Legislature(1997 - 1998)

03/27/1997 03:11 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 27, 1997                                        
                           3:11 p.m.                                           
                                                                               
                                                                               
 MEMBERS PRESENT                                                               
                                                                               
 Representative Con Bunde, Chairman                                            
 Representative Joe Green, Vice Chairman                                       
 Representative Al Vezey                                                       
 Representative Fred Dyson                                                     
 Representative J. Allen Kemplen                                               
                                                                               
 MEMBERS ABSENT                                                                
                                                                               
 Representative Brian Porter                                                   
 Representative Tom Brice                                                      
                                                                               
 COMMITTEE CALENDAR                                                            
                                                                               
 *HOUSE BILL NO. 193                                                           
 "An Act relating to financial assistance for students attending               
 certain graduate education programs; and providing for an effective           
 date."                                                                        
                                                                               
      - HEARD AND HELD                                                         
                                                                               
 HOUSE BILL NO. 152                                                            
 "An Act regulating hospice care."                                             
                                                                               
      - MOVED CSHB 152(HES) FROM COMMITTEE                                     
                                                                               
 *HOUSE BILL NO. 127                                                           
 "An Act relating to the citizen review board and panels for                   
 permanency planning for certain children in state custody; renaming           
 the Citizens' Review Panel For Permanency Planning as the Citizens'           
 Foster Care Review Board; extending the termination date of the               
 Citizens' Foster Care Review Board; and providing for an effective            
 date."                                                                        
                                                                               
      - HEARD AND HELD                                                         
                                                                               
 (* First public hearing)                                                      
                                                                               
 PREVIOUS ACTION                                                               
                                                                               
 BILL:  HB 193                                                               
 SHORT TITLE: REPAY GRADUATE EDUCATION AID                                     
 SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES                               
                                                                               
 JRN-DATE     JRN-DATE             ACTION                                      
 03/14/97       665    (H)   READ THE FIRST TIME - REFERRAL(S)                 
 03/14/97       665    (H)   HES, FINANCE                                      
                                                                               
 BILL:  HB 152                                                               
 SHORT TITLE: REGULATION OF HOSPICE CARE                                       
 SPONSOR(S): REPRESENTATIVE(S) RYAN                                            
                                                                               
 JRN-DATE     JRN-DATE             ACTION                                      
 02/24/97       441    (H)   READ THE FIRST TIME - REFERRAL(S)                 
 02/24/97       441    (H)   HES, FINANCE                                      
 03/20/97              (H)   HES AT  3:00 PM CAPITOL 106                       
                                                                               
 BILL:  HB 127                                                               
 SHORT TITLE: FOSTER CARE REVIEW BOARD                                         
 SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES                               
                                                                               
 JRN-DATE     JRN-DATE             ACTION                                      
 02/12/97       318    (H)   READ THE FIRST TIME - REFERRAL(S)                 
 02/12/97       318    (H)   HES, FINANCE                                      
                                                                               
 WITNESS REGISTER                                                              
                                                                               
 REPRESENTATIVE JOE RYAN                                                       
 Alaska State Legislature                                                      
 Capitol Building, Room 420                                                    
 Juneau, Alaska  99801                                                         
 Telephone:  (907) 465-3875                                                    
 POSITION STATEMENT:  Sponsor of HB 152                                        
                                                                               
 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  99503-7117                                                 
 Telephone:  (907) 561-8081                                                    
 POSITION STATEMENT:  Testified on CSHB 152(HES)                               
                                                                               
 PAULA McCARON                                                                 
 Hospice of Anchorage                                                          
 205 East Dimond, Number 187                                                   
 Anchorage, Alaska  99515                                                      
 Telephone:  (907) 248-6317                                                    
 POSITION STATEMENT:  Testified on CSHB 152(HES)                               
                                                                               
 CONNIE J. SIPE, Director                                                      
 Division of Senior Services                                                   
 Department of Administration                                                  
 3601 C Street, Suite 310                                                      
 Anchorage, Alaska  99503-5984                                                 
 Telephone:  (907) 563-5654                                                    
 POSITION STATEMENT:  Testified on CSHB 152(HES)                               
 RUPERT E. ANDREWS, Lobbyist                                                   
 American Association of Retired People (AARP)                                 
 9416 Long Run Drive                                                           
 Juneau, Alaska  99801                                                         
 Telephone:  (907) 789-7422                                                    
 POSITION STATEMENT:  Testified in support of CSHB 152(HES)                    
                                                                               
 DIANE BARRANS, Executive Director                                             
 Postsecondary Education Commission                                            
 Department of Education                                                       
 3030 Vintage Boulevard                                                        
 Juneau, Alaska  99801-7109                                                    
 Telephone:  (907) 465-6740                                                    
 POSITION STATEMENT:  Testified on HB 193                                      
                                                                               
 MIKE MAHER, Director of Student Financial Aid                                 
 Postsecondary Education Commission                                            
 Department of Education                                                       
 3030 Vintage Boulevard                                                        
 Juneau, Alaska  99801-7109                                                    
 Telephone:  (907) 465-6740                                                    
 POSITION STATEMENT:  Testified on HB 193                                      
                                                                               
 LAURA BURLESON, Student                                                       
 4758 Glasgow Street, Number 1                                                 
 Fairbanks, Alaska  99709                                                      
 Telephone:  (907)  479-7348                                                   
 POSITION STATEMENT:  Testified in support of HB 193                           
                                                                               
 JEAN RICHARDSON, Student                                                      
 2045 Jack Street, Apartment A                                                 
 Fairbanks, Alaska  99709                                                      
 Telephone:  (907) 451-9598                                                    
 POSITION STATEMENT:  Testified in support of HB 193                           
                                                                               
 PATRICIA SWENSON, Legislative Assistant                                       
     to Representative Bunde                                                   
 Alaska State Legislature                                                      
 Capitol Building, Room 104                                                    
 Juneau, Alaska  99801                                                         
 Telephone:  (907) 465-4843                                                    
 POSITION STATEMENT:  Provided sponsor statement for HB 127                    
                                                                               
 NANCY MILLER, Administrative Director                                         
 Citizens' Foster Care Review Board                                            
 1163 State Street                                                             
 Salem, Oregon  97310                                                          
 Telephone:  (503) 378-2244                                                    
 POSITION STATEMENT:  Testified on HB 127                                      
                                                                               
 CANDICE WHEELER                                                               
 2758 Upper Breckenridge Street                                                
 Salem, Oregon  97304-3434                                                     
 Telephone:  (503) 540-0263                                                    
 POSITION STATEMENT:  Testified on HB 127                                      
                                                                               
 BARBARA MALCHICK, Deputy Public Advocate                                      
 Office of Public Advocacy                                                     
 900 West Fifth Avenue, Number 529                                             
 Anchorage, Alaska  99501                                                      
 Telephone:  (907) 269-3500                                                    
 POSITION STATEMENT:  Testified in support of HB 127                           
                                                                               
