Legislature(1999 - 2000)
04/22/1999 03:05 PM House HES
| Audio | Topic |
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL
SERVICES STANDING COMMITTEE
April 22, 1999
3:05 p.m.
MEMBERS PRESENT
Representative Fred Dyson, Co-Chair
Representative John Coghill, Co-Chair
Representative Jim Whitaker
Representative Joe Green
Representative Carl Morgan
Representative Tom Brice
Representative Allen Kemplen
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
CONFIRMATION HEARINGS
University of Alaska Board of Regents
Frances H. Rose - Anchorage
Brian Rogers - Fairbanks
Robert A. Malone - Anchorage
Joseph E. Usibelli, Jr. - Healy
-CONFIRMATIONS ADVANCED
SENATE BILL NO. 56
"An Act allowing the disclosure of reports with regard to
inspection and investigations of certain health care facilities,
home health agencies, hospice programs, and assisted living homes;
authorizing the Department of Health and Social Services to license
home health agencies; and providing for an effective date."
- MOVED CSSB 56(L&C)OUT OF COMMITTEE
* HOUSE BILL NO. 187
"An Act relating to the certificate of need program for nursing
care facilities and other facilities; and providing for an
effective date."
- MOVED HB 187 OUT OF COMMITTEE
HOUSE BILL NO. 113
"An Act relating to a program of postsecondary education for high
school students."
- MOVED CSHB 113(HES) OUT OF COMMITTEE
* HOUSE BILL NO. 186
"An Act allowing the disclosure of reports with regard to
inspection and investigations of certain health care facilities,
home health agencies, hospice programs, and assisted living homes;
authorizing the Department of Health and Social Services to license
home health agencies; and providing for an effective date."
- SCHEDULED BUT NOT HEARD
(* First public hearing)
PREVIOUS ACTION
BILL: SB 56
SHORT TITLE: HOME HEALTH AGENCIES/HOSPITALS/HOSPICES
SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES
Jrn-Date Jrn-Page Action
2/08/99 186 (S) READ THE FIRST TIME - REFERRAL(S)
2/08/99 186 (S) HES, L&C
3/03/99 (S) HES AT 1:30 PM BUTROVICH ROOM 205
3/03/99 (S) HEARD AND HELD
3/03/99 (S) MINUTE(HES)
3/08/99 (S) HES AT 1:30 PM
3/08/99 (S) HEARD AND HELD
3/08/99 (S) MINUTE(HES)
3/15/99 (S) HES AT 1:30 PM BUTROVICH 205
3/15/99 (S) MOVED CS (HES) OUT OF COMMITTEE
3/15/99 (S) MINUTE(HES)
3/16/99 562 (S) HES RPT CS 2DP 3NR SAME TITLE
3/16/99 562 (S) DP: MILLER, WILKEN; NR: PETE KELLY,
3/16/99 562 (S) PEARCE, ELTON
3/16/99 562 (S) ZERO FISCAL NOTE (DHSS)
4/08/99 (S) L&C AT 1:30 PM BELTZ 211
4/08/99 (S) MOVED CS(L&C) OUT OF COMMITTEE
4/09/99 (S) RLS AT 12:15 PM FAHRENKAMP 203
4/09/99 (S) MINUTE(RLS)
4/09/99 843 (S) L&C RPT CS 3DP 1NR SAME TITLE
4/09/99 843 (S) DP: MACKIE, TIM KELLY, LEMAN; NR:
DONLEY
4/09/99 843 (S) PREVIOUS ZERO FN TO CS (DHSS)
4/12/99 878 (S) RULES TO CALENDAR 4/12/99
4/12/99 881 (S) READ THE SECOND TIME
4/12/99 881 (S) L&C CS ADOPTED UNAN CONSENT
4/12/99 881 (S) ADVANCED TO THIRD READING UNAN
CONSENT
4/12/99 881 (S) READ THE THIRD TIME CSSB 56(L&C)
4/12/99 882 (S) PASSED Y19 N- E1
4/12/99 882 (S) EFFECTIVE DATE(S) SAME AS PASSAGE
4/12/99 885 (S) TRANSMITTED TO (H)
4/13/99 786 (H) READ THE FIRST TIME - REFERRAL(S)
4/13/99 786 (H) HES
4/22/99 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 187
SHORT TITLE: CERTIFICATES OF NEED FOR HEALTH FACILITY
SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES
Jrn-Date Jrn-Page Action
4/09/99 703 (H) READ THE FIRST TIME - REFERRAL(S)
4/09/99 703 (H) HES, FIN
4/22/99 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 113
SHORT TITLE: POSTSECONDARY EDUC FOR HIGH SCHOOL STUDENTS
SPONSOR(S): REPRESENTATIVES(S) MASEK, Dyson
Jrn-Date Jrn-Page Action
2/24/99 301 (H) READ THE FIRST TIME - REFERRAL(S)
2/24/99 301 (H) HES, FIN
4/08/99 694 (H) COSPONSOR(S): DYSON
4/13/99 (H) HES AT 3:00 PM CAPITOL 106
4/13/99 (H) HEARD AND HELD
4/20/99 (H) HES AT 3:00 PM CAPITOL 106
4/20/99 (H) HEARD AND HELD
4/22/99 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
FRANCES H. ROSE, Appointee
to University of Alaska Board of Regents
900 West Fifth Avenue, Suite 601
Anchorage, Alaska 99501
Telephone: (907) 272-7575
POSITION STATEMENT: Testified as appointee to
University of Alaska Board of Regents.
