Legislature(1999 - 2000)
03/15/1999 01:39 PM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
SB 56-HOME HEALTH AGENCIES/HOSPITALS/HOSPICES and SB 57-CARE FOR VULNERABLE ADULTS and SB 58-SERVICES FOR ADULTS WITH LONG-TERM NEEDS and SB 59-CERTIFICATES OF NEED FOR HEALTH FACILITY CHAIRMAN MILLER brought up SB 56, SB 57, SB 58 and SB 59, the legislation resulting from the Long-Term Care Task Force meetings last summer. He thanked the committee members for their hard work on the bills during his absence. He stated the committee is under a time constraint because the Majority Caucus is scheduled to meet at 3:00 in the committee room. CHAIRMAN MILLER said he would hear first from people who have not yet testified on the legislation, and limit each speaker to 3 minutes to meet the committee's time frame. He would prefer to consider the four bills as a package so he asked the witnesses to address all of their concerns at once in their testimony. SENATOR WILKEN brought up the Committee Substitute for SB 56 and moved to adopt it as a working document. Without objection, CSSB 56(HES), Lauterbach Version H, was adopted. Number 116 MS. LARAINE DERR, Alaska State Hospital & Nursing Association (ASHNA), introduced Linda Fink, the Assistant Director, and stated the association supports the four bills overall. However, ASHNA has some concerns that it addressed in its letter to the committee. One real concern in the CS to SB 56 relates to the disclosure of reports in Section 3 on page 5, line 19. Their primary question regards the public disclosure of reports of annual inspections and investigations by the department. She asked for clarification of what "public" means, and whether it means available at the department, posted at the facilities, or published on the Web. She asked, when does 14 days begin, explaining this became a national issue last year with the joint commission that accredits hospitals. It brought forward the issue of putting the results of accreditation reviews on the Web, and hospitals across the nation rose up in opposition to it. State hospitals oppose that section of the bill. SENATOR WILKEN asked Ms. Derr what she would suggest for line 19 on page 5. She responded that ASHNA would prefer the reports of investigations not be made public. Nursing homes already make their inspection reports public but hospitals do not. SENATOR WILKEN asked why they would not want it made public. MS. DERR explained there are several types of errors with joint accreditation which hospitals feel would be subject to interpretation if made public. SENATOR WILKEN asked if it would be better to have a longer time frame for hospitals than nursing homes to work out those differences. MS. LINDA FINK, Assistant Director of ASHNA, replied it might depend on when the 14-day period begins. It is unclear whether it is when each part of the inspection is complete, when the survey is done, or when the plan is approved. SENATOR WILKEN read "after the information is made available to the facility or entity being reviewed." MS. DERR interjected they need clarification of what is meant by that section and what the department intends to do with it. MS. DERR stated the association supports SB 57 and has no questions regarding the bill. She brought up SB 58 and referenced several sections of the bill that are outlined in the ASHNA letter, stating she couldn't address all the issues in three minutes. CHAIRMAN MILLER stated that because the committee has heard a lot of testimony, he intends to move the bills out today and on to Senate Finance where Senator Wilken is a member. He said the bills are "an evolving project and certainly not in their final form right now," but since the association had not testified before, it would be good to address their concerns now. MS. DERR proceeded to outline their concerns about SB 58. She referred to Sec. 47.24.205, Adults to be served, line 9 and suggested following "long-term care need," the insertion of "which does not require hospitalization for an acute illness or injury or a subacute program for restorative care." The language is essentially limiting that a person is eligible if they have long- term care and do not have to go to the hospital. In Section 47.24.220, Delivery of services, she questioned how the public can be assured that anybody can provide this service across the rural and urban areas of the state, and what standards will be used. Their concern is equity. In Section 47.24.235, Comprehensive data system, she suggested adding the words "and private" after "local" on line 25. She stated this would provide further assurance that everyone can access the data. In Section 47.24.240, Assessment and care coordination services, on line 28, change the word "may" to "shall." She said this was also recommended by the Long-Term Care Task Force. MS. DERR then referred to SB 59, asking for more definition under the Certificate of Need. On page 2, line 26, insert the word "unnecessary" after "foster," to read "foster unnecessary reliance on the state general fund.." In SB 59, Section 4, page 3, MS. DERR stated there needs to be a definition of "non-nursing home beds and services." She