 SCOTT CALDER                                                                  
 P.O. Box 75011                                                                
 Fairbanks, Alaska  99707                                                      
 Telephone:  (907) 474-0174                                                    
 POSITION STATEMENT:  Testified on HB 127                                      
                                                                               
 ACTION NARRATIVE                                                              
                                                                               
 TAPE 97-24, SIDE A                                                            
 Number 0000                                                                   
                                                                               
 CHAIRMAN CON BUNDE called the House Health, Education and Social              
 Services Standing Committee meeting to order at 3:11 p.m.  Members            
 present at the call to order were Representatives Bunde, Vezey and            
 Kemplen.  Representative Dyson arrived at 3:12 p.m. and                       
 Representative Green arrived at 3:13 p.m.  Representatives Brice              
 and Porter were absent.  This meeting was teleconferenced to                  
 Anchorage, Fairbanks, Ketchikan, and offnet sites.                            
 HB 193 - REPAY GRADUATE EDUCATION AID                                       
                                                                               
 Number 0030                                                                   
                                                                               
 CHAIRMAN BUNDE announced the first item on the agenda was HB 193,             
 "An Act relating to financial assistance for students attending               
 certain graduate education programs; and providing for an effective           
 date."  A quorum was not present, but the chair explained that this           
 was the first time the bill was being heard and he would not ask              
 the committee to take any action on it today.                                 
                                                                               
 Number 0066                                                                   
                                                                               
 CHAIRMAN BUNDE explained that HB 193 addresses the WAMI program               
 (Washington, Alaska, Montana and Idaho Medical Education Program).            
                                                                               
                                                                               
 Representative Dyson joined the committee meeting and so HB 193               
 would be addressed later in the meeting.                                      
 HB 152 - REGULATION OF HOSPICE CARE                                         
                                                                               
 Number 0135                                                                   
                                                                               
 CHAIRMAN BUNDE announced the next item on the agenda as HB 152, "An           
 Act regulating hospice care."                                                 
                                                                               
 Number 0167                                                                   
                                                                               
 REPRESENTATIVE AL VEZEY made a motion to move the committee                   
 substitute for HB 152, Lauterbach, dated March 26, 1997.  Hearing             
 no objections CSHB 152(HES) was now before the committee.                     
                                                                               
 Number 0203                                                                   
                                                                               
 REPRESENTATIVE JOE RYAN, Sponsor of HB 152, said CSHB 152(HES)                
 addresses some of the problems that were voiced by people employed            
 by volunteer hospices.  Those people were afraid that the fees                
 might be such that they couldn't comply with the regulations and              
 they would go out of business.  Commissioner Perdue indicated that            
 the Department of Health and Social Services (DHSS) had no                    
 intention of issuing burdensome regulations and\or fees that would            
 cause volunteer hospices any problems.  He referred to page 7, line           
 6, Article 2, which creates a different set of licensing                      
 requirements for volunteer hospice programs.                                  
                                                                               
 REPRESENTATIVE RYAN said CSHB 152(HES) tries to ensure a level of             
 competence, based on national standards, so that people who are               
 entering the hospice program, either volunteer and\or for profit,             
 receive the kind of treatment they desire.  This level of service             
 is critical for people with a terminal illness and prevents                   
 mistreatment or abuse.  The concept of hospice care is that someone           
 has a terminal illness and receives services to end their life as             
 peaceably as possible, surrounded by family and friends.                      
                                                                               
 Number 0343                                                                   
                                                                               
 REPRESENTATIVE VEZEY questioned why we want to or need to license             
 hospices.                                                                     
                                                                               
 Number 0356                                                                   
                                                                               
 REPRESENTATIVE RYAN answered that there have been instances where             
 people have found inadequate conditions, people were not receiving            
 the level of care for which they were paying.  This bill would                
 ensure compliance within a national standard so that people receive           
 proper care, retain their dignity and are not taken advantage of in           
 this situation.  There are people who would abuse the system.  With           
 the increase in hospice services and the increase in the older                
 adult population, we want to make sure there is a standard of care            
 and treatment for these people.                                               
                                                                               
 Number 0423                                                                   
                                                                               
 REPRESENTATIVE VEZEY asked how a hospice could take advantage of              
 people.  He assumed people could discontinue hospice services.  He            
 was aware of fraud against senior citizens, but wondered how it               
 entered into this issue.                                                      
                                                                               
 Number 0467                                                                   
                                                                               
 REPRESENTATIVE RYAN explained that a person entering a hospice                
 program is entering with a terminal illness, they might not                   
 necessarily be able to get up and discontinue the service.  The               
 family support might not be as available, especially in Alaska,               
 because the person lacks an extended family.  People might have               
 some monies to pay for services and yet not receive basic services.           
 There have been instances where a person who was incontinent was              
 left for periods of time.  This bill ensures that there is someone            
 to provide oversight to inspect the hospice from time to time,                
 check the records, to make sure services are provided as promised,            
 the level of care is at the acceptable national standard and that             
 people are not being abused.  Some older people with serious                  
 terminal illnesses are not in a position to take care of                      
 themselves.                                                                   
                                                                               
 Number 0646                                                                   
                                                                               
 SHELBY LARSEN, Administrator, Health Facilities Licensing and                 
 Certification, Division of Medical Assistance, Department of Health           
 and Social Services, testified next via teleconference from an                
 offnet site in Anchorage.  It would be his agency's responsibility            
 to develop regulations and (Indisc--paper shuffling) and to provide           
 the oversight to the hospice organizations.  His division has been            
 trying to work with hospice organizations since they were notified            
 about CSHB 152(HES).  They believed the bill, the way it is                   
 currently written, is readable to both the certified and volunteer            
 organizations.  They do support the bill.                                     
                                                                               
 MR. LARSEN explained that some of the problems which occurred are             
 that certain organizations have offered hospice services, but many            
 times they were not providing all the services which are considered           
 essential hospice services or they were offering some services                
 somewhat related to what a hospice organization provides.  His                
 division is expecting that HMOs (Health Maintenance Organizations)            
 will begin entering Alaska.   The HMOs and other managed care                 
 organizations are set up in a way that services are often                     
 fragmented.  This bill would protect the public.  Any entity which            
 claims to provide hospice services would in fact have to adhere to            
 certain standards.                                                            
                                                                               
 MR. LARSEN commented that this bill also provides for oversight,              
 not currently available.  In the certified facilities, Medicare               
 requires 10 percent of the hospice organizations be evaluated each            
 year.  Currently there are three certified hospice organizations              
 which are only being looked at once every three years.  Hospice is            
 a growing provider and there is the expectation that there will be            
 more hospice organizations in the future.  If this was to happen,             
 the length of time between certification reviews would grow.  The             
 division sees this as a problem.                                              
                                                                               
