Legislature(2017 - 2018)HOUSE FINANCE 519
04/12/2017 01:30 PM FINANCE
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HOUSE FINANCE COMMITTEE April 12, 2017 2:35 p.m. 2:35:58 PM CALL TO ORDER Co-Chair Foster called the House Finance Committee meeting to order at 2:35 p.m. MEMBERS PRESENT Representative Neal Foster, Co-Chair Representative Paul Seaton, Co-Chair Representative Les Gara, Vice-Chair Representative Jason Grenn Representative David Guttenberg Representative Scott Kawasaki Representative Dan Ortiz Representative Lance Pruitt Representative Steve Thompson Representative Cathy Tilton Representative Tammie Wilson MEMBERS ABSENT None ALSO PRESENT Representative Justin Parish, Sponsor; Katherine Eldemar, Director, Division of Community and Regional Affairs; Lisa Worl, Staff, Representative Justin Parish; Ms. Patience Frederiksen, Director of Libraries, Archives, and Museums; Representative Ivy Spohnholz, Sponsor; Dr. Paul Barney, Doctor of Optometry; Joan Wilson, Assistant Attorney General, Department of Law; Laura Chartier, Staff, Representative Gara; Christy Lawton, Director, Office of Children's Services, Department of Health and Social Services; Representative Andy Josephson. PRESENT VIA TELECONFERENCE Sheila Wyne, Sheila Wyne Studios, Anchorage; Eva Malvich, AVCP, Bethel; Bethany Follett, City of Wasilla/Wasilla Museum and Visitor Center, Wasilla; Patricia Relay, Museums of Alaska, Valdez; Angela Linn, Museums of Alaska, Fairbanks; David Zumbro, Self, Anchorage; Dr. Janey Carl Rosen, Self, Anchorage; Dr. Kelly Lorenz, Self, Anchorage; Dr. Andrew Peter, Self, Homer; Dr. Jill Matheson, Self, Juneau; Dr. Kurt Heitman, American Academy of Ophthalmology, South Carolina; David Karpik, Self, Kenai; Jeff Gonnason, Chair, Alaska Optometry Association, Anchorage; Dr. Griff Steiner, Self, Anchorage; Rosalie Rein, Self, Fairbanks; Amanda Metivier, Facing Foster Care in Alaska, Anchorage; Marna Sanford, Tanana Chiefs Conference, Fairbanks; Trevor Storres, Alaska Children's Trust, Anchorage; Paul D. Kendall, Self, Anchorage; Byron Charles, Self, Ketchikan. SUMMARY HB 103 OPTOMETRY & OPTOMETRISTS HB 103 was HEARD and HELD in committee for further consideration. HB 166 MUSEUM CONSTRUCTION GRANT PROGRAM HB 166 was HEARD and HELD in committee for further consideration. HB 151 DHSS;CINA; FOSTER CARE; CHILD PROTECTION HB 151 was HEARD and HELD in committee for further consideration. Co-Chair Foster reviewed the agenda for the meeting. He intended to hear the introduction of the three scheduled bills, take public testimony, and ask for amendments. He would set the bills aside. They would be brought up again in the future. HOUSE BILL NO. 166 "An Act establishing a museum construction grant program in the Department of Commerce, Community, and Economic Development." 2:37:16 PM REPRESENTATIVE JUSTIN PARISH, SPONSOR, explained that HB 166 created a matching grant program. He read the sponsor statement: House Bill 166 establishes a matching grant program in the Department of Commerce, Community and Economic Development, for eligible museum construction, expansion or major renovation projects. Museums are eligible for this program if they are located in Alaska, entitled to receive state grants, and provide matching funds from other sources of at least 50 percent of the project costs. Alaska has more than 60 museums throughout the state that provide cultural, tourism, and educational programs. Alaska museums receive 380,993 annual visitors and they serve 29,469 school children each year. Alaskan communities are enriched with the art, history, and cultural language and education provided at the museums. The approval of this bill will enable museums to access and leverage funding so that they may improve, expand or upgrade as needed, when funds are appropriated. Included with the bill documents you will find twenty-three letters of support from nine different Alaskan museums, four regional or statewide museums organizations and Senator Bishop. The award is subject to appropriation and cannot exceed more than 50 percent of the total proposed project costs. HB 166 is a companion bill for SB 7, Sponsors: Stevens, Bishop, Stedman and Egan. Representative Parish was happy to answer any questions. Co-Chair Foster read the list of available testifiers. Vice-Chair Gara thought the bill was straightforward. He referred to Page 2, line 1 in subsection C. He thought the subsection read that the state could only grant an amount that was 50 percent of the grant amount. He suggested that it would be half of the grant amount rather than 50/50. He surmised that the maker of the amendment intended the amount to be up to 50 percent of the cost of the project. Representative Parish relayed that he had put grant project together. He thanked Vice-Chair Gara for his observation. He would be happy to work out a change. Vice-Chair Gara was happy to be corrected. Clarification could be provided at the next hearing. Representative Parish thought there was someone available who could clarify the language. Representative Wilson was aware of one [grant] for libraries. However, she did not believe it dealt with major renovation and construction. She thought it applied to a new library based on the community size. She asked if the library grant encompassed a major renovation and expansion. Representative Parish would field the question to someone more familiar with the program. He would leave his staff to answer any remaining questions. 2:42:50 PM KATHERINE ELDEMAR, DIRECTOR, DIVISION OF COMMUNITY AND REGIONAL AFFAIRS, introduced herself. Representative Wilson suggested there was a similar program for libraries based on population. She was under the impression the program covered the cost of building a new library. She wondered if the bills were similar. Ms. Eldemar responded that she would have to research the statute. She offered that there was never any funding to the library program through other venues. She continued that no applications were funded through the library statute. Representative Wilson thought she was incorrect. She indicated that North Slope had a new library and it went through a program. She was uncertain of the details. Ms. Eldemar referred to two statutes. She referenced AS.14.56.355 pertaining to a public construction and major expansion matching grant program. She explained that there was not an appropriation from the legislature under the statute. She furthered that funding was granted under AS 37.05.315 - not through the library grant statute. Representative Wilson commented that was the project she thought was being funded. She asked about the definition for major renovation but did not see one for expansion. She wondered about the size of the expansion. Ms. Eldemar would get back to the committee with an answer. Representative Guttenberg wondered about a structure for establishing a systematic approach to prioritizing museum capital funding requests in the state. He did not see anything in the bill outlining prioritization except for major renovations. He was concerned with the definition of a major renovation. He did not see anything that prioritized one thing over another. He asked if the amendment was only setting up a fund. Ms. Eldemar pointed to HB 166 on Page 1, Line 10-11. She read from the bill: The department may not accept an application for a grant under this section unless the legislature makes an appropriation for the grant program. Ms. Eldemar explained that it was put in procedurally because previously there were many applications submitted to the division for the library program. They were scored and given a number. Typically, the grant was awarded based on the score. Unfortunately, there was no appropriation. The division had gone through the process of creating regulations and reviewing and scoring the applications. However, the grant was never funded. Subsequently, funding was provided through the other statute she cited. Representative Guttenberg remarked that the bill would establish a new section on museum construction, expansion, and major renovation. He did not see a reference to scoring or prioritization of grant applications. He asked if a scoring system like the previous one would be used. Ms. Eldemar replied that if the bill became law, the division would not accept applications until funding was in place. Then, the division would start the process of putting together regulations, which would take about a year. Once the regulations were in place, the division would begin processing applications. The division would not take any action until appropriations were made. Criteria and procedures would be established through regulations. 2:48:55 PM Representative Guttenberg referred to information provided in member packets. There was a variety of museums, including the Tanana Valley Railroad Association. Some of them were private, public, and non-profit. He asked which entities would qualify for a grant. He asked if the Museum of the North would qualify for a grant or if a privately funded aviation museum would qualify. Ms. Eldemar responded that if the bill became law, the division would start by creating regulations. She would have to wait to see an application to verify whether it was complete, whether it satisfied requirements, or whether it was deficient in some way. She would not know until she saw an application or started the process. Representative Guttenberg thought it was good that she was not getting too far ahead. However, he suggested that it would be nice to know in advance of passing legislation where the line stood. He wondered, for instance, if a mom and pop dime store museum on the corner, the downtown Anchorage museum, a city-owned museum, or a university museum would qualify. He could wait for an answer after the meeting. 