Legislature(1995 - 1996)

03/07/1996 04:12 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
txt
          HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES                          
                       STANDING COMMITTEE                                      
                         March 7, 1996                                         
                           4:12 p.m.                                           
                                                                               
                                                                               
 MEMBERS PRESENT                                                               
                                                                               
 Representative Con Bunde, Co-Chair                                            
 Representative Cynthia Toohey, Co-Chair                                       
 Representative Gary Davis                                                     
 Representative Norman Rokeberg                                                
 Representative Al Vezey                                                       
 Representative Caren Robinson                                                 
 Representative Tom Brice                                                      
 Representative Al Vezey                                                       
                                                                               
 MEMBERS ABSENT                                                                
                                                                               
 None                                                                          
                                                                               
 COMMITTEE CALENDAR                                                            
                                                                               
 *HOUSE BILL NO. 318                                                           
                                                                               
 "An Act relating to advance directives for mental health                      
 treatment."                                                                   
                                                                               
      - PASSED OUT OF COMMITTEE                                                
                                                                               
 HOUSE BILL NO. 515                                                            
 "An Act relating to grants for residential services for certain               
 minors for whom the state has assumed responsibility; and providing           
 for an effective date."                                                       
                                                                               
      - PASSED OUT OF COMMITTEE                                                
                                                                               
 *HOUSE BILL NO. 528                                                           
                                                                               
 "An Act relating to applications for certificates of need and                 
 licensing of nursing homes; amending the standard of review for               
 certificates of need for health care facilities in the state;                 
 establishing a moratorium with respect to new applications by                 
 prohibiting the issuance of a certificate of need or a license for            
 additional nursing home capacity in the state until July 1, 1998;             
 and providing for an effective date."                                         
                                                                               
      - HEARD AND HELD                                                         
                                                                               
 (* First Public Hearing)                                                      
                                                                               
 PREVIOUS ACTION                                                               
                                                                               
 BILL:  HB 318                                                               
 SHORT TITLE: MENTAL HEALTH TREATMENT DECLARATIONS                             
 SPONSOR(S): REPRESENTATIVE(S) TOOHEY,B.Davis                                  
                                                                               
 JRN-DATE     JRN-PG               ACTION                                      
 04/21/95      1427    (H)   READ THE FIRST TIME - REFERRAL(S)                 
 04/21/95      1427    (H)   HES, JUDICIARY                                    
 03/07/96              (H)   HES AT  4:00 PM CAPITOL 106                       
                                                                               
 BILL:  HB 515                                                               
 SHORT TITLE: USE OF YOUTH SERVICES GRANTS                                     
 SPONSOR(S): REPRESENTATIVE(S) WILLIAMS                                        
                                                                               
 JRN-DATE     JRN-PG               ACTION                                      
 02/12/96      2729    (H)   READ THE FIRST TIME - REFERRAL(S)                 
 02/12/96      2729    (H)   HES, JUDICIARY, FINANCE                           
 02/29/96              (H)   HES AT  3:00 PM CAPITOL 106                       
 02/29/96              (H)   MINUTE(HES)                                       
 03/07/96              (H)   HES AT  4:00 PM CAPITOL 106                       
                                                                               
 BILL:  HB 528                                                               
 SHORT TITLE: NURS.HOME MORATORIUM/CERTIFICATES OF NEED                        
 SPONSOR(S): FINANCE                                                           
                                                                               
 JRN-DATE     JRN-PG               ACTION                                      
 02/26/96      2884    (H)   READ THE FIRST TIME - REFERRAL(S)                 
 02/26/96      2884    (H)   HES, FINANCE                                      
 03/07/96              (H)   HES AT  4:00 PM CAPITOL 106                       
                                                                               
                                                                               
 WITNESS LIST                                                                  
                                                                               
 DOROTHY PEAVEY, Executive Director                                            
 Mental Health Consumers of Alaska                                             
 430 West 7th Street, Suite 220                                                
 Anchorage, Alaska  99501                                                      
 Telephone:  (907)277-3817                                                     
 POSITION STATEMENT:  Testified on behalf of Mental Health Consumers           
                      of Alaska, in support of HB 318                          
                                                                               
 LEONARD ABEL, Program Administrator                                           
 Community Mental Health Services                                              
 Division of Mental Health & Developmental Disabilities                        
 Department of Health & Social Services                                        
 State of Alaska                                                               
 P.O. Box 110620                                                               
 Juneau, Alaska  99811-0620                                                    
 Telephone:  (907)465-3370                                                     
 POSITION STATEMENT:  Testified on behalf of the Division of                   
                      Mental Health, in support of HB 318                      
                                                                               
 JAN MCGILLIVARY, PRESIDENT                                                    
 Alaska Mental Health Association                                              
 4050 Lake Otis Parkway, #202                                                  
 Anchorage, Alaska  99508                                                      
 Telephone:  (907)463-0880                                                     
 POSITION STATEMENT:  Testified on behalf of the Alaska                        
                      Mental Health Association, in support                    
                      of HB 318                                                
                                                                               
