Legislature(2005 - 2006)CAPITOL 106


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                    ALASKA STATE LEGISLATURE                                                                                  
 HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE                                                               
                          May 3, 2005                                                                                           
                           3:28 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Representative Peggy Wilson, Chair                                                                                              
Representative Paul Seaton, Vice Chair                                                                                          
Representative Lesil McGuire                                                                                                    
Representative Sharon Cissna                                                                                                    
Representative Berta Gardner                                                                                                    
MEMBERS ABSENT                                                                                                                
Representative Tom Anderson                                                                                                     
Representative Vic Kohring                                                                                                      
COMMITTEE CALENDAR                                                                                                            
CS FOR SENATE BILL NO. 150(HES)                                                                                                 
"An Act relating to the Alaska children's trust grant awards."                                                                  
     - MOVED CSSB 150(HES) OUT OF COMMITTEE                                                                                     
HOUSE BILL NO. 288                                                                                                              
"An Act relating to the Medicaid personal needs allowance for                                                                   
assisted living home residents; and providing for an effective                                                                  
     - HEARD AND HELD                                                                                                           
HOUSE BILL NO. 271                                                                                                              
"An Act relating to limitations on overtime for registered                                                                      
nurses in health care facilities; and providing for an effective                                                                
     - HEARD AND HELD                                                                                                           
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: SB 150                                                                                                                  
SHORT TITLE: ALASKA CHILDREN'S TRUST FUND GRANTS                                                                                
SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES                                                                                 
03/21/05       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/21/05       (S)       HES, FIN                                                                                               
04/06/05       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
04/06/05       (S)       Heard & Held                                                                                           
04/06/05       (S)       MINUTE(HES)                                                                                            
04/15/05       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
04/15/05       (S)       Moved CSSB 150(HES) Out of Committee                                                                   
04/15/05       (S)       MINUTE(HES)                                                                                            
04/18/05       (S)       HES     RPT     CS           3DP     2NR                                                               
                         NEW TITLE                                                                                              
04/18/05       (S)       DP: DYSON, WILKEN, GREEN                                                                               
04/18/05       (S)       NR: ELTON, OLSON                                                                                       
04/18/05       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
04/18/05       (S)       <Above Bill Hearing Canceled>                                                                          
04/25/05       (S)       FIN    RPT    CS(HES)         4DP    2NR                                                               
                         NEW TITLE                                                                                              
04/25/05       (S)       DP: WILKEN, GREEN, DYSON, STEDMAN                                                                      
04/25/05       (S)       NR: HOFFMAN, OLSON                                                                                     
04/25/05       (S)       FIN AT 9:00 AM SENATE FINANCE 532                                                                      
04/25/05       (S)       Moved CSSB 150(HES) Out of Committee                                                                   
04/25/05       (S)       MINUTE(FIN)                                                                                            
04/26/05       (S)       TRANSMITTED TO (H)                                                                                     
04/26/05       (S)       VERSION: CSSB 150(HES)                                                                                 
04/27/05       (H)       READ THE FIRST TIME - REFERRALS                                                                        
04/27/05       (H)       HES, FIN                                                                                               
05/03/05       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
BILL: HB 288                                                                                                                  
SHORT TITLE: MEDICAID PERSONAL NEEDS ALLOWANCE                                                                                  
SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES                                                                                 
04/28/05       (H)       READ THE FIRST TIME - REFERRALS                                                                        
04/28/05       (H)       HES, FIN                                                                                               
05/03/05       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
BILL: HB 271                                                                                                                  
SHORT TITLE: LIMIT OVERTIME FOR REGISTERED NURSES                                                                               
SPONSOR(S): REPRESENTATIVE(S) WILSON                                                                                            
04/15/05       (H)       READ THE FIRST TIME - REFERRALS                                                                        
04/15/05       (H)       L&C, HES, FIN                                                                                          
04/30/05       (H)       L&C AT 1:00 PM CAPITOL 17                                                                              
04/30/05       (H)       Moved Out of Committee                                                                                 
04/30/05       (H)       MINUTE(L&C)                                                                                            
05/02/05       (H)       L&C RPT 4DP 3NR                                                                                        
05/02/05       (H)       DP:    CRAWFORD,    LYNN,    GUTTENBERG,                                                               
05/02/05       (H)       NR: LEDOUX, ROKEBERG, KOTT                                                                             
05/03/05       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
WITNESS REGISTER                                                                                                              
JASON HOOLEY, Staff                                                                                                             
to Senator Fred Dyson                                                                                                           
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented SB 150 on behalf of the Senate                                                                   
Health, Education and Social Services Standing Committee,                                                                       
sponsor, which is chaired by Senator Dyson.                                                                                     
JOEL GILBERTSON, Commissioner                                                                                                   
Office of the Commissioner                                                                                                      
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified on behalf of the department                                                                      
during the hearing on SB 150.                                                                                                   