2:50:56 PM Representative Kawasaki clarified that the division would not be creating regulations that would specify certain things until the legislation was passed and money was appropriated. Ms. Eldemar indicated that the details would come through regulations and that there would be opportunity for public comment. Representative Kawasaki wondered if the legislature needed to place the criteria and eligibility in the bill to narrow the scope. He wondered what kinds of museums the state wanted to support. He asked her to comment about museum funds being granted to places without museums versus places that already had large museums. He thought that communities without museums versus those that did would have priority. LISA WORL, STAFF, REPRESENTATIVE JUSTIN PARISH, asked Representative Kawasaki to repeat his policy question. Representative Kawasaki asked about new museum construction and whether it should be imbedded within the eligibility criteria as laid out in statute. He wondered if places that did not have museums would be a priority over those communities that already had museums. He asked if it was a priority of the bill sponsor. Ms. Worl responded that Representative Parish had received 23 letters of support for a host of different types of museums already established that held many different public cultural items. She encouraged members to invite a person from the city museum who was involved in the bill drafting who could respond. 2:54:48 PM Representative Thompson wanted to clarify that the bill would set up a fund for the legislature to deposit money and entities could make application. He wondered if the legislature could make a direct grant to a museum that would not require a match. He mentioned an atmospheric control. Ms. Eldemar responded affirmatively. Representative Pruitt asked about the other programs already in place. He wondered why there was a proposal to institute a new program. He inquired whether the legislature should be getting rid of other programs. Ms. Worl responded that the last one was written specifically for libraries and the current one applied to museums. She continued that when the bill was drafted it took the form of the proposal brought to the representative. She could provide clarification as to the reason for a separate account. Representative Pruitt asked if it was an appropriate time to be discussing additional capital funds for museums. He mentioned the House of Representatives recently having a massive debate on the floor about taking the Permanent Fund. He thought it was more important for the state to maintain what it already had. Ms. Worl agreed with his comments about money being short. The point of the bill was to set the mechanism in place when there were funds available for museums. 2:58:41 PM Representative Tilton asked if there was a listing of current museums throughout the state. Ms. Worl indicated Patience Fredrickson was on the line from the Archives Library and Museum. She offered to get back with Representative Tilton with an answer if Ms. Frederickson was not online. Co-Chair Foster OPENED PUBLIC TESTIMONY on HB 166. SHEILA WYNE, SHEILA WYNE STUDIOS, ANCHORAGE (via teleconference), spoke in support of HB 166. She mentioned the success of her art studio. She had artwork in the permanent collections of four museums in the state. She opined that it was critical for businesses like hers that museum institutions had access to programs that allowed for construction, expansion, and major renovations to keep up with advances in technology, the tourist industry, and trade. These museum programs and collections were magnets that attracted new and repeating clients. The quality was critical to local economies. She provided a personal experience as a designer for a performance event at the Anchorage Museum. The budget for the event $185,000 of which $160,000 came from sources outside of Alaska. There were 5,000 attendees. Several businesses benefitted from the event. She thought museum institutions were critical to communities, artists, and businesses. The museum construction matching grants will help with their mission. She encouraged support for the bill. 3:02:54 PM EVA MALVICH, AVCP, BETHEL (via teleconference), spoke in favor of HB 166. She was the director and curator for the Yupiit Piciryarait Museum and a tribal member of the native village of Mekoryuk (A co-owner of the museum). She mentioned a fire that burned the museum in 1980. It took 14 years from the time it burned to open the cultural center and open the collection to the public. She reminded members that the museum had not been able to be filled until 1967, the 100th year anniversary of the sale of Alaska. The state matched $2500 supplied by the community of Bethel, which was used to purchase lumber. However, the money ran out for the project. She noted that it would soon be the 150th anniversary of the sale of Alaska. It had been a long time since the museum was given an opportunity to ask for funding. She provided more information about the museum and its benefits. She spoke of a grant that would provide the museum with a desperately needed HVAC system. There had been several missed opportunities to house exhibits due to a non-functioning HVAC system. She provided examples of exhibits that had been damaged due to environmental factors and spoke about the expense of replacing the system. HB 166 would help immensely. Co-Chair Foster noted that Patience Frederickson was available online. 3:10:02 PM BETHANY FOLLETT, CITY OF WASILLA/WASILLA MUSEUM AND VISITOR CENTER, WASILLA (via teleconference), reported increased interest in local and state history. She spoke about the community programs offered at the museum that infused history and culture into a learning experience. She also mentioned other activities housed there. She believed HB 166 was critical to the city's museum buildings and programming and provided details about the current museum structure. It was bursting at the seams. She advocated that the museum needed more space and an update to its technology. Many libraries and museums had different and specific needs for providing services to the public. She opined that HB 166 provided the framework for Alaskans to support state museums and to preserve Alaska's heritage. 3:12:58 PM PATRICIA RELAY, MUSEUMS OF ALASKA, VALDEZ (via teleconference), had heard her colleagues share about the needs of their museums. She clarified the definition of a museum. A museum was an institution, whether public or private or in partnership that conserved and preserved and interpreted the collection of artifacts and objects of artistic, cultural, historical, and scientific importance making them available to the public as permanent or temporary exhibits. Museums served the public by preserving cultural heritage. Museums were facing critical infrastructure issues (She read from a prepared statement): I am contacting you today to thank you for your support of HB166, establishing a museum construction grant program and companion bill SB7. Research shows that almost half of all museums in the state are either currently involved in a construction project or will be in the next five years. That is incredible. This bill provides the structure for establishing a systematic approach to prioritizing museum capital project funding requests in the state. Museums and cultural organizations in Alaska are a critical part of the educational and economic infrastructure, spurring tourism and partnering with schools to teach the local curriculum. They contribute to our economy and wellbeing by: • Employing over 260 Alaskans; • Spend over $23,553,294. annually in the State; • Host over 624,695 visitors annually; and • Server over 36,290 school children annually. Despite this vital role of museums, our facilities and collections are at risk through decreasing federal, local and charitable giving. As collections grow and visitation increases, the pressure on our aging infrastructure must be managed. The Valdez Museum & Historical Archive is no stranger to this dilemma. The Valdez Museum & Historical Archive has accomplished a lot within the past few years: incorporating a successful expanded range of public programming, major upgrades to several exhibits, increasing its visitation, and raising its standards of collection management. Despite these achievements, the institution is now at a point in which its progress is being hampered by limitations of space. In order to maintain and improve its standards of professionalism, and to preserve its vision for the future, the organization needs to move away from its current environment of shared-purpose space and move towards a facility with dedicated space designed for single use functionality. At the core of our mission is education. Over the years we have had numerous teachers share their gratitude for how the Valdez Museum supports their work. Recently, Sheri Beck, a 4th grade teacher with the Valdez City Schools shared with our Museum Educator, "I just returned from a National Social Studies Convention in New Orleans. I thought of you so many times and wished we could be brainstorming side by side! I was also reminded how fortunate we are in Valdez and in my partnership with you, to have our local museum available for help and support. Thankyou! Your recent lesson with my students using artifacts and primary sources was such a wonderful example of what we heard at the conference as stellar teaching." Without the proper care and housing or the Museum's collections we would not be able to offer robust education programs. Thank you for sponsoring HB 166 and supporting SB 7, establishing a museum construction grant program, so that museums throughout the state of Alaska may continue to serve their communities. Help us make these bills a reality and speak up for Alaska's museums! 3:18:24 PM ANGELA LINN, MUSEUMS OF ALASKA, FAIRBANKS (via teleconference), reported having worked in Alaska for over 22 years, 20 of which she was the Senior Collections Manager of Ethnology and History at the University of Alaska, Museum of the North in Fairbanks. According to the Alaska Travel Industry Association, over 2 million visitors were coming to Alaska every year generating over $100 million in state revenues and $83 million in municipal revenues through taxes and other fees. Alaska museums provided a major draw for visitors. According to the American Alliance of Museums, 76 percent of all leisure travelers participated in cultural or heritage activities such as visiting museums. These travelers spent 60 percent more on average than other leisure travelers. Fairbanks had museums that specialized in and featured the unique stories of the indigenous people. She reported that there was a museum that featured planes, trains, and automobiles that have helped in building Alaska in the modern period. Alaska also had a children's museum where kids engaged in hands-on learning. There were many others including a museum where they were undertaking world-class research on collections that spanned millions of years of biological diversity and thousands of years of cultural traditions in the North. In the current year, there was a significant increase in tourism from Asian countries. Those visitors connected with Alaska through its museums. She continued to discuss the advantages of Alaska museums. She emphasized the need for museum construction and renovations funding and encouraging members to support HB 166. Representative Guttenberg asked if Ms. Linn thought the Museum of the North would be eligible under the grant. Ms. Linn hoped so. She was uncertain about the university's budgeting process. Her museum was a member of Museums Alaska and a major part of the museum community. She hoped her museum would be eligible for the funding. Co-Chair Foster CLOSED Public Testimony on HB 166. Representative Guttenberg asked if Ms. Frederiksen was still online. 