 Number 0862                                                                   
                                                                               
 PAULA McCARON, Hospice of Anchorage, testified next via                       
 teleconference from Anchorage.  She was pleased to see that CSHB
 152(HES) included the provisions requested by the volunteer                   
 hospices.   Specifically, the delineation of requirements for                 
 volunteer hospices regarding administration and the assurance that            
 licensing fees would not be assessed.  In talking to some of those            
 programs around the state, they indicated that they are much more             
 comfortable with those new provisions.                                        
                                                                               
 MS. McCARON commented that, basically, hospice provides volunteer             
 and bereavement support to families after the death of a loved one,           
 spiritual care and focus on supporting families and patients.                 
 Other health care systems only work with patients and do not                  
 provide the other services because they are not within the scope or           
 mission of that particular health care program.  There have been              
 situations where people are being offered nursing care, while it              
 may be high quality nursing care, it is being promoted as hospice             
 care.  People are not receiving the full range of services that               
 entail the hospice philosophy.  This was the reason for promoting             
 legislation.  When people are in a vulnerable and stressful place             
 in their lives and are relying on the words of others and referrals           
 by health care providers, not knowing fully what to expect, that              
 they could be ensured that they would receive the full level of               
 hospice services.                                                             
                                                                               
 Number 0965                                                                   
                                                                               
 CHAIRMAN BUNDE said that, typically, he imagined that hospice care            
 was arranged by a family member.  He asked if individuals checked             
 themselves into a hospice program without family involvement.                 
                                                                               
 Number 0981                                                                   
                                                                               
 MS. McCARON answered that, in her Anchorage program, most often the           
 referrals are a result of a family member.  The family member has             
 initiated a phone call and typically knows very little about the              
 services that a hospice provides.  The topic of dealing with a                
 loved one's impending death is so emotionally charged that often              
 people are doing all they can do to pick up the phone and make that           
 first call.  These people tend not to ask a lot of questions, in              
 terms of making sure they receive quality services.  They do                  
 express concern about the cost of care.  Referrals are usually done           
 by a family member, not the individual themselves.                            
                                                                               
 Number 1044                                                                   
 REPRESENTATIVE JOE GREEN said the definition of a hospice covers              
 physical, emotional, theological and other areas of service.  He              
 expressed concern that if there were rigid guidelines, would it               
 have an adverse affect on the volunteers, spiritually and                     
 emotionally.  He also asked if volunteers receive training.                   
                                                                               
 Number 1089                                                                   
                                                                               
 REPRESENTATIVE RYAN said CSHB 152(HES) would require that a                   
 volunteer receive 18 hours of training.  He felt that the people              
 who run volunteer hospice organizations, especially the volunteer             
 programs who adhere to the national standards, would request a                
 volunteer to receive training on the philosophy of a hospice and              
 what it is that a volunteer is expected to do.                                
                                                                               
 REPRESENTATIVE RYAN commented on the concept of hospice.  Kegler              
 Ross (Ph.) was the person who came up with the idea of death with             
 dignity, that you shouldn't be stuck alone in a hospital bed                  
 someplace with family visiting once in awhile.  He said we are just           
 going back to what used to happen, his grandmother died at home.              
 He explained that hospice aids the family.                                    
                                                                               
 Number 1171                                                                   
                                                                               
 CHAIRMAN BUNDE explained that there was initial testimony from                
 volunteer hospice organizations where people were concerned about             
 being subjected to regulations.  The committee has adopted CSHB
 152(HES) which alleviates some of those concerns.                             
                                                                               
 Number 1246                                                                   
                                                                               
 REPRESENTATIVE VEZEY felt this was an important area.  Although               
 CSHB 152(HES) talks about protecting terminally ill people from               
 fraud, he did not feel it was being addressed in this bill.  He did           
 not feel that CSHB 152(HES) addressed the issue of fraud as there             
 are not any gates in which do that.  He asked how fraud was                   
 perpetrated on a senior citizen or a terminally ill person.  He               
 felt that normally a family would request the service.  If there              
 isn't a family, he did not feel that a terminally ill person would            
 typically check themselves into a hospice.  He said a medical                 
 facility would go through some sort of process to transfer a person           
 to hospice care.  He asked what mechanisms would allow fraud to be            
 perpetrated and what could the legislature do to put some side-               
 boards up to make it difficult for fraud to occur.                            
                                                                               
 Number 1254                                                                   
                                                                               
 REPRESENTATIVE RYAN referred to the HMO concept on a nationwide               
 scale.  These are profit making organizations.  He discussed a                
 myriad of concerns regarding these organizations; not being able to           
 get an appointment in a timely manner and not getting services                
 outside the HMO.  This bill is a first step to ensure that                    
 everybody plays by the same rules, the national standards for                 
 hospice care.  It gives some oversight where there isn't any now.             
 In the future, there might be some other things that need to be               
 done.  He did not try to address all the possibilities which might            
 occur, it is just a basic framework to see that there is some                 
 oversight to ensure a standard level of hospice service.                      
                                                                               
 Number 1349                                                                   
                                                                               
                                                                               
 CONNIE J. SIPE, Director, Division of Senior Services, Department             
 of Administration, said her division provides Medicare counseling.            
 Medicare is a federal program which seniors qualify for by reason             
 of their own social security eligibility.  Hospice is a Medicare              
 benefit, something that the state of Alaska does not regulate.  As            
 a condition of receiving Medicare funding in the state, the state             
 has to agree to certify, to the federal Medicare agency, those                
 agencies which are qualified to be paid directly by Medicare.  The            
 federal government pays directly to an agency for the benefit,                
 known as the hospice benefit.  Alaska, for years, has had certified           
 hospice agencies, certified according to federal standards, which             
 qualifies them for federal payment.                                           
                                                                               
 MS. SIPE explained that the Division of Senior Services and the               
 DHSS are very supportive of getting this licensure in place as a              
 first step to make sure that we have some protection for the                  
 consumers of this service.  If someone holds themselves out as a              
 hospice agency, but doesn't care to receive Medicare money, then              
 the state has no ability to say that the organization should not              
 represent themselves as a hospice agency to consumers in their town           
 or area.  This is why licensure and federal Medicare payment                  
 certification allows certain standards.  The state does the                   
 licensure and the federal government has the state complete payment           
 certification, but the two are not the same.  If the state's                  
 certification agency in the state, located in the Division of                 
 Medical Assistance, said a certain hospice entity may not receive             
 Medicare payments because of a failure to meet the standards, then            
 that agency could provide services for their private pay clients.             
 The state would then not have any grounds to prevent them from                
 representing themselves as a hospice organization.                            
                                                                               
 MS. SIPE suggested that it is difficult, in this time when we are             
 not looking for more government regulation, to realize that if we             
 are interested in providing protection for the vulnerable elderly             
 it is important that, at the state level, we do the basic                     
 regulation of setting up licensure.  This bill would have more                
 detailed regulations.  The state's intent is to have the                      
 regulations parallel the federal certification standards.  Even if            
 some person or group held themselves out to be a hospice                      
 organization and decided not to be a federally certified Medicare             
 hospice agency, the state could enforce some basic standards.                 
                                                                               