MARGO MCCABE, Chair                                                                                                             
Alaska Children's Trust (ACT)                                                                                                   
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified on behalf of ACT during the                                                                      
hearing on SB 150.                                                                                                              
JON SHERWOOD, Medical Assistance Administrator                                                                                  
Office of the Commissioner                                                                                                      
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified on behalf of the department                                                                      
during the hearing on HB 288.                                                                                                   
JANE BARNES, Nursing Director                                                                                                   
Alaska Psychiatric Institute (API)                                                                                              
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Cautioned that HB 271 would have a negative                                                                
impact on patient care.                                                                                                         
DIANNE O'CONNELL, Labor Program Director                                                                                        
Alaska Nurses Association                                                                                                       
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 271.                                                                            
CAROL WIDMAN, Registered Nurse                                                                                                  
Alaska Psychiatric Institute                                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 271.                                                                            
DAVE WILLIAMS, Project Coordinator                                                                                              
Alaska Pioneer Homes                                                                                                            
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during the hearing on HB 271.                                                                    
ACTION NARRATIVE                                                                                                              
CHAIR PEGGY WILSON called the  House Health, Education and Social                                                             
Services  Standing  Committee meeting  to  order  at 3:28:52  PM.                                                             
Representatives Seaton,  Gardner, and Cissna were  present at the                                                               
call to  order.   Representative McGuire  arrived as  the meeting                                                               
was in progress.                                                                                                                
SB 150-ALASKA CHILDREN'S TRUST FUND GRANTS                                                                                    
CHAIR WILSON  announced that the  first order of business  was CS                                                               
FOR  SENATE BILL  NO. 150(HES)  "An  Act relating  to the  Alaska                                                               
children's trust grant awards."                                                                                                 
3:30:10 PM                                                                                                                    
JASON  HOOLEY,   Staff  to  Senator  Fred   Dyson,  Alaska  State                                                               
Legislature, presented  SB 150  on behalf  of the  Senate Health,                                                               
Education and Social Services  Standing Committee, sponsor, which                                                               
is chaired by Senator  Dyson.  He said that in  the late 80s, the                                                               
Alaska  Children's  Trust  was  created  by  the  legislature  to                                                               
provide  start-up funding  to community-based  programs dedicated                                                               
to  preventing  child  abuse.    The  amount  of  the  grants  is                                                               
prescribed in state statute.  Since  then, he said, "the board of                                                               
trustees   has   requested   some   additional   flexibility   in                                                               
determining the amount of grants  that they award."  The proposed                                                               
legislation would  meet that  request by:   removing  the $50,000                                                               
annual cap  on the  grants; refining the  funding formula  set in                                                               
statute;  including a  four-year  limit on  the  grant awards  in                                                               
order to  enforce the  original intent to  provide seed  money to                                                               
the  community  organizations;  setting  up  a  requirement  that                                                               
applicants include a self-sustainability  plan in their proposal;                                                               
and  giving the  board of  trustees  the authority  to reduce  or                                                               
eliminate  grants in  order to  enforce  program requirements  or                                                               
performance goals.                                                                                                              
3:31:36 PM                                                                                                                    
REPRESENTATIVE GARDNER asked what triggered the bill.                                                                           
3:32:06 PM                                                                                                                    
JOEL  GILBERTSON,  Commissioner,   Office  of  the  Commissioner,                                                               
Department  of  Health  and  Social  Services  (DHSS),  said  the                                                               
commissioners   of  the   Department  of   Education  and   Early                                                               
Development and  the Department of  Health & Social  Services, by                                                               
their office, were appointed to  the Alaska Children's Trust when                                                               
it was initiated; however, the bulk  of the members are not state                                                               
employees.  In response to  Representative Gardner's question, he                                                               
said what prompted the legislation  to move forward was a strange                                                               
circumstance,  which is  that  the  trust has  not  done any  new                                                               
grants in  over two years.   Because the funding doesn't  go into                                                               
operations, but rather  is used to start  up innovative programs,                                                               
getting them  up and  running, and moving  on to  something else,                                                               
the original statute contemplated  a step-down in funding support                                                               
over a  four-year period.   Some legislators assumed that  by the                                                               
fifth  year,  the program  being  funded  would  be on  its  own;                                                               
however, the statute  is vague.  As a result,  there are programs                                                               
that have continued to receive  a base amount of approximately 25                                                               
percent into the eighth year.                                                                                                   
COMMISSIONER GILBERTSON  said the  challenge with  the Children's                                                               
Trust  is  that   the  principal  of  the  fund   has  not  grown                                                               
drastically and  has a  fairly conservative  investment strategy.                                                               
The grant  making comes  solely from the  interest that  the fund                                                               
earns; the principal  cannot be touched.  Because  the market has                                                               
been fairly  flat, there  has been a  relatively fixed  amount of                                                               
money that comes out of earnings  of the fund on an annual basis;                                                               