3:21:50 PM MS. PATIENCE FREDERIKSEN, DIRECTOR OF LIBRARIES, ARCHIVES, AND MUSEUMS, introduced herself. Representative Guttenberg asked about the definition of museums. He referred to Chapter 57 indicating that some of the definitions and functions were not aligned with the language of the bill. He thought the definitions needed to be strengthened. He asked if she had looked at the bill and whether it worked. Ms. Frederiksen responded that she had not looked carefully at the bill, as it was under a different department. She was happy to look at the bill, review the definition of museum, and provide feedback. Representative Guttenberg referred to Chapter 57 [A.S. 14.57] under designated cultural and historical depositories. He wanted to make sure there were not conflicts between what was in statute and the bill language regarding a museum and funding. He wanted to make sure things were aligned. Ms. Frederiksen asked if Representative Guttenberg wanted her to talk to the Division of Commerce. Representative Guttenberg responded, "Okay. Alright. Thank you." Co-Chair Foster announced amendments were due at 5:00 pm Thursday, April 18, 2017. Representative Wilson relayed that several questions had been asked during the meeting. She wanted those questions answered prior to having to submit amendments, as the answers would be pertinent to the bill. She queried about a timeframe. Co-Chair Foster would take a brief at ease to inquire about a timeline. 3:25:13 PM AT EASE 3:26:32 PM RECONVENED Co-Chair Foster would not set a deadline for amendments until he had a better idea of when answers might be provided. HB 166 was HEARD and HELD in committee for further consideration. HOUSE BILL NO. 103 "An Act relating to the practice of optometry." 3:27:21 PM REPRESENTATIVE IVY SPOHNHOLZ, SPONSOR, read a prepared statement: HB 103 gives authority to the Board of Optometry to regulate the practice of optometrists, much as is done by doctors, nurses, midwives, chiropractors and dentists. It ensures that the Board of Optometry will have the opportunity to update their current and continuing standards and scope of practice based on the best evidence available. The bill will not allow optometrists to provide services outside of their scope of practice like performing invasive surgeries which will continue to be illegal. What it will allow is for optometrists to utilize the State of Alaska's rigorous regulatory process to manage themselves just as doctors, nurses, midwives, chiropractors and dentists do. HB 103 allows our robust regulatory process to work. The process for developing new regulations is public and transparent, ensuring that any new regulations will be fully vetted by the board, the public and the Department of Law before it becomes regulation. The Board of Optometry has a strong track record of regulating itself. In fact, the Board has implemented higher continuing education standards on the profession than the Legislature has required in statute which makes a strong case for why this board is more than capable of regulating its own education and practice. (Statute: 15 hours of continuing education while optometrists have required themselves to have 36 hours of continuing education.) It is my hope that this bill will get the Legislature out of the business of managing optometrists, so we can focus on our efforts and energy on issues which do require our attention and optometrists can get on with the business of caring for Alaskan's eye health. Co-Chair Foster invited Dr. Barney to the table. He reviewed a list of other available testifiers. DR. PAUL BARNEY, DOCTOR OF OPTOMETRY, introduced himself. Representative Wilson had been asked for a definition of surgery. She wondered if the doctor would have any issues if a definition was added to the bill for further clarification. Representative Spohnholz responded that she had strongly resisted adding a definition of surgery to the bill. She was intentionally trying to move the discussion out of the legislature's hands. She asserted that adding a definition of surgery would keep the discussion in the hands of the legislature. An invasive surgery was already not allowed in statute. It was unclear what the scope of practice would be for optometrists in 20 years, 30 years, or 40 years. She provided an analogous situation. She suggested that when a person went to the dentist 20 years previously the things a hygienist did versus what a dentist did were very different from what they did presently. For instance, currently, she visited the dentist's office twice per year. She saw the dentist at one visit and the hygienist at both. A hygienist provided almost all her oral health needs with very little consultation from her dentist, which 20 years ago would not have been imaginable. She did not think the legislature needed to be a part of such a conversation. She believed that the conversation should be had between the health care professionals and providers who were keeping on pace with the standards of practice and educational standards. She made the case that the definition did not belong in the bill. 3:32:25 PM Representative Wilson asked for the reference to the definition of invasive surgery in statute. Representative Spohnholz read the statute: AS 08.72.273 Removal of foreign bodies. A licensee may remove superficial foreign bodies from the eye and its appendages. This section is not intended to permit a licensee to perform invasive surgery. Representative Kawasaki referred to Section 3. He asked about the removal of language regarding the applicant and continuing education including eight hours for pharmaceuticals and 7 hours for non-topical therapeutic pharmaceutical agents. The language would be replaced with language that required continuing education requirements as prescribed by the board. He asked her to clarify whether the goal was to reduce the number of hours or to allow the board to determine the requirements. Dr. Barney replied that 8 hours of pharmaceutical requirements were written into statute a couple of decades prior. At the time the law was written, most of the education did not deal with pharmaceuticals. The legislature wanted to make certain that pharmaceutical education was required. Currently, the education available had changed dramatically. Most encompassed pharmaceuticals and their applications. He stated that the board was more likely to increase the number of required hours of education rather than reduce them. Representative Kawasaki mentioned concerns about the board overseeing the establishment of regulations for licensed optometrists, as they could permit them to do things outside of their scope of practice. He asked Dr. Barney to address the issue. Representative Spohnholz relayed that the primary concern of the opposition to the bill was that the board would start authorizing practices well outside of practitioners' education and expertise. There were similar professional distinctions such as those between dentists and oral surgeons. Dentists did not perform oral surgery, and there was no major concern or outcry that they were expanding their authority to do so. It was not within the scope of their training and practice. She highlighted that there was a rigorous process for drafting new regulations; they were required to be drafted in partnership with the Department of Law. The goal of the process was to to reconcile any proposed regulations with existing statute. The regulations were also thoroughly vetted and included public input. She was confident that the Ophthalmologists would be happy to participate in the same process. The Department of Law would go through a more rigorous review of the process following public comment. She was confident that the Department of Law and the attorney general would not allow for an expansion of the scope of practice beyond that which optometrists were trained and had the necessary expertise. 3:36:52 PM Representative Kawasaki asked how a licensed optometrist was regulated versus a hygienist. He wondered how optometrists were qualified. Representative Spohnholz deferred to Dr. Barney. Dr. Barney responded that to be eligible for licensure, an optometrist or student of optometry had to take a board examination. The board process started when optometry students were in school. A person had to take national boards and pass all sections to be eligible to take the state license test. For someone who graduated in 1980, for example, the statutes had not changed significantly. There had been a couple of scope-related bills that passed. Each time there was a scope expansion in which continuing education was required everyone had to get the training. The credits were offered in accredited colleges of optometry and had to be taken and successfully completed before optometrists could conduct the expanded procedures. The board would do something similar if HB 166 passed. Representative Kawasaki spoke to the comment about a person being licensed in 1970 versus presently. He mentioned driver's licenses. His mom got her license in 1950 and did not have to requalify for a license or take another test. He wanted to ensure strict confines of performance. Dr. Barney conveyed that continuing education was required on a yearly basis. If anyone were to fall behind on that requirement their license would be in jeopardy. Representative Spohnholz added that in contrast with Representative Kawasaki's mother's driver's license, which she believed required a periodic update to maintain it, an optometrist or another