Legislature(2013 - 2014)BELTZ 105 (TSBldg)

03/13/2013 01:30 PM JUDICIARY

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02:02:44 PM Start
02:04:02 PM Confirmation Hearing: Board of Governors of the Alaska Bar
02:14:09 PM Confirmation Hearing: Commission on Judicial Conduct
02:22:33 PM SB49
03:03:55 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Confirmation Hearings: TELECONFERENCED
William Gordon, Board of Governors of the Alaska
Robert Groseclose, Commission on Judicial Conduct
Scheduled But Not Heard
+ Bills Previously Heard/Scheduled TELECONFERENCED
Heard & Held
          SB  49-MEDICAID PAYMENT FOR ABORTIONS; TERMS                                                                      
2:22:33 PM                                                                                                                    
CHAIR COGHILL announced the consideration of SB 49.                                                                             
2:23:13 PM                                                                                                                    
WILLIAM  STREUR, Commissioner,  Department of  Health and  Social                                                               
Services  (DHSS), provided  answers  to  questions the  committee                                                               
raised during previous discussions of SB 49.                                                                                    
   1. How are adoptions playing out, what does it look like for                                                                 
      the future, and are the numbers going up, down, or                                                                        
      remaining flat?                                                                                                           
COMMISSIONER  STREUER  said  that  according  to  the  Office  of                                                               
Children's Services (OCS),  there were 329 adoptions  in 2011 and                                                               
316 adoptions in  2012. Those numbers are  indicative of year-to-                                                               
year  swings.  Adoption  numbers fall  as  reunification  numbers                                                               
rise, and OCS works toward  reunification for all the children in                                                               
custody.  He  asked the  committee's  indulgence  to continue  to                                                               
research the total number of  adoptions in the state, which would                                                               
involve  contacting the  five adoption  agencies that  operate in                                                               
SENATOR MCGUIRE  clarified that she  was looking  for information                                                               
on children who  were put up for adoption at  birth as opposed to                                                               
those  who were  removed from  their home  because of  neglect or                                                               
abuse. She said  she looked forward to getting that  data and the                                                               
information from the five adoption agencies in the state.                                                                       
COMMISSIONER STREUR committed to provide the follow up.                                                                         
2:26:26 PM                                                                                                                    
SENATOR  WIELECHOWSKI  requested  follow up  information  on  the                                                               
number  of children  adopted  from within  the  state versus  the                                                               
number  that are  adopted from  out-of-state. He  also asked  how                                                               
Alaska  is impacted  by the  bill that  passed in  Russia barring                                                               
adoptions to the U.S.                                                                                                           
COMMISSIONER STREUR agreed to attempt to get that information.                                                                  
   2. What are the avenues for a woman who carries a baby to term                                                               
      and after birth decides to place the child for adoption.                                                                  
He explained  that Catholic  Social Services,  Fairbanks Resource                                                               
Agency, Fairbanks  Counseling and Adoption, LDS  Family Services,                                                               
and  the  World Association  for  Parents  and Children  are  the                                                               
agencies that  work on adoptions  in Alaska that are  outside the                                                               
OCS  system.  In  addition,  many   of  the  tribes  assist  with                                                               
adoptions for tribal members.                                                                                                   
   3. What is the status of the intermission nursery?                                                                           
He relayed  that the  intermission crisis  nursery was  closed in                                                               
2003. The placements  came almost exclusively from  OCS with some                                                               
self-referrals. The facility was closed  because of misuse. If it                                                               
was restarted it would have to be a different model.                                                                            
SENATOR  WIELECHOWSKI asked  for information  on the  legislation                                                               
that passed several  years ago allowing women  to surrender their                                                               
COMMISSIONER STREUR  said he  would follow  up with  the numbers,                                                               
but in his  tenure just three babies have been  surrendered to an                                                               
emergency room.                                                                                                                 
CHAIR COGHILL noted that the safe haven was for 21 days.                                                                        
SENATOR  DYSON  asked for  an  explanation  of the  Indian  Child                                                               
Welfare Act (ICWA) in this context.                                                                                             
COMMISSIONER STREUR said that all cases determined to qualify,                                                                  
which is most Alaska Native families, are treated specially. He                                                                 
     The state  has a higher  level of standard to  meet and                                                                    
     must  provide active  versus reasonable  services along                                                                    
     the entire continuum of child  welfare. OCS is required                                                                    
     under ICWA to  notify the child's tribe  and tribes may                                                                    
     choose to  intervene as  a legal party  to the  case or                                                                    