 MS. SIPE said the same is true for us for home health care                    
 agencies, hospice agencies and certified nurse's aides.  The state            
 has leaned on federal certification payment standards, but the                
 state has not had their own enforcement mechanism in place.  The              
 state can go after organizations for criminal acts, but can't                 
 regulate how they enter the business, train staff, represent                  
 themselves, whether they get bonding, or other things which seem              
 necessary to have in place before an organization provides services           
 or calls themselves something to the public.  Licensure is a basic            
 beginning for the state of Alaska.  The high interest which was               
 shown last year, regarding protection for the vulnerable elderly,             
 is promoting legislation which would put in place some long overdue           
 regulations.  Alaska is one of the few states which doesn't have              
 basic licensure in place.  She referred to this bill, a certified             
 nurse's aid bill, as well as a possible home health agency                    
 licensing bill which would provide this basic licensure.                      
                                                                               
 MS. SIPE explained that under federal Medicare, a doctor prescribes           
 hospice.  Whether it is the family who suggests hospice to the                
 doctor, it is still the doctor who prescribes it under the federal            
 social security hospice benefit.  This benefit defines who is                 
 eligible, for how long a benefit period and what it covers.  It is            
 a valuable benefit under social security.  The majority of people,            
 who use hospice, receive it under this benefit.                               
                                                                               
 MS. SIPE said her father died 18 months ago in Florida under                  
 hospice care.  Once her father was signed up for Medicare hospice             
 care, by his doctor who certified in the normal course of his                 
 disease he would not be likely to live more than six months, the              
 hospice agencies and their nurses became a link.  Every time her              
 mother was worried, she did not have to take her husband to the               
 doctor.  The nurse would make an extra stop and check his vital               
 signs, check with the doctor to change his nausea medication.                 
 Medicare would have had to pay if her father had to run to the                
 doctor every time.                                                            
                                                                               
 MS. SIPE explained that the federal Medicare benefit includes extra           
 things such as paying for all of the prescription drugs relating to           
 pain relief and management of disease.  Normally Medicare does not            
 pay for any prescription drugs for our senior citizens.  The                  
 prescription drugs, which can be useful around death and dying, are           
 often expensive.  The other benefits include helping to pay for the           
 hospital bed, oxygen and other equipment.  Hospice is a wonderful             
 service and citizens will be using it whether or not the state                
 provides licensure.  Senior citizens, who use this benefit under              
 Medicare, will have some protection because of payment and                    
 certification linkage to the federal standards.  Younger citizens             
 who use hospice, under private pay or a private insurance, will not           
 have any way to ensure those standards.                                       
                                                                               
 Number 1655                                                                   
                                                                               
 RUPERT E. ANDREWS, Lobbyist, American Association of Retired People           
 (AARP), said his organization is in full support of CSHB 152(HES).            
 There was a concern that small communities would not be able to               
 meet the original regulations, but this has been addressed in the             
 current language of CSHB 152(HES).                                            
                                                                               
 Number 1678                                                                   
                                                                               
 REPRESENTATIVE FRED DYSON asked about the senior citizen ombudsman            
 in the state.                                                                 
                                                                               
 Number 1691                                                                   
                                                                               
 MS. SIPE answered that there was a long term care ombudsman, but              
 the official jurisdiction only has powers for long term care out of           
 home care or out of home care facilities only.  They can do                   
 intervention and health advocacy, but they don't have the same                
 powers as they have with nursing homes and assisted living homes.             
 Hospice would be an area that a long term care ombudsman is                   
 concerned about, but it wouldn't be within their strongest federal            
 jurisdiction nor are they authorized to serve people under age 60.            
 There are many users of hospice under age 60.                                 
                                                                               
 Number 1720                                                                   
                                                                               
 REPRESENTATIVE DYSON asked if AARP did not believe that most of the           
 consumers or family members, utilizing hospice care, are in the               
 position to make inspections and ensure quality services.                     
                                                                               
 Number 1738                                                                   
                                                                               
 MR. ANDREWS suggested that the main concern is that there should be           
 a standard of services.  As new units and services are added, they            
 should meet some standard for the consumer public.                            
                                                                               
 Number 1753                                                                   
                                                                               
 REPRESENTATIVE GREEN asked, under the current law, if he started a            
 hospice organization would there would be any standards under which           
 he would have to perform.  He also asked if he could receive                  
 Medicare payments for the services his organization provides.                 
                                                                               
 Number 1781                                                                   
                                                                               
 MS. SIPE explained that if his organization found families who                
 would privately pay him, he could do that and the state would not             
 have the ability to set standards for him or his employees.  If his           
 organization wished to be paid by Medicare or Medicaid for some of            
 the clients, then his organization would have to come to the state            
 and receive certification under the federal standards.  If his                
 organization operated in that area outside Medicare and Medicaid,             
 then the organization would not have to be licensed, they could               
 operate on a business license.  If the organization took people in,           
 then the state could come in and say that he was operating a                  
 nursing home without a license.  If he went into people's homes and           
 provided hospice care, then the state would not have a way to                 
 protect the consumers.  The consumers, at the very time that they             
 want the service, are dealing with the imminence of death.  Family            
 members do not have the energy to go out and investigate these                
 agencies.                                                                     
                                                                               
 Number 1830                                                                   
                                                                               
 REPRESENTATIVE GREEN clarified that there is no control over what             
 his proposed organization might charge these bereaved people.  He             
 asked if there were standards if his organization received Medicare           
 payments.                                                                     
                                                                               
 Number 1845                                                                   
                                                                               
 MS. SIPE explained that if his organization wanted to bill Medicare           
 a rate is set for each visit, the benefit period and for certain              
 other services.  The same would also apply if he wanted to bill               
 Medicaid, the state would set a rate.  At this point, the licensure           
 law does not contemplate setting rates for private pay clients.               
 This would still be in the private market sector.  If his                     
 organization dealt with someone who had AETNA insurance which                 
 covered hospice care, the provider would either have to agree what            
 AETNA paid or get a deductible from the consumer.  If his                     
 organization just took private pay clients, no one could say                  
 anything about what he did until a criminal fraud was committed.              
                                                                               
 Number 1878                                                                   
                                                                               
 REPRESENTATIVE GREEN verified that CSHB 152(HES) would rectify this           
 situation.                                                                    
                                                                               
 Number 1883                                                                   
                                                                               
 REPRESENTATIVE VEZEY clarified that there is no evidence of any               
 unscrupulous characters in this business right now.  He has not               
 heard anything about how fraud would be perpetrated and what the              
 state could do to prevent it.  Another concern is that we are                 
 talking about an inspection every three, four or five years.                  
 Inspections are not a very good policing force.  There is some sort           
 of policing force out there now because he has not heard anything             
 ill about hospice programs in Alaska.                                         
                                                                               
