Legislature(2005 - 2006)CAPITOL 120

05/05/2005 01:00 PM JUDICIARY


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 193 LICENSING MEDICAL OR CARE FACILITIES TELECONFERENCED
Moved CSHB 193(JUD) Out of Committee
+ SB 137 EVICTING INSTITUTIONAL PROPERTY USERS TELECONFERENCED
Scheduled But Not Heard
+ SB 135 ASSAULT & CUSTODIAL INTERFERENCE TELECONFERENCED
Scheduled But Not Heard
+ SB 20 OFFENSES AGAINST UNBORN CHILDREN TELECONFERENCED
Scheduled But Not Heard
+ SB 132 HUMAN RIGHTS COMMISSION TELECONFERENCED
Scheduled But Not Heard
+ SB 130 WORKERS' COMPENSATION/ INSURANCE TELECONFERENCED
Failed To Move Out Of Committee
*+ HB 232 FELONY THEFT TELECONFERENCED
Scheduled But Not Heard
+ Bills Previously Heard/Scheduled TELECONFERENCED
HB 193 - LICENSING MEDICAL OR CARE FACILITIES                                                                                 
                                                                                                                                
1:21:28 PM                                                                                                                    
                                                                                                                                
CHAIR McGUIRE  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."   [Before the                                                               
committee was CSHB 193(HES).]                                                                                                   
                                                                                                                                
[Because of its  length, what became known as Amendment  1 can be                                                               
found at the end of the first set  of minutes for HB 193 for this                                                               
date.]                                                                                                                          
                                                                                                                                
1:21:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   SHARON   CISSNA,   Alaska   State   Legislature,                                                               
indicating that she would be  providing testimony, first referred                                                               
to Section 54, located on pages 42-43 of CSHB 193(HES).                                                                         
                                                                                                                                
CHAIR  McGUIRE noted  that members'  packets  contain a  proposed                                                               
amendment that would remove Section 54 from CSHB 193(HES).                                                                      
                                                                                                                                
REPRESENTATIVE CISSNA relayed her  understanding that the purpose                                                               
of Section  54 is  to keep  seniors in their  own homes  and save                                                               
money through  the use  of home healthcare.   The  federal policy                                                               
has been "least  restrictive" and Alaska has  been responding via                                                               
Personal Care  Attendants (PCAs).   However,  the costs  for that                                                               
have risen.   She referenced a PowerPoint  presentation and noted                                                               
that it  contains a chart  illustrating that rise.   She surmised                                                               
that the Department of Health  and Social Services (DHSS) met the                                                               
challenge predominately  by cutting and capping  various services                                                               
such  as  respite  care  and  other  items.    The  problem,  she                                                               
recounted,  is that  these  cuts and  caps  have jeopardized  the                                                               
ability of seniors to stay in their homes.                                                                                      
                                                                                                                                
REPRESENTATIVE CISSNA  referred to  page 4 of  the aforementioned                                                               
presentation  and  recounted  the  situation  of  a  woman  who's                                                               
working full  time but  whose mother  has Alzheimer's.   Although                                                               
the mother qualifies for the "Medicaid  Waiver" and could go to a                                                               
nursing home,  the daughter wants her  mother to be able  to stay                                                               
at  home,  in  a  loving environment.    However,  currently  the                                                               
daughter can only  get a PCA for her mother  for 26 hours [during                                                               
the workweek].  Representative Cissna  then played a recording of                                                               
an interview with the daughter  for committee members wherein the                                                               
daughter expresses concerns regarding her mother's safety.                                                                      
                                                                                                                                
[This interview recording  was not picked up well  on the meeting                                                               
recording.]                                                                                                                     
                                                                                                                                
REPRESENTATIVE CISSNA  mentioned that the mother's  previous plan                                                               
would cover  her for  approximately 50 hours  per week,  and this                                                               
allowed the daughter to maintain her fulltime job.                                                                              
                                                                                                                                
1:28:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA  summarized  by   saying  that  after  new                                                               
regulations  became   effective  and  after  the   previous  plan                                                               
expired,  the mother's  new plan  now  covers only  30 hours  per                                                               
week.   This  has resulted  in the  daughter having  to cut  back                                                               
hours at  work, which might, incidentally,  jeopardize her health                                                               
insurance benefits.  Representative  Cissna opined that such cuts                                                               
will ultimately  result in  higher costs  to the  state.   And so                                                               
although the  department now  has the authority  to make  cuts to                                                               
the  aforementioned  types  of   programs,  she  asked  that  the                                                               
committee not remove  Section 54 from the  bill, reiterating that                                                               
Section  54 proposes  to keep  people  at home  at a  competitive                                                               
price.                                                                                                                          
                                                                                                                                
CHAIR  McGUIRE acknowledged  the work  Representative Cissna  has                                                               
put into senior care issues.                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA  opined  that   the  cuts  and  caps  will                                                               
ultimately have a detrimental impact on family caregivers.                                                                      
                                                                                                                                
REPRESENTATIVE  GARA  said  he supports  Representative  Cissna's                                                               
attempt to  get the program proposed  in Section 54 started.   He                                                               
asked what "chore" services have been cut to.                                                                                   
                                                                                                                                
REPRESENTATIVE CISSNA  offered her  understanding that it  is now                                                               
10  hours per  week, and  that  respite services  cannot be  used                                                               
while the primary caregiver is at work.                                                                                         
                                                                                                                                
1:33:12 PM                                                                                                                    
                                                                                                                                
RICHARD  MANDSAGER, M.D.,  Director, Division  of Public  Health,                                                               
Department  of Health  and Social  Services (DHSS),  presented HB
193  on  behalf of  the  administration.    He relayed  that  the                                                               
companion bill to HB 193 has  just passed the Senate, and that HB
193 has three main purposes.  He elaborated:                                                                                    
                                                                                                                                
     The  first  purpose  is  to  deal  with  an  incredible                                                                    
     statutory   and   regulatory   variation   around   the                                                                    
     multiplicity of types of  organizations and entity that                                                                    
     the Department  of Health and Social  Services licenses                                                                    
     or  certifies,  and the  intent  is  to simplify  [and]                                                                    
     streamline  -  [the process]  ...  -  to make  it  more                                                                    
     standard and more straightforward.   The second goal is                                                                    
     to also  standardize, across  all the  various entities                                                                    
     and  individuals  that  work for  those  entities,  the                                                                    
     kinds  of  background  checks   that  are  done  before                                                                    
     employment -  to work toward  improving the  health and                                                                    
     safety of  vulnerable Alaskans -  and the intent  is to                                                                    
     deal  both  on  the   criminal  side  -  with  criminal                                                                    
     background  checks  - and  on  the  civil side  -  with                                                                    
     fraud, abuse,  neglect, and Medicaid  fraud -  both for                                                                    
     entities,  the organizations,  the  CEOs,  and for  the                                                                    
     individuals that work with ... clients (indisc.).                                                                          
                                                                                                                                
