he  said,                                                              
 will have to help balance these types of issues.                                                                               
                                                                                                                                
 4:15:43 PM                                                                                                                   
                                                                                                                                
 MS.  STONKUS explained  that  this  [registry]  is  part  of  the                                                              
 process of assuring  that the folks that  are regulated meet  the                                                              
 standards that they are supposed to.  She added that  this allows                                                              
 them another  opportunity to  take concerns  that  they find  and                                                              
 assure that they will not happen again.                                                                                        
                                                                                                                                
 4:16:55 PM                                                                                                                   
                                                                                                                                
 REPRESENTATIVE CISSNA expressed  that she  is very interested  in                                                              
 this  legislation  and  in  making  necessary  amendments.    She                                                              
 inquired as to the process  of creating the registry and why  the                                                              
 legislature was not included in it's development.                                                                              
                                                                                                                                
 4:17:47 PM                                                                                                                   
                                                                                                                                
 DR. MANDSAGER  said, "The  formal answer  ... is  that, at  least                                                              
 until a  bill got submitted,  there wasn't  really something  for                                                              
 you to  work  with.   The informal  answer  ... we  [could]  have                                                              
invited  some of  the legislators  to  work on  this process  ...                                                               
maybe we should have."                                                                                                          
                                                                                                                                
CHAIR WILSON  asked Representative  Cissna if  she would  like to                                                               
represent  the  [House  Health,  Education  and  Social  Services                                                               
Standing  Committee] with  the [Department]  as  they go  through                                                               
that process.                                                                                                                   
                                                                                                                                
REPRESENTATIVE CISSNA said that she would be thrilled.                                                                          
                                                                                                                                
CHAIR WILSON  stated that Representative  Cissna is  appointed to                                                               
work with the Department on the employment misconduct registry.                                                                 
                                                                                                                                
4:19:02 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  said  that  he  would  like  to  see  Dr.                                                               
Mandsager  return  to  the House  Health,  Education  and  Social                                                               
Services  Standing Committee  with a  proposed amendment  for the                                                               
registry.                                                                                                                       
                                                                                                                                
DR.  MANDSAGER   clarified  that  the  proposed   amendment  that                                                               
Representative  Seaton  was   discussing  would  change  [Section                                                               
47.05.330, Subsection (f)] of HB 193.                                                                                           
                                                                                                                                
REPRESENTATIVE  SEATON stated  that is  correct.   He added  that                                                               
[Section 47.05.330, Subsection (e) in  HB 193] could have clearer                                                               
language, as well.                                                                                                              
                                                                                                                                
DR. MANDSAGER  related that most of  this bill [HB 193]  has been                                                               
created from "the best" of current statute.                                                                                     
                                                                                                                                
REPRESENTATIVE SEATON said that he  has heard so much [during the                                                               
legislative  session]  from  assisted   living  homes  about  the                                                               
problems of  current regulations and  changes.  He  remarked that                                                               
he  wanted to  make sure  that this  legislation does  not create                                                               
more of a problem.                                                                                                              
                                                                                                                                
DR. MANDSAGER  emphasized that  he would like  to be  notified of                                                               
any current problems with statute or regulation.                                                                                
                                                                                                                                
DR. MANDSAGER  brought attention  to Amendment 1,  labeled 24G-1,                                                               
4/4/2005 (9:32 AM), which read:                                                                                                 
                                                                                                                                
Page 2, lines 25 - 27:                                                                                                          
     Delete all material.                                                                                                       
                                                                                                                                
Page 15, line 20, following "center"":                                                                                          
      Insert "(A)"                                                                                                              
                                                                                                                                
 Page 15, line 21:                                                                                                              
      Delete "(A)"                                                                                                              
      Insert "(i)"                                                                                                              
                                                                                                                                
 Page 15, line 23:                                                                                                              
      Delete "(B)"                                                                                                              
      Insert "(ii)"                                                                                                             
                                                                                                                                
 Page 15, line 24, following "hospitalization;":                                                                                
      Insert "and"                                                                                                              
                                                                                                                                