asked if it means hospitals. Since it comes under the section of the law just addressing Certificate of Need, ASHNA thinks it applies to hospitals, and that concerns them. Number 255 SENATOR WILKEN asked Ms. Derr if any organizations were excluded by inserting the word "private," in SB 58, page 5, line 26. MS. FINK replied ASHNA hoped to include everyone with that language change. CHAIRMAN MILLER brought up his concern about Section 4, asking for clarification of whether entry to the program is a facility of $1 million dollars or more; he assumed a $200.0 structure for assisted living in North Pole would not run under the Certificate of Need program. MS. DERR agreed, saying her understanding is that the $1 million dollar figure would trigger the Certificate of Need program. Number 282 SENATOR ELTON referred to Section 3 of CSSB 56 and asked why there would be objection to a consumer like himself accessing information in a final report kept by the department and shared two weeks previously with the institution. He could understand why it might be dangerous to share partial information. MS. FINK repeated that one of the ASHNA's concerns is when the 14 days kick in. In response to Senator Elton, MS. DERR said depending on how it was worded and defined, they might become willing to release a final report to the public. CHAIRMAN MILLER stated four people are on-line to testify, in Anchorage and in Fairbanks. Mr. Shelby Larsen, Anchorage, said he had previously testified on SB 56 and would stay on-line to answer questions. MR. LARSEN replied to MS. DERR's earlier question regarding the disclosure of information in SB 56 on page 5, line 19. The department's intention is that survey reports of state licensure of hospitals and nursing homes and other facilities be made available to the public. After the facility has had an opportunity to respond with a plan of correction, which is 10 days after receiving the report, the survey reports would be available to the public upon request. Number 324 SENATOR ELTON asked if the facility's response would then be part of the final report. MR. LARSEN answered yes. SENATOR ELTON asked if there are provisions for extensions. MR. LARSEN said there is latitude under the licensure allowing for extensions. SENATOR ELTON asked if the language on line 19 would interfere with providing an extension, and if the 14-day time frame interferes with releasing a full report. MR. LARSEN said he would not oppose language allowing for informal dispute. Number 348 MS. MARY WEYMILLER, representing the Alzheimer Association, stated her support for SB 56, SB 57, SB 58 and SB 59. She related that her mother was diagnosed with Alzheimer's disease two years earlier. When they could no longer care for her safely at home, they looked for placement. The five assisted living homes in Fairbanks were not equipped to deal with the behaviors her mother displayed. The two-year waiting list for the Pioneers Homes, as well as unaffordable private nursing home care forced the family to move her mother out of state. She had never lived outside Alaska. MS. WEYMILLER said she found it invaluable to be able to access the investigation reports of hospitals while researching a home for her mother's placement and care. For that reason she supports SB 56. Later, an opening at the Fairbanks Pioneers Home allowed her mother to return home. She described her mother's worsening condition that she attributes to her time in the nursing home, and her loss of residency and resulting loss of the Longevity Bonus and PFD. MS. WEYMILLER stated that if a program like the one proposed in SB 58 had been in place, her mother could have remained in her home with her family. Number 373 SENATOR WILKEN thanked Ms. Weymiller for her work with the Alzheimers Association in Fairbanks and around the state, and for her testimony today. MS. KAY BURROWS, Director of the Division of Human Services, stated that she would remain on-line to answer questions regarding SB 57 and SB 58. MS. TERESA LYONS, representing the Alaska Nurses Association (ANA), stated that the ANA in general supports all four of the bills. Regarding SB 56, she requested that the record reflect the American Nurses Association and the ANA support the consumer's right to information about the quality of care provided in the health care industry. She urged appropriate language to avoid misinter- pretation. Regarding SB 58, MS. LYONS said their concerns were voiced by the ASHNA earlier. Referring to Section 47.24.205, on line 9, she asked that the language provide that adults with long-term needs don't lose access around the need for hospitalization. On the issue of public assurance and equity in Section 47.24.220, page 4, line 14, the ANA would like more definition regarding public assurance of who will provide services. CHAIRMAN MILLER invited several people in Juneau who had previously testified to do so again, and requested that they combine their remarks on more than one bill and limit their testimony to three minutes. Number 411 MS. SONYA SMITH stated she would continue returning to the legislature because there is a strong lack of support on a tribal level