BRIAN ROGERS, Appointee
to the University of Alaska Board of Regents
P.O. Box 80690
Fairbanks, Alaska 99708
Telephone: (907) 452-2461
POSITION STATEMENT: Testified as appointee to
University of Alaska Board of Regents.
SENATOR GARY WILKEN
Alaska State Legislature
Capitol Building, Room 514
Juneau, Alaska 99801
Telephone: (907) 465-3709
POSITION STATEMENT: Testified as sponsor of CSSB 56
and on HB 187.
ELMER LINDSTROM, Special Assistant
Office of the Commissioner
Department of Health and Social Services
P.O. Box 110601
Juneau, Alaska 99811
Telephone: (907) 465-1613
POSITION STATEMENT: Testified in support of CSSB 56.
LINDA FINK, Assistant Director
Alaska State Hospital and Nursing Home Association
426 Main Street
Juneau, Alaska 99801
Telephone: (907) 586-1790
POSITION STATEMENT: Testified in support of CSSB 56 and HB 187.
SHELBY LARSEN, Administrator
Health Facilities Licensing and Certification
Division of Medical Assistance
Department of Health and Social Services
4730 Business Park Boulevard, Suite 18
Anchorage, Alaska 99503
Telephone: (907) 561-8081
POSITION STATEMENT: Testified in support of CSSB 56.
RICK SOLIE
Fairbanks Memorial Hospital and Denali Center
1650 Cowles Street
Fairbanks, Alaska 99701
Telephone: (907) 452-8181
POSITION STATEMENT: Testified in support of CSSB 56.
JAY LIVEY, Deputy Commissioner
Department of Health and Social Services
P.O. Box 110601
Juneau, Alaska 99811
Telephone: (907) 465-3030
POSITION STATEMENT: Testified in support of CSSB 56 and HB 187.
LARAINE DERR, Director
Alaska State Hospital and Nursing Home Association
426 Main Street
Juneau, Alaska 99801
Telephone: (907) 586-1790
POSITION STATEMENT: Testified in support of HB 187.
DAVID PIERCE, Certificate of Need Coordinator
Facilities and Planning
Division of Administrative Services
Department of Health and Social Services
P.O. Box 110601
Juneau, Alaska 99811
Telephone: (907) 465-3001
POSITION STATEMENT: Provided information of HB 187.
EDDIE GRASSER, Legislative Assistant
to Representative Beverly Masek
Alaska State Legislature
Capitol Building, Room 432
Juneau, Alaska 99801
Telephone: (907) 465-3306
POSITION STATEMENT: Presented HB 113.
LARRY WIGET, Executive Director
Public Affairs
Anchorage School District
4600 DeBarr Road
Anchorage, Alaska 99519
Telephone: (907) 269-2255
POSITION STATEMENT: Testified on HB 113.
ACTION NARRATIVE
TAPE 99-41, SIDE A
Number 0001
CO-CHAIRMAN COGHILL called the House Health, Education and Social
Services Standing Committee meeting to order at 3:05 p.m. Members
present at the call to order were Representatives Dyson, Coghill,
Whitaker, Morgan and Kemplen. Representatives Brice and Green
joined the meeting at 3:06 p.m. and 3:07 p.m. respectively.
CONFIRMATION HEARINGS
CO-CHAIRMAN COGHILL announced the committee would consider four
nominees for the University of Alaska Board of Regents. They would
not vote for the nominees but would pass them out of committee for
full consideration of the House and Senate. (Resumes were provided
for all appointees.)
Number 0136
FRANCES H. ROSE, Appointee to University of Alaska Board of
Regents, came forward to testify saying she has lived in Alaska for
38 years. She was an employee of the university for 13 years in
adult basic education, and she has always had a deep interest in
the university. She believes in the university, and the fact that
it is the future of the state. The university is educating the
future citizens of the state, and they need to have a good, viable,
quality university to educate and keep the students in the state
rather than sending them all over the country. They need to be
able to train them for jobs and for higher education.
REPRESENTATIVE KEMPLEN commented that as a member of the Board of
Regents she will have an influential role for the university, and
he wondered where she is going to take this university.
Number 0307
MS. ROSE replied she is not going to take it alone but with
everyone's help. She believes the University of Alaska can become
a national leader in several areas of education including arctic
research, marine biology and mining. She believes that, for a lot
of things, the university should be the best, and it can be. She
is interested in developing some unique areas where they can excel.
She has heard from alumni who said they got good educations at the
university. It is important for the students to come home and have
jobs. They have to train for jobs, but they also need to have
economic development that will create the jobs.