 Number 1922                                                                   
                                                                               
 MS. SIPE clarified that she didn't speak for the DHSS, but she                
 would try to answer his questions.  Doctors, real estate agents,              
 nurses and other professions are licensed.  There isn't always an             
 inspection every year, but a complaint can be made about services,            
 quality, or a possible overreach of services to medical                       
 certification licensing.  This licensing agency has civil type of             
 investigators who can look into the matter.  They can use licensing           
 laws and take disciplinary action or write a letter.  It isn't just           
 those inspections which provide the oversight.  Without this                  
 licensure, a person would have to file a private lawsuit against              
 this person or organization.                                                  
                                                                               
 MS. SIPE explained that the lucky thing about this bill is that               
 since the federal government already pays the state for the cost of           
 certifying these agencies and investigating complaints, it                    
 shouldn't cost the state anything more.  She referred to the zero             
 fiscal note from DHSS.  It will only be an incremental amount above           
 that, it won't require a big new project to handle this licensure.            
                                                                               
 Number 1991                                                                   
                                                                               
 REPRESENTATIVE VEZEY asked how fraud was perpetrated against                  
 seniors and how it been adequately addressed in our laws.  He cited           
 the classic case where people are talked into signing over all                
 their worldly possessions in turn for being cared for the rest of             
 their life.                                                                   
                                                                               
 Number 2011                                                                   
                                                                               
 MR. ANDREWS expressed concern that the people who are administering           
 care to the public have a minimum amount of training, qualifying              
 them to do whatever duties they need to do, particularly in the               
 small, rural communities.  These communities do not always have the           
 opportunity to have registered nurses.  This bill would mandate a             
 minimum amount of training, so that no matter where a hospice unit            
 was created, there would be that standard of care available.                  
 Hospice provides follow-up counseling and work with the survivors.            
                                                                               
 Number 2049                                                                   
                                                                               
 CHAIRMAN BUNDE asked if it was fair to say that CSHB 152(HES) was             
 a consumer protection and equal protection issue, those who don't             
 pay for hospice currently have some consumer protection and those             
 who do pay out of their own pocket will be provided protection.               
                                                                               
 Number 2067                                                                   
                                                                               
 REPRESENTATIVE RYAN said this was a fair assessment.                          
                                                                               
 Number 2071                                                                   
                                                                               
 REPRESENTATIVE VEZEY made a motion to move CSHB 152(HES) out of               
 committee with individual recommendations and attached fiscal note.           
 Hearing no objection CSHB 152(HES) was moved from the Health,                 
 Education and Social Services Standing Committee.                             
 HB 193 - REPAY GRADUATE EDUCATION AID                                       
                                                                               
 Number 2138                                                                   
                                                                               
 CHAIRMAN BUNDE announced the next item on the agenda was HB 193,              
 "An Act relating to financial assistance for students attending               
 certain graduate education programs; and providing for an effective           
 date."                                                                        
                                                                               
 TAPE 97-24, SIDE B                                                            
 Number 0000                                                                   
                                                                               
 CHAIRMAN BUNDE explained that HB 193 addresses a forgiveness                  
 provision for those who take advantage of the state subsidy to                
 attend medical school.  If those graduates return to the state of             
 Alaska and practice medicine for five years, they would be forgiven           
 a portion of their indebtedness.  If they choose not to return,               
 then they would reimburse the state.  There are ten students a year           
 who go into this program, historically a little less than half                
 return to the state and practice medicine.  The program costs $1.6            
 million a year for a total of 40 students.  A hefty investment is             
 being made for these students and the state has a right to expect             
 that they will return.  The people at the university, who supervise           
 this program, are quick to note that another five physicians do               
 come to Alaska and practice medicine.  He suggested that Alaska               
 should receive the credit, rather than giving the program credit.             
                                                                               
 CHAIRMAN BUNDE noted that Ms. Barrans was hear to testify.  He                
 referred to her written comments and said he would work with her to           
 address those questions in the bill.  If needed, they would be                
 addressed in a committee substitute.                                          
                                                                               
 Number 0151                                                                   
                                                                               
 DIANE BARRANS, Executive Director, Postsecondary Education                    
 Commission, Department of Education, apologized for the lateness of           
 getting the written testimony to the committee.  The commission has           
 not taken a position on HB 193, it has not been reviewed, so at               
 this time they would be considered neutral.                                   
                                                                               
 Number 0189                                                                   
                                                                               
 CHAIRMAN BUNDE clarified that the postsecondary education                     
 commission would be the vehicle in which to collect the repayment.            
                                                                               
 Number 0203                                                                   
                                                                               
 REPRESENTATIVE GREEN said that some of the postsecondary education            
 loans have met with less than a desirable response in terms of                
 repayment.  He asked what sort of repayment occurs for those                  
 medical people who don't come back to Alaska.                                 
                                                                               
 Number 0227                                                                   
                                                                               
 MS. BARRANS explained that she did not have information about the             
 repayment plan for those medical students who are currently                   
 training and borrowing from the regular Alaska student loan program           
 and do not come back to the state.  A sophisticated system research           
 would have to be done to come up with that data.  The older loans             
 did not have the field of study, which is currently being done, so            
 it would be difficult to get meaningful information about how well            
 these people behave in terms of repayment.  She suspected that the            
 repayment behavior is quite good because some examinations for                
 students who graduate from four year colleges have occurred and it            
 has shown a high repayment rate.                                              
                                                                               
 Number 0285                                                                   
                                                                               
 CHAIRMAN BUNDE asked if any research had been done on if there is             
 a difference in repayment for those people who graduate from four             
 year institutions and remain non-residents of Alaska as opposed to            
 those who remain residents of Alaska.                                         
                                                                               
 Number 0307                                                                   
                                                                               
 MS. BARRANS answered that this is perhaps the case, but she would             
 have to review the information and get back to the committee.                 
                                                                               
 Number 0313                                                                   
                                                                               
 REPRESENTATIVE GREEN expressed concern that the state is paying a             
 significant amount for these students and we don't know whether               
 they are repaying the state.                                                  
                                                                               
 Number 0335                                                                   
                                                                               
 MS. BARRANS explained that global default rate calculations have              
 been done, but there is not a research staff to determine how many            
 psychiatrists or medical doctors repay the state.                             
                                                                               
 Number 0354                                                                   
                                                                               
 REPRESENTATIVE GREEN clarified that he was asking about loan                  
 tracking.                                                                     
                                                                               
 Number 0362                                                                   
                                                                               
 MS. BARRANS stated that approximately 18 percent of borrowers                 
 default.  Of that amount, the state continues to collect on an                
 additional 8 percent.  As far as the money given out, money to be             
 repaid, the state fails to collect between 11 and 12 percent of               
 that money due to default or death.                                           
                                                                               
 Number 0392                                                                   
 REPRESENTATIVE GREEN said this was pretty specific.  He asked                 
 whether the commission knew whether this was equal between those              
 who are in the state or those who are not in the state.                       
                                                                               