it has ranged from between  $210,000-$240,0000 per year.  He said                                                               
there comes a point in which a  25 percent obligation to 30 to 40                                                               
grants  fully  utilizes  the  money and  doesn't  allow  for  new                                                               
funding.    The  key  element  of  SB  150  is  to  clarify  what                                                               
Commissioner  Gilbertson  said was  the  intent  of the  original                                                               
legislation,  which is  that after  the four  years of  step-down                                                               
funding, the amount goes to zero.   He described the process as a                                                               
natural attrition every four years,  which would allow new grants                                                               
to be brought onto the program.                                                                                                 
COMMISSIONER  GILBERTSON noted  that  the trust  has received  an                                                               
earmark   in  the   last  federal   fiscal   year  for   specific                                                               
programming; however, that funding doesn't  go into the corpus of                                                               
the fund.  He offered further details.                                                                                          
3:37:02 PM                                                                                                                    
CHAIR WILSON  directed attention  to a  booklet in  the committee                                                               
packet, entitled,  "Alaska Children's Trust Annual  Report 2004,"                                                               
and noted that on page 12 the grantees are listed.                                                                              
3:37:15 PM                                                                                                                    
REPRESENTATIVE GARDNER noted that the  bill would also repeal the                                                               
cap on grants,  and she asked how  that fits in with  the idea of                                                               
trying to make money for new programs.                                                                                          
COMMISSIONER   GILBERTSON  responded   that  the   cap  provision                                                               
probably has less direct application in  the short term.  He said                                                               
he thinks  the trustees would like  to be able to  "be positioned                                                               
where they could  do something sizeable in this  state," should a                                                               
large amount  of money became  available.  He stated,  "What I've                                                               
seen is  we can spend  a lot of  money doing very  little things,                                                               
and  at the  end of  the day,  they rarely,  in their  cumulative                                                               
weight and  success, accomplish what you  can get done if  you do                                                               
one sizeable project and you put  your money behind it."  He said                                                               
the scope  of child abuse is  wide and, because there  is a small                                                               
amount  of money,  the mission  needs to  be tightly  defined and                                                               
funds need  to be targeted  around accomplishing "a  clear change                                                               
around  what the  trustees define  as child  abuse and  neglect."                                                               
Without SB 150,  he cautioned, there will be no  new grant making                                                               
for the third straight year.                                                                                                    
3:40:23 PM                                                                                                                    
REPRESENTATIVE  CISSNA  said  she  has  been  asking  about  "the                                                               
measurements"  for the  last  seven  years she  has  served as  a                                                               
Representative, and  she has  yet to see  the programs  come back                                                               
with them.  She stated, "Creating  the model is almost as much of                                                               
a necessity it  seems to me as  doing a lot of  other things that                                                               
wouldn't have lasting effect."                                                                                                  
3:41:27 PM                                                                                                                    
COMMISSIONER  GILBERTSON  encouraged  the  committee  to  involve                                                               
Margo McCabe in  the discussion, because she is the  chair of the                                                               
trust, while he is just a  member.  In response to Representative                                                               
Cissna's  concern, he  said he  thinks the  trustees will  "self-                                                               
acknowledge  that  there  really  hasn't  been  good  performance                                                               
measures in the  grants."  He offered examples.   He mentioned an                                                               
idea of moving from grants to performance contracts or measures.                                                                
3:43:04 PM                                                                                                                    
MARGO  MCCABE, Chair,  Alaska Children's  Trust, said  she thinks                                                               
Commissioner Gilbertson has  done a good job  covering the intent                                                               
of  the  proposed  legislation   and  explaining  why  the  trust                                                               
supports it.   She  echoed the  commissioner in  emphasizing that                                                               
over  the last  couple of  years the  trust has  only had  enough                                                               
money to fund recurring grants.   She said the trust thinks there                                                               
are a  lot of innovative  programs in existence worth  looking at                                                               
and would like  to have its money  freed up to do  so.  Regarding                                                               
performance measures, she said the trust  is about to issue a new                                                               
[request for  proposals (RFP)] and  has done good work  in giving                                                               
examples of  performance measures that  grantees can track.   She                                                               
said there  is a system  in place for  the trustees to  meet with                                                               
grantees to  ensure they  are meeting the  indicators.   She said                                                               
she thinks  SB 150  will move  the trust  closer to  ensuring the                                                               
grantees are  performing and will  sustain the programs  once the                                                               
grant  monies  are  gone.   She  concluded,  "The  sustainability                                                               
requirement just enforces what we're putting in our RFP."                                                                       
MS. MCCABE, in  response to a request from the  chair, listed the                                                               
Alaska Children's Trust board members.   In response to a follow-                                                               
up comment  from Chair  Wilson, she  agreed that  currently there                                                               
are not many members from smaller  communities.  In response to a                                                               
question  from  the  chair,  she  noted  that  the  trustees  are                                                               
appointed to the board by the governor.                                                                                         
CHAIR WILSON  said she would  like to see more  representation on                                                               
the board from rural Alaska.                                                                                                    
3:46:26 PM                                                                                                                    
MS. MCCABE  concurred.  She  said many  of the grantees  are from                                                               