Number 687
REPRESENTATIVE KEMPLEN commented that he doesn't see the strong
linkage between the university and the private sector for economic
diversification in the areas of patents, inventions and license
disclosures. He asked Ms. Rose what she is going to do to create
the products.
MS. ROSE agrees that the university should be making something from
the research that has been done and have a partnership with private
industry. She doesn't know exactly what she will do, but she will
bring this issue to the regents and make sure that they talk about
it and do something about it.
REPRESENTATIVE BRICE suggested the continuation of programs like
the mining cooperative extension programs to ensure strong support.
He appreciated her resume and thanked her for her public service.
REPRESENTATIVE GREEN asked her if she sees the future of the
university continuing to try to educate both academic and skills or
vocational types. He asked her if she sees the large umbrella at
this great university, or should they concentrate on certain
aspects to do better than anywhere else and maybe not have such a
broad base.
Number 0841
MS. ROSE answered that it is a question of balance. She wasn't
happy with the decision to abolish the community colleges but
realized the economics of it. There was a promise made then that
the mission of the community college would continue, and she
doesn't know how much of that mission continues. Because they are
one big statewide university in a big state, they almost have to be
all things to all people, but they have to have a balance. She
will reserve that answer to see how it really is working. She
offered to talk to Representative Green about it later.
CO-CHAIRMAN DYSON asked Ms. Rose where she would prioritize the
university along with roads, police, prisons, health care for the
elderly, disabled vets, child protection, foster care and assisted
adoption in the limited budget this year.
Number 0986
MS. ROSE commented that the investment in the university is a good
one and should be pretty close to the top. She doesn't envy their
job. She believes the university is important because the people
are gainfully employed and educated. If they have a productive,
vital citizenship, maybe they won't need as many police. The
university is an economic engine; it does promote economic
diversity. Maybe if they have economic diversity, they won't have
quite the budget crunch.
Number 1109
REPRESENTATIVE WHITAKER asked Ms. Rose about the regional politics
between the University of Alaska Fairbanks (UAF) and the University
of Alaska Anchorage (UAA), and how they can work together to better
serve the state.
MS. ROSE believes she is the regent for the whole state, and she
intends to be fair in that respect. All the campuses serve
different needs and students. She will be as fair as she possibly
can and try to do away with those turf wars.
CO-CHAIRMAN COGHILL asked Ms. Rose if the core curriculum that the
university is known for would be diminished because of the
specialization.
MS. ROSE answered they need to have the core curriculum in all
three campuses, and then they can spread out into more specialized
things.
Number 1266
BRIAN ROGERS, Appointee to the University of Alaska Board of
Regents, came forward to testify, saying he has been a resident of
Fairbanks for 29 years. Throughout those 29 years, he has been
associated with the university as student, part-time faculty
member, staffer, administrator, contributor and critic. Being a
member of the board allows him to use that experience to try to
help the university move forward in the difficult era of diminished
resources, trying to accomplish more yet trying to meet the
postsecondary needs of the people throughout Alaska. The
university has given him a lot, and he would like to give something
back and serving on the Board of Regents is a good way to do that.
REPRESENTATIVE KEMPLEN appreciates Mr. Rogers' willingness to
serve. He asked Mr. Rogers to respond to his previous question he
asked Ms. Rose.
Number 1344
MR. ROGERS indicated that the university's role in economic
development and commercializing technology is an important one.
They have had some successes and some failures. He referred to the
Fishery and Industrial Technology Center in Kodiak where they
developed new technology to detect bones in fish and fish quality
as being one of the successes. One of the failures was trying to
set up a technology development corporation to take advantage of
that. Basically, the volume of patentable ideas versus the cost is
a problem for the university. The idea of trying to do it all
themselves didn't work. Now they are working cooperatively with
other institutions to get assistance to commercialize those
technologies. Some things go forward that may not be seen. There
was permafrost research at UAF that has led to better road
construction, and that cuts the cost of maintenance. That is an
example of the university developing knowledge that has contributed
to lowering the cost of state government, federal government and
improving the roads so there are not quite as many potholes in
interior Alaska. There are some things going on, and he would like
to see more opportunity to take that technology and do something
with it.
Number 1435
REPRESENTATIVE KEMPLEN asked Mr. Rogers, with his business of
Information Insights perspective, how he sees the field of
technology advancing in Alaska.
MR. ROGERS agreed it is important, and he hopes the university can
move forward in this area because he cannot find enough qualified
people to hire. There is a lot of opportunity in Alaska to develop
industry around technology, but they need trained people to do it.
If students go outside for the training, they will be snapped up by
the companies there. Because of technology, Alaska has lost its
locational disadvantage in some areas. They can produce software
and Internet content and ship it anywhere in the world at no cost.
That is different than some of the other industries in Alaska where
they have high transportation cost barriers. He would like to use
some of his experience from his company at the university because
he believes that is how they can ship education around.
Number 1582
CO-CHAIRMAN DYSON asked Mr. Rogers how he would prioritize the
university with a limited budget.