CHAIR  McGUIRE raised  the issue  of predators  of children,  and                                                               
offered her understanding  that the system being  proposed via HB
193  may  well be  affordable  and  accessible to  nonprofit  and                                                               
volunteer  organizations that  should  also  be doing  background                                                               
checks but have found doing so to be too costly.                                                                                
                                                                                                                                
DR. MANDSAGER  referred to a  handout, derived from  a PowerPoint                                                               
presentation, provided by the DHSS  and dated 5/4/05, and relayed                                                               
that it in part provides  the committee with examples of problems                                                               
occurring under existing regulations.   For example, a supported-                                                               
living home  provider was misappropriating funds  from residents;                                                               
no background  check had been  conducted on that  provider, since                                                               
current law did not require  that particular home to be licensed.                                                               
There have also  been instances of physical  violence against and                                                               
mistreatment of  residents.   He noted  that currently  PCAs, who                                                               
are  typically  listed  by  multiple  employment  agencies,  must                                                               
submit  separate  fingerprint-based  background checks  for  each                                                               
agency, and [HB 193] proposes  to allow one such background check                                                               
to be made available to various employers.                                                                                      
                                                                                                                                
DR. MANDSAGER referred to page 4  of the DHSS's handout, and said                                                               
it reflects that the DHSS  administers 19 programs under as least                                                               
12  different  statutory  schemes for  licensure.    Furthermore,                                                               
various agencies/entities are governed  by different rules - some                                                               
statutory,  some regulatory.    As  a result  of  the passage  of                                                               
executive  order   (EO)  108,  consolidation  of   licensing  and                                                               
certification  activities in  the Division  of Public  Health has                                                               
begun, but  there is  internal tension  with regard  to different                                                               
divisions'   fiscal   responsibilities.       Page   6   of   the                                                               
aforementioned  handout,  he  remarked, highlights  some  of  the                                                               
variations  in rules  for the  different  types of  organizations                                                               
licensed and/or certified by the DHSS.   This page also lists the                                                               
various  types   of  organizations   that  will  be   subject  to                                                               
background checks should HB 193 pass.                                                                                           
                                                                                                                                
DR.  MANDSAGER  said that  page  7  of  the handout  lists  which                                                               
statutes  will be  changed by  passage of  the bill,  and page  8                                                               
lists some  of the items included  in the bill.   For example, HB
193 is proposing  a new article that will define  who is required                                                               
to   have  background   checks,  will   provide  for   regulatory                                                               
definition   of  barrier   conditions,  and   will  require   the                                                               
establishment   and  maintenance   of   a  centralized   registry                                                               
available  to  all  [prospective] employers.    He  characterized                                                               
background checks as  reflecting the criminal side  of a person's                                                               
history,  and  characterized what  he  termed  as the  misconduct                                                               
registry as  reflecting the "civil  side" of a  person's history,                                                               
the latter  registry being modeled  on what currently  exists for                                                               
certified nurse attendants (CNAs) in nursing homes and assisted-                                                                
living homes.                                                                                                                   
                                                                                                                                
DR.  MANDSAGER relayed  that the  key  provisions of  HB 193  are                                                               
listed on  page 9  of the aforementioned  handout and  pertain to                                                               
barrier conditions,  background checks, barring of  employment in                                                               
instances  where barrier  crimes  are  committed, the  misconduct                                                               
registry, and waiver  and appeals processes.  He  noted that page                                                               
10  of the  handout outlines  for the  committee the  regulations                                                               
that [licensing and certifying] staff must keep track of.                                                                       
                                                                                                                                
1:42:32 PM                                                                                                                    
                                                                                                                                
CHAIR  McGUIRE  made  a  motion to  adopt  Amendment  1,  labeled                                                               
05/04/05, 10:15  a.m.  [Amendment  1 can be  found at the  end of                                                               
the first set of minutes for HB 193 for this date.]                                                                             
                                                                                                                                
REPRESENTATIVE DAHLSTROM objected for the purpose of discussion.                                                                
                                                                                                                                
DR.  MANDSAGER  explained  that  Amendment  1  would  alter  CSHB
193(HES)  such   that  it   would  then   be  identical   to  the                                                               
aforementioned  Senate  companion  bill.    He  also  noted  that                                                               
members' packets  contain a side-by-side comparison  between that                                                               
companion  bill  and  CSHB  193(HES).    The  first  two  changes                                                               
proposed  by  Amendment  1 address  concerns  regarding  firearms                                                               
being possessed by individuals who  are picking up their child at                                                               
a licensed child care facility.                                                                                                 
                                                                                                                                
REPRESENTATIVE GRUENBERG  asked what the language,  "encased in a                                                               
container of a motor vehicle" means.                                                                                            
                                                                                                                                
1:45:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ANDERSON  surmised that  that  would  mean a  gun                                                               
case.                                                                                                                           
                                                                                                                                
REPRESENTATIVE GRUENBERG  asked whether  the gun case  would have                                                               
to be locked.                                                                                                                   
                                                                                                                                
DR.  MANDSAGER relayed  that the  discussion that  took place  in                                                               
Senate  committee hearings  implied that  the gun  case would  be                                                               
locked.                                                                                                                         
                                                                                                                                
CHAIR McGUIRE  noted that Representative Dahlstrom  has mentioned                                                               
that the term could also refer to a glove compartment.                                                                          
                                                                                                                                
REPRESENTATIVE  GRUENBERG  said his  concern  is  that a  firearm                                                               
could still be easily obtained from an unlocked gun case.                                                                       
                                                                                                                                
REPRESENTATIVE DAHLSTROM mentioned that the  flip side of that is                                                               
the  attention  that's  being  drawn  by  someone  who  transfers                                                               
his/her  firearm to  and  from the  trunk  of a  car  while at  a                                                               
licensed  child  care facility.    She  noted that  people  carry                                                               
firearms  for  protection  and various  other  reasons,  none  of                                                               
which, she surmised,  are furthered by having the  firearm in the                                                               
trunk of a vehicle.                                                                                                             
                                                                                                                                
1:46:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARA asked why this change is needed.                                                                            
                                                                                                                                
DR. MANDSAGER indicated that current  law prohibits a person from                                                               
bringing a firearm to a [licensed child care] facility.                                                                         
                                                                                                                                
REPRESENTATIVE GARA  offered his understanding, though,  that one                                                               
cannot currently  bring a  firearm to a  school.   Therefore, why                                                               
should  on be  permitted  to  bring a  firearm  to  a child  care                                                               
facility?                                                                                                                       
                                                                                                                                
1:47:35 PM                                                                                                                    
                                                                                                                                
STACIE KRALY,  Senior Assistant Attorney General,  Human Services                                                               
Section,  Civil  Division  (Juneau),  Department  of  Law  (DOL),                                                               
relayed  that the  discussion in  the  Senate committee  hearings                                                               
revolved  around the  issue  of whether  an  individual would  be                                                               
allowed  to have  an  unloaded firearm  in  his/her vehicle  when                                                               
he/she goes  to pick up or  drop off his/her child  at a licensed                                                               
child care facility.   In other words, the qualifier  used in the                                                               
proposed change  was that  the firearm be  unloaded, not  that it                                                               
was locked up in  the trunk or encased in a  container.  She said                                                               
that the DOL is neutral on that proposed change.                                                                                
                                                                                                                                