 BILL CROSS                                                                    
 Mental Health Consumers of Alaska                                             
 17346 Meadow Creek Drive                                                      
 Eagle River, Alaska  99577                                                    
 Telephone:  (907)696-1269                                                     
 POSITION STATEMENT:  Testified in support of HB 318                           
                                                                               
 KATHERINE A. JOHNSON                                                          
 Alaska Mental Health Board                                                    
 3100 West 71 Avenue                                                           
 Anchorage, Alaska  99524-0067                                                 
 Telephone:                                                                    
 POSITION STATEMENT:  Testified on behalf of the Mental Health                 
                      Board, in support of HB 318                              
                                                                               
 STEPHEN ESSLEY, Attorney                                                      
 Disability Law Center of Alaska                                               
 615 East 82nd, #101                                                           
 Anchorage, Alaska  99518                                                      
 Telephone:  (907)344-1002                                                     
 POSITION STATEMENT:  Testified on behalf of the Disability                    
                      Law Center, in support of HB 318                         
                                                                               
 BERRY JACK                                                                    
 Mental Health Consumers of Alaska                                             
 P.O. Box 141593                                                               
 Anchorage, Alaska  99514                                                      
 Telephone:  8\(907)338-0515                                                   
 POSITION STATEMENT:  Testified as a mental health consumer,                   
                      in support of HB 318                                     
                                                                               
 ROBIN COE, President                                                          
 Mental Health Consumers of Alaska                                             
 430 West 7th Street                                                           
 Anchorage, Alaska  99501                                                      
 Telephone:  (907)277-3817                                                     
 POSITION STATEMENT:  Testified as President of the Board of                   
                      Directors of MCHA, in support of HB 318                  
                                                                               
 DIANE WORLEY, Director                                                        
 Division of Family & Youth Services                                           
 Department of Health, Education & Social Services                             
 State of Alaska                                                               
 P.O. Box 110630                                                               
 Juneau, Alaska  99811-0630                                                    
 Telephone:  (907)465-3191                                                     
 POSITION STATEMENT:  Testified on behalf of the Division                      
                      of Family & Youth Services, in                           
                      support of HB 318                                        
                                                                               
 JAY LIVEY, Deputy Commissioner                                                
 Department of Health, Education & Social Services                             
 State of Alaska                                                               
 P.O. Box 11601                                                                
 Juneau, Alaska  99811-0601                                                    
 Telephone:  (907)465-3030                                                     
 POSITION STATEMENT:  Testified on behalf of the Department of                 
                      Health, Education & Social Services,                     
                      in support of HB 528                                     
                                                                               
 CONNIE SIPE, Director                                                         
 Division of Senior Services                                                   
 Department of Administration                                                  
 State of Alaska                                                               
 3601 C Street                                                                 
 Anchorage, Alaska  99503-5984                                                 
 Telephone:  (907)563-5654                                                     
 POSITION STATEMENT:  Testified on behalf of the Division                      
                      of Senior Services, in support of                        
                      HB 528                                                   
                                                                               
 DENNIS MURRAY, Administrator                                                  
 Heritage Place                                                                
 232 Rockwell Avenue                                                           
 Soldotna, Alaska  99669                                                       
 Telephone:  (907)262-2545                                                     
 POSITION STATEMENT:  Testified via teleconference from                        
                      Kenai, in opposition to HB 528                           
                                                                               
 LEANNA SMITH                                                                  
 P.O. Box 3103                                                                 
 831 South Chugach                                                             
 Palmer, Alaska  99645                                                         
 Telephone:  (907)745-3037                                                     
 POSITION STATEMENT:  Testified via teleconference from                        
                      Mat-Su, with concerns regarding HB 528                   
                                                                               
 GLORIA SIMEON, Executive Director                                             
 Calista Elders Council                                                        
 601 West 5th Avenue, Suite 200                                                
 Anchorage, Alaska  99501                                                      
 Telephone:  (907)279-8358                                                     
 POSITION STATEMENT:  Testified via teleconference from                        
                      Anchorage, with concerns regarding                       
                      HB 528                                                   
                                                                               
 HELEN KEIM, Home Care Coordinator                                             
 Homer Senior Citizens                                                         
 P.O. Box 1263                                                                 
 Anchor Point, Alaska  99556                                                   
 Telephone:  (907)235-7655                                                     
 POSITION STATEMENT:  Testified via teleconference from                        
                      Homer, in support of HB 528                              
                                                                               
 BRENDA STEENBLOCK                                                             
 Homer Senior Citizens                                                         
 P.O. Box 808                                                                  
 Homer, Alaska  99603                                                          
 Telephone:  (907)235-8075                                                     
 POSITION STATEMENT:  Testified via teleconference from                        
                      Homer, in support of HB 528                              
                                                                               
 ALYSHA MATHEWSON                                                              
 Homer Independent LIving Center                                               
 4556 Early Spring                                                             
 Homer, Alaska  99603                                                          
 Telephone:  (907)235-4046                                                     
 POSITION STATEMENT:  Testified via teleconference from                        
                      Homer, in support of HB 528                              
                                                                               