MR. ROGERS believes that educating Alaskans and creating new
knowledge and serving the public helps enhance the economic
opportunities in Alaska. If they have more economic activity
through the existing revenue sources the state has, the state, over
time, does better by the presence of a university. He would also
place that investment relatively high, but he would put it on equal
basis with education at the K-12 level. It doesn't do the
university any good at all if they get all the money, and students
are not being prepared in grades K-12. Like most Alaskans said in
the polls, he would put education at the top. He believes there
will be opportunities for the university to find other new revenue
sources, and he would like to help in that process.
CO-CHAIRMAN DYSON thanked Mr. Rogers for his willingness to serve.
Number 1700
REPRESENTATIVE WHITAKER praised Mr. Rogers as an admirable ally and
worthy adversary who has good intentions and intelligence and
expects great things with his involvement in the university.
REPRESENTATIVE BRICE expects Mr. Rogers' expertise will be very
valuable to help the university reach a much higher plateau than
what it is today and said the same to Ms. Rose.
CO-CHAIRMAN COGHILL wondered how the different missions of the
university help or hinder them in regard to core curriculum.
Number 1793
MR. ROGERS said they need to recognize that this is a multi-mission
university with responsibilities at the community college level.
It is important that the community college mission is recognized
throughout the country for providing job related training,
continuing education and for people who aren't in a position to
travel somewhere for an education and need to take it over a period
of years. It is just as important in a small community as it is in
the larger communities. The community college mission requires
that they continue to offer education throughout the state. The
challenge is to see how they can use technology and distance
delivery to moderate the costs and to deliver as much education for
the dollar as they can, recognizing that the costs are going to be
higher in many respects to reach the people in rural Alaska. The
people in rural Alaska who have jobs and are looking for additional
training, have fewer choices than people in urban Alaska. That job
training is just as important as the four-year mission and the
research mission.
Number 1881
CO-CHAIRMAN COGHILL recommended that all four appointments to the
University of Alaska Board of Regents be moved along to the floor.
SB 56 - HOME HEALTH AGENCIES/HOSPITALS/HOSPICES
Number 1906
CO-CHAIRMAN COGHILL announced the next order of business as Senate
Bill No. 56, "An Act allowing the disclosure of reports with regard
to inspection and investigations of certain health care facilities,
home health agencies, hospice programs, and assisted living homes;
authorizing the Department of Health and Social Services to license
home health agencies; and providing for an effective date." He
announced the committee would be addressing CSSB 56 instead of the
companion bill HB 186.
Number 1919
SENATOR GARY WILKEN, Alaska State Legislature, sponsor, presented
CSSB 56 saying that the bill comes out of the Long-Term Care Task
Force (LTCTF) Report and is the result of their recommendation
number three. Since the early 1980s, the Department of Health and
Social Services (DHSS) has annually inspected hospitals, nursing
homes, assisted living care facilities and passed a recommendation
as to their fitness to provide those services. Under current law,
those inspection reports are not available to the public. Simply,
SB 56 sets forth in law, that after the final report is finished
and sent to the facility, it will be made available to the public
within 14 days of that date. This bill formalizes the authority of
the DHSS to license home health agencies.
CO-CHAIRMAN DYSON asked Senator Wilken if there was any opposition
to this bill.
Number 2030
SENATOR WILKEN answered not that he was aware of. They had some
input from different groups, and the amendments in the Senate took
care of that.
REPRESENTATIVE GREEN asked what has changed in the Senate version
from the House version of the bill.
SENATOR WILKEN answered that the major change had to do with
defining what a final report was and allowing the caregiver to
respond to that report before it was made public and a technical
change which the department can explain.
Number 2116
ELMER LINDSTROM, Special Assistant, Office of the Commissioner,
Department of Health and Social Services, came forward to testify
in support of SB 56. He informed them that the licensing report
element is the significant change. The other technical amendment
only relates to the department's ability to license home health
agencies. They license and have statutory authority on a number of
things, but they did not have specific statutory authority for home
health agencies. Senator Wilken correctly described the one
substantive change in the Senate bill that resulted in the
committee substitute (CS), and it was to clarify that the DHSS
would release the final report 14 calendar days after it had been
made available to the facility. He believes that allayed the
concerns of the Alaska State Hospital and Nursing Home Association.
Number 2180
LINDA FINK, Assistant Director, Alaska State Hospital and Nursing
Home Association (ASHNHA), came forward to testify. She
acknowledged that they did have a concern about the final reports
being disclosed and that was addressed, and they do support the
legislation as it is.
Number 2212
SHELBY LARSEN, Administrator, Health Facilities Licensing and
Certification, Division of Medical Assistance, DHSS, testified via
teleconference in support of SB 56. He hopes the House version
will reflect the changes in the Senate version.
Number 2248
CO-CHAIRMAN DYSON made a motion to move CSSB 56(L&C) from committee
with individual recommendations and zero fiscal note. There being
no objection, CSSB 56(L&C) moved from the House Health, Education
and Social Services Standing Committee.
HB 187 - CERTIFICATES OF NEED FOR HEALTH FACILITY
Number 2266
CO-CHAIRMAN COGHILL announced the next order of business as House
Bill No. 187, "An Act relating to the certificate of need program
for nursing care facilities and other facilities; and providing for
an effective date."