healthcare professional was required to do continuing education to demonstrate that they were keeping pace with the changing profession over time. 3:40:11 PM Representative Wilson thought that the statute AS.08.72.273 did not define invasive surgery, rather, it discussed foreign bodies. She was looking for the definition of invasive surgery. Representative Spohnholz understood there to be a definition. She had talked with the Department of Law recently looking for the definition of invasive surgery. The department indicated it would get the definition of invasive surgery from the medical board. If the medical board's standard was used, the invasive surgery standard would be the same for dentistry, optometry, podiatry, across professions for anyone wanting to use a laser or knife to cut someone open. Representative Wilson wanted to hear from the Department of Law. JOAN WILSON, ASSISTANT ATTORNEY GENERAL, DEPARTMENT OF LAW, saw no definition for invasive surgery in statute. She furthered the board would likely proceed to define standards and practices, including eye surgery, in regulations. A three-fold review process: the board would draft regulations and a public notice stating that the board was considering new regulations. The Department of Law would then review the public notice to ensure the adopting agency was identified, the statutory authority and the statutes being implemented were identified, and deadlines were set for comments. The department also made sure that if an oral hearing was held, it was laid out properly. The point was for due process and public input. Co-Chair Seaton asked Representative Wilson to repeat her questions. Representative Wilson wanted to know where the definition could be found in statute. Representative Spohnholz relayed that the definition was not in statute but it was in regulations. She relayed that she had been working on the bill with Harriette Milks, Assistant Attorney General. Joan Wilson was pinch hitting while Ms. Milks was unavailable. Ms. Wilson would look up the medical regulation. Co-Chair Seaton indicated there would be time to find the definition, as there would be additional hearings on the bill. 3:45:21 PM Vice-Chair Gara liked the provision of the law that stated that an optometrist could remove a foreign object from someone's eye in case of an emergency. He asked what was in Alaska law that prevented someone from doing Lasik surgery compared to the laws of other states where optometrists were able to conduct the procedure. Mr. Barney replied that optometrists did not perform Lasik surgery in other states. Co-Chair Seaton asked if Dr. Barney had a statement he wanted to put on the record. Mr. Barney read a prepared statement: My name is Dr. Paul Barney, I am an optometrist and the current chair of the Alaska Board of Examiners in Optometry. I am also a past president of the Alaska Optometric Association. I live and practice in Anchorage and have done so for the past 17 years. I'm here today in support of HB-103. I support HB-103 because it will allow the Board of Optometry to regulate the details of the practice of Optometry, which is how Advanced Practice Nurses, Dentists, and Medical Doctors are regulated in Alaska. This legislation will not set a new precedence in health ca re, nor will it be a risk to Alaskans since this is already the way other health care providers are successfully regulated in Alaska. HB-103 will give Optometrists better opportunity to practice to the highest level of their education by allowing the Board of Optometry to write regulations that are commensurate with educational advances that occur with new technology. The current Optometry statute was written over 40 years ago and requires Optometry to pursue a statute change whenever there are advances in education and technology. As you know, statute changes are costly and time consuming. You'll hear arguments against this legislation stating that it will be dangerous to allow Optometrists to regulate themselves. But like all other professional regulatory boards, the Board of Optometry cannot promulgate regulations for practices or procedures that are beyond the education of Optometrists. The Board of Optometry is overseen by the AK Department of Law, just like other health care boards, and the AK Department of Law would ensure that the Board of Optometry's regulations were within the scope of Optometric education. Other safeguards are our medical legal system and insurance system. Any healthcare provider who provides care outside of their education is subject to disciplinary action by their respective board, as well as serious medical legal ramifications. Additionally, insurance carriers do not pay providers for care that they provide outside of their scope of education. As a result, there is no incentive for any healthcare provider to provide care outside of their education, and, there are very serious consequences, both financially and to their licensure, to practitioners who do provide care outside of their education. As chair of the Alaska Board of Optometry, I can assure you that the primary concern of the Board is the safety of the public. In the six years that I have served on the Board we have had no complaints from the public that were serious enough to even consider disciplinary action. Optometrists are conservative and cautious practitioners and the passage of HB-103 would not change their conservative nature. I would also like to share with you how I practice. I'm the Center Director of Pacific Cataract and Laser Institute in Anchorage. Our practice is a referral only practice and we specialize• in cataract care, laser vision correction, and medical consultative services. I work with an ophthalmologist and a nurse anesthetist. We all practice to the highest level that statutes will allow and by doing so, as a team we ca n provide high quality, more affordable care to Alaska ns. I have a very good relationship with the ophthalmologist that I work with, but if I were to provide ca re that is outside of my education it would not only jeopardize my relationship with the ophthalmologist but it would also undermine a n already very successful practice. Optometry provides over 70% of the eye care in the U.S. In some rural areas of Alaska, Optometrists are the only eye care provider in the community. HB-103 would be good for the state of Alaska, the bill puts the regulatory details regarding the practice of Optometry in the authority of the Alaska Board of Optometry. These changes are important to allow the profession and practice of Optometry to incorporate new technologies and advances in eye care as they occur. The citizens of Alaska deserve to be served by a profession that is allowed to stay current with advances in education and new technologies in eye care. I respectfully urge you to support HB-103. 3:50:52 PM DAVID ZUMBRO, SELF, ANCHORAGE (via teleconference), was an eye physician and surgeon in Anchorage and was a partner with Alaska Retina Consultants. He strongly opposed the legislation. He indicated that the legislation was not a simple house cleaning bill. Rather, it radically redefined a profession. Although the bill seemed innocent and safe and, as written, would allow non-physicians and non- surgeons to determine what medical and surgical treatments could be done to an eye. He believed it was special interest legislation. It was not safe for patients. He wondered where the public outcry was for the legislation. He asked for proof that current practice regulations adversely affected Alaska patients and the Alaska optometrists. It had been stated that the bill was not about surgery and that no surgeries would be done for which optometrists were not trained. He was worried about surgery. He relayed that a local optometrist told him that when the bill was first crafted that optometrists wanted to perform intraocular injections of medications currently performed by retina physicians. The current bill removed all previous regulations preventing injections. He wondered why regulations would be removed that prevented injections. He suggested that there were many bills in many states that would allow optometrists to advance their scope of practice into lasers and surgery. As a result, several states had adopted definition of surgery language in their statutes. Alaska could do the same thing. He opined that the bill was about advancing the optometric scope of practice into the practice of medicine for which they did not have training. He used to teach ophthalmology residents when he was active duty in the US military. One of the most difficult things to impart to young physicians in training was when to take a step back and not do something. He spoke of the Hippocratic Oath which all medical physicians took requiring them to do no harm. The surgical maturity to sit back and observe a patient did not happen overnight. It took many months of direct supervision and guidance by qualified and experienced physicians. The field of optometry did not have such a type of training background when it came to procedures and lasers. They were not trained in any ophthalmic procedures, lasers, or surgeries. He had no problem with the Board of Optometry regulating the Optometry profession in the practice of optometry. However, if the bill became law optometrists would be regulating themselves in the practice of ophthalmology. As an ophthalmologist he felt he had a say in the issue. The regulation would be without any physician or surgeon oversight, without any training or experience or background, and he had concerns about patient safety and its dangers. He thanked the committee. Co-Chair Seaton asked how many ophthalmologists were in Alaska. Dr. Zumbro responded that there were approximately 26. Vice-Chair Gara agreed with not wanting optometrists to perform surgery. The doctor prior had indicated there was no intention of optometrists doing surgery. He asked Dr. Zumbo if he agreed that in other states optometrists did not perform Lasik surgery. Dr. Zumbro agreed that optometrists did not do Lasik surgery in the United States. 