 JOYANNA GEISLER                                                               
 P.O. Box 2474                                                                 
 Homer, Alaska  99603                                                          
 Telephone:  (907)235-5401                                                     
 POSITION STATEMENT:  Testified via teleconference from                        
                      Homer, in support of HB 528                              
                                                                               
 JOE ALTER, Chairman                                                           
 Pioneers' Home Advisory Board                                                 
 P.O. Box 20304                                                                
 Juneau, Alaska  99802                                                         
 Telephone:  (907)586-6680                                                     
 POSITION STATEMENT:  Testified on behalf of the Pioneers'                     
                      Home Advisory Board and Alaska                           
                      Commission on Aging, in support of                       
                      HB 528                                                   
                                                                               
 ACTION NARRATIVE                                                              
                                                                               
 TAPE 96-23, SIDE A                                                            
 Number 014                                                                    
                                                                               
 CO-CHAIRMAN CON BUNDE called the meeting of the House Health,                 
 Education & Social Services Committee to order at 4:12 p.m.                   
 Members present were Representatives Bunde, Toohey, and Vezey.                
 Representatives Rokeberg, Davis, and Brice arrived shortly after              
 the meeting started.                                                          
                                                                               
 HB 318 - MENTAL HEALTH TREATMENT DECLARATIONS                                
                                                                              
 CO-CHAIR BUNDE announced that the first order of business would be            
 House Bill 318.  He called on the sponsor, Representative Toohey,             
 to introduce the bill.                                                        
                                                                               
 Number 060                                                                    
                                                                               
 REPRESENTATIVE CYNTHIA TOOHEY stated that HB 318 would allow an               
 individual to make advance directives regarding his or her mental             
 health treatment.  The person would need to be of sound mind when             
 making the declaration, which would designate an attorney-in-fact             
 who would act only when the individual was determined to be                   
 incapable.  The directive would address the use of psychotropic               
 medications, electro-convulsive therapy, and the length of short-             
 term admission, up to 17 days, into a treatment facility.  The                
 declaration would be in effect for three years, unless the                    
 individual became incapable.  In that case, the declaration would             
 continue in effect until the individual was no longer incapable.              
 While an individual is capable, he or she can revoke the                      
 declaration in whole or in part at any time.  This declaration                
 gives the individual the opportunity to make his or her wishes                
 known about treatments--ones that have worked in the past, as well            
 as ones that would be desired in the future, as well as treatments            
 that have not worked in the past and would not be desired in the              
 future.  It provides for a substitute decision-maker with whom the            
 doctor would consult should the declaration not be specific enough,           
 or should the doctor recommend a treatment not specified.  HB 318             
 is similar to an Oregon law.  In Oregon they have found that                  
 individuals who have fought hospitalization and medication in the             
 past, now were more willing to go to the hospital, because they had           
 a declaration in place, and they felt their decisions would be                
 heeded.  HB 318 is supported by Charter North, Alaska State                   
 Hospital & Nursing Home Association, South Central Counseling                 
 Center, the Mental Health Association of Alaska, and the Mental               
 Health Consumers of Alaska, and the Department of Health, Education           
 & Social Services.  There is a zero fiscal note attached.                     
                                                                               
 REPRESENTATIVE TOOHEY stated that there were a number of                      
 individuals present who wished to testify, including Dorothy Peavey           
 of the Mental Health Consumers of Alaska, and Leonard Abel from the           
 Department of Health, Education & Social Services.  Representative            
 Toohey noted that she remembered as a child receiving a very urgent           
 letter from her cousin, who was schizophrenic, asking never to let            
 her doctor use electro-shock therapy.                                         
                                                                               
 CO-CHAIRMAN BUNDE acknowledged the presence of Representatives                
 Robinson and Rokeberg.  He stated that because of the lack of time,           
 and the large number of persons wishing to testify, the committee             
 would first hear all testimony, then address any questions.  He               
 then called on the first witness, Dorothy Peavey.                             
                                                                               
 Number 331                                                                    
                                                                               
 DOROTHY PEAVEY, Executive Director of the Mental Health Consumers             
 of Alaska (MCHA), stated that MCHA is a nonprofit organization                
 composed of individuals who suffer from mental illness.  When her             
 organization became aware of Oregon's law concerning advance                  
 directives for mental health treatment, it seemed like a natural              
 thing for them to support.  This proposed legislation gives a voice           
 to people suffering from mental illness, at a time when their                 
 opinion would not normally be heard.  It empowers consumers to make           
 responsible decisions about their care, and provides a mechanism              
 for those decisions to be carried forward at a time when they are             
 incapable.  She emphasized that the correct term is incapable, not            
 incompetent.  Incompetency is decided by a judge.  To become                  
 incapable under this legislation, a person would have to at one               
 point have filled out a declaration.  Then, in the opinion of two             
 physicians (one of whom is a psychiatrist), or a physician and a              
 professional mental health clinician, the person would be found to            
 be incapable, and the mechanism would take effect.  At that point,            
 upon the advice and council of the attorney-in-fact, the individual           
 could be hospitalized for a period of up to 17 days, without having           
 to go to court to be found incompetent.  Decisions about treatment            
 would also take effect.  If a person had a history with a                     
 medication, then they could make their wishes known, and the doctor           
 would have to pay attention to those wishes.                                  
                                                                               