Number 2300
SENATOR WILKEN presented HB 187 which is the companion bill to SB
59 which has to do with the Certificate of Need (CON). The DHSS
reviews all nursing home expansions over $1 million because when
they add those facilities to the inventory of caregiving
facilities, there is a Medicaid impact, of which the state pays 40
percent. Under current law, there are two tests that the DHSS
applies to new facilities: factors of accessibility and quality.
If they pass those two tests, the CON is granted, and the state
assumes the obligation of the 40 percent toward Medicaid. The two
bills, HB 187 and SB 59, add a new standard to this test which has
to do with cost effectiveness of the new facility, and that becomes
and test upon which new facilities are graded.
TAPE 99-41, SIDE B
Number 2357
REPRESENTATIVE BRICE asked Senator Wilken to discuss the amendment
on day surgery. The amendment has not been offered, but it is in
the packets.
SENATOR WILKEN deferred to the department.
Number 2292
RICK SOLIE, Fairbanks Memorial Hospital and Denali Center,
testified via teleconference from Fairbanks in support of HB 187 as
it is currently written. This legislation will allow the state to
meet the need of an aging population, as well as to try to contain
the cost to the state in Medicaid dollars. He is concerned with
the amendment relating to imaging services and day surgeries as an
exemption from the CON laws. He spoke against that amendment. The
amendment goes contrary to the bill before them. In this sense, it
would exempt these areas from the CON requirements. Currently, if
someone wanted to build a service which includes a health care
facility, like radiation therapy, mental health or ambulatory
surgery, he believes, if they were to exempt that, it would not hit
the mark on what the CON law is intended to do. People can argue
about whether the government should be in the business of
regulating this, but he believes that to piecemeal exempt is not a
prudent approach. There is still some benefit to the idea of a CON
whether or not it controls costs; it also has an ability to impact
quality and access of the services that are offered as well.
CO-CHAIRMAN DYSON asked if Mr. Solie thought that the state isn't
currently doing a good enough job of making sure that medical
providers are fit and able.
MR. SOLIE believes that the state is doing an adequate job in
inspecting facilities for fitness and ability. This amendment
would take away the oversight that the state currently has in this
area. Day surgery and imaging centers would no longer be required
to present a CON application to the DHSS as they currently are. To
pull out pieces of the CON law doesn't make good policy without
some substantial study.
CO-CHAIRMAN DYSON said it seemed that Mr. Solie's objection to the
amendment would be his objection to competition and maybe
diversified options for the patients.
Number 2005
MR. SOLIE remarked that he hit on the crux of the issue. It
relates to whether or not the state should be involved in
determining a need and allowing for new capacity being constructed
in this particular area, and that is the debate nationally whether
competitive forces should be allowed to prevail. It is an
interesting issue and some of it has been involved in the debate
over competition in other sectors of the economy. Health care is
not the same kind of commodity that toothpaste, widgets, telephones
or even electricity are. There are issues of cross subsidies when
certain components of hospital business are able to support other
components of it, particularly when they are dealing with sole
providers. The issue of whether or not they want to allow a
community hospital to have "profit pockets," to support areas of
that facility that may not be a profit pocket, is a philosophical
and community debate.
CO-CHAIRMAN DYSON asked if he was inferring that if they allow too
much competition, the quality of service will go down.
MR. SOLIE was hesitant to say that. Quality is related to the
provider and their ability to provide the necessary aspects of
health care which includes the facility, but more importantly
includes the physician. He wonders if it makes sense to exempt out
these services from the current system of state oversight that is
there to, not only determine quality, but also access and determine
that they don't end up with excess capacity which ultimately the
consumers pay for.
Number 1865
CO-CHAIRMAN DYSON asked if he means that government needs to
protect the private sector from getting over committed. He asked
Mr. Solie why should a local physician who wants to open a "Doc in
a Box" day surgery center have to jump through an extra set of
hoops to get a CON to provide those kinds of services.
Number 1829
MR. SOLIE answered that in respect to Fairbanks. Anchorage has two
hospitals; Fairbanks has one supported by the community. Day
surgery and imaging centers tend to be more profitable services.
They are the ones being heavily competed for. In Anchorage, there
are a number of ambulatory surgeries. When they get competition in
those areas, they would like to see prices fall; he suspects what
occurred in Anchorage is that the gross charges for the two
hospitals have gone up to cross subsidize their outpatient costs.
There is Medicaid data available that shows the history in
Anchorage over the last five years, that there was a 20 percent
increase in the gross charges of the two hospitals there; in
Fairbanks, the gross charges have gone up 3 to 4 percent. He
argues that what happens is cross subsidies from the inpatient
costs protect outpatient services that aren't profitable.