REPRESENTATIVE  GRUENBERG, in  response to  comments, noted  that                                                               
current law  prohibits one from  possessing a firearm  at certain                                                               
facilities.   He opined that  if the intent  is to ensure  that a                                                               
firearm  be encased  in  a  gun case,  then  the language  should                                                               
actually  state "gun  case"  rather than  "container  of a  motor                                                               
vehicle",  particularly  since  a  gun case  is  not  actually  a                                                               
container of a motor vehicle and is instead a portable item.                                                                    
                                                                                                                                
REPRESENTATIVE  GRUENBERG made  a  motion  to conceptually  amend                                                               
Amendment 1,  to change the words,  "encased in a container  of a                                                               
motor vehicle" to "encased in a gun case in a motor vehicle".                                                                   
                                                                                                                                
REPRESENTATIVE  DAHLSTROM   said  she   has  problems   with  the                                                               
practicality of  the language  in that portion  of Amendment  1 -                                                               
both its  current language  and that which  is being  offered via                                                               
the amendment to  Amendment 1.  She offered her  belief that most                                                               
people who carry  firearms will not have them locked  up in a gun                                                               
case  nor  will the  firearms  be  unloaded.    What good  is  an                                                               
unloaded gun, she queried.                                                                                                      
                                                                                                                                
1:52:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GRUENBERG said  his  concern is  that he  doesn't                                                               
know  what is  meant  by the  term  "in a  container  of a  motor                                                               
vehicle".  Would that be a glove box, for instance?                                                                             
                                                                                                                                
REPRESENTATIVE  DAHLSTROM said  that that  meaning would  be fine                                                               
with her.                                                                                                                       
                                                                                                                                
REPRESENTATIVE    GRUENBERG    concurred,   but    offered    his                                                               
understanding  that the  language makes  it sound  as though  the                                                               
container must be a  part of the car - thus a  gun case would not                                                               
apply.                                                                                                                          
                                                                                                                                
CHAIR   McGUIRE   concurred   with   Representative   Gruenberg's                                                               
summation.  She  asked whether changing the  language to "encased                                                               
in a glove compartment or a locked gun case".                                                                                   
                                                                                                                                
REPRESENTATIVE GRUENBERG  indicated that he would  be amenable to                                                               
such a change.                                                                                                                  
                                                                                                                                
CHAIR McGUIRE  offered her  belief that  the current  language in                                                               
Amendment 1 would not allow for the use of a gun case.                                                                          
                                                                                                                                
1:53:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARA  said he would  be more  comfortable changing                                                               
the language  in Amendment  1 such that  it mirrors  the language                                                               
pertaining the possession of firearms on school grounds.                                                                        
                                                                                                                                
REPRESENTATIVE GRUENBERG  withdrew his motion to  amend Amendment                                                               
1, but indicated that he may wish to revisit the issue later.                                                                   
                                                                                                                                
DR.  MANDSAGER  explained  that   the  next  change  proposed  by                                                               
Amendment 1  would delete Section  14 of CSHB 193(HES).   Section                                                               
14,  he relayed,  has been  found to  be adding  language in  the                                                               
wrong place, and  so needs to be removed.   The changes Amendment                                                               
1 proposes to  pages 12 and 14, he opined,  are important because                                                               
they add  the crime of  medical assistance fraud to  the criminal                                                               
history and  registry provision and  applies both  to individuals                                                               
and to entities.                                                                                                                
                                                                                                                                
1:55:29 PM                                                                                                                    
                                                                                                                                
DR. MANDSAGER explained  that the change proposed  by Amendment 1                                                               
to page  16 will  insert language, via  a new  Section 47.05.350,                                                               
regarding  immunity  for  using   information  obtained  under  a                                                               
criminal history background check.                                                                                              
                                                                                                                                
MS. KRALY  additionally explained that this  proposed language is                                                               
already  included in  the bill  but in  the wrong  place, and  so                                                               
Amendment 1 also  includes a corresponding change  to delete this                                                               
language from that wrong location.                                                                                              
                                                                                                                                
DR. MANDSAGER explained  that the change proposed  by Amendment 1                                                               
to  page  21,  line  9,  is in  response  to  concerns  that  the                                                               
department  could issue  policies  or  procedures independent  of                                                               
regulation,  and  the  change  clarifies  that  any  policies  or                                                               
procedures are not  simply arbitrary rules but  have gone through                                                               
the regulatory process.                                                                                                         
                                                                                                                                
1:56:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GRUENBERG  asked   whether  the  department  must                                                               
follow  the  Administrative  Procedure Act  (APA)  regarding  the                                                               
adoption of regulations.                                                                                                        
                                                                                                                                
MS. KRALY  confirmed that the  department must follow the  APA in                                                               
that regard.                                                                                                                    
                                                                                                                                
DR. MANDSAGER explained  that the change proposed  by Amendment 1                                                               
to  page 23,  lines 30-31  should clarify  that licensing  by the                                                               
department does not obligate the  department to place or maintain                                                               
an individual.                                                                                                                  
                                                                                                                                
1:57:26 PM                                                                                                                    
                                                                                                                                
MS.  KRALY,  in response  to  questions,  relayed that  the  term                                                               
"entity" is  defined in  statute as  referring to  any of  the 18                                                               
entities that the department licenses,  and that use of that term                                                               
in the  proposed change is  also meant to  apply to any  of those                                                               
entities.   In other  words, the department  is not  obligated to                                                               
find  residents  for  any  entity  just  because  the  department                                                               
licensed  the   entity,  nor  is  the   department  obligated  to                                                               
subsidize  any  entity  it  licenses.   In  response  to  further                                                               
questions,  acknowledged  that  this  proposed  change  basically                                                               
seeks to  immunize the  department from  financial responsibility                                                               
towards the entities it licenses.                                                                                               
                                                                                                                                
DR. MANDSAGER explained  that the change proposed  by Amendment 1                                                               
to page  32, line 4, will  ensure that the provisions  of the APA                                                               
also apply.                                                                                                                     
                                                                                                                                
MS.  KRALY, in  response to  questions, clarified  that both  the                                                               
provisions  of  the APA  and  the  procedures for  administrative                                                               
hearings   would   apply   to  the   quasi-adjudicatory   process                                                               
established via proposed  AS 47.32.150(a), and that  for the most                                                               
egregious   type  of   sanctioning  and   licensing  actions   an                                                               
administrative law judge will be used.                                                                                          
                                                                                                                                
2:01:44 PM                                                                                                                    
                                                                                                                                
DR. MANDSAGER, in  response to comments, offered  his belief that                                                               
the rest of the changes proposed  by Amendment 1 are technical in                                                               
nature - conforming language and renumbering.                                                                                   
                                                                                                                                