 MS. PEAVEY stated that she has discussed HB 318 with providers from           
 across the state, and that it has been endorsed by the Mental                 
 Health Providers Association, as well as the groups and individuals           
 named by Representative Toohey.  The bill has support from                    
 families, consumers, and providers.  One question that came up in             
 the Senate hearing was why 17 days was chosen for the time period             
 a person could be hospitalized.  She emphasized that this was a               
 reasoned number.  If a person were to be hospitalized on a Friday             
 afternoon, the 17 days would provide 10 days of evaluation and                
 treatment, if one of the weekends was a three day holiday.  At that           
 point, the doctors could decide if the individual had made a                  
 significant improvement, or whether the individual needed to be               
 held.  Ms. Peavey then invited questions from the committee.                  
                                                                               
 Number 609                                                                    
                                                                               
 CO-CHAIRMAN BUNDE noted for the record that Representative Brice              
 had joined the meeting.  Co-Chairman Bunde then called on the next            
 witness, Leonard Abel.                                                        
                                                                               
 LEONARD ABEL, Ph.D., Community Mental Health Services Program                 
 Administrator, Department of Health, Education & Social Services              
 (State of Alaska), stated he would testify in support of HB 318.              
 Dr. Abel stated that he previously worked for Southcentral                    
 Counseling Center in Anchorage.  About 11 years ago, a client came            
 to him and asked if there was a document she could sign, so that if           
 she became incapable, she would receive the proper treatment.  At             
 the time, there was no such document.  Dr. Abel recognized that the           
 client understood her illness, and knew that if she became                    
 incapable, she might resist treatment, and would have to be                   
 involuntarily committed.  If, on the other hand, she had signed a             
 declaration such as embodied in HB 318, this could be prevented.              
 Persons with mental illnesses, when stabilized on medication, can             
 make reasonable decisions.  When the illness is out of control, the           
 capacity to make such decisions is gone.  Dr. Abel reiterated that            
 he very strongly supports the bill.  It seems to have good                    
 safeguards for the patient, for the attorney-in-fact, and for the             
 mental health professionals.                                                  
                                                                               
 Number 946                                                                    
                                                                               
 CO-CHAIRMAN BUNDE called on the next witness, Jan McGillivary.                
                                                                               
 JAN MCGILLIVARY stated she would speak as President/CEO of the                
 Alaska Mental Health Association (AMHA), and also on behalf of the            
 Building Bridges Campaign, and the Alaska Mental Health Program               
 Director's Association.  As President of AMHA, she represents 600             
 Alaskans.  These kinds of advance directives are very common for              
 persons suffering from HIV and other grave illnesses.  As President           
 of AMHA, she believes the proposed bill is long overdue.  The                 
 Building Bridges Campaign and the Alaska Mental Health Program                
 Director's Association also strongly support the bill.  Ms.                   
 McGillivary noted that she has an allergy to codeine, and therefore           
 she has a personal advance medical directive on file.  She stated             
 that in her 15 years in the mental health field, she has                      
 encountered many consumers who know they are allergic to certain              
 medications.  The proposed legislation would address that problem.            
 She urged the committee to pass the bill.                                     
                                                                               
 Number 1075                                                                   
                                                                               
 CO-CHAIRMAN BUNDE called on the next witness, Bill Cross.                     
                                                                               
 BILL CROSS, a member of the Mental Health Consumers of Alaska,                
 stated that he was once determined to be mentally "incontinent,"              
 but had recovered from the condition.  He further stated that he              
 supports HB 318, because he is aware that there are some treatments           
 he does not respond well to.  By signing such a declaration, he can           
 help his doctors, by letting them know what he has responded well             
 to in the past.                                                               
                                                                               
 Number 1153                                                                   
                                                                               
 KATHERINE A. JOHNSON, a member of the Alaska Mental Health Board,             
 stated that the board supports HB 318.  The board applauds the work           
 of MCHA in developing this legislation.  The Advance Directives               
 bill extends to consumers of mental health services an important              
 control mechanism over their own treatment.  Control of personal              
 destiny is essential to human dignity.  HB 318 provides a means by            
 which difficult situations may be anticipated and addressed, giving           
 consumers a voice they have previously lacked.  The board joins the           
 mental health community in urging the House Health, Education &               
 Social Services Committee to move HB 318, with favorable                      
 recommendations.                                                              
                                                                               
 Number 1201                                                                   
                                                                               
 STEVEN ESSLEY, an attorney with the Disability Law Center of                  
 Alaska, stated that the center supports HB 318.  He noted that                
 there may actually be a negative fiscal impact from the bill, since           
 it would preclude the need for an involuntary commitment hearing.             
 The Office of Public Advocacy has said that there are about 180               
 involuntary medication hearings each year.  This bill might also              
 eliminate the necessity for a number of those hearings.  He                   
 reiterated that the Disability Law Center of Alaska supports HB
 318.                                                                          
                                                                               
