Legislature(1997 - 1998)
02/24/1997 09:00 AM Senate HES
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
SB 96 REGULATION OF HOSPICE CARE
Number 424
CHAIRMAN WILKEN announced SB 96 as the next order of business.
CHARLES QUARRE' , President of the Hospice of the Central Peninsula,
informed the committee that the Hospice of the Central Peninsula
had been in operation for 10 years with 90 members and 50
volunteers. The Hospice of the Central Peninsula operates under
the guidelines of the National Hospice Organization. Mr. Quarre'
did not believe it is necessary to include volunteer hospice
programs for licensing. A fee would cause the hospice to pay for
the fee out of the funds used to provide services to its clients.
Mr. Quarre' said that the Central Peninsula Hospice adheres to all
the licensing provisions of volunteer hospice programs. Mr.
Quarre' recommended that volunteer hospice programs be excluded
from SB 96. The Central Peninsula Hospice has not received any
complaints during its 10 years of operation. If there is a problem
with hospices, that could be handled under the current laws and
regulations.
SENATOR WARD asked how long the Central Peninsula Hospice had been
in existence and how much of a clientele does it serve. CHARLES
QUARRE' reiterated that the Central Peninsula Hospice is in its
tenth year and it normally serves approximately 20-22 clients per
year. Most of these clients cannot afford any paid hospice.
SENATOR GREEN inquired as to who requested SB 96.
Number 462
BENJAMIN BROWN , Staff to Senator Kelly, said that this bill was in
response to a request from Hospice of Anchorage. Mr. Brown noted
that the concerns of the small volunteer hospices should be
addressed. Hospice of Anchorage does not intend to make it
difficult to operate a hospice program, particularly volunteer
hospice programs. Mr. Brown informed the committee that 38 states
have state licensing laws for hospice programs, of the 12 that do
not six of those have pending licensing laws. Mr. Brown cited the
growth in hospice as the main reason for SB 96. About one of every
three persons in the U.S. dying from cancer and AIDS use a hospice
program.
Mr. Brown preferred to let those speaking from Hospice of Anchorage
discuss the specifics. The committee packet does include a
sectional analysis. There is only one section in SB 96 which
creates Chapter 18 in Title 18 of Alaska Statutes. The three
articles in Chapter 18 regulate hospices under DHSS. Article 1
establishes parameters for licensing hospice programs that are
formal businesses. Article 2 establishes standards for volunteer
hospice programs. Mr. Brown noted that during drafting,
Legislative Legal Services pointed out that much would hinge on the
use of "relevance" in Article 2. It will be left to DHSS to
determine in regulation what the relevant provisions of the code
for larger, formally organized hospices would be applied to
volunteer hospices. This is the concern mentioned by Mr. Quarre'
which would need to be addressed in order to define "relevant" so
as not to place onerous regulations on the volunteer hospices.
Article 3 merely defines terms in the bill and provides penalties
for violations of the statutes.
SENATOR LEMAN asked if of the 38 states with such legislation, do
any have exclusions for volunteer hospices? BENJAMIN BROWN
specified that SB 96 was drafted from Maine's law which does not
specify what is relevant, the Department of Health is left to
determine the regulations. Mr. Brown stressed that SB 96 does not
intend to create difficulties for small, volunteer organizations.
The intent is to standardize without regulating with too much
burden as well as having the regulation pay for itself.
Number 522
MIKE SHIFFER , Board Member with Hospice of Anchorage, indicated the
need to ensure the quality of hospice care that was being diluted
by the definition of what a hospice program is. Mr. Shiffer
supported SB 96 and did not want to restrict any of the volunteer
hospices efforts. Mr. Shiffer offered to work with the committee
and the volunteer hospices on this issue.
PAULA MCCARRON , Executive Director of Hospice of Anchorage,
informed the committee that she had been working with the program
since 1982. Hospice of Anchorage began as a volunteer program in
1980 and is a member of the National Hospice Organization who
establishes what a hospice program should entail. Ms. McCarron
echoed comments regarding the increased profile and use of hospice
programs. The current change in health care increases the need for
licensing of hospice programs. Originally, hospice began as an
alternative for persons who wished to die at home. Currently,
people are not afforded the opportunity to remain in a hospital.
Furthermore, increased reimbursement for home care services, and a
need for people to remain near their home has sometimes made
hospice the program of choice by patients, family and other health
care providers.
Mr. McCarron expressed concern with the use of the term hospice
without regard for the philosophy of the National Hospice
Organization. SB 96 would preserve and protect the components of
the National Hospice Organization while ensuring that those seeking
such services would receive at least a minimum level of standards
and quality.
Number 563
SHELBERT LARSEN , Administrator of Health Facilities Licensing &
Certification for DHSS, stated that he had heard about SB 96 last
week and therefore, has not had much time to review. Mr. Larsen
did not oppose the idea of licensing hospice programs, but there
are some concerns with SB 96. If the bill moves forward, the
powers of DHSS should be very clear with regard to licensing, the
denial of a license, the suspension of a license, and the
revocation of a license. Mr. Larsen recommended the deletion of
Section 18.18.030. Medicare only requires on site visits for those
facilities at 10-15 percent frequency, therefore many years could
pass before any oversight would take place. Currently, there are
no licensed facilities or provider types that are Medicare
certified that have deemed status for licensure. Mr. Larsen echoed
the concerns regarding the need to define "relevant" in Section
18.18.040.
TAPE 97-18, SIDE B
Mr. Larsen was unsure as to the results of lines 16-18 on page 2.
Currently, licensed facilities have the right to throw out the
department although such action can effect the licensure status.
The meaning of "discrete entity" in subsection (c) under Section
18.18.100 is not clear. Mr. Larsen recommended the deletion of a
"discrete entity." In conclusion, Mr. Larsen noted that he could
recommend many other changes and would forward his suggestions to
the committee.
CHAIRMAN WILKEN noted that SB 96 would be held in order to receive
that information from Mr. Larsen. He asked if the committee had
any questions.
SENATOR WARD requested a copy of the national standards to which
have been referred.
SENATOR GREEN asked if this created a need for occupational
licensing. BENJAMIN BROWN replied no. The end of Article 1 says
that licensure of a facility or a program does not obviate the need
for the individuals part of that program's interdisciplinary team
to have the appropriate occupational licenses. This only creates
program licensure of the hospice.
SENATOR WARD asked if SB 96 would create a situation in which
someone who does not currently have to be licensed would have to
become licensed. BENJAMIN BROWN explained that would depend upon
what provisions in Article 1 were deemed relevant to volunteers.
No one would have to obtain additional licenses if DHSS determines
that a volunteer program can exist without a doctor, a certified
nurse practitioner, or other people with various licenses. There
is nothing explicit in the statute that would require additional
licenses for individuals. Mr. Brown said that the relevant
provisions for volunteer programs and service providers should be
determined. In response to Senator Ward, Mr. Brown said that SB 96
does not require additional licenses, but the resulting regulations
may if the definition of "relevant" is not clarified.
CHAIRMAN WILKEN did not see the need for this legislation and
indicated that discussion regarding the need would be discussed at
the next hearing of SB 96. This legislation would also require a
fiscal note which should be completed before the next hearing of
this bill.
BENJAMIN BROWN noted that during testimony he reviewed Georgia and
California's statutes and found no reference to volunteer programs.
He did not know how other states deal with volunteer programs, but
the intent here is to allow them to function without unnecessary
regulation. Mr. Brown said that would be reviewed.
CHAIRMAN WILKEN announced that SB 96 would be held pending further
information.
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