 Number 0396                                                                   
                                                                               
 MS. BARRANS explained that the statistical analysis shows that the            
 repayment behavior of those who remain outside the state is                   
 somewhat better than those who remain in the state.                           
                                                                               
 Number 0421                                                                   
                                                                               
 MIKE MAHER, Director of Student Financial Aid, Postsecondary                  
 Education Commission, Department of Education, stated that of the             
 plus $1.3 million which is funneled through the commission for this           
 program, it is a direct grant.  None of the money is paid back into           
 the program.  Ms. Barrens talked about how these students can also            
 borrow through the regular student loan program, approximately                
 $10,000 a year.  This is an area which is being tracked, they are             
 just like any other general fund money which the legislature                  
 appropriates every year.  This is the $1.6 million direct grant               
 which is not returned.  This bill attempts to turn this portion               
 into a loan program.                                                          
                                                                               
 Number 0476                                                                   
                                                                               
 CHAIRMAN BUNDE clarified that many of the students eligible for the           
 grant program also receive student loans.                                     
                                                                               
 Number 0513                                                                   
                                                                               
 LAURA BURLESON, Student, testified next via teleconference from               
 Fairbanks.  She voiced her support for the proposed format of this            
 program.  As a pre-medical student, she is aware of the importance            
 of this program.  Getting into medical school is more difficult               
 than it ever was in the past.  She received a medical school                  
 rejection letter with an explanation that the school had received             
 10,096 applications for 113 positions.  This is true throughout               
 most of the country.  The WAMI program gives students from Alaska,            
 who don't have an in-state medical school, a medical school                   
 preference and a chance at getting admitted.  She was in favor of             
 keeping the program.  She realized, in these financial times, the             
 state needs to find ways to generate revenue and felt this bill was           
 fair.  If the state is going to pay something for a person's                  
 education, then something should be required in return whether it             
 is by serving the state or paying money back if a student decides             
 to practice medicine elsewhere.                                               
                                                                               
 MS. BURLESON expressed concern about the repayment conditions.  The           
 bill says does not require repayment while the student is in                  
 medical residency.  Above this, the bill states that repayment is             
 not required until six months after termination of the graduate               
 program.  If she chose to move out of state, she questioned whether           
 repayment would begin right after residency or within that six                
 months after medical school.  Aside from that concern, she is in              
 support of this bill as it is fair to the students, the state and             
 the taxpayers.  It is an equitable solution and a compromise.                 
                                                                               
 Number 0647                                                                   
                                                                               
 JEAN RICHARDSON, Student, testified next via teleconference from              
 Fairbanks.  She thought HB 193 was a good bill, it focused the                
 intent of the lending program.  This program is supposed to be                
 there for students who need it, it asks that they not move out of             
 state and assists them in getting preference to an out of state               
 medical school as Alaska does not have a state medical school.  It            
 takes those people, who are committed to staying in Alaska, gives             
 them a chance to go to school and then come back to Alaska.  They             
 wouldn't be competing against people who plan to move out of                  
 Alaska.  Those people are not providing a benefit back to the                 
 state.                                                                        
                                                                               
 Number 0688                                                                   
                                                                               
 CHAIRMAN BUNDE stated that their testimony was refreshing as                  
 compared with other students, in years past, who had told him no,             
 that if they had to repay the money they would go somewhere else on           
 a scholarship.  Those students were only participating in this                
 program because Alaska was giving them 100 percent.                           
                                                                               
 Number 0712                                                                   
                                                                               
 REPRESENTATIVE VEZEY asked the status of the WAMI program.                    
                                                                               
 Number 0721                                                                   
                                                                               
 CHAIRMAN BUNDE said the legislature had looked at changing the                
 program a year or two ago.                                                    
                                                                               
 Number 0729                                                                   
                                                                               
 MS. BARRANS suggested that they might be thinking of the Western              
 Interstate Commission on Higher Education (WICHE) student exchange            
 program which was also health education; veterinary medicine,                 
 optometry, allied health, occupational therapy, et cetera.  That              
 program has been effectively phased out.  The WAMI program is the             
 sole program through which Alaskans have preferential access to               
 medical education at the University of Washington.                            
                                                                               
 Number 0744                                                                   
                                                                               
 CHAIRMAN BUNDE commented that last year the legislature passed a              
 bill affecting the whole student loan program, which allowed a                
 floating interest rate and diligence in repayment.  He said as this           
 is the first time the bill has been heard, no action will be taken            
 on it today.                                                                  
 HB 127 - FOSTER CARE REVIEW BOARD                                           
                                                                               
 Number 0801                                                                   
                                                                               
 CHAIRMAN BUNDE announced the next item on the agenda was HB 127,              
 "An Act relating to the citizen review board and panels for                   
 permanency planning for certain children in state custody; renaming           
 the Citizens' Review Panel For Permanency Planning as the Citizens'           
 Foster Care Review Board; extending the termination date of the               
 Citizens' Foster Care Review Board; and providing for an effective            
 date."                                                                        
                                                                               
 Number 0827                                                                   
                                                                               
 PATRICIA SWENSON, Legislative Assistant to Representative Bunde,              
 referred to the committee substitute.  The goal of the committee              
 substitute for HB 127 and of foster care review in general is to              
 assure that children do not linger unnecessarily in out-of-home               
 care.  To that end, this legislation strengthens the independence             
 of both the citizens' foster care review board and the local review           
 panels.  Additionally the sunset date for the board is extended to            
 June 30, 2000.                                                                
                                                                               
 MS. SWENSON stated that independent foster care review panels are             
 not a new concept.  South Carolina enacted the first legislation in           
 1974.  Since that time, 26 other states have followed their                   
 example.  Foster care review panels, in all the states, have been             
 successful at decreasing the amount of time children linger in out-           
 of-home care as well as in decreasing the number of times a child             
 needs to be moved from one out-of-home placement to another.  The             
 accomplishment of these goals saves both staff time and state                 
 dollars for the involved agencies, but more importantly it creates            
 a more stable environment for children in out-of-home placements.             
 She said all of these are things that the committee substitute for            
 HB 127 hopes to accomplish.                                                   
                                                                               
 MS. SWENSON listed the highlights of the committee substitute for             
 HB 127.  The citizens' foster care review board is reestablished,             
 the members will be appointed by the Governor, the board will also            
 appoint local panel members in each judicial district throughout              
 the state.  It will create an executive director position.  The               
 executive director will be empowered to write grants and\or                   
 contracts to local agencies, help expand existing local panels and            
 help create new panels in all areas of the state.  The executive              
 director will keep statistics which will indicate whether or not              
 the board is achieving the goal of decreasing the amount of time              
 children spend in out-of-home placements.  If this is accomplished,           
 the board will be able to show a cost savings to the state.                   
                                                                               