 Number 1294                                                                   
                                                                               
 BERRY JACK, a consumer with Mental Health Consumers of Alaska,                
 stated he does not have a family which is legal defined by law.  He           
 does have a power of attorney.  This bill would allow him to                  
 complete all avenues of his life.  HB 318 would give him a voice              
 and protect his rights.  He asked that the committee support the              
 bill.                                                                         
                                                                               
 Number 1350                                                                   
                                                                               
 ROBIN COE, President of the Board of Directors for the Mental                 
 Health Consumers of Alaska, testified that the proposed legislation           
 was vital.                                                                    
                                                                               
 Number 1375                                                                   
                                                                               
 CO-CHAIRMAN BUNDE asked if anyone else wished to testify regarding            
 HB 318.  Seeing there were no further witnesses, Co-Chair Bunde               
 closed the public testimony on HB 318.  He then asked for questions           
 or comments from the committee.                                               
                                                                               
 REPRESENTATIVE TOM BRICE commented that the proposed legislation              
 was long overdue.                                                             
                                                                               
 REPRESENTATIVE NORMAN ROKEBERG moved that the House Health,                   
 Education & Social Services Committee pass HB 318 from committee,             
 with individual recommendations and a zero fiscal note.  There                
 being no objections, HB 318 was passed out of the House HESS                  
 Committee.                                                                    
                                                                               
 HB 515 - USE OF YOUTH SERVICES GRANTS                                       
                                                                               
 Number 1469                                                                   
                                                                               
 CO-CHAIRMAN BUNDE announced that the next order of business to come           
 before the committee was HB 515.                                              
                                                                               
 KYLE JOHANSEN, staff to Representative Bill Williams, stated that             
 a hand-out on the bill had been delivered to each committee                   
 member's office, and that Tom Lane, of the Department of Health &             
 Social Services, was available to answer questions.                           
                                                                               
 Number 1580                                                                   
                                                                               
 DIANE WORLEY, Director, Division of Family & Youth Services,                  
 Department of Health, Education, & Social Services, State of                  
 Alaska, stated that the division supports HB 515.  She previously             
 worked for a direct service provision agency.  Because the agency             
 was prohibited from using grant funds to purchase a building, they            
 had to move frequently.  This resulted in confusion for clients.              
 To remedy the situation, her organization established a private,              
 non-profit foundation, which purchased the building, and then                 
 rented it to the agency.  This was appropriate and legal, but a               
 direct route would have been much easier.  Ms. Worley emphasized              
 that the proposed legislation would strengthen client services by             
 providing consistency, and represents good business practice for              
 nonprofit organizations.  She invited questions from the committee.           
                                                                               
 Number 1659                                                                   
                                                                               
 CO-CHAIRMAN BUNDE asked for further testimony.  There being no                
 further testimony, public testimony on HB 515 was closed.                     
                                                                               
 REPRESENTATIVE ROBINSON asked if previous problems relating to the            
 bill had been solved.                                                         
                                                                               
 CO-CHAIRMAN BUNDE replied that they had.                                      
                                                                               
 Number 1707                                                                   
                                                                               
 REPRESENTATIVE BRICE stated that this bill would actually result in           
 a reduction in costs to the state.  He moved HB 515 with zero                 
 fiscal notes and individual recommendations be passed out of the              
 committee.                                                                    
                                                                               
 REPRESENTATIVE ROBINSON asked how maintenance needs would be dealt            
 with, once a building was purchased.                                          
                                                                               
 CO-CHAIRMAN BUNDE responded that whether a building is purchased or           
 rented, there are still maintenance needs.  There being no                    
 objections, House Bill 515 with zero fiscal notes and individual              
 recommendations was passed out of the House Health, Education &               
 Social Services Committee.                                                    
                                                                               
 HB 528 - NURS.HOME MORATORIUM/CERTIFICATES OF NEED                          
                                                                               
 Number 1835                                                                   
                                                                               
 CO-CHAIRMAN BUNDE announced that the next order of business to come           
 before the committee was HB 528.                                              
                                                                               
 JAY LIVEY, Deputy Commissioner, Department of Health & Social                 
 Services, that stated he would give a brief overview of the bill.             
 The certificate of need process is a planning process by which the            
 state reviews the appropriateness of the development of hospitals             
 and nursing homes in the state.  Applications are made to the state           
 for projects in excess of one million dollars of capital cost, and            
 the state reviews them against criteria which are established in              
 the existing certificate of need law.  A project must have a                  
 certificate of need from the state in order to proceed.                       
                                                                               
 MR. LIVEY further explained that if the one million dollar                    
 threshold is not exceeded, then existing beds can be converted.  In           
 the past, hospital beds have been converted to long-term care beds.           
 As long as one million dollars is not expended, this process is               
 allowable under current law.  HB 528 makes two changes to existing            
 law.  First, it defines a criteria by which applications for                  
 certificates of need are reviewed.  Currently, the review criteria            
 is primarily based on the need for a particular service.  If an               
 application shows that a particular service area lacks enough                 
 nursing home beds, then the certificate will most likely be                   
 granted.  One of the changes in HB 528 would be to apply a cost               
 effectiveness criteria to the request.  In addition to surveying              
 need, the division could also determine if the proposed service               
 would be the most cost effective way to meet the need.                        
                                                                               