3:55:32 PM DR. JANEY CARL ROSEN, SELF, ANCHORAGE (via teleconference), was a Doctor of Ophthalmology, specifically an oculoplastics surgeon and neuro-ophthalmologist which meant he was an eyelid surgeon and worked with neurology and neuro surgery. He took care of bumps and cysts on eyelids. He provided more information on his professional background. He had heard repeatedly the bill was not about surgery, optometry had no business doing surgery, and optometrists did not want to do surgery. The sponsor had said the bill was not about surgery and her aide had stated that all surgery language was removed from the bill. He had heard that as time changed the scope of practice should be modernized by the optometry board and should a surgical procedure be deemed within the scope of practice by the board they did not want to come back to the legislature. The assistant attorney general previously stated that public testimony would help decide if a surgery was appropriate for an optometrist. He wondered if members were bothered by those statements. He suggested that not only would no one have actual surgical experience on the board and the legislature would ask the public for help. He thought asking an expert with actual experience was more appropriate. He reviewed several examples of problems from botched surgeries. Dental boards and nurse practitioner boards policed themselves because they learned procedures in graduate school. Optometry students did not perform surgery, lasers, or injections on real people. He did not believe an 8-hour class was enough training. He was asking folks to wake up and consider what was being proposed. He read from the Journal of the American Medical Association about a study done in Oklahoma where they performed laser surgeries. He believed the legislation was racing towards a slippery slope. He thought there should be more public outcry. 3:59:06 PM DR. KELLY LORENZ, SELF, ANCHORAGE (via teleconference), was a board-certified Ophthalmologist and strongly opposed HB 103. She believed the bill was an unprecedented expansion of practice. The legislation would allow for limitless surgical procedures without any defined training in surgical techniques. She indicated that she had met patients that had been told by their optometrist that there was only one cataract surgeon that came to Alaska. The bill did not have the best interest of Alaskans in mind and there was no public outcry for it. She spoke of the importance of having a skilled professional with years of training under the supervision of an experienced preceptor. She read statistics from a medical journal about a recent study regarding laser procedures in Oklahoma and the fact that optometrists had repeated the laser more than twice as much as ophthalmologists. She thought it was also essential to have the ability to manage the inevitable complications that arose from laser and traditional surgery. She brought up other serious issues members should consider before signing what she considered to be a blank slate. She advised members to be cautious and to demand specifics. She urged members to oppose the bill in its current form. 4:01:41 PM DR. ANDREW PETER, SELF, HOMER (via teleconference), was an optometrist from Homer and asked members to support HB 103. He relayed a list of services he provided. He mentioned that the clinic's daily schedule could accommodate 4 to 6 urgent care patients. It was common for the appointments to be fully utilized. He spoke to the challenges of living in rural Alaska. He quoted some statistics concerning the number of optometrists and ophthalmologists in the state. He encouraged members to help optometrists be more nimble and accessible. He thanked the committee and made himself available for questions. Representative Wilson thought the definition of surgery was the key issue. She wondered if it would be something that could be discussed. Dr. Peter responded that one of the ophthalmologists had defined surgery as cutting, blading, or altering tissue. Under that definition, tattoo artists and tattoo removal specialists performed surgery. He relayed that if a patient came in with a piece of metal in their eye and he removed it, it would be considered surgery. He provided other examples of potential surgeries. He hoped the legislature could take itself out of the business of managing optometry eyecare. 4:06:16 PM DR. JILL MATHESON, SELF, JUNEAU (via teleconference), was an optometrist in Juneau. She spoke of her previous experience on the Board of Optometry. Over the previous 25 years she had testified numerous times before several legislative committees in support of changes to the Alaska optometry statute. Efforts had been successful due to the level of trust legislators had given optometrists over time and after sifting through testimony. She asked for member's support in having the optometry board regulate optometrists. The bill did not give any expansion of privilege to optometrists. It allowed the optometry board to decide what optometrists were trained and qualified to do via the regulatory process of the board and within their scope and training. She assumed that the members of the state board were appointed and confirmed by the legislature to do the same. There were separate boards because each profession was unique. She suggested that only optometrists knew what doctors of optometry were trained and qualified to do. She was aware members were trying to figure out what "fiscally responsible" looked like. The bill had been heard by four committees multiple times. She suggested that if the optometry board could regulate optometrists there would still be a very public process via open public testimony. Also, boards had to be self-sufficient. The bill allowed the profession of optometry to evolve. She trusted the appointed optometry board members to make any necessary changes. 4:09:15 PM DR. KURT HEITMAN, AMERICAN ACADEMY OF OPHTHALMOLOGY, SOUTH CAROLINA (via teleconference), strongly opposed HB 103. He remarked that the bill was a surgery bill. The bill made two crucial changes to existing Alaska law. First, it removed surgery restrictions already in existing law. It also inserted a new definition of the word optometry in Section 6 that included the words "treatment" and "procedures". The insertion of the word treatment put no limitations on the type of treatment. In other words, all surgeries in the eye would be allowed under the law because the Board of Optometry could define invasive surgery any way they wanted. HB 103 allowed the board cart blanch authority to redefine their field into a surgical field. He had seen an example in North Carolina where optometrists defined laser as non-invasive. He wondered why proponents of the bill opposed the inclusion of language that clearly specified that surgery was outside the scope of practice of optometrists avoiding patient harm. Without specific language restricting surgery, Alaska would be the first state in the country to adopt such broad, unprecedented legislation. There would be no restrictions of optometrists being able to obtain surgical privilege. Optometrists provided a valuable service to communities and were an integral part of the eyecare team. However, they were not medical doctors and did not graduate from a comprehensive surgical residency. There were only three states that allowed optometrists restricted surgical authority. The first was Oklahoma. In Oklahoma, optometrists expanded scope to include surgeries because of language in a bill similar to HB 103. He continued to provide background regarding Oklahoma law. He had reminded the board of an incident at the Palo Alto VA hospital where veterans were hardened because of poor glaucoma follow-up. Because of the incident the VA strengthened its directives prohibiting optometrists from performing laser procedures - the same procedures that would be allowed by the current language in HB 103. He disagreed that the bill was similar to other bills governing professional boards such as nursing, dentistry, or engineers. Unlike nursing and dentistry, optometry school was not a medical or surgical education. Optometrists received about 1900 hours of clinical education in their 4-year training compared to 20,000 hours that ophthalmologists received, about one-tenth the medical education. He disagreed that the bill was about governing boards. He continued to provide a comparison between education received by optometrists and ophthalmologists. He thanked committee members. 4:13:47 PM DAVID KARPIK, SELF, KENAI (via teleconference), was a Doctor of Optometry. He spoke in support of HB 103. He provided information on his professional background. He suggested that the optometrist might be the only doctor that a patient had access to because of Alaska's wide geographic distribution. He reported that a recent publication ranked Alaska 50th in access to health care. All health care providers should practice within the scope of their training. He supported the legislation due to its simplicity. It would replace the aging current optometry law that needed updating. He asserted the delay in updating the old optometry statute hindered access to eyecare and increased Medicaid travel costs in the state. Other prescribing professions such as dentistry and advanced practice nurses were regulated by their state board. The Board of Optometry ensured protection of the public and timely updates of practice. He thanked members for their support of the bill. He brought up the procedures that had been performed for decades by optometrists in their offices legally and safely in Alaska. He suggested that opposition had not familiarized themselves with current law. Treatment was an integral part of the profession. He thanked him for his time. Co-Chair Seaton asked if there was opposition to removing laser surgery from the scope of practice. Dr. Karpik responded that training and technology changed all the time. He thought the purpose of the bill was a durable statute that would stand the test of time like the state constitution. He was in favor of the current statute language in the bill. 4:18:44 PM JEFF GONNASON, CHAIR, ALASKA OPTOMETRY ASSOCIATION, ANCHORAGE (via teleconference), spoke in favor of HB 103. He was born and raised in Ketchikan and Craig and was the first Alaska Native optometrist. He practiced in Anchorage and performed clinics in the villages when he was a young man. He suggested that HB 103 did not authorize any optometrist to do anything. He relayed that of the four independent prescribing professions only optometry had been treated unfairly for several years. The Alaska Optometry Board deserved to receive the same level of trust as other health care professions. He opined that