smaller communities  around the  state, so a  considerable amount                                                               
of time is spent focusing on those communities.                                                                                 
3:47:11 PM                                                                                                                    
COMMISSIONER  GILBERTSON  said   the  trust  conducts  geographic                                                               
mapping of some  of the issues around child abuse.   He mentioned                                                               
a media  campaign that  focuses on modeling  behaviors.   He said                                                               
child abuse and neglect occurs  in every community in Alaska, but                                                               
there  is  great  disparity geographically,  which  needs  to  be                                                               
acknowledged as resources are being put forth.                                                                                  
3:49:11 PM                                                                                                                    
REPRESENTATIVE GARDNER inquired about  license plate and heirloom                                                               
birth certificate programs.                                                                                                     
MS. MCCABE  said those  programs, which  are offered  through the                                                               
Office  of  Vital Statistics,  were  in  place before  she  began                                                               
serving  on  the board  and  have  become self-sustaining.    She                                                               
deferred further comment to the commissioner.                                                                                   
3:50:22 PM                                                                                                                    
COMMISSIONER GILBERTSON  noted that  the trust  does not  have an                                                               
administrative  budget  or  staff,  but  has  done  a  tremendous                                                               
volunteer  effort getting  involved  in RFPs  and contracts,  and                                                               
going above  and beyond  what normal trustees  would have  to do.                                                               
He said the  Department of Revenue provides support  to the trust                                                               
by  managing  the financial  accounts,  investing  the fund,  and                                                               
providing  a portion  of staff  time  to advise  the trustees  on                                                               
financial issues.   The  Department of  Health &  Social Services                                                               
provides  administrative  support  and   uses  resources  in  its                                                               
department  for the  actual administration  of the  grants.   The                                                               
heirloom certificates  and license plates  are two other  ways to                                                               
raise  funds.     He  described  the   heirloom  certificates  as                                                               
"slightly  more ornate  than the  traditional document  you would                                                               
get from vital statistics."                                                                                                     
3:51:31 PM                                                                                                                    
REPRESENTATIVE  SEATON expressed  concern regarding  removing the                                                               
$50,000 cap.   He  noted that  the highest  grants the  trust has                                                               
given have  been for  $20,000, and  it would  appear that  if the                                                               
trust  went  above  $50,000,  then   all  the  efforts  would  be                                                               
concentrated  in the  most  populated  areas of  the  state.   He                                                               
questioned  if there  really  is  a need  to  remove  the cap  or                                                               
whether the trust  is just looking at possibly  having more money                                                               
to grant in the future.                                                                                                         
COMMISSIONER GILBERTSON  said he thinks it's  important to remove                                                               
the  cap.   First, it  would position  the trust  going into  the                                                               
future as  the corpus of  the fund  grows.  Also,  smaller grants                                                               
are not  as efficient.   He said it  shouldn't be assumed  that a                                                               
single grant cannot have statewide  application; the trustees are                                                               
committed to a  statewide application of the trust.   In fact, on                                                               
a  per capita  basis, the  grants are  probably heavily  weighted                                                               
towards  rural  regions, which  he  opined  is appropriate.    He                                                               
concluded, "It's very  difficult for us to manage  the trust with                                                               
some of the constraints that are placed on it right now."                                                                       
MS. MCCABE  said that she  supports lifting  the cap in  order to                                                               
position the trust  board to receive larger grants  in the future                                                               
which then can  be distributed in the most appropriate  way.  She                                                               
said there  is no intent to  change the strategy in  terms of how                                                               
many [grants] are  distributed.  She stated,  "We're committed to                                                               
continue funding programs all around the state."                                                                                
COMMISSIONER GILBERTSON  offered some  examples of how  the trust                                                               
uses  its  funds.   He  noted  that  the  trust has  been  unable                                                               
administratively to  expend funds given to  the it to do  a media                                                               
campaign because of the existing statute.                                                                                       
CHAIR WILSON asked who holds the trust accountable.                                                                             
3:56:52 PM                                                                                                                    
COMMISSIONER  GILBERTSON  replied  that  the trust  is  a  public                                                               
entity  appointed by  the  governor.   Ultimately,  he said,  the                                                               
individual ultimately  responsible is  the commissioner  of DHSS.                                                               
He explained:                                                                                                                   
     Procedurally, the  way the trust actually  works is the                                                                    
     trustees  make the  spending decisions,  those spending                                                                    
     decisions are  integrated into the grant  making of the                                                                    
     Office  of Children's  Services  and, as  commissioner,                                                                    
     I'm  the one  who actually  signs the  authorization to                                                                    
     expend the  funds, ... approves  the RFP,  and approves                                                                    
     the grant awards.                                                                                                          
CHAIR WILSON asked if [the  trust] would object to reporting each                                                               
year to  both the  Senate Health,  Education and  Social Services                                                               
Standing  Committee and  the House  Health, Education  and Social                                                               
Services Standing Committee.                                                                                                    
3:58:13 PM                                                                                                                    
COMMISSIONER  GILBERTSON responded  that the  trust publishes  an                                                               
annual report that  documents where the funds go, and  he said he                                                               