 Page 15, following line 24:                                                                                                    
      Insert the following new material:                                                                                        
                     "(B)  includes a facility that performs                                                                    
         invasive diagnostic or therapeutic services;"                                                                          
 Page 16, lines 16 - 17:                                                                                                        
      Delete all material.                                                                                                      
                                                                                                                                
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      Delete "(5)"                                                                                                              
      Insert "(4)"                                                                                                              
                                                                                                                                
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      Delete "(6)"                                                                                                              
      Insert "(5)"                                                                                                              
                                                                                                                                
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      Delete "(7)"                                                                                                              
      Insert "(6)"                                                                                                              
                                                                                                                                
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      Delete "(8)"                                                                                                              
      Insert "(7)"                                                                                                              
                                                                                                                                
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      Delete "(9)"                                                                                                              
      Insert "(8)"                                                                                                              
                                                                                                                                
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      Delete "(10)"                                                                                                             
      Insert "(9)"                                                                                                              
                                                                                                                                
 Page 17, line 8:                                                                                                               
      Delete "(11)"                                                                                                             
      Insert "(10)"                                                                                                             
                                                                                                                                
Page 17, line 9:                                                                                                                
     Delete "(12)"                                                                                                              
     Insert "(11)                                                                                                               
                                                                                                                                
Page 17, line 17:                                                                                                               
     Delete "(13)"                                                                                                              
     Insert "(12)"                                                                                                              
                                                                                                                                
Page 17, line 22:                                                                                                               
     Delete "(14)"                                                                                                              
     Insert "(13)"                                                                                                              
                                                                                                                                
Page 17, line 28:                                                                                                               
     Delete "(15)"                                                                                                              
     Insert "(14)"                                                                                                              
                                                                                                                                
Page 17, line 30:                                                                                                               
     Delete "(16)"                                                                                                              
     Insert "(15)"                                                                                                              
                                                                                                                                
Page 18, line 1:                                                                                                                
     Delete "(17)"                                                                                                              
     Insert "(16)"                                                                                                              
                                                                                                                                
Page 18, line 5:                                                                                                                
     Delete "(18)"                                                                                                              
     Insert "(17)"                                                                                                              
                                                                                                                                
Page 18, line 10:                                                                                                               
     Delete "(19)"                                                                                                              
     Insert "(18)"                                                                                                              
Page 18, line 13:                                                                                                               
     Delete "(20)"                                                                                                              
     Insert "(19)"                                                                                                              
                                                                                                                                
Page 18, line 17:                                                                                                               
     Delete "(21)"                                                                                                              
     Insert "(20)"                                                                                                              
                                                                                                                                
Page 31, following line 9:                                                                                                      
     Insert a new bill section to read:                                                                                         
   "* Sec. 29.  AS 47.32.010 is amended by adding a new                                                                       
subsection to read:                                                                                                             
          (c)  The provisions of AS 47.05.300 - 47.05.390,                                                                      
     regarding criminal history, criminal history checks,                                                                       
     criminal history use standards, and a centralized registry,                                                                
      apply to entities listed in (b) of this section as provided                                                               
      in AS 47.05.300."                                                                                                         
                                                                                                                                
 Renumber the following bill sections accordingly.                                                                              
                                                                                                                                
 Page 32, line 23:                                                                                                              
      Following "APPLICABILITY":                                                                                                
           Insert "REGARDING CERTAIN SECTIONS"                                                                                  
                                                                                                                                
      Following "by":                                                                                                           
           Insert "secs. 1 - 16, 18 - 28, 30 - 32, and 34 - 40                                                                  
 of"                                                                                                                            
                                                                                                                                
 Page 32, line 26:                                                                                                              
      Delete "secs. 1 and 17"                                                                                                   
      Insert "sec. 1"                                                                                                           
                                                                                                                                
 Page 32, line 27:                                                                                                              
      Delete "or selection as any of the following:"                                                                            
      Insert "of"                                                                                                               
 Page 32, lines 28 - 29:                                                                                                        
      Delete all material.                                                                                                      
                                                                                                                                
 Page 32, line 30:                                                                                                              
      Delete "(B)"                                                                                                              
                                                                                                                                
      Delete "Act,"                                                                                                             
      Insert "Act; and"                                                                                                         
                                                                                                                                