the optometry board would never authorize any practice outside the scope of education and training. Doctors of Optometry were held to the same standard of care as any medical provider treating patients. Section 5 of HB 103 was clear on the topic. The optometry practice definition in Section 6 was modeled after the exact wording from the Alaska dental statutes. Dr. Gonnason continued that two opposition arguments had prevailed over the course of the previous 40 years. The first argument was that optometrists were a danger to the public. The second argument was that optometry education was not adequate. He thought both arguments had been proven to be untrue. Optometry education and training was identical to the dentist model requiring 8 years to 10 years of university level education and residencies. Optometrists were real doctors. He relayed that optometrist had been prescribing medications for 25 years including prescribing scheduled narcotics for the past 10 years with no issues of harm. Alaska optometry supported limiting opioid use. Optometrists were defined as physicians under federal Medicare. There had never been a case of patient harm before the state optometry board involving prescriptions of treatment. Yet, over the past 40 years, the opposition had testified predicting terrible harm that never occurred. Dr. Gonnason argued that the clinical education of optometrists did not have to parallel that of an ophthalmologist any more than the education of a family physician having to parallel that of a neuro surgeon. He commented that optometrists and ophthalmologists did very little of the same things. Optometrists did not do any of the advanced specialty surgeries done by subspecialists. Rather, they did minor procedures in which they were competent. He suggested that surgery would be difficult to define in statute because technically anything that touched human tissue was surgery. He provided examples of surgery. He thought the definition should be in regulations rather than in statute to avoid having to come back to the legislature for changes. He pointed to a letter in member packets from a VA hospital where an optometrist did laser procedures with zero incidents of harm. He referred to an Oklahoma study which he thought was flawed. He was available for questions. 4:23:20 PM DR. GRIFF STEINER, SELF, ANCHORAGE (via teleconference), was an ophthalmologist in Anchorage. He read from a prepared statement: The ophthalmologists and others that oppose this bill (HB103) in no way want to prevent optometrists from practicing to the full extent of their specialty and training. This boils down to whether they intend to do surgery, which would truly be inappropriate. The bill should not pass as it currently written. If the optometrists want an autonomous board, but no surgery, then a concise definition of surgery can easily be added. If they oppose a definition of surgery, it can only mean they want to perform surgery. More than one optometrist has approached you indicating a desire to do a type of laser called YAG laser capsulotomy. They have not used these words, because capsulotomy means to cut a hole in the capsule. They instead have described this as "shining a light in the eye to clear up some clouding." But, the laser does not shine as it is invisible. The invisible light needs a second laser "HeNe" beam (Helium-neon) to focus the primary cutting laser. This laser cuts a hole in the membrane that holds the lens implant in place following cataract surgery (the removal of the natural lens when is has become cloudy). This is not a benign procedure, particularly in those without proper surgical training. This laser cuts a hole in a critical tissue in the eye and there is no shining involved. This is just one example, but is the first surgery they intend to approve. Ask them if they want to do surgery. It was not appropriate. Dr. Steiner was available for questions. Representative Wilson clarified that optometrists did the procedure currently. Dr. Steiner indicated that they did not do the procedure in Alaska. He thought only one or two states allowed it, Oklahoma and maybe Kentucky. He believed that it would be the first procedure approved by the Board of Optometrists. It was the type of procedure optometrists would advance into - something they have not been trained to do or have ever done. Representative Wilson asked if additional training had been offered in the two states he mentioned. Dr. Steiner was aware that a weekend course was offered on how to do a laser procedure. Following the training, optometrists were approved by their boards. 4:27:57 PM AT EASE 4:28:10 PM RECONVENED Co-Chair Foster CLOSED Public Testimony. Co-Chair Foster relayed that amendments were due by Monday, at 5:00 PM. HB 103 was HEARD and HELD in committee for further consideration. 4:28:35 PM AT EASE 4:31:48 PM RECONVENED Co-Chair Foster indicated that he was going to change the deadline for the amendments to HB 103. He relayed that they were now due by Friday, April 14th by noon. HOUSE BILL NO. 151 "An Act relating to the duties of the Department of Health and Social Services; relating to training and workload standards for employees of the Department of Health and Social Services; relating to foster care licensing; relating to placement of a child in need of aid; relating to the rights and responsibilities of foster parents; relating to subsidies for adoption or guardianship of a child in need of aid; requiring the Department of Health and Social Services to provide information to a child or person released from the department's custody; and providing for an effective date." Foster youth in Alaska are not getting the chances they deserve. The Children Deserve a Loving Home Act aims to increase the likelihood that foster youth will have the same opportunities in life, and same health and well-being, as their peers. When roughly 40% of our foster youth end up homeless at some point in their lives after leaving care, and roughly 20% end up in jail, it's a call for reform. The nation's leading foster care non-profit, Casey Family Programs, has the correct goal to reduce the number of youth languishing in foster care by 50% by 2020. Alaska should join that effort. We should achieve it not by leaving youth in neglect and abuse to keep our foster care numbers down, but by getting neglected and abused youth out of the foster care system, into a permanent, loving home, much more quickly than we do now. Many Alaskans recognize that our child welfare system has room to improve; this bill seeks to make real positive changes that support youth and families, as well as the caseworkers who serve them. It's been well documented by many sources that when case workers are overworked, outcomes for children and families suffer. The Office of Children's Services (OCS) recommends standards of approximately 12 cases or families per worker - but today, most caseworkers are carrying caseloads that vastly exceed that amount (as high as 43 families in Wasilla, 36 in Homer, and 30 or more in six of the state's main OCS offices). Conditions in rural Alaska, especially the challenges of remote travel, make even a 12-family caseload overwhelming for workers in such regions. Beyond the risk of poorer outcomes, high caseloads contribute to high worker turnover, a costly problem that slows timelines to permanency. This bill seeks to improve both caseload levels and worker retention by implementing significant new training and workforce standards. New workers would receive a minimum of six weeks of training and would carry no more than six cases/families in the first three months, and 12 families in the first six months. These standards are recognized to improve outcomes, enable faster timelines to permanency, and allow caseworkers to perform their duties as intended. In addition, this bill provides for a number of other changes to support the well-being of youth in care, and to promote quicker timelines for children returning to, or finding new, permanent homes. The bill extends subsidies for adoptions and guardianships to age 21, to incentivize permanency and the closing of cases, and promotes contact with siblings and with previous out-of-home caregivers to promote the well- being of children and maintain a network of support for them. Another important tenet of this bill is enacting timelines for waivers to licensing requirements for relatives who may want to care for a child, but are not licensed foster parents. The bill also makes it easier for youth and foster parents to engage in normal day-to-day activities, such as going on vacation without prior caseworker approval, with fewer requirements. In addition, youth at age 14 are empowered to participate in their case plan. This bill also strengthens the requirement to search for relatives before placing a child with foster parents, recognizing that placements with family are often the best and most loving option for youth. Providing support, and a voice, for youth and families who need our help is perhaps one of our most important duties in public service. This bill seeks to give caseworkers the tools they need to carry out their duties to the best of their abilities, and it seeks to support youth and families with provisions that support well-being, make it easier for children to move out of the system and into a permanent home more quickly, and provide the necessary resources for a system that can function well. This bill is intended to create an environment where loving homes are the priority for all youth. 