 MS. SWENSON stated that the ability to keep accurate statistics               
 depends on the cooperation of the Division of Family and Youth                
 Services (DFYS).  The state board must be able to get the necessary           
 information from the DFYS, which has not been possible most of the            
 time.  However, the DFYS is creating a new data system which will             
 allow a link to the state board office.  The division has indicated           
 a willingness to allow existing employees of the panel to have                
 input into the creation of the data system which will ensure proper           
 data collection by the state board.                                           
                                                                               
 MS. SWENSON explained that another part of this bill is that the              
 state board will be responsible for training all local panel                  
 members.  Local panel members will be appointed by the state board            
 in each judicial district of the state.  More than one panel can              
 also be allowed in each district.  The panels will consist of three           
 or more volunteers.  The duties of the review panel are stated                
 clearly.  The state board or local panels are granted access to any           
 state agencies records for the purpose of locating interested                 
 parties for hearing notification.                                             
                                                                               
 Number 1006                                                                   
 MS. SWENSON said, finally, the bill contains a provision that will            
 allow the recommendations and findings of the panel to be placed              
 into the court's records for consideration in the disposition of a            
 case.  Input about the provisions of this committee substitute was            
 obtained from Office of Public Advocacy, public defender's office,            
 private lawyers within the system, DFYS and the Department of                 
 Administration.  There are some concerns that have been consistent            
 throughout the discussions.  Three of the largest concerns regard             
 placing language in the bill stating that the panels will comply              
 with Title 4-E review requirements.  Another concern is the                   
 broadness in the language used to grant the state board and the               
 local panels access to other agency's records for the purpose of              
 locating and notifying interested parties of hearings.  The                   
 existing panel is very willing and anxious to work with the                   
 departments towards a solution to meet the needs of everyone                  
 concerned.  The panel wishes to retain the ability to function as             
 an independent oversight entity and will have its findings and                
 recommendations weighed equally with the concerns of others who are           
 interested in each case.  The intention of the state board and the            
 local review panel is to have a fair process with as much                     
 participation as possible from interested parties.                            
                                                                               
 Number 1284                                                                   
                                                                               
 CHAIRMAN BUNDE stated that the basis of HB 127 is a citizen                   
 oversight review of work done by DFYS.  It would try to make sure             
 that parents or grandparents are involved in hearings regarding a             
 child's disposition.                                                          
                                                                               
 MS. SWENSON said the panel independently hears cases and asks                 
 questions about whether reasonable efforts have been made to                  
 prevent an initial placement in foster care.  The panel finds out             
 whether the child's current placement is appropriate and if                   
 progress has been made to alleviate the cause of the out-of-home              
 placement.  They also check on the compliance level of the parents            
 or anyone involved in the case plan.                                          
                                                                               
 CHAIRMAN BUNDE stated that they would be considered a gentle                  
 watchdog group.                                                               
                                                                               
 Number 1284                                                                   
                                                                               
                                                                               
 NANCY MILLER, Director, Citizen Review Board Program, State of                
 Oregon, testified next via teleconference from an offnet site.  In            
 Oregon they are housed in the judicial branch, but the functions              
 are very much the same as the functions that are being proposed in            
 HB 127.  The review board system maintains a comprehensive data               
 base that collects about 25 data points on every reviewed child in            
 foster care.  Reviews are started, in Oregon, at six months, so               
 they are tracking the long term population.  One of the criticisms            
 of the program is that they start too late.  She supported the 90             
 day start time which is in HB 127.  The data, located in the                  
 committee file, shows a decreasing length of time for children in             
 long term foster care.  In 1992, children were spending an average            
 of 36.5 months in foster care and in 1996, that number was down to            
 27.9 months.  This data is only on the long term population.  The             
 Oregon child welfare agency's data looks very different, in terms             
 of the overall length of stay which is down 22 months because they            
 are also counting the children who go in and out of the system up             
 at the front end.  The review board does not see these children.              
                                                                               
 Number 1237                                                                   
                                                                               
 MS. MILLER explained that the review board also tracks the number             
 of moves of children in care.  In 1992, for the long term                     
 population, there was 4.1 moves per child and for 1996 that number            
 is down to 3.1 moves.  When you look at both of these statistics,             
 you are measuring the fiscal savings to the state, in terms of                
 having the boards review these cases, and the emotional savings for           
 children, in terms of reducing the trauma of moving them from                 
 placement to placement.  In their monthly care report, they talk              
 about the Citizen Review Board (CRB), which is the abbreviation for           
 their program in Oregon.  The CRB is meant to be an active player             
 and partner in the system to access those outcomes for children.              
 She would not say that the reason for the reduction in the length             
 of stay is due to the CRB, but she would say that the overall                 
 length of stay for all the kids in care is increasing and the only            
 difference, for the long term population is that the CRB is                   
 involved.  This says, to her, that the CRB has a significant                  
 impact.                                                                       
                                                                               
 MS. MILLER stated that when this program started in Oregon, they              
 were called an adversarial watchdog group.  It was clear in their             
 legislation that there is a dual mission and the mission of HB 127            
 looks the same to her.  The job is not only to review the cases of            
 individual children, to make sure that they are moving through the            
 system, but to make recommendations on policies, procedures and               
 laws relating to substitute care.  They are providing both the                
 oversight role and one of advocacy.  There are about 350 volunteers           
 serving on 70 boards around Oregon.  Those folks are highly                   
 educated about the child welfare system and how it works.  They are           
 active in advocating for resources for the children in their                  
 community.  They have been instrumental in providing information to           
 the agency to ensure that the agency is dealing with programs which           
 work.  Two group homes closed down as a result of the intervention            
 of the board, those homes were not adequately providing for the               
 children.                                                                     
                                                                               
 Number 1342                                                                   
                                                                               
 MS. MILLER cautioned the committee about saying that HB 127 has               
 only a watchdog role.  This is certainly a part of the goal, but              
 the advocacy role is equally as important.                                    
                                                                               
 Number 1350                                                                   
                                                                               
 CHAIRMAN BUNDE stated that he viewed it as a very protective                  
 watchdog role.                                                                
                                                                               
 Number 1375                                                                   
                                                                               
 CANDICE WHEELER testified next via teleconference from an offnet              
 site.  She worked with the foster care and home program in                    
 Anchorage since its inception in late 1993 to the fall of 1996 when           
 (Indisc.)  She had been a social worker for almost 30 years and               
 substitute care has been her area of expertise.  (Indisc.) mommy              
 and daddy.  She has seen first-hand the kind of incredible                    
 emotional trauma which occurs to children in the substitute care              
 system.  Having worked as a social worker, it was exciting for her            
 to come to the foster care review program.  In her three years                
 there, she became a real believer in this effort.  Calling this               
 type of program a watchdog does seem to have a negative                       
 implication, but we need, as citizens, to be watchdogs for our                
 children.  These children belong to Alaska.                                   
 MS. WHEELER said that one of the great strengths of citizen reviews           
 is in dealing with the crises of individual children.  There are 20           
 to 25 individual citizens who give their time to really sit and               
 listen, day after day, to what is happening in the foster care                
 system.  These people are empowered to go out and advocate as Ms.             
 Miller talked about in her testimony.  It is critical, from that              
 standpoint, to have someone outside the system serve those children           
 and provide oversight to the programs.                                        
                                                                               