     they   may   assert   their   jurisdiction   over   the                                                                    
     proceedings.  ICWA requires  that  for Native  children                                                                    
     eligible for  enrollment as a tribal  member, the tribe                                                                    
     must be  notified of a  pending adoption. This  is true                                                                    
     for   adoptions  processed   through   the  Office   of                                                                    
     Children's  Services  or   through  private  adoptions.                                                                    
     Tribal  courts in  Alaska may  facilitate customary  or                                                                    
     cultural   adoptions.  These   do  not   require  legal                                                                    
     relinquishment  of   parental  rights   under  legalese                                                                    
     similar to  a legal guardianship. This  could be viewed                                                                    
     as   special  treatment   for  Native   adoptions.  The                                                                    
     cultural adoption  in essence means the  state provides                                                                    
     the  consent  to the  tribal  court  who finalizes  the                                                                    
     process and in these  cases the termination of parental                                                                    
     legal rights is not terminated.                                                                                            
     If a  Native mother chooses  to give up her  infant for                                                                    
     adoption, [she]  must wait 10  days after  signing over                                                                    
     the power  of attorney  for the baby  physically giving                                                                    
     the   baby  up   before   they  can   sign  the   legal                                                                    
     relinquishment paperwork. They  must sign the paperwork                                                                    
     in front of a judge.  This is different from non-Native                                                                    
     mothers who  do not have to  sign in front of  a judge,                                                                    
     and can  sign the relinquishment  paperwork immediately                                                                    
     after the  birth, and they  don't have to wait  10 days                                                                    
     after giving the baby up.                                                                                                  
     Once the  relinquishment paperwork is signed,  there is                                                                    
     another  10-day waiting  period  before  the judge  can                                                                    
     finalize  the relinquishment.  This  is  true for  both                                                                    
     Native  and  non-Native  mothers. Native  mothers  must                                                                    
     sign a tribal  notification waiver if they  do not want                                                                    
     their  tribe to  be notified  of the  adoption. If  the                                                                    
     mother's tribe  is noticed on  the adoption,  the tribe                                                                    
     may  intervene  and  take   over  jurisdiction  of  the                                                                    
2:33:19 PM                                                                                                                    
SENATOR DYSON asked  what happens when it isn't  obvious that the                                                               
adoptive  child  falls  under ICUA  jurisdiction  and  the  tribe                                                               
decides to intervene and claim the child.                                                                                       
COMMISSIONER STREUR said  he would have to do  follow up research                                                               
based on legal counsel.                                                                                                         
SENATOR  DYSON  asked if  a  tribe  can  reach past  a  completed                                                               
adoption and lay claim to a child based on ICWA requirements.                                                                   
2:34:37 PM                                                                                                                    
COMMISSIONER  STREUR  said  he  would  have  to  investigate  the                                                               
question legally.                                                                                                               
SENATOR DYSON asked if ICUA says  that the adoptive parent has to                                                               
be  a member  of the  same tribe  as the  child or  classified as                                                               
COMMISSIONER STREUR  said that the  tribe has first  priority for                                                               
adoptions followed by Native and finally non-Native.                                                                            
SENATOR  DYSON asked  for  follow  up information  on  a case  he                                                               
became involved in.                                                                                                             
2:36:29 PM                                                                                                                    
SENATOR  MCGUIRE asked  for follow  up information  on the  South                                                               
Dakota  model which  is  designed to  increase  adoptions in  the                                                               
state, including those under ICWA.                                                                                              
COMMISSIONER STREUR agreed to investigate the model.                                                                            
   4. What are the qualifications for Head Start?                                                                               
COMMISSIONER STRUER  clarified that  the Department  of Education                                                               
and  Early Development  (DEED),  not DHSS,  administers the  Head                                                               
Start  program.  However, the  basic  requirements  are that  the                                                               
children are  at least three years  old and come from  low income                                                               
families.  Ten  percent may  be  from  families that  exceed  the                                                               
financial  guidelines but  meet other  program criteria.  Most of                                                               
the children in remote Alaska are  eligible due to the poverty of                                                               
access  amendment  to  the  Economic  Opportunity  Act.  Children                                                               