REPRESENTATIVE  COGHILL,  referring  to the  change  proposed  by                                                               
Amendment 1  regarding firearms,  offered his  understanding that                                                               
it  merely  mirrors  language pertaining  to  the  possession  of                                                               
firearms around school areas.                                                                                                   
                                                                                                                                
REPRESENTATIVE DAHLSTROM  removed her  objection to  the adoption                                                               
of Amendment 1.                                                                                                                 
                                                                                                                                
CHAIR McGUIRE asked whether there were any further objections.                                                                  
                                                                                                                                
REPRESENTATIVE  GRUENBERG  referred  to the  change  proposed  by                                                               
Amendment 1 to delete proposed  AS 47.32.900(1)(B), which defines                                                               
"ambulatory  surgical  center"  as   including  a  facility  that                                                               
performs invasive diagnostic or therapeutic services.                                                                           
                                                                                                                                
DR. MANDSAGER said that after  discussion with industry personnel                                                               
and physicians, it  became clear to him that inclusion  of such a                                                               
definition was  impractical and  so he has  decided to  have that                                                               
language  removed.    He  offered  his  understanding  that  this                                                               
language  was  removed via  an  amendment  in the  House  Health,                                                               
Education   and   Social   Services   Standing   Committee,   but                                                               
Legislative Legal and Research Services  neglected to include the                                                               
change in CSHB 193(HES).                                                                                                        
                                                                                                                                
2:03:27 PM                                                                                                                    
                                                                                                                                
CHAIR  McGUIRE, after  ascertaining  that there  were no  further                                                               
objections, announced that Amendment 1 was adopted.                                                                             
                                                                                                                                
REPRESENTATIVE  ANDERSON  made a  motion  to  adopt Amendment  2,                                                               
labeled  04/29/05, 2:30  PM.,  which  read [original  punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
     Page 1, lines 9 - 11:                                                                                                      
         Delete "expanding reimbursable services under                                                                        
      Medicaid waivers for older Alaskans and adults with                                                                     
     disabilities to include adult companion services;"                                                                       
     Page 42, line 24 through page 43, line 23:                                                                                 
          Delete all material.                                                                                                  
     Renumber bill sections accordingly.                                                                                        
     Page 47, line 9:                                                                                                           
          Delete "58"                                                                                                           
          Insert "57"                                                                                                           
     Page 47, line 10:                                                                                                          
          Delete "59"                                                                                                           
          Insert "58"                                                                                                           
     Page 47, line 13:                                                                                                          
          Delete "58(b)"                                                                                                        
          Insert "57(b)"                                                                                                        
     Page 47, line 15:                                                                                                          
          Delete "60 - 62"                                                                                                      
          Insert "59 - 61"                                                                                                      
                                                                                                                                
DR.   MANDSAGER   relayed   that   Amendment   2   reflects   the                                                               
administration's   desire   to   have   Section   54,   and   its                                                               
corresponding  language  in  the  title,  deleted.    It  is  the                                                               
administration's position,  he remarked, that  HB 193 is  not the                                                               
appropriate bill with which to  deal with Medicaid waiver issues,                                                               
particularly  given  that  a  study   regarding  such  issues  is                                                               
scheduled to be launched this summer.                                                                                           
                                                                                                                                
REPRESENTATIVE  GARA objected  to  the  motion.   He  said he  is                                                               
concerned  that those  with disabilities  are  being forced  into                                                               
nursing  homes;  opined  that  Representative  Cissna's  proposed                                                               
language - Section  54 - attempts to address this  issue now; and                                                               
relayed that it  is not acceptable to him for  the legislature to                                                               
delay  addressing this  issue until  next year,  until after  the                                                               
aforementioned study is completed.                                                                                              
                                                                                                                                
STEVEN P.  ASHMAN, Director, Division of  Senior and Disabilities                                                               
Services,  Department  of  Health  and  Social  Services  (DHSS),                                                               
relayed  that  under  the  new   regulations,  the  frequency  of                                                               
services was reduced.  However,  the division has not seen anyone                                                               
that's been diverted  from the waiver program and  placed into an                                                               
institution.   Instead, the  division has seen  some of  the cost                                                               
efficiencies  that were  anticipated  under  the respite  program                                                               
being  shifted over  to the  PCA  budget, which  has helped  many                                                               
families.   He,  too, noted  that the  division will  be doing  a                                                               
long-term-care study, and said  the division anticipates spending                                                               
$260 million next  year for long-term-care services  and wants to                                                               
ensure that any changes which will  be made will be good changes,                                                               
that they will be the best practices.                                                                                           
                                                                                                                                
2:06:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GARA  pointed out,  however,  that  next year  is                                                               
still next  year.  He surmised  that the reason the  division has                                                               
not  seen  people going  into  nursing  homes is  because  family                                                               
members are  making more sacrifices  to keep their loved  ones at                                                               
home, and  so that is  not a good  indication that there  isn't a                                                               
problem.   He reiterated that he  objects to the motion  to adopt                                                               
Amendment 2.                                                                                                                    
                                                                                                                                
CHAIR McGUIRE  said she  supports [Amendment  2] but  agrees with                                                               
Representative Gara.  She added:                                                                                                
                                                                                                                                
     It  really  was  frustrating  this interim  to  try  to                                                                    
     communicate a  message ... from our  constituents.  And                                                                    
     it is three branches  of government, but we're supposed                                                                    
     to be  the lawmaking  branch and  we're supposed  to be                                                                    
     setting the  policies and then  we pay for  whatever it                                                                    
     is that  we set. ...  Not the  other way around  - that                                                                    
     you set  it and  then cut the  budget that  you request                                                                    
     from us  - and I  sort of feel  a little bit  like that                                                                    
     went on.                                                                                                                   
                                                                                                                                
2:09:02 PM                                                                                                                    
                                                                                                                                
A roll call  vote was taken.   Representatives McGuire, Anderson,                                                               
Coghill,  Kott, and  Dahlstrom  voted in  favor  of Amendment  2.                                                               
Representatives Gruenberg and Gara  voted against it.  Therefore,                                                               
Amendment 2 was adopted by a vote of 5-2.                                                                                       
                                                                                                                                
REPRESENTATIVE  GRUENBERG referred  to Amendment  1, specifically                                                               
the change  proposed to page  38, lines  7-15.  He  asked whether                                                               
that is a substantive change.                                                                                                   
                                                                                                                                
DR.  MANDSAGER  replied  that  this   change  will  clarify  that                                                               
"assisted  living  homes" means  the  same  thing throughout  the                                                               
bill.                                                                                                                           
                                                                                                                                
REPRESENTATIVE GRUENBERG asked whether  the change will result in                                                               
any diminution of service to the client.                                                                                        
                                                                                                                                
DR.  MANDSAGER said  no,  adding that  the  language will  merely                                                               
match the current statutory definition.                                                                                         
                                                                                                                                
