Legislature(1997 - 1998)
03/21/1997 09:05 AM Senate HES
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* first hearing in first committee of referral
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= bill was previously heard/scheduled
SB 96 REGULATION OF HOSPICE CARE
CHAIRMAN WILKEN introduced SB 96 as the next order of business and
noted that there was a CS for consideration. Chairman Wilken said
that he would entertain a motion.
SENATOR LEMAN moved to adopt CSSB 96(HES), Lauterbach version dated
3/10/97, for discussion purposes. Without objection, it was so
ordered.
BEN BROWN , Staff to Senator Kelly, recalled that there had been
some questions regarding why volunteer hospice programs were being
regulated. After conferring with Hospice of Anchorage, the
requestor of the bill, Mr. Brown said that the legislation attempts
to provide some consumer protection and provide a standard. SB 96
would allow people to know what to expect when entering into a
hospice situation. In order to avoid a loophole in the original
bill, the CS specifies under Article 2 which standards are applied
to the volunteer hospice programs. Mr. Brown emphasized that SB 96
intends to establish minimal standards. Mr. Brown acknowledged the
concern that the regulations adopted to enforce the standards could
be complicated.
Some of the definitions were also changed in Article 3. On page 8,
the Administrative Procedure Act is referenced in order to protect
those whose license is revoked. The definition of "hospice
program" was changed by deleting the reference to "discrete entity"
because some of the Hospitals and Nursing Homes feared that would
not allow them to offer a hospice program within the institution.
The definition of "interdisciplinary team" was changed to include
a primary health care provider in order to cover a physician or an
advanced nurse practitioner allowing flexibility. The definition
on line 14, page 9 was changed to "primary health care provider" to
conform with the aforementioned change.
SENATOR LEMAN asked for clarification regarding the change from
primary physician to health care provider with regard to page 9,
line 9. BEN BROWN clarified that the definition of "medical
director" would still require a licensed physician and that
definition only applies to the certified programs. The definition
of "interdisciplinary team", those who coordinate the care plan of
a dying person, was changed to a health care provider. The other
change to a health care provider is located on line 14, page 9.
Number 250
CHAIRMAN WILKEN inquired as to the burden this would create for a
volunteer hospice, a noncertified hospice, with regard to the cost
and administrative requirements. Chairman Wilken requested that
Mr. Brown submit an answer to the committee in writing.
PAULA MCCARRON informed the committee that she had been employed
with Hospice of Anchorage since 1982. She noted the changes to
accommodate the volunteer hospices. Ms. McCarron informed the
committe of legislation in Virginia which did not include the
volunteer hospice category, now those volunteer hospices are
battling to preserve the volunteer programs since there is no
definition allowing for the volunteer hospice to exist. Ms.
McCarron believed that SB 96 would preserve the tradition of
volunteer hospices as well as legitimizing the volunteer programs
by increasing funding opportunities in the future. Hospice of
Anchorage has grown from volunteer efforts of concerned community
members and health care workers who desired an alternative to
terminally ill persons to stay at home. There have been many
changes since that time. Ms. McCarron noted that the average
length of a hospital stay for hospitalized patients is down to
three or four days. Hospitals once had social admissions which
would alleviate the stress of family members caring for a dying
loved one; this is rarely an option. Coverage for nursing and
assisted living homes is limited and out of the reach for most
Alaskans. All of these factors with the increasing aging
population and people living alone translates into a growing need
for quality hospice services. SB 96 is primarily a consumer
protection act.
PATRICIA SENNER , Registered Nurse and Executive Director of the
Alaska Nurses Association (ANA), supported CSSB 96(HES) which will
help develop the type of quality services needed for this time in
life. The Nursing Association likes the two-tier approach in the
legislation. A minimal standard for volunteer hospices prevents
them being regulated out of business while providing the public an
avenue in which to take action against unscrupulous providers. Ms.
Senner noted that those hospices receiving reimbursement receive it
from national insurance companies who may require licensure for
reimbursement. Ms. Senner said that the ANA is pleased with the
bill's emphasis on the role of the registered nurse and advanced
nurse practitioners. Advanced nurse practitioners were requested
for inclusion in the definition of primary care provider. In
Alaska, advanced nurse practitioners are allowed to have
independent practice and are increasingly caring for dying seniors.
Ms. Senner emphasized that the ANA completely agrees with the
hospice philosophy as outlined in the bill.
Number 140
MIKE SHIFFER , Board of Hospice in Anchorage, informed the committee
that Hospice of Anchorage is a private nonprofit organization that
does not receive any state funds. Alaska needs licensed hospice
programs. The environment of health care is changing. Hospice
programs make it possible for the terminally ill to die in a home
environment by focusing on comfort care. Hospice involves the
coordinated use of and interdisciplinary team including physicians,
nurses, social workers, therapists, pastoral and bereavement
counselors, and volunteers. The unique component of hospice's
interdisciplinary team is its volunteers. Hospice of Anchorage
provides hospice services without regard for ability to pay.