MR. SOLIE indicated that no one is going to come to Fairbanks now
and try to take away the monopoly that the hospital has on mental
health because that has never been a profitable service to the
hospital. They have been concerned for a long time about their
ability to continue it. Their ability to pay for services like
mental health, drug and alcohol treatment and some others that are
not profitable, relate sometimes to the other services that may be
able to support some kind of a profit. To a degree, it is a
community decision about whether they want to have a hospital with
some of these profit pockets, and the extent to which those profits
are appropriate is also a community decision. He suggested that in
this case, a for-profit, stand-alone center would not be doing
anything but taking the profits to wherever, which is fine, but
that is part of what a community hospital will often use to support
its non profitable operations. It is an issue that is significant,
and he would be concerned if, at this late date, the legislature
chose to get into it, particularly while there are CONs pending.
Number 1668
JAY LIVEY, Deputy Commissioner, Department of Health and Social
Services, came forward to testify in support of HB 187. They
believe HB 187 will help them to in the future cost manage the
Medicaid expenditures for long-term care. Given the long-term care
population in Alaska (above 85 years old) over the next 10 or 20
years, they are going to have to figure out how to serve them that
is different than the way they do it now. They believe that this
bill helps the department to have some tools to cost manage the
Medicaid program in the future.
CO-CHAIRMAN DYSON asked if the local inference here is that if they
can keep down the competition, they can allow the people who have
the monopoly to get more of a market share and therefore, be able
to do the cross subsidization for the people who can't pay their
way or aren't covered by insurance out of the programs. There is
kind of a restriction of trade and some kind of soft monopoly in
order to help out the cross subsidization they need to do in order
to accomplish a public purpose.
MR. LIVEY said the issues are a bit different on the long-term care
side than on the acute-care side. The amendment that is being
considered pushes the issues together. The DHSS believes that
right now there is not much competition in long-term care. They
are a payer of long-term care through Medicaid. For institutional
care in Alaska, they probably pay 80 to 85 percent on average in a
year for all the long-term care that is provided in facilities
because Medicaid is the only thing that pays for long-term care; it
is too expensive in this state for those who privately pay to go
into a nursing home. From their perspective, this legislation
offers the DHSS criteria that they can use in the future to allow
them to develop alternatives and to allow some competition for
long-term care to develop, because all the resources won't be going
in to one type of care; they can develop some home- and
community-based alternatives that are less expensive and use their
money more efficiently.
Number 1515
CO-CHAIRMAN DYSON asked what does a "Doc in a Box" exemption do
that is negative for long-term care.
MR. LIVEY answered that that is really unrelated to the long-term
care legislation that came out of the LTCTF.
The Committee took an at-ease from 4:17 to 4:18 p.m.
Number 1428
MR. LIVEY said within the CON statute, they offer CONs to two
different kinds of facilities: long-term care and acute care. The
state has a different level of interest in long-term care than in
acute care. Primarily because Medicaid is paying a much higher
percentage of the long-term care bill than they are paying on the
acute-care bill. As it currently stands, he doesn't believe that
the "Doc in a Box" does not need a CON. The two kinds of services
that are raised in this amendment do require a CON, but they are
not necessarily an urgent care center.
Number 1337
MR. LIVEY indicated that if the bill as proposed were to pass, they
believe it would create more alternatives to long-term care:
assisted living, home and community based kinds of care where an
individual is served in their home or community without having to
go into a nursing home. They believe the bill will create
alternatives for care.
CO-CHAIRMAN COGHILL asked if the amendment opened more
alternatives.
Number 1303
MR. LIVEY said the amendment is very specific to imaging centers
and day surgery and really has nothing to do with the long-term
care aspect of the original bill. It all deals with the CON
program, but it is different kinds of services.
REPRESENTATIVE BRICE observed that the amendment is like "putting
a fish tail on a duck." It doesn't quite fit into the argument.
He suggested that if they keep their focus on HB 187, a lot of the
confusion will dissipate.
Number 1205
LARAINE DERR, Director, Alaska State Hospital and Nursing Home
Association, came forward to testify. She liked the analogy of
"putting the fish tail on a duck." They support HB 187 as
originally drafted. They do not support the amendment for reasons
they have already heard. It is mixing something different into
what the original legislation intended.
Number 1167
CO-CHAIRMAN DYSON asked Ms. Derr why they would suggest this bill
when it would keep them from making more money.
MS. DERR answered they think there should be legislation that
addresses the hospitals outside of the nursing homes.
CO-CHAIRMAN DYSON asked her why they want to get a CON before they
install new equipment in their facility that will allow them to
charge more money.
Number 1129
MS. DERR said the hospitals do not want that. They would rather
not have a CON to install new equipment. This CON addresses
nursing home beds so it is a different issue. She doesn't believe
that a CON allows the nursing homes to charge more money.
CO-CHAIRMAN DYSON believes the opposite. If they have to get a CON
before they can enhance their facility, which will allow them to
build more at a higher rate, this bill works against their
interest.
Number 1065
LINDA FINK said she doesn't believe it works against them. It does
put more controls on when beds can be built, but a large portion of
their funding comes from Medicaid, and they support controlling
those costs as much as possible.
MS. DERR said nursing homes don't usually have a lot of equipment.