2:11:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GRUENBERG,   noting  that  one  of   the  changes                                                               
proposed  by Amendment  1 will  repeal AS  25.27.244(s)(2), asked                                                               
what that statute pertains to.                                                                                                  
                                                                                                                                
MS.  KRALY  said that  it  pertains  to  child support,  and  the                                                               
proposed  change   is  in  response   to  a  concern   raised  by                                                               
Legislative Legal and Research Services.  She added:                                                                            
                                                                                                                                
     The  premise is  that we're  licensing entities  rather                                                                    
     than  individuals,  and  so what  that  was  doing  was                                                                    
     allowing some  garnishment issues, and  there's another                                                                    
     issue  that deals  with postsecondary  education loans.                                                                    
     And you can't garnish an  entity for a loan default but                                                                    
     you  can   garnish  an  individual,  and   since  we're                                                                    
     licensing  entities,  rather   than  individuals,  that                                                                    
     needed to be changed.                                                                                                      
                                                                                                                                
2:12:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARA  made a motion  to adopt Amendment  3, which,                                                               
with   handwritten   additions,    read   [original   punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
     Page 1, line 9, following "Services;":                                                                                   
          Insert "relating to public assistance for health                                                                    
     facilities and assisted living  homes, to rates charged                                                                  
     by an  assisted living  home, and  to the  liability of                                                                  
     recipients of  home or community-based services  to pay                                                                  
     for those services;                                                                                                      
                                                                                                                                
     Page 18, following line 9                                                                                                  
     Insert new bill sections to read:                                                                                          
     Sec. 22 AS 47.07.070(a) is amended to read:                                                                                
          (a) Except as provided under (d) - (f) of this                                                                    
     section,  the [THE]  department  shall, by  regulation,                                                                
     set rates  of payment for health  facilities under this                                                                    
     chapter  and AS  47.25.120  -  47.25.300 in  accordance                                                                    
     with 42  U.S.C. 1396  (Title XIX, Social  Security Act,                                                                    
     Medical   Assistance)   and   this  section.   A   rate                                                                    
     established under  this section  takes effect  under AS                                                                    
     44.62  (Administrative  Procedure  Act) but  not  until                                                                    
     approved   in   writing   by  the   commissioner.   The                                                                    
     commissioner  may  delegate  the performance  of  these                                                                    
     functions.                                                                                                                 
     Sec.  23   AS  47.07.070  is  amended   by  adding  new                                                                    
     subsections to read:                                                                                                       
          (d) For residential support living services                                                                           
     provided   to   an   eligible  recipient   of   medical                                                                    
     assistance living  in an assisted living  home licensed                                                                    
     under AS  47.33, the  minimum daily  reimbursement rate                                                                    
     to  the  assisted  living  home   for  room  and  board                                                                    
     expenses is $28.                                                                                                           
          (e) The department may not establish a maximum                                                                        
     daily rate  for room and  board expenses charged  by an                                                                    
     assisted living home.                                                                                                      
          (f) A calculation of the rate for administrative                                                                      
     and  general   costs  for  a  provider,   including  an                                                                    
     assisted living  home, shall be determined  in the same                                                                    
     way as a calculation  of the administrative and general                                                                    
     cost rate  for a Pioneers'  Home.  In  this subsection,                                                                    
     "administrative   and   general  costs"   means   those                                                                    
     expenses that are common to  the overall operation of a                                                                    
     provider  providing  home  and  community-based  waiver                                                                    
     services  and that  are not  directly assignable  to or                                                                    
     borne by a specific program  or recipient of a home and                                                                    
     community-based service.                                                                                                   
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 41, following line 5                                                                                                  
          Insert a new bill section to read:                                                                                    
     Sec. 49 AS 47.07.070(c) is repealed."                                                                                      
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 41, following line 14                                                                                                 
          Insert a new bill section to read:                                                                                    
      Sec 52. The uncodified law of the State of Alaska is                                                                      
     amended by adding a new section to read:                                                                                   
       REGULATIONS ANNULLED.  7 AAC 43.1058(j) and 7 AAC                                                                        
     43.1058(k)(1)(B) are annulled."                                                                                            
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
           Note to Leg. Legal:  Conform all internal                                                                            
     bill section references as necessary.                                                                                      
                                                                                                                                
REPRESENTATIVE GARA, indicating  that the goal of  Amendment 3 is                                                               
to establish  a minimum room  and board rate for  assisted living                                                               
homes, made a  motion to amend Amendment 3, to  take out proposed                                                               
subsection  (e)  of  proposed  AS  47.07.070.    There  being  no                                                               
objection, the amendment to Amendment 3 was adopted.                                                                            
                                                                                                                                
REPRESENTATIVE  GARA acknowledged  that several  legislators have                                                               
had  concerns about  the  reduction  in the  rates  paid to  help                                                               
people  stay  at  assisted  living homes.    That  reduction  was                                                               
essentially a transfer, he noted, and  went from $28 a day to $18                                                               
a day, and  although some monetary compensation  occurred via the                                                               
Medicaid  program,  many assisted  living  homes  feel that  they                                                               
can't  legally  use  that  program.   Amendment  3,  as  amended,                                                               
attempts to  "roll back the  new summer regulation to  the former                                                               
$28 [per] day  compensation rate."  He  offered his understanding                                                               
that corresponding  amendments with  regard to funding  have been                                                               
made to the  [operating] budget.  However, also  according to his                                                               
understanding, he  remarked, until  a new regulation  is adopted,                                                               
any forthcoming  funds cannot be  spent; thus the  department may                                                               
relay the need to adopt a new regulation.                                                                                       
                                                                                                                                
2:15:18 PM                                                                                                                    
                                                                                                                                
MR.  ASHMAN said  that Amendment  3, as  amended, will  deal with                                                               
individuals who  have incomes in excess  of Supplemental Security                                                               
Income (SSI)  and Adult Public  Assistance (APA), and  will allow                                                               
clients  to retain  their SSI  and APA  and use  it for  whatever                                                               
purpose  they  wish.   Furthermore,  if  the  department  becomes                                                               
authorized to promulgate emergency  regulations on this issue, it                                                               
will  then do  so, providing  for an  effective date  of July  1,                                                               
2006.                                                                                                                           
                                                                                                                                
REPRESENTATIVE  GARA said  he wants  to  be assured  that if  the                                                               
funding is made  available this year, that  assisted living homes                                                               
will be compensated at $28 per day immediately, not 2006.                                                                       
                                                                                                                                
MR. ASHMAN offered  his understanding that an option  might be to                                                               
institute reimbursement retroactively.                                                                                          
                                                                                                                                
MS. KRALY also  offered her understanding that if  the funding is                                                               
made available via the budget,  monies would be paid to assisted-                                                               
living  home operators  starting  July  1, and  that  in lieu  of                                                               
regulatory  authorization, the  [DHSS]  will work  as quickly  as                                                               
possible to amend  the regulations back to what they  were a year                                                               
ago.                                                                                                                            
                                                                                                                                