identified for  Early Head Start range  in age from birth  to age                                                               
   5. What are the safety nets available for women that keep                                                                    
      their children?                                                                                                           
COMMISSIONER STRUER identified the following programs:                                                                          
   · The Women, Infants, and Children (WIC) Program provides                                                                    
     nutrition  services and  other assistance  to women  who are                                                               
     pregnant, nursing,  or have children  under age  five. Other                                                               
     family  members and  legal guardians  can  also qualify  for                                                               
     help  for children  under age  five. He  offered to  provide                                                               
     more informative literature.                                                                                               
   · Child Care Assistance provides referrals and subsidies for                                                                 
     mothers  receiving  assistance, families  transitioning  off                                                               
     welfare,  and  low-income  working  families  to  assist  in                                                               
     mainstreaming back into a productive work environment.                                                                     
   · The Alaska Temporary Assistance Program provides cash                                                                      
     assistance  and  work  support for  families  with  children                                                               
     under age 18.                                                                                                              
   · The Commodity Supplemental Food Program is for pregnant,                                                                   
     breastfeeding,  and   postpartum  women  with   infants  and                                                               
     children  up to  age six.  This program  cannot be  accessed                                                               
     concurrent with WIC.                                                                                                       
SENATOR  WIELECHOWSKI asked  if  he had  looked  at the  programs                                                               
available  through Medicaid  for family  planning where  Medicaid                                                               
pays 90 percent and the state pays 10 percent.                                                                                  
COMMISSIONER   STREUR  replied   that  he   tried  to   get  that                                                               
information  today, but  was unsuccessful.  He added  that family                                                               
planning  assistance  was  available through  the  [Division]  of                                                               
Public  Health, and  a wide  variety of  programs were  available                                                               
through Medicaid for both pregnant and postpartum women.                                                                        
SENATOR WIELECHOWSKI asked  if DHSS had or intended  to look into                                                               
the Medicaid  family planning program  for birth control.  It was                                                               
his understanding  that the state  has the option of  taking this                                                               
program which is administered through Denali Kid Care.                                                                          
CHAIR COGHILL  recalled that the  family planning  Medicaid rules                                                               
fall  under Social  Security  Title X,  but  can be  administered                                                               
under Denali Kid Care.                                                                                                          
SENATOR  WIELECHOWSKI  asked Commissioner  Struer  if  he had  or                                                               
planned to look into that program.                                                                                              
COMMISSIONER  STREUR  responded,  "We've been  looking  at  every                                                               
single  option we  can  for  young families  in  terms of  family                                                               
planning." He  reiterated that extensive services  were available                                                               
through the  Division of Public  Health, and added that  he would                                                               
be surprised if  the department didn't already cover  most of the                                                               
services offered  through Medicaid and Denali  Kid Care. However,                                                               
he would do further research.                                                                                                   
CHAIR COGHILL described a mingling  of monies flowing into Denali                                                               
Kid Care and Public Health based on programmatic approaches.                                                                    
2:43:37 PM                                                                                                                    
SENATOR MCGUIRE  asked Commissioner Struer to  consider providing                                                               
a single,  accessible access point for  poor women to get  a list                                                               
of the resources and services he described today.                                                                               
COMMISSIONER  STREUR  responded  that   the  Division  of  Public                                                               
Assistance  is already  a one-stop-shop  where an  individual can                                                               
access the continuum of services.  He discussed the work DHSS had                                                               
done to  break down  the silos within  the department  to connect                                                               
the  services and  acknowledged  there  was more  work  to do  to                                                               
better serve the whole person.                                                                                                  
2:46:54 PM                                                                                                                    
SENATOR WIELECHOWSKI  asked Commissioner  Struer to  describe the                                                               
process  DHSS went  through to  develop the  new regulations  and                                                               
what they were.                                                                                                                 
COMMISSIONER STREUR  explained that  a new  section was  added to                                                               
DHSS's  regulations governing  abortion payment  conditions. This                                                               
was prompted by  "losing a half a million dollars  every year out                                                               