They don't usually have the imaging equipment; that is usually in
the hospitals. The majority of the nursing homes in the state are
co-located with a hospital, so if nursing home patients need that
service, they go to the hospital. Nursing homes don't usually have
more than $1 million pieces of equipment.
CO-CHAIRMAN DYSON asked how they can enhance the rate they charge
the state.
Number 1010
MS. DERR said the way the rates are set are a cost-reimbursable
basis. If they wanted to enhance their rates, they give their
patients more services. But that is all reviewed by the DHSS in an
auditing process, and they would see that and would not pay.
CO-CHAIRMAN DYSON said hospitals can enhance their rate by adding
more services and fancier machines. They can do that to be a
better service to their clients. They can also bill at a higher
rate. He asked if there was nothing the long-term care facilities
can do to enhance the rate they charge, like adding more beds, more
cable TV.
Number 0954
MS. DERR agreed they could make more money by adding more beds.
But that is when they have to go to the CON process for long-term
care. They agree that there should be more control.
REPRESENTATIVE BRICE asked Mr. Livey what the state's financial
responsibility is per bed when it comes on-line after construction.
MR. LIVEY answered that when a new nursing home bed is built and
certified, if a Medicaid-eligible patient moves into that bed, then
Medicaid is required to pay the bill.
Number 0926
REPRESENTATIVE BRICE asked if there are requirements for the state
to pay for empty beds.
MR. LIVEY answered that the way the rate setting system works is
that they pay what it costs a nursing home to provide the care. To
the extent that there are fixed costs included in paying for an
empty bed, they do. For example, they have to have a nurse
whether the beds are full or not.
REPRESENTATIVE BRICE asked how successful the DHSS has been in
regulating the cost of ensuring appropriate levels of long-term
care through use of the CON process.
Number 0771
MR. LIVEY answered that over the past 10 years, there have been a
number of nursing home beds that have expanded recently. He
believes the DHSS should have been more successful in controlling
the number of beds. Their concern in controlling the number of
nursing home beds is not to control access to long-term care; it is
to be able to provide a less expensive kind of long-term care and
more alternatives. With the number of people coming through the
system in the future, they simply cannot afford to provide care to
those people in nursing homes. There is not enough money.
Number 0698
DAVID PIERCE, Certificate of Need Coordinator, Facilities and
Planning, Division of Administrative Services, Department of Health
and Social Services, came forward to answer questions. Since the
inception of the CON program in 1979, there have been over 200
nursing home beds that were not built as a result of that program.
Within the last two years, there were 60 beds that were not built;
some were denied, and some just didn't go through the process. In
some cases, there were concurrent reviews where several entities
were trying to build in the same place, and one was chosen over the
others. Ten beds will cost approximately $1 million dollars a year
to operate and for depreciation expense. A 60-bed facility will
cost Medicaid about $3 million. For every ten beds, it is about $1
million dollars in Medicaid, and about 50 percent of that will be
state funds.
CO-CHAIRMAN COGHILL asked Mr. Pierce if this legislation does not
make it, how would that affect the availability and the vision of
long-term health care.
Number 0559
MR. PIERCE said the trend now is moving away from
institutionalizing people to letting them stay in their homes as
long as possible. There is going to be an increase in the number
of people who are going to need some kind of care; however, they
don't have to be in expensive long-term care institutions. They
can stay at home. This legislation will help the DHSS make
determinations regarding whether new institutional beds are needed
or not, or whether more people could stay at home who are going to
be served.
Number 0501
CO-CHAIRMAN DYSON made a motion to move the amendment which read:
Page 3, line 3:
Delete "A"
Insert "Except as provided in (c) of this section, a [A]
Page 3, following line 14:
Insert a new bill section to read:
* Sec. 4. AS 18.07.031 is amended by adding a new
subsection to read:
(c) A certificate of need is not required for the
(1) construction of a day surgery center or
imaging center;
(2) alteration of the bed capacity of a health
care facility if the alteration is necessary solely to
accommodate the addition of day surgery or imaging
services to the facility; or
(3) addition of day surgery or imaging
services to a health care facility."
Renumber the following bill sections accordingly.
Page 7, line 3:
Delete "a new paragraph"
Insert "new paragraphs"
page 7, following line 3:
Insert new paragraphs to read:
(13) "day surgery" means surgery performed on
a patient who arrives at the surgery facility on the day
of surgery and is not expected to remain overnight at the
facility after the surgery is performed;
(14) "imaging" means diagnostic testing, such
as fluoroscopy or an x-ray, computerized axial tomography
(CAT scan), bone scan, ultrasonography, scintigraphy, or
magnetic resonance imaging (MRI), that produces a picture
or conception with a likeness to an objective reality by
providing clarity, contrast, and detail through the use
of colored fluids, radionucleides, or other materials
introduced to the human body; ionizing or nonionizing
radiation; or an external magnetic field;"
Page 7, line 4:
Delete "(13)'
Insert "(15)"
REPRESENTATIVE BRICE objected.
A roll call vote was taken. Co-Chairman Dyson voted for the
amendment. Representatives Whitaker, Brice and Coghill voted
against it. Therefore, the amendment failed by a vote of 3-1.