could  certainly  make  a  commitment to  the  chair  that  every                                                               
legislator gets a copy.                                                                                                         
REPRESENTATIVE  SEATON   referred  to  [the   sponsor  statement,                                                               
included  in  the  committee  packet,   which  includes  a  chart                                                               
describing the funding  formula].  He questioned  whether the way                                                               
the chart was written may be ambiguous.                                                                                         
COMMISSIONER  GILBERTSON  explained  that the  funding  scale  is                                                               
existing law.  He said the  grantee comes forward with a proposal                                                               
with an  amount for a program  set.  The percentages  are figured                                                               
each year  from the set amount.   In response to  a question from                                                               
Chair Wilson,  he reiterated that  everyone he has spoken  to has                                                               
said the intent was that there  would be a natural turnover after                                                               
four years,  but that  sentence is  missing in  statute.   Of the                                                               
sixteen grantees going into the  upcoming grant years, 12 of them                                                               
will be past  four years, three of the remaining  the fourth year                                                               
and one will be in its third year.   There will be no grantees in                                                               
the first or second year.                                                                                                       
4:02:59 PM                                                                                                                    
COMMISSIONER  GILBERTSON, in  response to  a question  from Chair                                                               
Wilson as  to where  that language exists  in the  bill, directed                                                               
attention to page 2, lines 7-8, which read:                                                                                     
         (d) The board may not award grants to a single                                                                         
     project or program for more than four years.                                                                               
COMMISSIONER  GILBERTSON, in  response  to  a follow-up  question                                                               
from Chair  Wilson, said  there are  two more  areas in  the bill                                                               
with "salient  pieces of  new language."   One  part of  the bill                                                               
would  require the  grantees to  have a  sustainability or  self-                                                               
sufficiency plan.  The other new language read as follows:                                                                      
          (g) The board may reduce or discontinue a grant                                                                       
     awarded or  distributed under this section  at any time                                                                    
     during the  grant period  if the  project is  not being                                                                    
     successful   in   accomplishing  its   objectives,   as                                                                    
     determined by the board.                                                                                                   
4:04:17 PM                                                                                                                    
REPRESENTATIVE   CISSNA   reiterated   her   concerns   regarding                                                               
performance measures.  She said  the state needs to have partners                                                               
in  the  private  sector  that provide  services.    She  offered                                                               
further examples.   She suggested adding language  to include new                                                               
organizations with ideas for programs.                                                                                          
4:06:52 PM                                                                                                                    
COMMISSIONER   GILBERTSON   said   he   doesn't   disagree   with                                                               
Representative Cissna.   He  said he  has a  lot programs  in his                                                               
department   that  need   to  be   addressing  the   issues  that                                                               
Representative Cissna is  talking about.  He  said questions that                                                               
need to be addressed are:   "How do we bring competition into the                                                               
marketplace for  grant making; ...  how do we make  our decisions                                                               
on awarding  grants based  on performance -  on outcomes  that we                                                               
the  payer  have set;  and  how  do  we  hold our  grantees,  ...                                                               
contractors, ... vendors, or our  providers accountable for those                                                               
outcomes?"  He added that the  Alaska Children's Trust is not the                                                               
entity to engage  in that conversation, because  the sole purpose                                                               
of the trust is about primary prevention and keeping it simple.                                                                 
CHAIR WILSON closed public testimony.                                                                                           
4:09:49 PM                                                                                                                    
REPRESENTATIVE  SEATON  moved  to  report CSSB  150(HES)  out  of                                                               
committee  with individual  recommendations and  the accompanying                                                               
fiscal  notes.   There  being  no  objection, CSSB  150(HES)  was                                                               
reported out of  the House Health, Education  and Social Services                                                               
Standing Committee.                                                                                                           
The committee took an at-ease at 4:10:45.                                                                                       
HB 288-MEDICAID PERSONAL NEEDS ALLOWANCE                                                                                      
[Not on  tape, but reconstructed  from the  committee secretary's                                                               
log notes, was the following:]                                                                                                  
CHAIR WILSON announced  that the next order of  business would be                                                               
HOUSE  BILL NO.  288 "An  Act relating  to the  Medicaid personal                                                               
needs  allowance   for  assisted   living  home   residents;  and                                                               
providing for an effective date."                                                                                               
4:13:47 PM                                                                                                                    
JON  SHERWOOD, Medical  Assistance Administrator,  Office of  the                                                               
Commissioner,   Department  of   Health   and  Social   Services,                                                               
testifying on  behalf of the  department, said that HB  288 helps                                                               
to address  a change made to  regulation.  He said  it would only                                                               
apply  to people  who  are  not receiving  cash  assistance.   He                                                               
mentioned an increase  to personal needs allowance, as  well as a                                                               
possible amendment.                                                                                                             
The committee took an at-ease from 4:16:00 to 4:17:13.                                                                          
[The recording begins again starting here.]                                                                                     
4:17:16 PM                                                                                                                    
REPRESENTATIVE  WILSON  said,  "The  folks that  want  this  bill                                                               