 MR. LIVEY stated that the proposed bill would also propose a two-             
 year moratorium on the granting of a certificate of need or the               
 licensing of additional long-term care beds in the state.  This               
 section is needed to stop the conversion of nursing home beds.  He            
 noted that the proposed moratorium would not apply to extended care           
 or sub-acute care beds.   Mr. Livey explained that the Department             
 of Health & Social Services supports HB 528, because the department           
 expects to spend about $54 million on nursing home care during the            
 current fiscal year, which represents care for about 640 Alaskans             
 in nursing homes.  Nursing home care costs an average of about $86            
 thousand per year per patient.  Of all nursing home revenues in the           
 state, 85 percent come from Medicaid.  In contrast, the cost of               
 supporting a person in the home and community-based waiver program            
 is about $30 thousand per year.  Over the next few years, there is            
 a potential for 160 new nursing home beds to be added in the state,           
 both through conversions and new construction.  If this were to               
 happen, the annual total cost to the state would be about $47                 
 million.  The department believes that the state cannot control the           
 Medicare budget, given this kind of growth in long-term care beds.            
 Thus, HB 528 would help the state in its cost containment efforts.            
                                                                               
 Number 2055                                                                   
                                                                               
 CONNIE SIPE, Director, Division of Senior Services, Department of             
 Administration (State of Alaska), stated that the proposed                    
 moratorium was also a response to the changing budget situation,              
 both state and federal.  The division believes that putting a                 
 moratorium on the licensing of nursing home care beds will give the           
 home and community care system time to grow and catch up, which               
 will benefit everyone.  Home and community care is not only less              
 expensive for the state, it is also more often cost affordable by             
 the family or individual, which means they can carry a larger                 
 proportion of the cost of care.  The growth of the home health care           
 system means that public money is being better spent.                         
                                                                               
 MS. SIPE also commented that professionals in the field of aging              
 are trying to move away from the idea that long-term care is an               
 unavoidable part of the continuum.  Long-term care is now viewed as           
 part of a network, which also includes home care and assisted                 
 living alternatives.  If home health care and assisted living are             
 added on to family care, many people may never need a nursing home            
 bed.                                                                          
                                                                               
 Number 2190                                                                   
                                                                               
 REPRESENTATIVE TOOHEY asked what would happen to pending                      
 certificate of need applications under the proposed legislation.              
                                                                               
 MR. LIVEY responded that the applications would be reviewed under             
 the new criteria.                                                             
                                                                               
 REPRESENTATIVE TOOHEY then asked what would happen if a certificate           
 had already been granted.                                                     
                                                                               
 MR. LIVEY replied that if a certificate had already been granted,             
 then the project could go forward.                                            
                                                                               
 CO-CHAIRMAN BUNDE announced that teleconference testimony would now           
 be taken.  He called on the next witness, Dennis Murray, via                  
 teleconference from Kenai.                                                    
                                                                               
 DENNIS MURRAY, Administrator of Heritage Place in Soldotna, Alaska,           
 stated that he had a different perspective on HB 528.  For example,           
 he said, the legislation references a low occupancy rate for                  
 nursing homes in Alaska.  However, this is not true in southcentral           
 Alaska.  Both facilities in Anchorage are at near 100 percent                 
 occupancy.  His own facility has run between 97 and 100 percent               
 occupancy for the past 12 months.                                             
                                                                               
 TAPE 96-23, SIDE B                                                            
 Number 001                                                                    
                                                                               
 MR. MURRAY further noted that the state has, in fact, two nursing             
 home systems, which include private facilities and the Pioneer Home           
 system.  He also observed that Alaska has one of the lowest per               
 capita nursing home populations in the country.  But, we also have            
 an exploding elderly population.  He commented that the proposed              
 legislation appears short-sighted.                                            
                                                                               
 Number 037                                                                    
                                                                               
 LEANNA SMITH, of the Palmer Senior Center, testified via                      
 teleconference from Mat-Su.  She agreed with Ms. Sipes that the               
 cost of home and community-based care was much lower than nursing             
 home care.  She stated, however, that only a small number of people           
 can currently receive help from the state for the cost of home                
 care.  She stated that if nursing home beds are available, Medicaid           
 will pick up the cost for people who cannot afford to pay.                    
 However, if no beds are available, and assisted living funds are              
 also unavailable, people will be left without care.  Ms. Smith                
 asked if there would be some way to transfer funds from Medicaid to           
 help with assisted living.                                                    
                                                                               
 Number 074                                                                    
                                                                               
 GLORIA SIMEON, Executive Director of the Calista Elders Council,              
 testified via teleconference from Anchorage.  Ms. Simeon stated               
 that since 1986 the elders of the Calista region have worked to               
 organize themselves so that the regional entity could provide                 
 services and programs to them responsive to their needs.  The                 
 council is concerned that too many elders have to leave the region            
 to receive the medical care and services they require.  She stated            
 that elders are forced to leave their homes, families, friends, and           
 most important their language.  They are relocated to unfamiliar              
 environments, and exposed to a language and way of life that is not           
 their own.  No roads link the Calista region to the rest of the               
 state, and the cost of a ticket from one of the regional villages             
 to Anchorage is in excess of seven hundred dollars.  The region is            
 also one of the most economically depressed in the state, and most            
 families cannot afford the cost of even an annual visit to their              
 elderly relatives in nursing homes.  Left alone in an unfamiliar              
 environment, the elders lose their will to live and often come home           
 in a short period of time, to be buried.  This conflicts with the             
 values and traditions of the Yupik culture.                                   
                                                                               
