02/12/2008 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB319 | |
| HB276|| HB279 | |
| HB279 | |
| Presentation on Alzheimer's Disease | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 319 | TELECONFERENCED | |
| *+ | HB 276 | TELECONFERENCED | |
| *+ | HB 279 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
February 12, 2008
3:09 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Bob Roses, Vice Chair
Representative Anna Fairclough
Representative Wes Keller
Representative Paul Seaton
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 319
"An Act relating to the practice of dentistry and to dental
assistants."
-MOVED CSHB 319(HES) OUT OF COMMITTEE
HOUSE BILL NO. 276
"An Act extending the termination date of the Alaska Commission
on Aging; and providing for an effective date."
-MOVED HB 276 OUT OF COMMITTEE
HOUSE BILL NO. 279
"An Act relating to the duties and powers of the Alaska
Commission on Aging and the Department of Health and Social
Services."
-MOVED CSHB 279(HES) OUT OF COMMITTEE
PRESENTATION ON ALZHEIMER'S DISEASE
- HEARD, BUT NOT SCHEDULED
PREVIOUS COMMITTEE ACTION
BILL: HB 319
SHORT TITLE: DENTISTS & DENTAL ASSISTANTS
SPONSOR(s): REPRESENTATIVE(s) RAMRAS
01/15/08 (H) READ THE FIRST TIME - REFERRALS
01/15/08 (H) HES, L&C
02/07/08 (H) HES AT 3:00 PM CAPITOL 106
02/07/08 (H) Heard & Held
02/07/08 (H) MINUTE(HES)
02/12/08 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 276
SHORT TITLE: EXTEND ALASKA COMMISSION ON AGING
SPONSOR(s): REPRESENTATIVE(s) DOLL
01/04/08 (H) PREFILE RELEASED 1/4/08
01/15/08 (H) READ THE FIRST TIME - REFERRALS
01/15/08 (H) HES, FIN
02/12/08 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 279
SHORT TITLE: COMMISSION ON AGING
SPONSOR(s): REPRESENTATIVE(s) DOLL, KERTTULA
01/04/08 (H) PREFILE RELEASED 1/4/08
01/15/08 (H) READ THE FIRST TIME - REFERRALS
01/15/08 (H) HES, FIN
02/12/08 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
PATTY KRUEGER, Staff
to Representative Jay Ramras
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 319, Version K, on behalf of
Representative Ramras, sponsor.
PAUL SILVEIRA, DMD
Valdez, Alaska
POSITION STATEMENT: Testified in support of HB 319.
PETE HIGGINS, DDS; Acting President
Alaska Dental Society
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 319.
DAVID LOGAN, DDS; Chair
Alaska Dental Society Legislative Committee
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 319.
REPRESENTATIVE ANDREA DOLL
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 276 as the sponsor.
KEN ALPER, Staff
to Representative Andrea Doll
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
276.
REPRESENTATIVE ANDREA DOLL
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 279 as the sponsor.
BILL HOGAN, Deputy Commissioner
Family, Community, and Integrated Services
Office of the Commissioner
Department of Health & Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
279.
DENISE DANIELLO, Executive Director
Alaska Commission on Aging (ACoA)
Commissioner's Office
Department of Health and Social Services (DHSS)
POSITION STATEMENT: Testified in support of HB 279.
BANARSI LAL, Chair
Alaska Commission on Aging (ACoA)
Commissioner's Office
Department of Health and Social Services (DHSS)
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 279.
PAT DAVIDSON, Legislative Auditor
Legislative Audit Division
Legislative Agencies & Offices
Juneau, Alaska
POSITION STATEMENT: Testified during the hearing on HB 279.
CONNIE SIPE, Executive Director
Center for Community
Sitka, Alaska
POSITION STATEMENT: Presented a report from the Alzheimer's
Resource of Alaska.
DEBBIE NEWSHAM, Board Member
Alzheimer's Resource of Alaska
Anchorage, Alaska
POSITION STATEMENT: Gave a history of her experience as the
caregiver of an Alzheimer's patient.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:03:21 PM.
Representatives Fairclough, Keller, Seaton, Gardner, Roses, and
Wilson were present at the call to order. Representative Cissna
arrived as the meeting was in progress.
HB 319-DENTISTS & DENTAL ASSISTANTS
3:11:00 PM
CHAIR WILSON announced that the first order of business would be
HOUSE BILL NO. 319, "An Act relating to the practice of
dentistry and to dental assistants."
REPRESENTATIVE GARDNER moved to adopt CSHB 319, Version 25-
LS1281\K, Bullard, 2/11/08, as a working document. Hearing no
objection, Version K was before the committee.
3:12:02 PM
PATTY KRUEGER, Staff to Representative Jay Ramras, Alaska State
Legislature, presented the changes to HB 319 that are reflected
in Version K. She explained that the Alaska Dental Society
recommended that this part of the statute remain unchanged;
therefore, Sections 1, 2, and 3, were deleted. The next change
was suggested by the committee; that the definition of the
duties of a dental assistant, versus those of a dental
hygienist, should be more narrowly defined. This was done by
changes to the language in AS 08.36.346. She further explained
that on page 3, line 30, of Version [E], the word "subgingival"
was deleted to correct a drafting error.
3:13:41 PM
REPRESENTATIVE FAIRCLOUGH asked for the location of the
reference to "subgingival" in Version K.
MS. KRUEGER responded that the deletion of "subgingival", in
Version K, is on page 2, line 28.
3:14:53 PM
REPRESENTATIVE GARDNER asked why Sections 1, 2, and 3 were
deleted.