aren't here,  and so we're  going to table  the bill --  let's go                                                               
ahead and put the amendment on  it, and then we'll table the bill                                                               
until  they see  fit to  be interested  enough to  come and  talk                                                               
about it."                                                                                                                      
4:17:33 PM                                                                                                                    
REPRESENTATIVE  CISSNA   moved  Amendment  1,   labeled,  "24G-1,                                                               
5/2/2005,  (8:14   A.M.),"  which   read  as   follows  [original                                                               
punctuation provided]:                                                                                                          
     Page 1, line 6:                                                                                                            
          Delete "$260"                                                                                                         
          Insert "$1,396"                                                                                                       
     Page 1, line 13:                                                                                                           
          Delete "$260"                                                                                                         
     Insert "$1,396"                                                                                                            
[There being no objection, it was so ordered.]                                                                                  
[HB 288 was held over.]                                                                                                         
HB 271-LIMIT OVERTIME FOR REGISTERED NURSES                                                                                   
4:18:05 PM                                                                                                                    
CHAIR  WILSON announced  that  the final  order  of business  was                                                               
HOUSE BILL  NO. 271 "An  Act relating to limitations  on overtime                                                               
for registered  nurses in health  care facilities;  and providing                                                               
for an effective date."                                                                                                         
4:18:25 PM                                                                                                                    
[CHAIR WILSON turned the gavel over to Vice-Chair Seaton.]                                                                      
The committee took an at-ease from 4:18:37 PM to 4:19:26.                                                                     
4:19:31 PM                                                                                                                    
CHAIR  WILSON,  as  sponsor  of HB  271,  stated  that  mandatory                                                               
overtime causes significant  problems, including increased injury                                                               
rates,  for both  patients and  health care  workers, and  can be                                                               
life  threatening.   She  reported that  the  abuse of  mandatory                                                               
overtime  shifts  has been  associated  with:   unhealthy  weight                                                               
gain, increased  use of alcohol  and tobacco, and  lowered levels                                                               
of  functional ability  in  job performance.    A national  study                                                               
showed  that   between  44,000-98,000  hospital  deaths   can  be                                                               
attributed   to   medical   errors   each  year.      The   final                                                               
recommendation  of  the  Institute   of  Medicine  was  that  all                                                               
overtime done  by nurses  - voluntary and  mandatory -  should be                                                               
CHAIR WILSON noted  that in a study entitled,  "The Working Hours                                                               
of Hospital  Staff Nurses and  Patient Safety," published  in the                                                               
July/August  issue of  Health  Affairs, found  that  the risk  of                                                             
making an  error is  three times higher  when nurses  work shifts                                                               
longer than  12 hours,  which she  indicated is  one of  the main                                                               
reasons  nurses are  leaving their  profession.   She recalled  a                                                               
study a  couple of years  ago that said  by the year  2010, 4,000                                                               
more  nurses will  be needed  in Alaska.   She  offered anecdotes                                                               
about her experience as a nurse.                                                                                                
CHAIR WILSON  said the proposed  legislation will not  prohibit a                                                               
nurse from working  overtime, but it will  discourage an employer                                                               
from assigning  mandatory overtime.   It  would also  prohibit an                                                               
employer  from threatening  or retaliating  against  a nurse  who                                                               
refuses overtime.   Nationwide,  she said,  10 other  states have                                                               
mandated this type of legislation,  while similar legislation has                                                               
been proposed in 20 other states.                                                                                               
REPRESENTATIVE  GARDNER   said  she  supports   this  legislation                                                               
because  it seems  like a  human rights  issue.   Notwithstanding                                                               
that, she  asked what  the result  would be  for patient  care in                                                               
Alaska if the bill passes.                                                                                                      
4:28:16 PM                                                                                                                    
CHAIR  WILSON  noted  that critical  access  hospitals  would  be                                                               
exempted.   She said hospitals  in Alaska work with  personnel as                                                               
much  as  they  can  to  ensure that  they  don't  use  mandatory                                                               
[overtime]  for nurses.   She  said the  only complaints  she has                                                               
received  were  from  state institutions:    API,  the  Pioneer's                                                               
Homes, and  [the Department  of Corrections].   In response  to a                                                               
follow-up  question from  Representative  Gardner, she  confirmed                                                               
that the bill would apply to state institutions.                                                                                
REPRESENTATIVE CISSNA said that part  of this is really a quality                                                               
issue for patients.                                                                                                             
4:31:24 PM                                                                                                                    
VICE CHAIR SEATON  asked why the bill only  applies to registered                                                               
nurses  and further  asked  if  the effect  will  be that  lesser                                                               
qualified employees are substituted for those nurses.                                                                           
CHAIR WILSON said that is  a possibility; however, she said there                                                               
are guidelines  regarding what level  of practitioner must  be on                                                               
duty to supervise others.                                                                                                       
4:33:57 PM                                                                                                                    
VICE CHAIR SEATON  clarified that he wants to know  if it's being                                                               
said that  overtime is dangerous  for registered nurses,  but not                                                               
for licensed practitioner nurses.                                                                                               