 Number 1465                                                                   
 MS. WHEELER referred to an editorial in the Anchorage newspaper a             
 few years ago after a 14-year-old boy shot his father in central              
 Alaska.  The article said that the way the system is set up, there            
 is no way for anyone in the state to know the truth, what is                  
 happening to kids in the foster care and child protection system.             
 The article said that if DFYS does its job, the public needs to               
 know that and if the agency isn't doing its job, the public needs             
 to know that too.  This is the kind of thing that citizen reviews             
 and independent reviews bring to the table for kids who are in out-           
 of-home care.                                                                 
                                                                               
 MS. WHEELER stated that she is supportive of this legislation which           
 strengthens what has been done in Anchorage and allows it to move             
 to the rest of the state.  Many times outlying areas have asked the           
 program in Anchorage why they can't have a citizen review.  Her               
 organization works with Native groups, non-profit groups and areas            
 throughout the state because kids often gravitate to Anchorage.               
 This kind of program needs time to work, it has only been in                  
 existence for three and a half years.  Funding has been short so it           
 has been difficult to demonstrate the kind of statistics that Ms.             
 Miller used.  It is worthwhile to look at similar programs around             
 the United States to see their results and what results can be                
 expected in Alaska when the program expands.                                  
                                                                               
 MS. WHEELER stated full support of these changes, they are critical           
 and they will be the kind of things which will make a real                    
 difference for individual children and for all of Alaska's                    
 children.  Better services for them, when they've had the horrible            
 trauma of being separated from their original parents.                        
                                                                               
 Number 1561                                                                   
                                                                               
 BARBARA MALCHICK, Deputy Public Advocate, Office of Public                    
 Advocacy, testified next via teleconference from Anchorage.  Among            
 her duties, she is a guardian ad litem and supervises all the                 
 guardian ad litems.  It is her job to represent the best interest             
 for children who are in the foster care system.  On behalf of the             
 guardian ad litems and the children that they represent, she                  
 strongly supported the continuation and the strengthening, through            
 expansion, of the citizens' foster care review board.  With                   
 adequate funding, staffing and training the review board is a                 
 valuable tool to make the system more responsive to the needs of              
 the children in foster care, both on the individual small picture             
 and on the big picture level.  The process holds people responsible           
 and gets the correct services for the child; either through getting           
 the child back at home, preferably, or finding another alternative            
 permanent placement for the child.  On the bigger picture, the                
 foster care review board can be an advocate for overall changes               
 within our system.                                                            
                                                                               
 Number 1621                                                                   
                                                                               
 MS. MALCHICK suggested that some provisions need to be changed in             
 HB 127.  The bill proposes to move the initial review from 180 days           
 to 90 days and she said there might be some problems with moving              
 this date up.  It is also important to look at the provision                  
 regarding submitting the panel's report to the court.  She felt               
 solutions could be reached and added that the state needs this sort           
 of a bill.                                                                    
                                                                               
 Number 1657                                                                   
                                                                               
 SCOTT CALDER testified next via teleconference from Fairbanks.                
 Generally speaking, he was against HB 127.  A bill similar to HB 92           
 or SB 15 from the 19th Legislature would be appropriate.  Merely              
 extending the sunset termination date of the program, as it                   
 currently exists in law, effective since July 1, 1990.   The                  
 important thing to remember here is that when we are talking about            
 citizen oversight, essentially it is agency personnel who comply to           
 some appropriate legal, moral or other standard.  The legislature             
 was elected to do these things for us.  He suggested the reason for           
 this review process is to periodically document the work of state             
 government in statute.  He did not feel it was a good idea to                 
 create a new and improved, high dollar level of bureaucracy to save           
 children and all of those other things.  Many other speakers do not           
 talk about the problems of saving children from state government,             
 this is the heart of the matter when it comes to citizen review.              
 Subjecting children, parents and families to an inquisitorial                 
 process is already in place.  We need an irresistible oversight               
 effort directed specifically at state agencies by the people of the           
 state of Alaska.  This has already been done by the Citizens'                 
 Review Panel for Permanency Planning Act of 1990.  Historically,              
 the problem has been the implementation of the program which                  
 requires the Governor of this state to make appointments to local             
 panels.  It has been six and a half years where there has not been            
 full compliance with the requirement by law to make appointments to           
 the local and state panel.                                                    
                                                                               
 Number 1742                                                                   
                                                                               
 MR. CALDER briefly wanted to run through a memorandum from Legal              
 Services.  In general the bill renames all of this.  He did not               
 think it needed to be renamed, we need to remember it as it has               
 existed and ask the question of why it has not been allowed to                
 occur.  Many of the sections referred to the changing of the name             
 and the constitution of the panel.  Section 2 states that the DHSS            
 would notify the state board, rather than the local panel.  This is           
 not a very good way to have local oversight.  It avoids people at             
 the local level who are doing the overseeing.  The word, "citizen"            
 has been removed in Section 3.  There have been excellent reasons             
 for supporting the Citizen Review Panel for Permanency Planning Act           
 of 1990, however these reasons, which are good reasons, have been             
 wrongly supported by a series of misleading claims about false                
 assertions and implications of facts, that are not facts about the            
 law, but about the desire to evade existing laws.                             
                                                                               
 Number 1812                                                                   
                                                                               
 REPRESENTATIVE GREEN clarified that Ms. Wheeler was responding to             
 the committee substitute, version F.  He verified that the policy             
 would be that board members would be limited to two consecutive               
 terms.  He asked if that was consistent with what was in place in             
 Oregon.  He made a motion to move that the committee adopt the                
 committee substitute for HB 127, version F, Lauterbach, as the                
 working document.  Hearing no objections CSHB 127(HES) was before             
 the committee.                                                                
                                                                               
 Number 1870                                                                   
                                                                               
 MS. MILLER responded to a concern that panels have to meet the                
 requirements of 42 U.S. C. 671-675 (PL 96-272).  In Oregon, their             
 citizens' review board meets all those requirements.  Their child             
 welfare agency does no review.  In terms of submitting the reports            
 to the court, this is done directly after each review.  This is               
 sometimes difficult if the court hearing occurs right after their             
 review, but most of the time the board is able to get it there in             
 time.  Their child welfare agency had been nervous about whether or           
 not they could meet all the federal requirements.  However if the             
 committee wished to talk with Oregon's shared regional                        
 representative, Carol Overbeck (Ph.) in Region 10, she would assure           
 you that the citizen review could do that.  If the committee wanted           
 any further information, she would be happy to send it by mail or             
 fax.                                                                          
 ADJOURNMENT                                                                   
                                                                               
 There being no further business to conduct, CHAIRMAN BUNDE                    
 adjourned the meeting of the House Health, Education and Social               
 Services Standing Committee at 4:35 p.m.                                      
                                                                               

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