 Page 32, line 31:                                                                                                              
      Delete all material.                                                                                                      
                                                                                                                                
 Page 33, line 2:                                                                                                               
      Delete "1 - 31 and 33 - 39"                                                                                               
      Insert : "1 - 16, 18 - 28, 30 - 32, and 34 - 40"                                                                          
                                                                                                                                
 Page 33, line 3:                                                                                                               
      Delete "1 - 31 and 33 - 39"                                                                                               
      Insert : "1 - 16, 18 - 28, 30 - 32, and 34 - 40"                                                                          
                                                                                                                                
 Page 33, line 5:                                                                                                               
      Delete "; and"                                                                                                            
      Insert "."                                                                                                                
                                                                                                                                
 Page 33, lines 6 - 10:                                                                                                         
      Delete all material.                                                                                                      
                                                                                                                                
Page 33, line 13:                                                                                                               
     Delete "1 - 31 and 33 - 39"                                                                                                
     Insert : "1 - 16, 18 - 28, 30 - 32, and 34 - 40"                                                                           
Page 33, lines 14 - 19:                                                                                                         
     Delete all material.                                                                                                       
                                                                                                                                
Page 33, following line 19:                                                                                                     
     Insert a new bill section to read:                                                                                         
                                                                                                                                
   "* Sec.  42.   The uncodified  law of the  State of  Alaska is                                                             
amended by adding a new section to read:                                                                                        
     APPLICABILITY REGARDING SEC.  17 OF THIS ACT; DEPARTMENT                                                                   
ACTION.  (a)  The changes made by sec. 17 of this Act apply to                                                                  
          (1)  applications or requests submitted within the 30                                                                 
days  before, or  submitted on  or after,  the effective  date of                                                               
sec.  17 of  this Act  for initial  licensure, certification,  or                                                               
other approval or selection as any of the following:                                                                            
               (A)  an entity or individual service provider                                                                    
     that is subject to AS 47.05.300 - 47.05.390, enacted by                                                                    
     sec. 17 of this Act;                                                                                                       
               (B)  an entity listed in AS 47.32.010(b), enacted                                                                
     by sec. 1 of this Act, that is not described in (A) of this                                                                
     paragraph; and                                                                                                             
          (2)  applications or requests submitted within the 30                                                                 
days  before, or  submitted on  or after,  the effective  date of                                                               
sec. 17 of this Act, for  renewal of a license, certification, or                                                               
other approval or  selection for an entity  or individual service                                                               
provider that is subject to  AS 47.05.300 - 47.05.390, enacted by                                                               
sec. 17 of this Act.                                                                                                            
     (b)  The Department of Health and Social Services may not                                                                  
make a  final determination regarding  an application  or request                                                               
described in (a) of this  section earlier than the effective date                                                               
of sec. 17 of this Act.                                                                                                         
     (c)  In this section,                                                                                                      
          (1)  "entity" includes an entity subject to AS                                                                        
47.05.300 - 47.05.390,  enacted by  sec. 17 of  this Act,  and an                                                               
entity listed in AS 47.32.010(b), enacted  by sec. 1 of this Act,                                                               
that is not subject to  AS 47.05.300 - 47.05.390, enacted by sec.                                                               
17 of this Act;                                                                                                                 
          (2)  "individual service provider" has the meaning                                                                    
given in AS 47.05.390, enacted by sec. 17 of this Act."                                                                         
                                                                                                                                
Renumber the following sections accordingly.                                                                                    
Page 33, line 25:                                                                                                               
     Delete "1 - 31 and 33 - 39"                                                                                                
     Insert : "1 - 16, 18 - 28, 30 - 32, and 34 - 40"                                                                           
                                                                                                                                
 Page 34, line 1:                                                                                                               
      Delete "1 - 31 and 33 - 39"                                                                                               
      Insert : "1 - 16, 18 - 28, 30 - 32, and 34 - 40"                                                                          
                                                                                                                                
 Page 34, line 18:                                                                                                              
      Delete "AND OTHER REQUESTS"                                                                                               
                                                                                                                                