CHAIR WILSON  said, "I'm sure  that that  would be also  the same                                                               
for them."   She said she  wouldn't have any objection  to adding                                                               
4:34:26 PM                                                                                                                    
JANE  BARNES,  Nursing  Director,  Alaska  Psychiatric  Institute                                                               
(API),  told  the  committee that  API  employees  40  registered                                                               
nurses  and has  no  LPNs.   Currently there  are  5 staff  nurse                                                               
vacancies, which  is about the  norm.  Some improvement  was made                                                               
when the  a raise was approved  in 2002; at that  time there were                                                               
12 vacancies, or 25 percent of  the staff nursing positions.  Ms.                                                               
Barnes  said API  does use  mandatory overtime  in order  to meet                                                               
patient  care demands.    It uses  mandatory  overtime only  when                                                               
needed  to  minimally  staff  the  patient  care  unit,  and  the                                                               
mandatory overtime  used is minimal.   She offered  some details.                                                               
She  stated that  the use  of  voluntary overtime  is higher,  at                                                               
about 337 hours  monthly.  It is estimated that  over half of the                                                               
nurses who volunteer  for overtime do so to  avoid being assigned                                                               
mandatory overtime.                                                                                                             
MS. BARNES  said should HB  271 pass,  she expects about  half of                                                               
the nurses currently doing voluntary  overtime to decline working                                                               
overtime altogether.   She said  she anticipates that  the result                                                               
would be  maybe 200  hours of  overtime that  wouldn't be  met by                                                               
voluntary  means.   She predicted  that [API]  would have  to use                                                               
"agency nurses" at  $60/hour for 13-week periods.   It could also                                                               
ask for the establishment of  additional positions, but given the                                                               
fact that  there is already  a difficulty filling  the positions,                                                               
that may be of little help.                                                                                                     
MS.  BARNES,   regarding  agency  nurses,  indicated   that  it's                                                               
problematic  that those  nurses are  there for  short periods  of                                                               
time and  sometimes don't  know how to  use certain  equipment or                                                               
have to  learn a program  unique to API's therapeutic  milieu and                                                               
work with  a team.   A new nurse at  API, she noted,  partakes in                                                               
intensive training  for four  weeks, which she  pointed out  is a                                                               
third of an agency nurse's contract time.                                                                                       
MS. BARNES concluded:                                                                                                           
     The  total elimination  of  mandated overtime,  without                                                                    
     any options  for a lesser  bill, such as  limiting that                                                                    
     overtime  to so  many hours  at a  time, places  a real                                                                    
     burden on us as an employer,  and I believe will have a                                                                    
     negative impact on patient care.                                                                                           
REPRESENTATIVE GARDNER asked  if it is fair to say  that the real                                                               
problem is that  [API] cannot find the staff it  needs to hire or                                                               
can't retain staff.                                                                                                             
4:40:44 PM                                                                                                                    
MS. BARNES answered that API can  usually find people to hire but                                                               
cannot retain them.  She said API  is one of the few hospitals in                                                               
town that will hire a  "full-time, permanent placement, brand new                                                               
nurse, new [graduate]."   Most other hospitals  require nurses to                                                               
have  6-12  months  experience  as   an  associate  nurse.    She                                                               
explained that  the nurses API hires  often work for one  year to                                                               
get that experience  and then leave to work  someplace else where                                                               
they can earn 25-35 percent more per hour.                                                                                      
REPRESENTATIVE  GARDNER concluded  that bottom  line is  that the                                                               
pay rate is too low to retain qualified people.                                                                                 
MS. BARNES answered yes.                                                                                                        
REPRESENTATIVE CISSNA surmised that not  only is the pay too low,                                                               
but also  API must pay more  in constant training.   She asked if                                                               
that has ever been calculated.                                                                                                  
MS. BARNES offered her understanding  that the committee received                                                               
a fiscal  impact statement.   She  said she  doesn't have  a good                                                               
calculation regarding what it takes to train any new employee.                                                                  
VICE  CHAIR SEATON  asked if  API is  paying less  for registered                                                               
nurses than compared to hospitals in town.                                                                                      
MS. BARNES answered that's correct.   She added that API has also                                                               
lost  nurses to  doctor's offices.   In  response to  a follow-up                                                               
question  from Vice  Chair  Seaton, she  guessed  that API's  pay                                                               
scale is set by the legislature.                                                                                                
4:44:03 PM                                                                                                                    
DIANNE   O'CONNELL,  Labor   Program   Director,  Alaska   Nurses                                                               
Association, said she  has been working with "a  number of nurses                                                               
throughout  the state,  and  quite  a few  at  API, actually,  in                                                               
developing,  ... supporting,  and encouraging  the passage  of HB
271."   She  said there  is more  than one  way of  attacking the                                                               
problem  at  hand.   She  noted,  "It's  been primarily  a  state                                                               
institution  problem."    She indicated  that  nurses  from  many                                                               
facilities  throughout   the  state  are  concerned   that  their                                                               
colleagues are  in "what they  consider an  untenable situation,"                                                               
but also that the problem will spread if nothing is done now.                                                                   
MS.  O'CONNELL,   referring  to  Vice  Chair   Seaton's  previous                                                               
question, stated  her belief that the  pay scale [at API]  is set                                                               
by the Department  of Administration and perhaps  approved by the                                                               