4:32:35 PM Co-Chair Seaton MOVED to ADOPT proposed committee substitute for HB 151, Work Draft 30-LS0451\I (Glover, 4/17/17). Representative Wilson OBJECTED for discussion. REPRESENTATIVE LES GARA, SPONSOR, DISTRICT 20, introduced himself. LAURA CHARTIER, STAFF, REPRESENTATIVE GARA, would walk the committee through the newest version of the bill, version I. 4:33:52 PM AT EASE 4:36:18 PM RECONVENED [Co-Chair Foster passed the gavel to Representative Guttenberg] Representative Gara indicated his staff would walk through the committee substitute changes to the bill. Ms. Chartier proceeded to explain that Section 1 provided a short title. Section 2 reflected the main change made from the previous committee substitute (CS) version. The section provided for funding for adoptions and guardianships for older youth. In the previous version of the bill it was written in such a way that all youth who were adopted, regardless of the age which they were adopted, would receive subsidies for adoptions and guardianships up to age 21. The current draft specifies that those adoption and guardianship subsidies would only apply only to youth ages 18 to 21. They were limiting it to the older youth population, which was the original intent of the bill. Also, the word "subsidy" was replaced with "stipend" to differentiate from any federal language or federal programs. She reiterated the most significant change from the previous version of the bill was limiting those adoption and guardianship subsidies to older youth, ages 18 through 21. Representative Wilson asked if she was talking about children who did not get adopted until they were 18. In other words, if they were to get adopted at 18 they would have the subsidy from 18 to 21 years of age. Representative Gara responded that the language would likely remove this portion of the bill. Currently, the state would pay a daily rate if a person adopted or was a guardian for a youth but only until age 18. The problem was that there was youth who were 18, 19, and 20 who did not have a permanent home. The goal was to extend the subsidies to age 21. However, federal law prohibited states from doing that for just 18, 19, and 20-year-old youths. If a person was adopted at age 1 they would receive the subsidy through age 21 even if they did not need the incentive. It became a $7.4 million fiscal note, something the state could not afford. It was not the priority piece of the legislation. Instead, as a work around, he suggested coming up with a state program in which federal law would not be used for youth 18, 19, and 20. However, it created a perverse incentive so that if a person was thinking about adopting a child at age 16 they might wait until age 18 to get 3 years of subsidies. There was no way to make the provision work and would likely be removed. Ms. Chartier continued to Section 3 which enabled contacts with previous out-of-home caregivers. She relayed there were 2 pieces of the bill that encouraged contact with people who might be close to a youth in their life and one of them was a previous out-of-home care giver. Section 4 required that a supervisor had to certify in writing at different times in the foster care process that a search for relatives had been carried out. She relayed that what was being added was that a supervisor had to certify in writing at different points in the foster care placement process that a search for relatives had been carried out. In other words, a supervisor would literally sign off that such a search had been carried out. Section 5 of the bill included language on what was called a prudent parent standard. It was language to make it easier for foster parents to make day-to-day decisions involving a child's activities. Section 6 engaged youth who were 14 and older in their case planning process, something adopted from federal language like the prudent parent standard. 4:40:41 PM Representative Wilson was not aware of case plans for adults. She wondered if there was a case plan for children. Representative Gara responded in the negative. He explained that youths 14 or older did not have the right to designate certain people to be part of their case planning. Youth over 14 years old would be able to nominate up to 2 extra people important to them to be part of their case planning team. Representative Wilson asked if it was a different type of plan than that of their parents. She agreed youth should have a say on where they were going. She was trying to figure out if there were two kinds of case plans. Representative Gara indicated it was a hybrid case. The case would involve both the interest of the child and the parents. He believed the child had a right to have a say in their future. In Section 6 it stated that a youth age 14 and older should be able to have a say in those involved in their case plan. The change would allow for up to 2 other people to be included in the case planning process. Representative Wilson expressed confusion. She relayed that she was only familiar with the way the case plans were run where a parent had to attend a parenting class, get a psychological evaluation, and follow an evaluation. Hopefully, if a parent followed the plan, they would be reunified with their child. If they chose not to participate, it could result in adoption. She was trying to better understand the section. She wondered if a child would be able to request where they wanted to go. Representative Gara responded affirmatively. He stated that the early case plan that had to be filed within the first 60 days was to figure out if the child would be able to return to their parents and what the parents would have to do to get their child back. After the first 60 days, there was still a case plan for a child. The Office of Children's Services (OCS) could provide more information about the later stages of the case plan. Representative Wilson agreed with the concept. She just was trying to figure out the mechanics. Representative Gara responded that it was the same case plan. He was hopeful that the result would be reunification early on. 4:45:26 PM Representative Thompson mentioned that earlier in the conversation the bill sponsor referred to a child over 14. He heard the representative clarify that it applied to 14 years or older. Ms. Chartier continued with Section 7. The section included the language to promote contact between siblings. It allowed for OCS to share contact information for siblings if it was in the best interest of both parties involved. Section 8 and 9 had a provision requiring a certification that a search for relatives had been carried out. It changed throughout the statute. In Section 10 there was a minor change to statutory language replacing the phrase, "One parent" with "Adult family member." She continued with Section 11 was another mention about sibling contact provisions. The main change in the bill could be found in Section 12. The change reflected the implementation of new training and workload standards for staff. She was sure Representative Gara would discuss the information in more detail. Essentially, it extended training for new workers up to 6 weeks and lowered their caseloads. Workers in their first 3 months would have 6 cases. Workers in their first 6 months would have a caseload of 12. There was a very minor language change to the section from the previous version of the bill. She referred to page 10 at the top of the page. It clarified the staff that was covered by the section of the bill. It was a small change to the language to make sure all the staff would be covered under the training and workload standards. She continued to Section 13 that encouraged assistance with family members obtaining variances to foster care licensing. If an adult family member did not necessarily want to go through the typical licensing process they could obtain a variance. Section 14 outlined that youth leaving care would be provided with official documents or receive assistance in obtaining their official documents. The bill contained a list of specific documents that were covered. Section 15 implemented a timeline for decisions to be made on applications for foster care home licensing or on variances to that licensing. They were not changing the process of applying but adding a timeline for a decision to be made either way within 45 days. Section 16 and 17 related to the applicability of the act. In the final section, Section 18 on the timeline. In version N of the bill the training standards were to be implemented in the first year and in year 2 there would be enough staffing to meet the new caseload standard. Version I pushed out the staffing to year 3. The department would have 3 full years to meet the staffing requirement. There were a couple of additional provisions to be implemented in year 1 including the involvement of children 14 years old and older in their case planning and the prudent parent standard as well as the certification of relative searches. Alternate-Chair Guttenberg referred to Section 13. He asked Representative Gara to speak to assisting a family member and attaining a license or any variances. 4:50:04 PM Representative Gara replied that it was a complicated process. Sometimes there was a family that was not a foster parent. He explained that there were 2 types of foster parents - relatives and out-of-home caregivers. Relatives did not need a license. There was a category of people who might not receive the daily reimbursement rate. In rural areas, especially in areas where there was little caseworker contact, the application process was complex. He hoped the bill would fix the caseworker contact issue. The provision stated that an out-of-home caregiver should be helped in the application process. Representative Wilson asked whether Section 13 would require family members to be certified or whether they would be able to get help if they wanted to be certified. She thought Representative Gara was responding affirmatively, as his head was nodding up and down. [Representative Gara nodded his head]. She also asked what would prevent a family member from getting any funding without being certified. Representative Gara deferred to OCS for the answer. Alternate-Chair Guttenberg asked if there were other items Representative Gara wanted to discuss. Representative Gara responded that he had reviewed all the changes from the version that passed the Health and Social Services Committee to the CS. It would be up to the committee to adopt the CS, then he could explain the bill. Representative Wilson WITHDREW her OBJECTION. There being NO OBJECTION, the CS for HB 151 was ADOPTED. Representative Pruitt commented that obviously Health and Social Services (HSS) had reviewed the bill, yet there was a CS. He wondered why some of the changes had not been identified in the subcommittee process. Representative Gara conveyed that the bill was his bill rather than a HSS bill. However, he had worked with the department as much as possible. The largest change was that there was a handful of youth, ages 18, 19, and 20 who he wanted to see get into an adoptive home or into a permanent guardianship. He thought it would be great to be able to offer a subsidy to families that could not afford to take children in. He reported not being able to find a