 Page 34, line 21:                                                                                                              
      Delete "1 - 31 and 33 - 39"                                                                                               
      Insert : "1 - 16, 18 - 28, 30 - 32, and 34 - 40"                                                                          
                                                                                                                                
 Page 34, lines 22 - 23:                                                                                                        
      Delete "1 - 31 and 33 - 39"                                                                                               
      Insert : "1 - 16, 18 - 28, 30 - 32, and 34 - 40"                                                                          
                                                                                                                                
 Page 34, line 25:                                                                                                              
      Delete "1 - 31 and 33 - 39"                                                                                               
      Insert : "1 - 16, 18 - 28, 30 - 32, and 34 - 40"                                                                          
                                                                                                                                
 Page 34, line 30:                                                                                                              
      Delete "1 - 31 and 33 - 39"                                                                                               
      Insert : "1 - 16, 18 - 28, 30 - 32, and 34 - 40"                                                                          
                                                                                                                                
 Page 35, line 2:                                                                                                               
      Delete "1 - 31 and 33 - 39"                                                                                               
      Insert : "1 - 16, 18 - 28, 30 - 32, and 34 - 40"                                                                          
      Delete all material.                                                                                                      
                                                                                                                                
 Page 35, line 23:                                                                                                              
      Delete "(f)"                                                                                                              
      Insert "(e)"                                                                                                              
                                                                                                                                
 Page 35, following line 25:                                                                                                    
      Insert a new bill section to read:                                                                                        
    "* Sec. 45.   The  uncodified law  of the State  of Alaska  is                                                            
 amended by adding a new section to read:                                                                                       
      TRANSITION:  PENDING APPLICATIONS AND OTHER REQUESTS                                                                      
 REGARDING SEC.   17 OF THIS ACT.   (a)   An application or  other                                                              
 request  for  licensure,  certification,  or  other  approval  or                                                              
 selection as an entity or individual service provider  that would                                                              
 be subject  to AS 47.05.300 - 47.05.390,  enacted by  sec. 17  of                                                              
 this Act,  that  was  submitted  more than  30  days  before  the                                                              
 effective date of sec. 17  of this Act and is pending  department                                                              
 action on  the  effective  date of  sec.  17 of  this  Act  shall                                                              
 continue to be  processed, and either granted  or denied, by  the                                                              
 department under  the applicable  statutes and  regulations  that                                                              
 were in effect on  the day before the  effective date of sec.  17                                                              
of this Act.  In this subsection,                                                                                               
          (1)  "entity" means an entity that would be subject to                                                                
AS 47.05.300 - 47.05.390, enacted by sec. 17 of this Act;                                                                       
          (2)  "individual service provider" has the meaning                                                                    
given in AS 47.05.390, enacted by sec. 17 of this Act.                                                                          
     (b)  In this section,                                                                                                      
          (1)  "department" means the Department of Health and                                                                  
Social Services;                                                                                                                
          (2)  "license" includes a renewed license."                                                                           
                                                                                                                                
Renumber the following bill sections accordingly.                                                                               
                                                                                                                                
Page 35, line 28, following "REGULATIONS.":                                                                                     
     Insert "(a)"                                                                                                               
                                                                                                                                
Page 35, line 29, following "implement":                                                                                        
     Insert "secs. 1 - 16, 18 - 28, and 30 - 40 of"                                                                             
                                                                                                                                
Page 35, following line 31:                                                                                                     
     Insert the following new material:                                                                                         
     "(b)  The Department of Health and Social Services may                                                                     
proceed to adopt regulations necessary to implement secs. 17 and                                                                
29 of this Act.  The regulations take effect under AS 44.62.                                                                    
   * Sec. 47.  The uncodified law of the State of Alaska is                                                                   
amended by adding a new section to read:                                                                                        
     CERTIFICATION OF EFFECTIVE DATE OF REGULATIONS.  The                                                                       
lieutenant governor shall certify to the revisor of statutes the                                                                
effective date of the regulations adopted by the Department of                                                                  
Health and Social Services under sec. 46(b) of this Act."                                                                       
                                                                                                                                
Renumber the following bill sections accordingly.                                                                               
                                                                                                                                