for these bills. She was unsure of the federal appropriations for this type of service. She asked if there is any kind of funding available to assist the many individuals with disabilities. She encouraged support on these issues which other communities are looking into. She had been informed that there are no funding resources, and she mentioned state waiver contracts for $180.0 per client to private nonprofits. She asked where else she could look. She knows of several families facing economic hardship as a result of not having money to care for elders and the disabled. She stated the vulnerable adult laws have appropriations at a state level, but because of tension, there hasn't been a resolution between the state and tribal agencies. Number 441 CHAIRMAN MILLER informed Ms. Smith that the HESS members share her concerns, and the bills would go to Finance Committee next. He said he does not have an answer on the funding question, but he hoped to get some answers before the bills are scheduled in Finance. MS. SMITH stated she wouldn't like to see the bills passed without tribal representation in these areas. She asserted that there is too much politics interfering with the issues. Number 459 MS. TIFFANY SHAQUANIE told a parable she had written about a mentally ill student who had no one to help him with his disability. She then described the student's real situation and learning disabilities. She asked, "In the constitutional law of the disabled youth population in discrimination, what are the public funds being used for?" She continued, "Where does the representation come in for a mentally ill student? Because there is not being appropriated through federal mandates in support of Native children in public schools." She asked the committee to define specifically what is meant by "mental illness." Referring to the Gavel to Gavel programming, MS. SHAQUANIE asserted that the Native legislators up north have asked for funding to help improve these situations and have been denied their funding right on television. She asked what the federal funds are for, and who is in receipt of those funds. Regarding federal Indian education, she asked where the tribal representation can come in to help with the solution. MS. SHAQUANIE stated she is not here to be politicked. She knows these facts, and she would appreciate it if the committee would answer her family's questions in person by appointment or by phone, rather than being politicked through the media. Number 520 CHAIRMAN MILLER asked Ms. Shaquanie to leave a written copy of her testimony for the record. MS. SHAQUANIE said that her family requested some answers in their last testimony that haven't been brought to them, so she would not feel comfortable leaving her testimony knowing that their questions aren't going to be answered again. CHAIRMAN MILLER replied his staff has contacted the division and they are working on the funding questions, explaining that this was brought up just last week "and some things take time." As soon as his office gets some information, they will give it to her. MS. SHAQUANIE answered "it does take time but it still only takes a second to inform." CHAIRMAN MILLER responded he would inform as soon as he can, explaining to her that he wants to give the right information, rather than just informing. Number 532 SENATOR WILKEN told Ms. Shaquanie that there are specific examples of money flowing directly to the Native children for education. In one example, the state receives over $50 million dollars in federal money in lieu of being able to tax federal lands. Of that $50 million dollars, $11 million dollars off the top goes directly to Native education needs; it doesn't go into the state's K-12 Formula. The balance of the $50 million dollars is distributed throughout the entire state, so that in essence, those who qualify for the $11 million receive all of it, as well as a portion of the remaining $39 million dollars. It is one example of money going directly to the things Ms. Shaquanie has been talking about. MR. DON WILLIAMS SR. explained he is taking Dilantin, and his doctor advised him to be more socially active but he doesn't have the funds, only enough to get by. He said he's getting support from a variety of sources, and he feels comfortable at home now. TAPE 99-11, SIDE B Number 001 MR. WILLIAMS continued, stating his accident was in December of 1990 and he unable to talk or walk, so he's come a long way. The Provider Assistance Program has been beneficial to him. CHAIRMAN MILLER informed Mr. Williams that Sharon Clark, committee aide, would help him call the Ombudsman who deals with these situations to see if anything else can be done to further assist him. Number 573 SENATOR ELTON also offered that his office would help Mr. Williams. He suggested that under current law and under the proposal in SB 58, the Department of Health & Social Services might outline what can be done now with tribal governments and nonprofits, and what may change under SB 58. He said he would try to get that information to Sonya Smith. CHAIRMAN MILLER thanked Mr. Williams for his testimony. He asked Mr. Williams to work with Ms. Clark to