workable and affordable way to do so. The big change came when he saw the $8 million fiscal note. He realized that by covering 18-year- old children, the state would have to cover 1-year-old, 2- year-old, and 3-year-old children as well which would be too costly. He was unable to find an affordable way to do it. Representative Pruitt confirmed that because of the fiscal note and the bill being heard in the House Finance Committee, the section was pulled out along with the fiscal note. Representative Gara relayed that the fiscal note came out late in the HSS committee process. He indicated that when he saw it he promised the committee he would fix or get rid of it. 4:54:28 PM Alternate-Chair Guttenberg OPENED Public Testimony for HB 151. Representative Gara indicated Ms. Metivier and Ms. Rein were online and could provide expert testimony. He asked if they could elaborate on the bill. 4:55:07 PM ROSALIE REIN, SELF, FAIRBANKS (via teleconference), was a licensed social worker on the front lines of OCS. She highlighted 2 components of HB 151 that were particularly helpful in improving relationships between workers and the families they served: training and caseloads. She reported that caseloads were directly tied to the worker being in contact with the children and families on a regular basis. She had heard over 5 hours of testimony at a townhall meeting held in Fairbanks. One of the main concerns raised by parents was a lack of communication with their workers. She could not adequately express the responsibilities of caseworkers. There were not enough hours in a day to keep good communication with invested parties. Many workers used nights and weekends to respond to the most urgent phone calls yet did not have time to do high level social work. She explained that high level social work encompassed fostering connections between siblings in separate homes and diligent relative searches. She spoke to the advantages of making these connections. Actual social work was about educating the parties of the importance of providing each child with a network of support. She reviewed the time- consuming grunt work it took to facilitate connections. She saw HB 151 as an opportunity to ensure that caseworkers had the training they needed to develop a skill set specific to child protection and to learn how to foster resiliency. She reviewed research that suggested that caseworkers who had social work education and appropriate training were better able to facilitate permanency. Higher caseloads and the high rate of frontline staff turnover was a growing problem within OCS. She favored the caseload cap in HB 151 and reviewed the consequences of staff turnover and the associated domino effect. Representative Gara indicated he had to attend another meeting. His staff would remain available for questions. 4:59:15 PM AMANDA METIVIER, FACING FOSTER CARE IN ALASKA, ANCHORAGE (via teleconference), spoke in support of HB 151. She reported having been in foster care for 3 years and had aged out of the system. She had been a licensed foster parent for the previous 10 years to teenagers within OCS. She highlighted a few things in the bill that were recommended by youth in the foster care system presently. Identifying relatives promoted kinship placement for children. The bill added a provision that an OCS supervisor had to certify that a relative search had been conducted. By doing this early on it avoided the risk of having to pull a child away from a foster parent they bonded with because of a grandmother coming forward. Sibling contact was a very important piece, as youth separated from their siblings often experienced more trauma. Older siblings were often caregivers to younger children. Being separated from them felt like having one's own child removed. The bill promoted ongoing contact with siblings. For example, if a young child was adopted while the sibling remained in the system, they would have the right to have their sibling's information, maintain contact through phone calls and social media, and have in-person visits to continue their relationship. She has had contact with countless young people who had been split up from their siblings in the system. She shared a story about a child who had seen her brother on the bus but had not spoken to him because she no longer knew him. She continued that another large piece of the bill dealt with older youth potentially being involved with their case planning. It was about engaging older youth, 14 and older, in the development and ongoing process of their case plan. For young people 14 and older, they should be at court hearings and attending team meetings. The bill would give them the option of inviting 2 people to be advocates on their behalf at meetings and to be a voice for them. She suggested that young people engaged in their plan were more likely to follow through and be onboard. She mentioned the idea of normalcy, which came from the federal language around the reasonable and prudent parent standard. It would allow foster parents to do things like sign a permission slip for a field trip. She provided an additional example. The largest piece of the legislation was the training and workload standards and burnout. She provided an example. 5:04:30 PM MARNA SANFORD, TANANA CHIEFS CONFERENCE, FAIRBANKS (via teleconference), testified in favor of HB 151. She expressed excitement about the bill. She highlighted a provision related to youths remaining in state custody until the age of 21. She supported the provision. She stated that foster children were not allowed to do many things such as attend sleepovers. She spoke about extremely high caseloads for social workers in Alaska. She understood state expenditures were under the gun, but she assured the committee the bill was a good investment. 5:07:29 PM TREVOR STORRES, ALASKA CHILDREN'S TRUST, ANCHORAGE (via teleconference), testified in strong support of HB 151. He remarked that the most valuable resource in the state was its children. Events such as child abuse and neglect had great impacts on brain and social development. It created more trauma for a child when OCS had to remove them from their home. He spoke to ensuring that the system did not hamper the treatment of trauma or add more trauma to a child's life. He suggested that due to high caseloads and the lack of training at OCS it was difficult to maintain assurances. The bill ensured that OCS had appropriate caseloads and training to provide the needed support for children in the system. The things case workers dealt with were difficult to manage with very high caseloads (2,3, or 4 times the national average). He discussed high staff turnover rates. He spoke to additional benefits of the legislation. 5:09:57 PM PAUL D. KENDALL, SELF, ANCHORAGE (via teleconference), did not have a position on the bill. He spoke to several items unrelated to HB 151. He wondered if any of the children were borderline babies or illegal aliens. He referred to money paid monthly to foster parents. He continued to relay testimony unrelated to the bill. 5:14:07 PM BYRON CHARLES, SELF, KETCHIKAN (via teleconference), relayed a personal experience where he witnessed a child being told a GED was not enough. He did not understand why the legislature could not make a right decision. He advocated careful background checks and careful monitoring. He thought the system was too cumbersome. He spoke of having college students work with children. Alternate-Chair Guttenberg CLOSED Public Testimony for HB 151. Alternate Chair Guttenberg reported that amendments for HB 151 were due in the chairman's office by 5:00 PM Friday, April 14, 2017. 5:17:27 PM Representative Wilson asked for a moment to talk to the department about a case plan and a 14-year-old. CHRISTY LAWTON, DIRECTOR, OFFICE OF CHILDREN'S SERVICES, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, introduced herself. Representative Wilson was unclear about children participating in their own case plan. She asked about a child that was 14 years old or older attending the team decision making with the parents underneath the case plan for the parents or another type of case plan. Ms. Lawton responded that every child was provided a case plan when they came into care in addition to their parents. Representative Wilson wondered if the children would participate in team decision making with their parents, or just their own plan with 2 adults of their choice. Ms. Lawton responded that typically team decision making meetings were not about case planning. She believed the provision of the bill was that when they were having a meeting about case planning and talking about permanency or services for youth that were 14 or older they could bring in adult supports. Currently, they should be including children in the discussion about their case planning development as age appropriate. The Office of Children's Services did that in various forms including home visits and various means. Representative Wilson asked if there were 2 separate meetings. Ms. Lawton believed the intent of the sponsor on the specific language was about a meeting for the child. It might be possible that the parent would be there and sometimes older youth participated in team decision making meetings with their parents when they were discussing placement. The preferred practice was for older youth to be engaged in all the meetings as appropriate. Representative Wilson asked if a case plan was written for the parent. She had never known a child to be involved in case plan meetings, as they were more about the parents following through. She asked if there were currently older children involved in the parents' case plan. Ms. Lawton responded that typically a child did not participate in a case plan meeting. However, she heard the representative using the term "team decision making meetings" which were different. Representative Wilson would have a big problem with children suddenly being in with their parents because it could cause a significant amount of misunderstanding. She did not have a problem if the child was having a meeting separate from the one their parents had. She did not have a problem with 2 separate meetings. Ms. Lawton responded, "Correct." Alternate-Chair Guttenberg reviewed the agenda for the following day. HB 151 was HEARD and HELD in committee for further consideration. ADJOURNMENT 5:21:25 PM The meeting was adjourned at 5:21 p.m.