Page 36, line 1:                                                                                                                
     Delete "40, 42, and 43"                                                                                                    
     Insert "41, 42, and 44 - 47"                                                                                               
                                                                                                                                
Page 36, line 3:                                                                                                                
     Delete "32"                                                                                                                
     Insert "33"                                                                                                                
                                                                                                                                
Page 36, following line 3:                                                                                                      
     Insert a new bill section to read:                                                                                         
   "* Sec. 50.  Sections 17 and 29 of this Act take effect                                                                    
          (1)  on the effective date of the regulations adopted                                                                 
by the Department of Health and Social Services under sec. 46(b)                                                                
of this Act implementing sec. 17 of this Act, or March 1, 2006,                                                                 
whichever is earlier; but                                                                                                       
           (2)  no earlier than July 2, 2005."                                                                                  
Renumber the remaining bill section accordingly.                                                                                
                                                                                                                                
Page 36, line 4:                                                                                                                
      Delete "44 and 45"                                                                                                        
      Insert "48 - 50"                                                                                                          
                                                                                                                                
 DR. MANDSAGER explained:                                                                                                       
                                                                                                                                
      Most of this  ... has  to do with  renumbering ...  the                                                                   
      first issue  ... is  a  dating issue.   When  this  was                                                                   
      drafted,  it   was   envisioned   that   the   criminal                                                                   
      background check  would start on  July 1,  2005 ...  by                                                                   
      the  time   legislation   finally  gets   passed,   and                                                                   
      regulation development  ... most of  Amendment 1  moves                                                                   
      the effective date  to the  spring of 2006  ... or  ...                                                                   
      after the bill  gets passed.   The other  issue ...  is                                                                   
      the last two lines  of page 1 and  you have to open  up                                                                   
      part of your bill to  go with this, which is, page  15,                                                                   
      line 24 ... on page 2 [of HB 193], it lists  all of the                                                                   
      entities  that   this  applies   to  ...   as   medical                                                                   
      technology changes,  certain very  complex stuff  moves                                                                   
      out of hospitals into free standing things and  in many                                                                   
      states in the country  right now, there are three  main                                                                   
      kinds  of  these  activities  ...  radiation  treatment                                                                   
      units  ...  for  treating  cancer  with  radiation  ...                                                                   
      chemotherapy units  for treating cancer  and the  third                                                                   
      is cardiac  catheterization  laboratories ...  as  they                                                                   
      move out  [of hospitals] ...  [the] last  two lines  on                                                                   
      page  1  ...  [can]  put  some  flexibility   into  the                                                                   
      definition of  an ambulatory  surgical  center ...  the                                                                   
      state could  say that  this entity,  now,  is going  to                                                                   
      become licensed and going to propose "regs"  to propose                                                                   
      licensing or regulating that entity.                                                                                      
                                                                                                                                
      In our state,  there really  is only one  of those  ...                                                                   
      because of  our small population  ... there  is a  free                                                                   
      standing cardiac catheterization lab in Anchorage  that                                                                   
      is outside the  hospital and  outside of any  licensure                                                                   
      or regulation at present  ... this is about ...  trying                                                                   
      to  find  ...  some  language  that  would   give  some                                                                   
      flexibility but  would not be  so broad  that would  be                                                                   
      way too broad.  If we can't come up with  language then                                                                   
      ... in  the future, the  whole statute  should just  be                                                                   
      amended for some particular thing.                                                                                        
                                                                                                                                
DR. MANDSAGER  referred to Amendment  1, Version  24G-1, 4/4/2005                                                               
(9:32 AM),  page 1, line 18  and stated that the  word "facility"                                                               
needs to be defined.                                                                                                            
                                                                                                                                
4:29:20 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON   said  that  the   entities  listed   in  [Section                                                               
47.32.010] of HB 193 need to be regulated.                                                                                      
                                                                                                                                
REPRESENTATIVE SEATON asked why the entities  on page 2 of HB 193                                                               
have to be regulated.  He  said that these entities are medically                                                               
technical and specific  already, and doesn't see the  need to put                                                               
more regulations on them.                                                                                                       
                                                                                                                                