contact the Ombudsman. Number 555 MR. JONATHAN SMITH stated he lives at 271 Switzer Village. He said a lot of the support Don Williams receives is from Jonathan's family, and from Kake, Hoonah, Angoon, Sitka and Klawock. His mother plays the biggest role in Mr. Williams' care. His family is "living to fight this bill," because they need Mr. Williams in their lives, and they are afraid he'll be taken away from them. Number 497 CHAIRMAN MILLER invited Senator Green to offer her amendment, and mentioned someone offnet would testify on it, if the committee wishes. Senator Green said her staff is also present to answer questions. SENATOR LYDA GREEN explained that it came to her attention that the office of the Long-Term Care Ombudsman needs separation from the division it oversees. The amendment proposes the Long-Term Care Ombudsman be moved to the Legislature where the current Ombudsman is situated. The amendment language primarily moves the current Long-Term Care Ombudsman statute defining duties and reappointment to the Legislature. Currently it's a hired position but the two Ombudsman positions would work side-by-side and their method of appointment should be similar. The amendment would make it a position appointed by a committee composed of senators and house members. CHAIRMAN MILLER asked if the amendment moves the office from one agency of government to another but does not change the duties or powers of the position. MS. MARVEEN COGGINS, staff to Senator Green, answered that is correct. The amendment makes the position side-by-side with the State Ombudsman's Office but not a part of it. The State Ombudsman oversees all the state agencies, and if the Long-Term Care Ombudsman (LTCO) was placed in that office, a conflict of interest would develop if the LTCO ever needed investigation. Number 462 Frances Purdy, offnet in Girdwood, said she would answer questions on Senator Green's amendment. SENATOR WILKEN asked how the Long-Term Care Ombudsman is selected now. MS. COGGINS said selection is by the Alaska Commission on Aging. The amendment models it on the selection of the State Ombudsman by a panel of three senators and three representatives. The removal procedure is also similar. SENATOR WILKEN asked the expected fiscal impact of the proposed change. MS. COGGINS said the existing federal funding would follow the transfer of the Long-Term Care Ombudsman's Office. CHAIRMAN MILLER put his name to the amendment to bring it before the committee. He moved the amendment, then objected for the purpose of further discussion. Number 442 SENATOR ELTON wondered aloud if efficiencies would arise from combining the two Ombudsman offices and their administrative staff. One person on the staff with long-term care expertise could be hired and designated to deal with those issues. He asked if the Chairman planned to adopt the amendment today, because he would like to have time to assimilate the issues. SENATOR WILKEN asked Senator Green if the Administration had seen the amendment. She responded no. He asked how it ties into any of the four bills which the committee wants to move as a package. He suggested it is an issue that could be a separate piece of legislation. SENATOR GREEN said it is designated as part of SB 57. CHAIRMAN MILLER stated some valid concerns have been raised by members. He supported the concept and would be willing to adopt the amendment now, but it is a legitimate concern and a major shift to move the office out of one department to another. He'd like to move the bill today, and Senator Green is a member of Finance, the next referral for SB 57. SENATOR GREEN agreed to address those concerns in Finance Committee. She offered to find answers in the meantime if any members have questions. She said the Ombudsman "must be at arms- length" from the person being assessed or evaluated, and that doesn't happen with the Long- Term Care office. SENATOR ELTON suggested that Maria Moya, the State Ombudsman, could meet with himself and other members, if the committee is not going to vote on the amendment. CHAIRMAN MILLER moved and asked unanimous consent to withdraw his amendment. Without objection, it was withdrawn. CHAIRMAN MILLER brought up his earlier question about Section 4 of SB 59 regarding Certificate of Need. He asked if the language wouldn't affect the assisted living homes if they don't meet the $1 million dollar threshold. Number 393 MR. DAVID PIERCE, Coordinator of Certificate of Need Program, explained the intent of Section 4 is to ensure that there are home and community-based services in place first when new nursing home beds are contemplated. This would not affect assisted living in any way because the homes are currently not required to have a Certificate of Need because they are not considered a health care facility. No matter the cost of assisted living, at this point in time they are not required to have a Certificate of Need. CHAIRMAN MILLER asked the wish of the committee. SENATOR WILKEN moved SB 56, SB 57, SB 58 and SB 59 be reported from committee with individual recommendations and their respective fiscal notes. Hearing no objection, the four bills moved from committee.