of my budget because of what  I pay for abortions," he said. More                                                               
importantly,  it was  to make  sure that  the abortions  that the                                                               
state pays for  meet the intent of the Supreme  Court decision of                                                               
2002.  For a  physician  or provider  in Alaska  to  be paid  for                                                               
performing  an  abortion under  Medicaid,  they  are required  to                                                               
certify  either  that  it  meets   the  conditions  of  the  Hyde                                                               
Amendment  or that  it doesn't  meet the  conditions of  the Hyde                                                               
Amendment   but  that   the  abortion   procedure  is   medically                                                               
necessary. Only the  physician can signify that  the abortion was                                                               
medically   necessary.  There   is  no   definition  of   medical                                                               
necessity,  but  DHSS  is  allowed to  track  the  required  Hyde                                                               
procedures, which  are reimbursable  under federal  guidelines or                                                               
non-Hyde,  which are  reimbursable  under the  2002 decision.  He                                                               
offered to provide a copy of the form.                                                                                          
SENATOR WIELECHOWSKI asked  him to discuss the  public comment on                                                               
the new regulations.                                                                                                            
COMMISSIONER  STREUR confirmed  that DHSS  did receive  a lot  of                                                               
public  comment.  Many  of the  comments  were  not  particularly                                                               
constructive, but  they were regarding access,  denial of access,                                                               
or increasing access. Planned  Parenthood contributed in multiple                                                               
lively discussions and ultimately accepted  that the form met the                                                               
letter of the law in the Supreme Court decision.                                                                                
SENATOR WIELECHOWSKI asked if the  new regulation permits doctors                                                               
to perform elective abortions.                                                                                                  
COMMISSIONER  STREUR  responded  that the  certificate  does  not                                                               
address physician limits of practice.  It speaks to reimbursement                                                               
for an  elective abortion versus  a medically  necessary abortion                                                               
through Medicaid.                                                                                                               
SENATOR WIELECHOWSKI  inquired if a  doctor would have  to verify                                                               
medical necessity in order to receive payment.                                                                                  
COMMISSIONER STREUR answered yes.  The attending physician has to                                                               
certify  to one  of the  two  conditions listed  below to  obtain                                                               
reimbursement. The first option  addresses the Hyde Amendment and                                                               
the second option addresses the Supreme Court decision.                                                                         
     · I certify based upon all the information available to me                                                                 
        that before  performing  the  abortion procedure  on  the                                                               
        above patient her pregnancy  was the result of  an act of                                                               
        rape or incest,  or the abortion  procedure on  the above                                                               
        patient was performed due to  physical disorder, physical                                                               
        injury, or physical illness, including a life-endangering                                                               
        physical  condition  caused   by  or  arising   from  the                                                               
        pregnancy itself, that would place the woman in danger of                                                               
        death unless an abortion was performed.                                                                                 
     · I certify based upon all the information available to me                                                                 
        that the above does not apply, but the abortion procedure                                                               
        was medically necessary.                                                                                                
SENATOR  WIELECHOWSKI asked  if physicians  have been  submitting                                                               
the certificate  and if DHSS  has been accepting them  and making                                                               
COMMISSIONER STREUR  explained that the requirement  is effective                                                               
April 1, 2013, but some certifications have already come in                                                                     
2:52:35 PM                                                                                                                    
SENATOR  WIELECHOWSKI  noted  the   exception  in  the  bill  for                                                               
abortion services  in cases of  rape or  incest, and asked  if he                                                               
had given any thought to how that determination would be made.                                                                  
COMMISSIONER STREUR said he had  given it thought but hadn't come                                                               
to  a conclusion.  He  added  that he  didn't  intend  to form  a                                                               
conclusion until he had to deal with it in some form or manner.                                                                 
SENATOR WIELECHOWSKI  said he  thought it  was important  to have                                                               
some  discussion about  who would  make the  determination before                                                               
the bill  comes to  a vote.  He asked  Commissioner Struer  if he                                                               
would be able to come to  some conclusion about how the provision                                                               
would be enacted  either before the bill moved  from committee or                                                               
before it  came to  a vote  on the  floor. "As  a Senator  who is                                                               
going to be voting on this, I  would want to know what the policy                                                               