DR.  MANDSAGER   said,  "there  may  be   enough  self-regulating                                                               
mechanisms in place  for those high end,  medical, complex things                                                               
between insurance,  the cost of  operations ... because  the cost                                                               
of development  is going to  be so high ...  it very may  well be                                                               
that this idea we should just drop for now.                                                                                     
                                                                                                                                
4:31:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA  inquired  as  to  the  [American  Medical                                                               
Association's,  AMA]   involvement  in  issues  related   to  the                                                               
licensing of the aforementioned health facilities.                                                                              
                                                                                                                                
DR. MANDSAGER  clarified that physician  licensing is  handled by                                                               
the  Board  of Medicine.    He  said that  Representative  Seaton                                                               
brought  up the  issue of  the fact  that physicians  have enough                                                               
regulations in place already that deal with "quality."                                                                          
                                                                                                                                
[The  committee  treated  Amendment 1,  Version  24G-1,  4/4/2005                                                               
(9:32 AM) as before it.]                                                                                                        
                                                                                                                                
[CHAIR WILSON turned the gavel over to Vice-Chair Seaton.]                                                                      
                                                                                                                                
VICE-CHAIR SEATON  moved to  adopt Amendment  1, to  Amendment 1,                                                               
labeled Version 24G-1, 4/4/2005 (9:32 AM), as follows:                                                                          
                                                                                                                                
     Page 1, delete lines 18-21                                                                                                 
                                                                                                                                
There being no objection, it was so ordered.                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON moved  to adopt  Amendment 1,  as amended.                                                               
There being no  objection, Amendment 1, as  amended, Version 24G-                                                               
1, 4/4/2005 (9:32 AM), was adopted.                                                                                             
                                                                                                                                
 The committee took an at-ease from 4:34:58 to 4:45:03.                                                                         
                                                                                                                                
 4:45:43 PM                                                                                                                   
                                                                                                                                
 REPRESENTATIVE GARDNER  moved to rescind  the committee's  action                                                              
 in adopting  the amended  Amendment 1,  [Version 24G-1,  4/4/2005                                                              
 (9:32 AM)].  There being no objection, [the amended]  Amendment 1                                                              
 was rescinded.                                                                                                                 
                                                                                                                                
 REPRESENTATIVE GARDNER moved to adopt Amendment 2, to Amendment                                                                
 1, [Version 24G-1, 4/4/2005 (9:32 AM)], as follows:                                                                            
                                                                                                                                
      [Page 1], delete lines 4-21                                                                                               
                                                                                                                                
 REPRESENTATIVE GARDNER moved to adopt Amendment 1, Version 24G-                                                                
 1, 4/4/2005 (9:32 AM), as amended.  There being no objection,                                                                  
 Amendment 1, Version 24G-1, as amended, was adopted.                                                                           
                                                                                                                                
 4:47:44 PM                                                                                                                   
                                                                                                                                
 DR. MANDSAGER offered Amendment 2, labeled Version 24G-1,                                                                      
 4/4/2005 (2:43 PM), which read:                                                                                                
                                                                                                                                
      Page 9, line 24:                                                                                                          
           Delete "(e)"                                                                                                         
           Insert "(f)"                                                                                                         
                                                                                                                                
      Page 9, line 28:                                                                                                          
           Delete "(e)"                                                                                                         
           Insert "(f)"                                                                                                         
                                                                                                                                
      Page 10, line 10:                                                                                                         
           Delete "(e)"                                                                                                         
           Insert "(f)"                                                                                                         
                                                                                                                                
      Page 10, line 18:                                                                                                         
           Delete "(e)"                                                                                                         
           Insert "(f)"                                                                                                         
                                                                                                                                
      Page 10, line 27:                                                                                                         
           Delete "(e)"                                                                                                         
           Insert "(f)"                                                                                                         
                                                                                                                                
      Page 11, following line 25:                                                                                               
           Insert the following new material:                                                                                   
           "(e)  The department may not take action under                                                                       
       (d)(9) of this section unless the commissioner has                                                                       
     reasonable cause  to believe that  continued management                                                                    
     by the entity while the  entity is attempting to cure a                                                                    
     violation would be injurious to  the health, safety, or                                                                    
     welfare  of  individuals  receiving services  from  the                                                                    
     entity."                                                                                                                   
                                                                                                                                