 MS. SIMEON stated that while she understands the reasoning behind             
 the proposed legislation, she is also aware that the majority of              
 nursing homes are located in urban centers.  She further                      
 understands that the rural health corporations are developing and             
 expanding programs to offer home care delivery, and are considering           
 assisted living centers as a viable option on a community level.              
 However, the reality is that there is a need for a nursing home               
 facility in the Calista region, and the regional hospital is an               
 ideal place to locate such a facility.                                        
                                                                               
 MS. SIMEON further stated that a study done by the state of Alaska            
 in 1993 showed 41 Calista elders in nursing facilities throughout             
 the state, and that being forced to relocate resulted in poor                 
 adjustment and a much higher death rate.  The study also indicates            
 that the two fastest growing segments of our population are elders,           
 age 65 and over, and children age 5 and under.  With the number of            
 elders increasing, the state needs to examine how future needs will           
 be met.  She proposed that, rather than putting a moratorium on               
 nursing homes and beds, the state should take a serious look at the           
 present and future needs of its elders, and focus on how these                
 needs can be met.  In closing, Ms. Simeon suggested that elders               
 should be involved in the development of any plan, and that they              
 should be able to live out the remainder of their lives as close to           
 their homes as possible.                                                      
                                                                               
 Number 219                                                                    
                                                                               
 HELEN KEIM, Care Coordinator, Homer Senior Citizens, testified via            
 teleconference from Homer.  Ms. Keim stated that she supports HB
 528.  She urged the committee's support for the Choice medicaid               
 waiver program for the elderly, and asked the committee not to cut            
 funding for the program.  The average cost of a Choice client is              
 $25 to $30 thousand annually, as opposed to $100 thousand or more             
 for each long-term care patient.  Also, the Choice program keeps              
 clients in their own homes, as opposed to an institution.                     
                                                                               
 CO-CHAIRMAN BUNDE announced that a number of people still wished to           
 testify.  He stated he would attempt to hear the bill again on                
 Tuesday, March 12.                                                            
                                                                               
 Number 293                                                                    
                                                                               
 BRENDA STEENBLOCK, Administrative Assistant, Homer Senior Citizens,           
 testified via teleconference from Homer.  Ms. Steenblock stated               
 that Homer's new, 40 unit assisted living facility is scheduled to            
 open in May.  She stated that Homer Senior Citizens supports HB
 528.                                                                          
                                                                               
 Number 325                                                                    
                                                                               
 ALYSHA MATHEWSON, of Homer Independent Living Center, testified via           
 teleconference from Homer.  Ms. Mathewson stated that she supports            
 HB 528 because the state needs to develop home and community-based            
 services as an alternative to costly nursing home facilities.  Each           
 person receiving extended care has their own personal                         
 circumstances.  Some would choose to stay at home, but cannot                 
 afford to pay the cost of a home health aide.  These fees would               
 total approximately $240 per day, but Medicaid doesn't cover this             
 service.  In the Palmer area, Medicaid pays about $12 thousand per            
 month for long-term care.  If this amount were instead paid                   
 directly to the certified home health aides, there would be a                 
 savings of $4800 per month.                                                   
                                                                               
 MS. MATHEWSON stated that she would also like to see further                  
 development of the Medicaid Choice program.  She urged the                    
 committee to pass the bill, keeping mind that changes in the health           
 care delivery system are urgently needed.                                     
                                                                               
 Number 400                                                                    
                                                                               
 JOYANNA GEISLER, of Homer, testified that she provides services for           
 people with disabilities throughout the entire Kenai Peninsula.               
 She stated that she supports HB 528.  All of her clients with                 
 disabilities would definitely prefer to receive community-based               
 services, rather than live in nursing homes.  She noted that such             
 community-based services cost about one-third the amount of                   
 institutional care.  Ms. Glyser stated the bill seems to be a win-            
 win situation, as it would reduce costs to the state and improve              
 the quality of life for disabled and elderly Alaskans.  She further           
 noted she supports limiting the growth of long-term care beds, and            
 diverting the resulting funds into community-based services.                  
                                                                               
 Number 462                                                                    
                                                                               
 REPRESENTATIVE TOOHEY mentioned the handout received from Homer               
 Senior Citizens.  She noted that the handout compares the price of            
 services available, and contrasted this with materials received               
 from Providence Hospital, which do not mention cost.                          
                                                                               
 CO-CHAIRMAN BUNDE responded that information on cost of services              
 could most likely be obtained before the bill was heard again.                
                                                                               