REPRESENTATIVE  GARA  indicated  that  for  the  time  being  his                                                               
intention  is try  to get  Amendment 3,  as amended,  adopted and                                                               
then,  when he  gets something  in  writing assuring  him of  the                                                               
department's intent on  this issue, he will  withdraw Amendment 3                                                               
as the bill continues through the legislative process.                                                                          
                                                                                                                                
2:18:04 PM                                                                                                                    
                                                                                                                                
CHAIR  McGUIRE said  she would  agree to  oppose Amendment  3, as                                                               
amended, but pointed out that it  would be nice to have something                                                               
in  writing  anyway  so  as  to  understand  the  timing  on  the                                                               
regulation process.  She remarked  that Representative Gara makes                                                               
a  good  point,   that  assisted  living  homes   are  under  the                                                               
assumption  that they  will be  fine if  the budgetary  change is                                                               
forthcoming and  so are  acting a  certain way  in order  to stay                                                               
afloat; therefore if the monies  aren't actually going to be made                                                               
available until  2006, it won't  help assisted living  homes now.                                                               
She  reiterated  that it  would  be  nice  to have  something  in                                                               
writing, something  stating that  the department will  pursue the                                                               
promulgation of emergency regulations.                                                                                          
                                                                                                                                
2:20:05 PM                                                                                                                    
                                                                                                                                
MR. ASHMAN said he would  discuss the issue with the commissioner                                                               
of DHSS,  adding his  assurance that the  department does  have a                                                               
commitment to follow through if the funding is made available.                                                                  
                                                                                                                                
2:20:19 PM                                                                                                                    
                                                                                                                                
CHAIR McGUIRE  objected to  the motion to  adopt Amendment  3, as                                                               
amended.                                                                                                                        
                                                                                                                                
2:20:40 PM                                                                                                                    
                                                                                                                                
A  roll   call  vote  was  taken.     Representatives  Dahlstrom,                                                               
Gruenberg, and  Gara voted in  favor of Amendment 3,  as amended.                                                               
Representatives   McGuire   and   Anderson  voted   against   it.                                                               
Therefore, Amendment 3,  as amended, was adopted by a  vote of 3-                                                               
2.                                                                                                                              
                                                                                                                                
The committee took an at-ease from 2:21 p.m. to 2:23 p.m.                                                                       
                                                                                                                                
2:23:03 PM                                                                                                                    
                                                                                                                                
CHAIR  McGUIRE   relayed  that   the  House   Judiciary  Standing                                                               
Committee would continue  discussion - perhaps even  moving on to                                                               
the  next  bill  -  and  be  awaiting  a  letter  from  the  DHSS                                                               
addressing  members'  concerns   regarding  the  assisted  living                                                               
provider regulations.                                                                                                           
                                                                                                                                
REPRESENTATIVE GRUENBERG referred to  Amendment 1 and offered his                                                               
understanding that it  would repeal a provision  that would allow                                                               
the department to pull a person's  license if he/she has not paid                                                               
child support.                                                                                                                  
                                                                                                                                
REPRESENTATIVE GRUENBERG made  a motion to adopt  Amendment 4, to                                                               
delete the language  added to the bill via  adoption of Amendment                                                               
1 that read:                                                                                                                    
                                                                                                                                
     Page 41, following line 2:                                                                                                 
          Insert a new bill section to read:                                                                                    
        "* Sec. 46.  AS 25.27.244(s)(2) is repealed."                                                                         
                                                                                                                                
                                                                                                                                
REPRESENTATIVE ANDERSON objected for the purpose of discussion.                                                                 
                                                                                                                                
2:25:13 PM                                                                                                                    
                                                                                                                                
MS. KRALY said that the DOL has no objection Amendment 4.                                                                       
                                                                                                                                
CHAIR McGUIRE announced that Amendment 4 was adopted.                                                                           
                                                                                                                                
CHAIR McGUIRE announced that CSHB  193(HES), as amended, would be                                                               
set aside until later in the meeting.                                                                                           
                                                                                                                                
                          AMENDMENT(S)                                                                                        
                                                                                                                                
Amendment 1  [Labeled 05/04/05, 10:15 a.m.]  (adopted):                                                                       
                                                                                                                                
     Page 1, line 7, following "clinics;":                                                                                      
                                                                                                                                
          Insert "relating to possession of a firearm at                                                                      
     licensed entities and facilities;"                                                                                       
                                                                                                                                
     Page 4, line 3, following "children":                                                                                      
                                                                                                                                
          Insert ", except that a person 21 years of age or                                                                 
     older may possess  an unloaded firearm in  the trunk of                                                                
     a motor  vehicle or encased  in a container of  a motor                                                                
     vehicle"                                                                                                               
                                                                                                                                
     Page 6, line 31 through page 8, line 15:                                                                                   
                                                                                                                                