     Page 11, line 26:                                                                                                          
          Delete "(e)"                                                                                                          
          Insert "(f)"                                                                                                          
                                                                                                                                
     Page 12, line 1:                                                                                                           
          Delete "(f)"                                                                                                          
          Insert "(g)"                                                                                                          
                                                                                                                                
     Page 12, line 2:                                                                                                           
          Delete "(e)"                                                                                                          
          Insert "(f)"                                                                                                          
                                                                                                                                
     Page 12, line 6:                                                                                                           
          Delete "(g)"                                                                                                          
          Insert "(h)"                                                                                                          
                                                                                                                                
          Delete "(e)"                                                                                                          
          Insert "(f)"                                                                                                          
                                                                                                                                
     Page 12, line 9:                                                                                                           
          Delete "(f)"                                                                                                          
          Insert "(g)"                                                                                                          
                                                                                                                                
     Page 12, line 12:                                                                                                          
          Delete "(f)"                                                                                                          
          Insert "(g)"                                                                                                          
                                                                                                                                
     Page 12, line 13:                                                                                                          
          Delete "(h)"                                                                                                          
          Insert "(i)"                                                                                                          
                                                                                                                                
          Delete "(f)"                                                                                                          
          Insert "(g)"                                                                                                          
                                                                                                                                
     Page 12, line 15:                                                                                                          
          Delete "(e)"                                                                                                          
          Insert "(f)"                                                                                                          
                                                                                                                                
     Page 12, line 17:                                                                                                          
          Delete "(i)"                                                                                                          
          Insert "(j)"                                                                                                          
                                                                                                                                
           Delete "(e)"                                                                                                         
           Insert "(f)"                                                                                                         
                                                                                                                                
      Page 12, line 25:                                                                                                         
           Delete "(j)"                                                                                                         
           Insert "(k)"                                                                                                         
                                                                                                                                
      Page 13, line 1:                                                                                                          
           Delete "does not apply"                                                                                              
           Insert "applies"                                                                                                     
                                                                                                                                
     Page 13, line 1, following "hearing.", through line 3:                                                                     
           Delete all material.                                                                                                 
                                                                                                                                
      Page 13, line 8, following "AS 44.62":                                                                                    
           Insert "or AS 44.64"                                                                                                 
                                                                                                                                
      Page 14, line 20:                                                                                                         
           Delete "47.32.150(h)"                                                                                                
           Insert "47.32.150(i)"                                                                                                
                                                                                                                                
      Page 24, following line 5:                                                                                                
           Insert a new bill section to read:                                                                                   
         "* Sec. 15.  AS 44.64.030(a)(33) is amended to                                                                     
      read:                                                                                                                     
                (33)  AS 47.32 (Department of Health and                                                                    
     Social Services licensing) [AS 47.33 (ASSISTED LIVING                                                                  
      HOMES)];"                                                                                                                 
                                                                                                                              
      Renumber the following bill sections accordingly.                                                                         
                                                                                                                                
      Page 32, following line 11:                                                                                               
           Insert a new bill section to read:                                                                                   
      "* Sec. 38.  AS 44.64.030(a)(15), 44.64.030(a)(16),                                                                     
      and 44.64.030(a)(34) are repealed."                                                                                       
                                                                                                                                
      Renumber the following bill sections accordingly.                                                                         
                                                                                                                                
      Page 32, line 26:                                                                                                         
           Delete "17"                                                                                                          
           Insert "18"                                                                                                          
                                                                                                                                
      Page 32, line 29:                                                                                                         
           Delete "17"                                                                                                          
           Insert "18"                                                                                                          
                                                                                                                                
     Page 33, line 2:                                                                                                           
          Delete "1 - 31 and 33 - 39"                                                                                           
          Insert "1 - 32 and 34 - 41"                                                                                           
                                                                                                                                
     Page 33, line 3:                                                                                                           
          Delete "1 - 31 and 33 - 39"                                                                                           
          Insert "1 - 32 and 34 - 41"                                                                                           
                                                                                                                                