 Number 504                                                                    
                                                                               
 JOE ALTER, Chairman of the Pioneer's Homes Advisory Board and a               
 member of the Alaska Commission on Aging (ACOA), stated that the              
 Pioneers' Homes Advisory Board represents roughly half of the long-           
 term care beds in the state.  On behalf of the Commission on Aging,           
 Mr. Alter read a resolution, as follows:  "Alaska Commission on               
 Aging Resolution 96-3, In support of a moratorium on construction             
 of additional facility beds:                                                  
                                                                               
 "WHEREAS Alaska's existing long-term care system is now largely               
 made up of institutional, long-term care services; and                        
                                                                               
 "WHEREAS the current availability of nursing home beds in many                
 areas exceeds the actual need for nursing home beds in the state;             
 and                                                                           
                                                                               
 "WHEREAS Alaska's seniors have indicated through surveys an                   
 overwhelming preference for alternatives to nursing homes, and they           
 want to live in the least restrictive setting close to family and             
 friends;  and                                                                 
                                                                               
 "WHEREAS seniors often have to choose nursing home care, which is             
 the most intensive, restrictive and expensive type of care, because           
 there is no community-based service available;  and                           
                                                                               
 "WHEREAS the future of Medicaid financing is under discussion at              
 the federal level;  and                                                       
                                                                               
 "WHEREAS the state Medicaid financing is finite, and is forcing               
 choices among Medicaid programs;  and                                         
                                                                               
 "WHEREAS the growth and maintenance of much needed community-based            
 care is threatened by construction of unnecessary nursing home                
 beds; and                                                                     
                                                                               
 "WHEREAS if new nursing home beds are added, senior's choices will            
 be restricted, because new nursing home beds compete directly for             
 public funds available for community-based services;  and                     
                                                                               
 "WHEREAS HB 528 will encourage the development of home and                    
 community-based services, and allow time for Alaska to move toward            
 a more balanced, long-term care system;                                       
                                                                               
 "NOW, THEREFORE, BE IT RESOLVED that the Alaska Commission on Aging           
 strongly encourages the Alaska legislature to enact HB 528, which             
 would place a two year moratorium on new, nursing home beds.                  
                                                                               
 "Adopted this 5th day of March, 1996.                                         
                                                                               
 Donald M. Hoover, Chair, Alaska Commission on Aging"  This                    
 concluded Mr. Alter's testimony.                                              
                                                                               
 Number 653                                                                    
                                                                               
 HARLAN KNUDSON, representing the Alaska State Hospital and Nursing            
 Home Association, stated that he is a strong proponent of home and            
 community-based care, but that his organization opposes HB 528.               
 The association shares the concerns about cost, but disagrees with            
 this approach to solving the problem, and with the findings of the            
 bill.  They do not agree that there is an overabundance of nursing            
 home beds in the metropolitan areas of the state.  He referred to             
 a January 31, 1992, census report on licensing and certification,             
 which shows 764 beds being reimbursed in the Medicare system.  He             
 stated this is important, because it disputes other figures                   
 relating to the number of licensed beds in the state.                         
                                                                               
 MR. KNUDSON further stated that the 1992 report shows 100 percent             
 and 98 percent occupancy for nursing homes in Anchorage.  One of              
 the pending certificates of need, which would be impacted by the              
 proposed legislation, is for a nursing home in the Palmer/Mat Su              
 area.  Mr. Knudson pointed out that the 1996 census report shows              
 that rates for nursing home care in Anchorage have actually shown             
 a slight decrease since 1992, in one center, and have only                    
 increased about $20 per day in another center.  He also noted that,           
 of the two centers in Anchorage, one is 98 percent full, and the              
 other 96 percent.  He stated that the bill proposes a solution                
 which is far too simplistic.  When nursing home beds are full,                
 there is no place open for acute care and convalescent patients.              
 They then have to stay in the hospital, which is the most expensive           
 setting.  Mr. Knudson also pointed out that in 1992, there were 764           
 licensed beds.  In 1996, there are 768.  This represents an                   
 increase of only four beds in five years.  He summed up his                   
 testimony by calling the committee's attention to Section 2 of the            
 bill, which changes the word "shall" issue a certificate of need to           
 "may" issue a certificate of need.  This refers to situations where           
 the criteria have already been met.  Mr. Knudson reminded the                 
 committee that there is a big difference between "shall" and "may".           
 The proposed statue would allow the department to deny a                      
 certificate, even when need has been proven.  This represents a               
 major change in public policy.                                                
                                                                               
 MR. KNUDSON also stated that providers feel shut out of the policy-           
 making procedure, with respect to long-term care.  Perhaps a one              
 year moratorium would be appropriate.  The HESS Department should             
 be required to work with advocacy groups, providers, bush and rural           
 Alaska, and propose a bill that will meet the people's needs.  He             
 referred to a report by the American Association of Retired Persons           
 which raises serious questions about the cost of home and                     
 community-based care.  He reiterated that HB 528 does not                     
 effectively deal with problems in the system.                                 
 CO-CHAIRMAN BUNDE announced that HB 528 would be scheduled for                
 further hearing.                                                              
                                                                               
 ADJOURNMENT                                                                   
                                                                               
 There being no further business to come before the House Health,              
 Education & Social Services Committee, the meeting was adjourned at           
 5:30 p.m..                                                                    
                                                                               

Document Name Date/Time Subjects