is," he said.                                                                                                                   
COMMISSIONER  STREUR  responded  that   he  couldn't  provide  an                                                               
answer, but  he thought  that a lot  would depend  on Legislative                                                               
Legal  Services, the  legal counsel  for DHSS,  and probably  the                                                               
courts should it go forward.                                                                                                    
CHAIR  COGHILL offered  his perspective  that  the allegation  of                                                               
rape would  be indicated on  the doctor's  certification, nothing                                                               
2:55:32 PM                                                                                                                    
SENATOR MCGUIRE stated  that she would hope  that state resources                                                               
would not be  expended to investigate women in  what would amount                                                               
to a witch hunt.  If a woman tells her doctor  she has been raped                                                               
or a victim of incest, she should be believed.                                                                                  
COMMISSIONER  STREUR related  that  the  only investigation  that                                                               
DHSS is doing is requiring the certification.                                                                                   
2:56:11 PM                                                                                                                    
SENATOR   DYSON  expressed   hope  for   universal  honesty   and                                                               
acknowledged reality.                                                                                                           
CHAIR COGHILL  said the  discussion about  not getting  between a                                                               
woman and her doctor has  been legitimate. It's also a legitimate                                                               
discussion that some  abortions are elective and,  to date, those                                                               
haven't been defined.                                                                                                           
SENATOR  WIELECHOWSKI asked  if  the intention  is  to require  a                                                               
doctor or DHSS to report a  rape or incest to the authorities for                                                               
COMMISSIONER STREUR  said he couldn't  speak to  the requirements                                                               
for a  physician, but he  didn't believe it was  the department's                                                               
responsibility to report what is on the certification form.                                                                     
CHAIR COGHILL asked if there  weren't already mandatory reporting                                                               
COMMISSIONER STREUR answered yes.                                                                                               
CHAIR  COGHILL  said  he believes  that  mandatory  reporting  is                                                               
important, particularly when it protects the young and innocent.                                                                
COMMISSIONER  STREUR said  he  didn't disagree  but  by the  time                                                               
Medicaid  is informed,  it's beyond  third hand.  He deferred  to                                                               
legal counsel to further articulate DHSS responsibility.                                                                        
CHAIR  COGHILL  opined that  policy  makers  would look  at  that                                                               
within the mandatory reporting requirements.                                                                                    
2:59:52 PM                                                                                                                    
SENATOR WIELECHOWSKI  asked Commissioner Struer if  he envisioned                                                               
creating a new form to address rape and incest.                                                                                 
COMMISSIONER  STREUR  responded  that   DHSS  bases  payment  for                                                               
abortion on  the Hyde Amendment  and the Supreme  Court decision.                                                               
If  SB  49 is  signed  into  law, the  form  will  be amended  to                                                               
accommodate what's in the bill.                                                                                                 
SENATOR WIELECHOWSKI asked  if DHSS received legal  advice not to                                                               
define medical necessity in the regulation.                                                                                     
COMMISSIONER  STREUR  said  the   department  had  legal  counsel                                                               
through the  entire process,  but he  didn't recall  getting that                                                               
advice. The  Supreme Court  didn't provide  a definition  and the                                                               
regulation followed that decision for basing payment.                                                                           
CHAIR COGHILL  said he believes  the bill refines what  the court                                                               
3:02:41 PM                                                                                                                    
SENATOR WIELECHOWSKI asked Commissioner  Struer to follow up with                                                               
what the Planned Parenthood litigation cost the state.                                                                          
CHAIR  COGHILL   suggested  he  get  the   information  from  the                                                               
Department of Law (DOL).                                                                                                        
CHAIR COGHILL  stated that he would  hold SB 49 in  committee and                                                               
bring it up again on Friday  along with any amendments that might                                                               
be offered.                                                                                                                     

Document Name Date/Time Subjects
1 - SJR 9 Sponsor Statement.pdf SJUD 3/13/2013 1:30:00 PM
SJUD 3/15/2013 1:30:00 PM
SJUD 3/18/2013 1:30:00 PM
2 - SJR 9 Quick Reference.pdf SJUD 3/13/2013 1:30:00 PM
SJUD 3/15/2013 1:30:00 PM
SJUD 3/18/2013 1:30:00 PM
3 - Leg Legal March 8 Memo.pdf SJUD 3/13/2013 1:30:00 PM
SJUD 3/15/2013 1:30:00 PM
SJUD 3/18/2013 1:30:00 PM
4 - Leg Legal March 4 Memo.pdf SJUD 3/13/2013 1:30:00 PM
SJUD 3/15/2013 1:30:00 PM
SJUD 3/18/2013 1:30:00 PM
5 - Amendments to the Constitution.pdf SJUD 3/13/2013 1:30:00 PM
SJUD 3/15/2013 1:30:00 PM
SJUD 3/18/2013 1:30:00 PM
6 - Alaska Performance Scholarship Data.pdf SJUD 3/13/2013 1:30:00 PM
SJUD 3/15/2013 1:30:00 PM
SJUD 3/18/2013 1:30:00 PM
7 - AlaskaAdvantage Education Grant.pdf SJUD 3/13/2013 1:30:00 PM
SJUD 3/15/2013 1:30:00 PM
SJUD 3/18/2013 1:30:00 PM
8 - Select Grants to Ed Programs Facilities Training.pdf SJUD 3/13/2013 1:30:00 PM
SJUD 3/15/2013 1:30:00 PM
SJUD 3/18/2013 1:30:00 PM