     Page 33, line 7:                                                                                                           
          Delete "17"                                                                                                           
          Insert "18"                                                                                                           
                                                                                                                                
     Page 33, line 9:                                                                                                           
          Delete "17"                                                                                                           
          Insert "18"                                                                                                           
                                                                                                                                
     Page 33, line 13:                                                                                                          
          Delete "1 - 31 and 33 - 39"                                                                                           
          Insert "1 - 32 and 34 - 41"                                                                                           
                                                                                                                                
     Page 33, line 16:                                                                                                          
          Delete "17"                                                                                                           
          Insert "18"                                                                                                           
                                                                                                                                
     Page 33, line 17:                                                                                                          
          Delete "17"                                                                                                           
          Insert "18"                                                                                                           
                                                                                                                                
     Page 33, line 19:                                                                                                          
          Delete "17"                                                                                                           
          Insert "18"                                                                                                           
                                                                                                                                
     Page 33, line 25:                                                                                                          
          Delete "1 - 31 and 33 - 39"                                                                                           
          Insert "1 - 32 and 34 - 41"                                                                                           
                                                                                                                                
     Page 34, line 1:                                                                                                           
          Delete "1 - 31 and 33 - 39"                                                                                           
          Insert "1 - 32 and 34 - 41"                                                                                           
                                                                                                                                
     Page 34, line 21:                                                                                                          
          Delete "1 - 31 and 33 - 39"                                                                                           
          Insert "1 - 32 and 34 - 41"                                                                                           
                                                                                                                                
     Page 34, lines 22 - 23:                                                                                                    
          Delete "1 - 31 and 33 - 39"                                                                                           
          Insert "1 - 32 and 34 - 41"                                                                                           
                                                                                                                                
      Page 34, line 25:                                                                                                         
           Delete "1 - 31 and 33 - 39"                                                                                          
           Insert "1 - 32 and 34 - 41"                                                                                          
                                                                                                                                
      Page 34, line 30:                                                                                                         
           Delete "1 - 31 and 33 - 39"                                                                                          
           Insert "1 - 32 and 34 - 41"                                                                                          
                                                                                                                                
      Page 35, line 2:                                                                                                          
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DR.  MANDSAGER  related  that  the  [Alaska  State  Hospital  and                                                               
Nursing  Home Association,  ASHNHA]  raised  concerns about  this                                                               
amendment,  specifically, on  page 2,  lines 2-5.   He  said that                                                               
ASHNHA  was concerned  about the  Department's  proposal to  take                                                               
over management  of institutions  in cases  of immediate  risk to                                                               
life  and  safety  and  that  they  consider  this  a  high  risk                                                               
endeavor.    ASHNHA  suggested  that  the  Commissioner  [of  the                                                               
Department of Health and Social  Services] be involved when these                                                               
decisions are considered.                                                                                                       
                                                                                                                                
DR. MANDSAGER said:                                                                                                             
                                                                                                                                
     And then  the second  issue is, down  at the  bottom of                                                                    
     page three of  the amendment, starting at  line 25, and                                                                    
     this  is to  fix a  drafting error  on page  13 of  [HB
     193],  and it  has to  do with  administrative hearings                                                                    
     ... line 1  of page 13 said that AS  44.64.060 does not                                                                    
     apply and  then there's a  sentence about the  parts of                                                                    
     the  administrator  procedure  act that  do  apply  ...                                                                    
     that's  wrong ...  this  amendment  changes, "does  not                                                                    
     apply"  to "applies"  and deletes  the second  sentence                                                                    
     ...                                                                                                                        
                                                                                                                                
4:49:25 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   GARDNER  moved   Amendment  2,   Version  24G-1,                                                               
4/4/2005 (2:43  PM) [text previously  provided].  There  being no                                                               
objections, Amendment  2, Version 24G-1, 4/4/2005  (2:43 PM), was                                                               
adopted.                                                                                                                        
                                                                                                                                
4:50:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON returned the gavel to Chair Wilson.                                                                       
                                                                                                                                
[HB 193 was held over.]                                                                                                         

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