legislature.   She said  currently there  is a  request in  for a                                                               
reclassification study,  which would take registered  nurses, for                                                               
example, "down a notch or two" in  order to make up for the 25-35                                                               
percent  pay differential.   She  said hopefully  that will  take                                                               
place; however, she  noted that that's a  "separate project" than                                                               
mandatory  overtime, although  they  are related.   She  revealed                                                               
that she had worked as a chaplain  at API, and she said it was an                                                               
emotional   place  to   work  [compared   to  some   health  care                                                               
institutions].  She  said, "And if you're there  and you're faced                                                               
with this mandatory  overtime in addition to  the lower salaries,                                                               
in  addition to  the stress,  in addition  to being  a brand  new                                                               
nurse, you're going to leave."                                                                                                  
MS. O'CONNELL stated that the  reason the bill addresses RNs only                                                               
at  present is  that that's  where  the biggest  shortage is  and                                                               
that's where  most of the  responsibility lies for  patient care.                                                               
She echoed Ms.  Barnes' notation that although there  may be only                                                               
40 hours  of mandatory overtime, there  are 337 hours a  month of                                                               
what is euphemistically called "voluntary overtime."                                                                            
4:50:04 PM                                                                                                                    
CAROL  WIDMAN, Registered  Nurse,  Alaska Psychiatric  Institute,                                                               
testified in support of HB 271.   She said every time she goes to                                                               
work she  is subject  to mandatory  overtime.   She said  she has                                                               
difficulty coming  in on her days  off because she has  two small                                                               
children; therefore, she  is generally at the top of  the list of                                                               
those who  have to stay [for  mandatory overtime].  She  said she                                                               
gives medications to  20-30 patients.  She  stated that mandatory                                                               
overtime is  very dangerous  and has  caused many  medication and                                                               
judgment errors.                                                                                                                
4:51:14 PM                                                                                                                    
DAVE WILLIAMS,  Project Coordinator,  Pioneers' Homes,  said that                                                               
RNs are crucial  to pioneers' homes, but there are  also LPNs and                                                               
Certified Nurse  Assistants (CNAs).   He said  there is a  lot of                                                               
overtime.  Most of it is  voluntary, but some of it is mandatory.                                                               
He  said  the   pioneers'  homes  staff  of   RNs  work  overtime                                                               
voluntarily  because they  care  greatly for  the residents  they                                                               
serve.  He  said the bill would require  careful documentation as                                                               
to whether overtime was voluntary  or mandatory, because "some of                                                               
the provisions  in the  bill would  penalize if  it wasn't."   In                                                               
response  to a  question from  Vice Chair  Seaton, he  stated his                                                               
belief that every  one of the RNs, LPNs, and  CNAs work overtime.                                                               
He noted  that the  RNs are "Nurse  I, II, and  III in  the state                                                               
system" and are  the people who the pioneers'  homes are required                                                               
by licensure to  have on board in order to  provide services.  He                                                               
said  he does  not  know what  the pioneers'  homes  would do  if                                                               
nobody showed up to work and  it was necessary to call someone up                                                               
without the ability to use mandatory overtime.                                                                                  
MR.  WILLIAMS  said one  alternative  may  be to  use  contracted                                                               
services; however,  he said  he doesn't  know how  practical that                                                               
would be, especially in a more  remote place.  He stated that the                                                               
issue is supply;  there are not enough RNs available.   He opined                                                               
that nurses who  work at the pioneers' homes  carefully weigh the                                                               
benefits they  receive, because  "it's the  package of  wages and                                                               
benefits that need  to be balanced against what's  in the private                                                               
sector."  He proffered that if  working at the pioneers' homes is                                                               
made  more  valuable,  then  there  may  come  a  time  when  the                                                               
hospitals  would have  a "hole"  in their  system.   He indicated                                                               
that he also  works with hospitals and he confirmed  that they do                                                               
"look at contract nurses."  He  reemphasized the need to have RNs                                                               
available in  order to operate.   He said  he would get  a fiscal                                                               
note  to  the committee  to  reflect  how  much overtime  at  the                                                               
pioneers' homes is voluntary and how much is mandatory.                                                                         
4:55:42 PM                                                                                                                    
REPRESENTATIVE  CISSNA asked  if "lifting"  is used  to alleviate                                                               
the nursing  load.  In  response to a request  for clarification,                                                               
she  said   by  "lifting"   she  means   shifting  some   of  the                                                               
responsibilities that  don't require  the education  of an  RN to                                                               
other employees.                                                                                                                
MR. WILLIAMS  said the pioneers' homes  do that, which is  why it                                                               
employs a lot of CNAs.                                                                                                          
4:57:11 PM                                                                                                                    
VICE CHAIR SEATON closed public testimony.                                                                                      
CHAIR WILSON moved to adopt the fiscal note from the Department                                                                 
of Labor and Workforce Development, dated 4/19/05.  There being                                                                 
no objection, it was so ordered.                                                                                                
VICE CHAIR SEATON returned the gavel to Chair Wilson.                                                                           
[HB 271 was held over.]                                                                                                         
There being no further business before the committee, the House                                                                 
Health, Education and Social Services Standing Committee meeting                                                                
was adjourned at 4:57:55 PM.                                                                                                  

Document Name Date/Time Subjects