Legislature(1997 - 1998)
03/27/1997 03:11 PM House HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL
SERVICES STANDING COMMITTEE
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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