          Delete all material.                                                                                                  
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 12, line 16, following "jurisdiction":                                                                                
          Insert "or to have committed medical assistance                                                                       
     fraud  under AS  47.05.210 or  a substantially  similar                                                                    
     provision in another jurisdiction"                                                                                         
     Page 14, line 8, following "jurisdiction":                                                                                 
          Insert "or to have committed medical assistance                                                                       
     fraud  under AS  47.05.210 or  a substantially  similar                                                                    
     provision in another jurisdiction"                                                                                         
     Page 16, following line 11:                                                                                                
          Insert "Sec. 47.05.350.  Immunity.  An entity or                                                                    
     individual  service provider  that obtains  information                                                                    
     about an employee under a  criminal history check under                                                                    
     AS 47.05.310 may use that  information only as provided                                                                    
     in  regulations  adopted  by the  department  under  AS                                                                    
     47.05.320.    However,  if that  entity  or  individual                                                                    
     service provider reasonably  relies on that information                                                                    
     provided   under  the   regulations   adopted  by   the                                                                    
     department to deny employment to  an individual who was                                                                    
     selected for  hire as an  employee, including  during a                                                                    
     period  of   provisional  employment,  the   entity  or                                                                    
     individual service provider is  not liable in an action                                                                    
     brought  by  the  individual based  on  the  employment                                                                    
     determination resulting from the information."                                                                             
     Page 21, line 29, following "AS 47.32.010(b)":                                                                             
          Insert ", as defined by regulation"                                                                                   
     Page 23, line 30, following "(c)", through line 31:                                                                        
          Delete all material and insert "The issuance of a                                                                     
     license  by  the  department   does  not  obligate  the                                                                    
     department  to place  or maintain  an individual  in an                                                                    
     entity or  through an entity,  or to  provide financial                                                                    
     support to an entity."                                                                                                     
     Page 32, line 4:                                                                                                           
          Delete "applies"                                                                                                      
          Insert "and AS 44.62.330 - 44.62.630 apply"                                                                           
     Page 32, lines 24 - 30:                                                                                                    
          Delete all material.                                                                                                  
     Page  34,  line   21,  following  "ambulatory  surgical                                                                    
     center":                                                                                                                   
          Insert "means a facility that"                                                                                        
     Page 34, line 22:                                                                                                          
          Delete all material.                                                                                                  
     Page 34, line 23:                                                                                                          
          Delete "(i)"                                                                                                          
          Insert "(A)"                                                                                                          
     Page 34, line 25:                                                                                                          
          Delete "(ii)"                                                                                                         
          Insert "(B)"                                                                                                          
          Delete "and"                                                                                                          
     Page 34, lines 27 - 28:                                                                                                    
          Delete all material.                                                                                                  
     Page 35, line 5:                                                                                                           
          Delete "or"                                                                                                           
     Page 35, following line 5:                                                                                                 
          Insert "(iii) offers personal assistance as                                                                           
     defined in AS 47.33.990; or"                                                                                               
     Page 35, line 6:                                                                                                           
          Delete "(iii)"                                                                                                        
          Insert "(iv)"                                                                                                         
     Page 37, line 13, following "care":                                                                                        
          Insert "or rehabilitative services"                                                                                   
     Page 37, line 31:                                                                                                          
          Delete "35"                                                                                                           
          Insert "34"                                                                                                           
     Page 38, line 7, following "to", through line 15:                                                                          
          Delete all material and insert "assisted living                                                                       
     homes as defined in AS 47.32.900."                                                                                         
     Page 41, following line 2:                                                                                                 
          Insert a new bill section to read:                                                                                    
        "* Sec. 46.  AS 25.27.244(s)(2) is repealed."                                                                         
     Page 41, line 6:                                                                                                           
          Delete "47.33.420,"                                                                                                   
     Page 41, line 18:                                                                                                          
       Delete "1 - 15, 17 - 19, 21 - 35, 37 - 42, and 44                                                                        
     - 51"                                                                                                                      
          Insert "1 - 14, 16 - 18, 20 - 34, and 36 - 51"                                                                        
     Page 41, line 21:                                                                                                          
          Delete "35"                                                                                                           
          Insert "34"                                                                                                           
     Page 41, line 22:                                                                                                          
          Delete "35"                                                                                                           
          Insert "34"                                                                                                           
     Page 41, line 24:                                                                                                          
       Delete "1 - 15, 17 - 19, 21 - 35, 37 - 42, and 44                                                                        
     - 51"                                                                                                                      
          Insert "1 - 14, 16 - 18, 20 - 34, and 36 - 51"                                                                        
     Page 41, line 25:                                                                                                          
       Delete "1 - 15, 17 - 19, 21 - 35, 37 - 42, and 44                                                                        
     -"                                                                                                                         
          Insert "1 - 14, 16 - 18, 20 - 34, and 36 -"                                                                           
     Page 41, line 27:                                                                                                          
          Delete "35"                                                                                                           
          Insert "34"                                                                                                           
     Page 41, line 30:                                                                                                          
       Delete "1 - 15, 17 - 19, 21 - 35, 37 - 42, and 44                                                                        
     - 51"                                                                                                                      
          Insert "1 - 14, 16 - 18, 20 - 34, and 36 - 51"                                                                        
     Page 42, line 2:                                                                                                           
          Delete "SEC. 20"                                                                                                      
          Insert "SECS. 19 AND 35"                                                                                              
     Page 42, line 3:                                                                                                           
          Delete "sec. 20"                                                                                                      
          Insert "secs. 19 and 35"                                                                                              
     Page 42, line 5:                                                                                                           
          Delete "sec. 20"                                                                                                      
          Insert "secs. 19 and 35"                                                                                              
     Page 42, line 8:                                                                                                           
          Delete "20"                                                                                                           
          Insert "19"                                                                                                           
     Page 42, line 9:                                                                                                           
          Delete "35"                                                                                                           
          Insert "34"                                                                                                           
     Page 42, line 12:                                                                                                          
          Delete "sec. 20"                                                                                                      
          Insert "secs. 19 and 35"                                                                                              
     Page 42, line 14:                                                                                                          
          Delete "20"                                                                                                           
          Insert "19"                                                                                                           
     Page 42, line 17:                                                                                                          
          Delete "sec. 20"                                                                                                      
          Insert "secs. 19 and 35"                                                                                              
     Page 42, line 20:                                                                                                          
          Delete "20"                                                                                                           
          Insert "19"                                                                                                           
          Delete "35"                                                                                                           
          Insert "34"                                                                                                           
     Page 42, line 21:                                                                                                          
          Delete "20"                                                                                                           
          Insert "19"                                                                                                           
     Page 42, line 23:                                                                                                          
          Delete "20"                                                                                                           
          Insert "19"                                                                                                           
     Page 43, line 27:                                                                                                          
          Delete "35"                                                                                                           
          Insert "34"                                                                                                           
     Page 43, line 28:                                                                                                          
          Delete "35"                                                                                                           
          Insert "34"                                                                                                           
     Page 43, line 29:                                                                                                          
       Delete "1 - 15, 17 - 19, 21 - 35, 37 - 42, and 44                                                                        
     - 51"                                                                                                                      
          Insert "1 - 14, 16 - 18, 20 - 34, and 36 - 51"                                                                        
     Page 44, line 5:                                                                                                           
          Delete all material.                                                                                                  
     Page 44, line 6:                                                                                                           
          Delete "(4)"                                                                                                          
          Insert "(3)"                                                                                                          
          Delete "18"                                                                                                           
          Insert "17"                                                                                                           
     Page 44, line 7:                                                                                                           
          Delete "(5)"                                                                                                          
          Insert "(4)"                                                                                                          
          Delete "19"                                                                                                           
          Insert "18"                                                                                                           
     Page 44, line 8:                                                                                                           
          Delete "(6)"                                                                                                          
          Insert "(5)"                                                                                                          
          Delete "21"                                                                                                           
          Insert "20"                                                                                                           
     Page 44, line 9:                                                                                                           
          Delete "(7)"                                                                                                          
          Insert "(6)"                                                                                                          
          Delete "22"                                                                                                           
          Insert "21"                                                                                                           
     Page 44, line 10:                                                                                                          
          Delete "(8)"                                                                                                          
          Insert "(7)"                                                                                                          
          Delete "23"                                                                                                           
          Insert "22"                                                                                                           
     Page 44, line 11:                                                                                                          
          Delete "(9)"                                                                                                          
          Insert "(8)"                                                                                                          
          Delete "24 and 25"                                                                                                    
          Insert "23 and 24"                                                                                                    
     Page 44, line 12:                                                                                                          
          Delete "(10)"                                                                                                         
          Insert "(9)"                                                                                                          
          Delete "27"                                                                                                           
          Insert "26"                                                                                                           
     Page 44, line 13:                                                                                                          
          Delete "(11)"                                                                                                         
          Insert "(10)"                                                                                                         
          Delete "28"                                                                                                           
          Insert "27"                                                                                                           
     Page 44, line 14:                                                                                                          
          Delete "(12)"                                                                                                         
          Insert "(11)"                                                                                                         
          Delete "29"                                                                                                           
          Insert "28"                                                                                                           
     Page 44, line 15:                                                                                                          
          Delete "(13)"                                                                                                         
          Insert "(12)"                                                                                                         
          Delete "30"                                                                                                           
          Insert "29"                                                                                                           
     Page 44, line 16:                                                                                                          
          Delete "(14)"                                                                                                         
          Insert "(13)"                                                                                                         
          Delete "31"                                                                                                           
          Insert "30"                                                                                                           
     Page 44, line 17:                                                                                                          
          Delete "(15)"                                                                                                         
          Insert "(14)"                                                                                                         
          Delete "32"                                                                                                           
          Insert "31"                                                                                                           
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          Delete "(16)"                                                                                                         
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       Delete "1 - 15, 17 - 19, 21 - 35, 37 - 42, and 44                                                                        
     - 51"                                                                                                                      
          Insert "1 - 14, 16 - 18, 20 - 34, and 36 - 51"                                                                        
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          Delete all material.                                                                                                  
     Renumber the following bill sections accordingly.                                                                          
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          Insert "61"                                                                                                           
                                                                                                                                