Number 0390
CO-CHAIRMAN DYSON made a motion to move HB 187 from the committee
with individual recommendations and attached fiscal note. There
being no objection, HB 187 moved from the House Health, Education
and Social Services Standing Committee.
The Committee took an at-ease from 4:39 to 4:40 p.m.
HB 113 - POSTSECONDARY EDUC FOR HIGH SCHOOL STUDENTS
Number 0260
CO-CHAIRMAN COGHILL announced the next order of business as House
Bill No. 113, "An Act relating to a program of postsecondary
education for high school students."
Number 0210
EDDIE GRASSER, Legislative Assistant to Representative Beverly
Masek, came forward to present the committee substitute of HB 113,
version K. The first change is on page 1, line 12 where they added
language consistent with the U.S. codes which deal with the
Americans for Disability Act (ADA). The next change is on page 2,
line 4, where they replaced the words "eleventh and twelfth grades"
with "otherwise receiving a secondary school education as described
in AS 14.40.010(b)(1) or (10) - (12)." They also added language
there "who is under 20 years of age" to prevent students remaining
in the secondary school situation and purposely flunking the
standards test or a course required for graduation, so they won't
ever graduate and can stay in the high school and manage to get a
college education basically free through the foundation formula.
The next change is on page 2, lines 16 and 17, which allows the
school district to make arrangements with the postsecondary
institution to work out agreements where the instructor may
actually teach the course in the secondary school, rather than the
student going to the university.
TAPE 99-42, SIDE A
Number 0036
REPRESENTATIVE BRICE asked if that section means the secondary
students cannot take postsecondary classes if they are offered at
the high school.
Number 0077
MR. GRASSER answered that the intent is to allow students to remain
in the high school, even though the postsecondary school has the
adjunct professor coming into the high school to teach the course,
and that is the language that the drafter came up with. Section 2
in the original draft that had to do with the credits being given
was deleted.
MR. GRASSER told them the next major change is in Sec. 14.30.780,
the funding section. This language has shifted the funding to the
school district, but it also allows the school district to
negotiate with the postsecondary institution. There is a
percentage in the foundation formula that is set aside for the
school districts for special needs children which would include the
gifted children. They figure many of the students taking advantage
of this program will be the gifted students. He commented that the
school districts don't like this funding section, and he recognizes
that there are problems with the section. The section with a
formula that the DOE would reimburse the district for these
students was deleted, and that was why there was an indeterminate
fiscal note. There probably still will be an indeterminate fiscal
note because part of the foundation formula still goes toward these
special needs students.
Number 0505
CO-CHAIRMAN COGHILL mentioned that in Valdez the students were
bearing some of the cost of the courses, but there was also a
scholarship program for those who couldn't pay.
MR. GRASSER said the money for the students who couldn't afford to
pay was coming out of the foundation formula.
CO-CHAIRMAN COGHILL suggested it might be possible for the students
to pay the tuition.
Number 0572
MR. GRASSER said that has been part of the discussion, but then
that leaves out those who cannot afford to take advantage of the
program. Different arrangements already exist throughout the
state, and they are trying to allow enough flexibility within the
district to negotiate arrangements with the university on how it
would happen.
CO-CHAIRMAN DYSON asked what the districts don't like in this bill.
Number 0641
MR. GRASSER said the districts didn't like the section on the
funding because they have to pay, and there is no provision for the
state to give money to the districts for the tuition costs.
MR. GRASSER referred them to page 3, line 24 where the language was
cleaned up on what fees would be paid for attending the
postsecondary institution. On page 3, line 29, it inadvertently
did not get changed from "nationally" to "regionally" accredited.
Other than the funding section, if the committee is otherwise
comfortable with this bill, he advised them that the sponsor would
like to see it moved on to the Finance Committee and try to work
out the funding arrangement there.
Number 0776
CO-CHAIRMAN DYSON made a motion to amend CSHB 113 on page 3, line
29 from "nationally" to "regionally."
CO-CHAIRMAN COGHILL asked whether there was any objection. There
being none, the amendment was adopted.
REPRESENTATIVE BRICE suggested that there could be clearer language
on page 2, lines 15, 16 and 17, and they could deal with it some
place else.
Number 0854
MR. GRASSER understood his concern and agreed they both had the
same intent there.
Number 0880
LARRY WIGET, Executive Director, Public Affairs, Anchorage School
District, came forward to testify and said he hasn't had a chance
to look at this bill, but he would send it back to his school board
to see if they have any concerns about the funding level or Section
2(b).
CO-CHAIRMAN DYSON told Mr. Wiget if they do have concerns after
looking at HB 113, he will move to rescind their action and change
them on Tuesday, if they pass this bill out today.
Number 0948
CO-CHAIRMAN DYSON made a motion to move CSHB 113, 1-LSO461\K, Ford,
4/22/99, as amended, out of committee with individual
recommendations and indeterminate fiscal note. There being no
objection, CSHB 113(HES) moved from the House Health, Education and
Social Services Standing Committee.
ADJOURNMENT
Number 0989
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 4:59 p.m.
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