Hospice works with the patient and family to accept death as a
natural part of life; the family and the patient are considered the
unit of care. Mr. Shiffer noted that hospice addresses the
spiritual, emotional, social, physical care and comfort of the
patient. Licensure will ensure that hospice services are provided
according to an established standard. Mr. Shiffer strongly
supported this legislation. Mr. Shiffer referred Chairman Wilken
to page 6, subsection (j) which clarifies his previous question.
TINA KOCSIS , Director of Hospice of Tanana Valley, said that she
would speak to the issue of the two different hospices in Alaska,
volunteer hospices and certified or for profit hospices. With
regards to the notion that certified hospices are more organized
than volunteer hospices, Ms. Kocsis said that was not correct.
According to the National Hospice Organization and Medicare
standards, volunteer hospices have medical directors. The position
is merely voluntary. As a volunteer hospice in Fairbanks, it does
not employee nurses, physical therapists, or other related medical
personnel but work closely with home health nursing providers.
Patients are not charged for any services and no payments are
received from any third-party payers. The Hospice of Tanana Valley
is supported by donations, memorials, fundraisers, and small grants
from the community. Hospice of Tanana Valley is the largest, most
comprehensive bereavement program in Alaska. Ms. Kocsis noted that
Hospice of Tanana Valley exceeds the regulations specified in the
bill and the National Hospice Organization and Medicare Certified
Standards.
TAPE 97-32, SIDE A
Ms. Kocsis urged the committee to take steps to eliminate any
hardships that may be created for volunteer hospices because of
this licensing process.
BARBARA RICH said that most of the issues regarding the volunteer
hospices had been addressed in the CS before the committee. Ms.
Rich was concerned with the cost this would pose for hospices with
limited funds. If this bill is passed, Ms. Rich hoped that the
Department of Health would develop regulations that would be easy
to adhere. The regulations in the bill are lower than required of
the hospice in Fairbanks.
CHAIRMAN WILKEN asked Ms. Kocsis to review page 6, lines 9-27 of
the CS; would that level of paper work be acceptable. TINA KOCSIS
said that the level specified in the bill is already being exceeded
in the Tanana Valley Hospice. The specifications in the bill are
fine.
BEN BROWN clarified that regarding the presence of a medical
director at volunteer hospices, Mr. Brown only meant that the bill
does not require that of volunteer hospices. Mr. Brown pointed out
that only lines 9-20 on page 6 apply to volunteer hospices.
Number 071
CHARLES QUARRE , President of Hospice of the Central Peninsula,
noted that Hospice of the Central Peninsula was a volunteer hospice
that serves approximately 20 clients annually. Hospice of the
Central Peninsula is a member and adheres to all the guidelines of
the National Hospice Organization. Hospice of the Central
Peninsula has one part-time director and about 50 volunteers. Mr.
Quarre expressed concern that this legislation would create an
additional burden. Mr. Quarre requested that the volunteer
hospices be deleted from the legislation because all the
requirements under Article 2 are being adhered to.
BEN BROWN clarified that Article 2 could be deleted or steps can be
taken to ensure that the department does not adopt regulations more
stringent than specified in the language of the statute.
Furthermore, the department can be prohibited from adopting
regulations and only adopt guidelines or procedures. Mr. Brown
noted that Mr. Larsen who will do the inspections and regulation
can speak to this issue.
SHELBY LARSEN , Administrator of Health Facilities Licensing &
Certification, supported SB 96. The licensing process is not
burdensome. There is a two to three page application that must be
completed annually. The licensing process also includes an on site
inspection which would be followed by a report. If the volunteer
agencies are already adhering to the standards specified in the
bill, the report would be brief. The purpose of the bill and
subsequent regulations would be to ensure that quality is
maintained in the future. Oversight is also important; only
minimal oversight occurs with certified hospice organizations. Mr.
Larsen believed that more oversight was necessary. Mr. Larsen
informed everyone that the department has a policy that any
organizations effected by the regulations are involved in order to
have input. It is not the intent of the department to develop
regulations that would put hospice organizations out of business.
The regulations are developed for minimum standards, quality care,
and protection of the clients. Mr. Larsen stressed that there will
not be an annual fee, there has never been an annual fee charged
for licensure although that is an option of the department.
CHAIRMAN WILKEN referred to page 7, line 8 when asking if proof of
auto insurance and a valid driver's license were required of other
volunteer organizations. SHELBY LARSEN did not know. CHAIRMAN
WILKEN asked Mr. Brown to follow up on that matter.
CHAIRMAN WILKEN asked Mr. Larsen to provide the committee examples
of why this licensure is necessary. SHELBY LARSEN said that Alaska
has not had any problems. As resources are shrinking, the health
industry is attempting to find resources. There are organizations
that, in an attempt to capture resources, say that hospice care is
provided when it is not. In some areas, as managed care has
developed, hospice-like services may be provided but in a
fragmented manner through the HMOs. Those are not true hospices.
SB 96 would ensure that when an organization says that it provides
hospice services that it truly does, not just pieces. Mr. Larsen
said that managed care is creeping into Alaska and this is a
concern for the future.
CHAIRMAN WILKEN held SB 96. There being no further business before
the committee, the meeting was adjourned at 10:53 a.m.
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