[End of amendment(s); CSHB 193(HES), as amended, was set aside                                                                  
until later in the meeting.]                                                                                                    
                                                                                                                                
HB 193 - LICENSING MEDICAL OR CARE FACILITIES                                                                                 
                                                                                                                                
2:59:04 PM                                                                                                                    
                                                                                                                                
CHAIR McGUIRE announced  that the committee would  next return to                                                               
the  hearing on  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."  [Before the  committee was CSHB 193(HES), which                                                               
was amended earlier in the meeting.]                                                                                            
                                                                                                                                
REPRESENTATIVE   GRUENBERG  made   a   motion   to  rescind   the                                                               
committee's action  in adopting  Amendment 4, adopted  earlier in                                                               
the  meeting, that  deleted the  language added  to the  bill via                                                               
adoption of Amendment 1 that read:                                                                                              
                                                                                                                                
     Page 41, following line 2:                                                                                                 
          Insert a new bill section to read:                                                                                    
        "* Sec. 46.  AS 25.27.244(s)(2) is repealed."                                                                         
                                                                                                                                
CHAIR McGUIRE,  after ascertaining that there  were no objections                                                               
to  the motion  to  rescind the  committee's  action in  adopting                                                               
Amendment  4,  announced that  the  committee  has rescinded  its                                                               
action  in  adopting Amendment  4;  therefore  the language  that                                                               
proposes to  repeal AS 25.27.244(s)(2)  is now still part  of the                                                               
bill.                                                                                                                           
                                                                                                                                
REPRESENTATIVE GRUENBERG made  a motion to adopt  Amendment 5, to                                                               
alter the language added via  Amendment 1 that proposes to repeal                                                               
AS  25.27.244(s)(2)   such  that  it  would   instead  repeal  AS                                                               
25.27.244(s)(2)(B)(ii).   There being  no objection,  Amendment 5                                                               
was adopted.                                                                                                                    
                                                                                                                                
3:01:48 PM                                                                                                                    
                                                                                                                                
CHAIR McGUIRE  - after  recapping some of  the actions  taken and                                                               
intentions  expressed  earlier  in  the meeting  with  regard  to                                                               
Amendment  3,  as  amended  -   made  a  motion  to  rescind  the                                                               
committee's  action in  adopting  Amendment 3,  as amended  [text                                                               
provided during  the first portion of  the minutes on HB  193 for                                                               
this date].                                                                                                                     
                                                                                                                                
REPRESENTATIVE GARA objected to the motion.                                                                                     
                                                                                                                                
STEVEN P.  ASHMAN, Director, Division of  Senior and Disabilities                                                               
Services, Department  of Health and Social  Services (DHSS), said                                                               
that Amendment  3, as amended,  essentially restores  [the former                                                               
regulatory language] with regard to  clients being able to retain                                                               
their  Supplemental  Security  Income   (SSI)  and  Adult  Public                                                               
Assistance (APA) and  spend it any way they desired.   He said he                                                               
has gone on  record as saying, and written letters  to the effect                                                               
that it is  the intent of the department to  allow the clients to                                                               
spend the aforementioned income any way they want.                                                                              
                                                                                                                                
3:04:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GARA said  he  wants to  ensure  that the  former                                                               
process under  which clients got  $362 per month in  APA payments                                                               
and  could use  it for  room  and board  would still  apply.   He                                                               
offered  his understanding  that should  the funding  go through,                                                               
then the  APA payments would  go back up  to $362 for  those that                                                               
used to qualify for those payments.                                                                                             
                                                                                                                                
MR.  ASHMAN  clarified,  however,  that it  is  the  department's                                                               
intent to  retain the Medicaid  refinancing and the  "cost shift"                                                               
that  occurred last  year.   He  offered  his understanding  that                                                               
[Amendment 3,  as amended] will  free up, for  the aforementioned                                                               
clients, all excess  funds, funds which can then be  spent in any                                                               
fashion,  just as  was  the case  prior to  the  adoption of  the                                                               
[latest] regulations.                                                                                                           
                                                                                                                                
REPRESENTATIVE GARA said he still has a concern.                                                                                
                                                                                                                                
CHAIR McGUIRE said she hopes  that the committee will rescind its                                                               
action in adopting  amendment 3, as amended,  and that afterwards                                                               
she and  other members can  work together with the  department to                                                               
ensure that their concerns are addressed.                                                                                       
                                                                                                                                
REPRESENTATIVE   GARA  expressed   a  preference   for  retaining                                                               
Amendment  3,  as   amended,  as  a  means   of  encouraging  the                                                               
department to address members' concerns.                                                                                        
                                                                                                                                
3:07:32 PM                                                                                                                    
                                                                                                                                
A roll call  vote was taken.   Representatives McGuire, Anderson,                                                               
Coghill,  Kott, and  Dahlstrom voted  in favor  of the  committee                                                               
rescinding  its  action  in adopting  Amendment  3,  as  amended.                                                               
Representatives Gruenberg and Gara  voted against it.  Therefore,                                                               
the committee  rescinded its action  in adopting Amendment  3, as                                                               
amended, by a vote of 5-2.                                                                                                      
                                                                                                                                
REPRESENTATIVE  DAHLSTROM  moved  to  report  CSHB  193(HES),  as                                                               
amended,  out of  committee with  individual recommendations  and                                                               
the accompanying fiscal notes.                                                                                                  
                                                                                                                                
REPRESENTATIVE  GARA  objected to  note  that  the motion  should                                                               
include the forwarding of the attached letter from Mr. Ashman.                                                                  
                                                                                                                                
CHAIR  McGUIRE acknowledged  that point  and asked  whether there                                                               
were any  further objections.   There  being none,  CSHB 193(JUD)                                                               
was reported from the House Judiciary Standing Committee.                                                                       
                                                                                                                                

Document Name Date/Time Subjects