MS. KRUEGER explained that dental hygienists function under
general supervision by dentists and Version [E] specified
"direct" and "indirect" supervision; if the sections were not
deleted, the kind of direction under which hygienists function
would be limited.
3:15:23 PM
CHAIR WILSON asked for public testimony.
3:15:37 PM
PAUL SILVEIRA, DMD, informed the committee that he is
representing the Alaska Dental Society and himself. His
practice is located in Valdez, which is a very rural area even
though it is located on the road system. He stated his support
for HB 319 and explained that this bill will affect his practice
and his patients in a positive way. Dr. Silveira's office has
been without a dental hygienist for three months; this means he
must do the work of a hygienist. He pointed out that a dental
office is a health care facility, but is also a small business
that must be profitable for his employees and himself. Not
having a hygienist means that he must spend time doing this
service and the fee for a "prophy" just covers his overhead. In
fact, the Medicaid reimbursement for this service does not cover
his cost. This bill will allow a dental assistant to do coronal
polishing and free the dentist's time for other procedures. Dr.
Silveira stressed that the passage of this bill will allow him
to better serve the needs of his patients and maintain his
practice. Furthermore, it is hard to attract hygienists to
Valdez and to other rural areas. He stated that he does not
have a problem with having his assistants certified in some
manner; however, a national certification course would put undue
restrictions on those working in rural areas due to the travel
required. He suggested that certification by a correspondence,
or a distance education, program would be best. Dr. Silveira
emphasized that he can not operate his practice at a loss for
very long.
3:22:25 PM
REPRESENTATIVE FAIRCLOUGH expressed her appreciation of Dr.
Silveira's testimony that, through this bill, additional care
can be provided to those individuals on Medicaid. She asked
whether he would support the addition of a sunset clause to the
bill in order to measure the amount of the increase in care to
Medicaid patients.
DR. SILVEIRA said that he would not be opposed; however, the
problems with Medicaid are a big subject to discuss.
3:23:52 PM
CHAIR WILSON stated that both Medicare and Medicaid would "fit
in." At this time, the committee is looking for ways to have
more access to care for constituents.
3:24:11 PM
DR. SILVEIRA told the committee that he accepts Medicaid for
kids only. This is because Medicaid rules are too arduous and
the penalties are big; these are problems in addition to the
ridiculously small reimbursement amount. The bill will help
with this problem, but he opined that he would not add Medicaid
patients simply because of the bill.
3:25:25 PM
REPRESENTATIVE FAIRCLOUGH stated that committee members have
heard previous testimony that HB 319 will allow dentists to
provide additional care to Medicaid patients. She reluctantly
questioned the sincerity of those who support this bill and
wondered whether their support was in order to make more money
or in order to increase service for Medicaid and Medicare
patients.
DR. SILVEIRA confirmed that he could see more patients in his
community.
3:27:34 PM
CHAIR WILSON asked whether a dentist can have other patients
waiting in case a Medicaid patient does not show up for the next
appointment.
DR. SILVEIRA explained that he does not treat his Medicaid
patients differently than others.
3:28:47 PM
CHAIR WILSON said that her suggestion was for more efficiency.
3:28:57 PM
DR. SILVEIRA stressed that this bill will allow him to offer
more hygiene services when his practice is without a hygienist.
When he has a hygienist, the hygienist, not the dental
assistant, would probably do the coronal polishing.
3:29:59 PM
PETE HIGGINS, DDS, Acting President, Alaska Dental Society,
informed the committee that he is in favor of the bill; in fact,
he has been working for the last few years to increase access to
care in the rural areas of the state. He said that there is a
shortage of dental hygienists in rural areas throughout the
state and coronal polishing and the placing of dental materials
by dental assistants will certainly help the dentists working in
rural areas. Dr. Higgins told the committee that the Alaska
Native corporations and the federal government have been doing
this program for years. The Alaska Dental Society is also
working with Medicaid to try to get more dentists involved in
the Medicaid program and bring access to this group of patients.
House Bill 319 will make serving Medicaid patients more
economically feasible. He opined that many other states have
already adopted this program; Alaska is always behind the times.
He concluded that the approval of expanded duties for assistants
is needed and is a program that should go through. In fact, his
assistant is certified, but can not be used in this category due
to the lack of legislation.
3:33:20 PM
CHAIR WILSON noted that the results of a study done by the
Department of Health and Social Services (DHSS) on the
reimbursement of Medicaid costs will be released soon.
3:34:03 PM
DR. HIGGINS said that Alaska is unique due to the lack of an
extensive road system. This program will help to involve local
dental assistants that are already living and working in rural
areas.
3:35:07 PM
CHAIR WILSON closed testimony.
3:35:16 PM
REPRESENTATIVE ROSES asked whether "direct supervision", as
defined on page 3 of Version K, means that the dentist is in the
office where the patient is, or just in the building somewhere.
He requested that "dental office" be defined as opposed to the
"dental facility" described under "indirect supervision." He
expressed his difficulty in understanding the difference between
"dental office" and "dental facility".
3:36:52 PM
DAVID LOGAN, DDS, and Chair, Alaska Dental Society Legislative
Committee, explained that, in the bill "dental office" and
"dental facility" are the same. The definitions were borrowed
from the dental hygienists statutes and that is the only reason
for this distinction.
3:37:36 PM
REPRESENTATIVE ROSES remarked:
So, for the record, ... the intent of the sponsor of
this bill, and for our purposes, that the two are
interchangeable, and that one can not later come and
say 'Well, I was in the building even though it was
five stories, I was on the fifth floor.' As opposed
to somebody that at least is in auditory contact with
somebody that may need assistance. Because, I see
this as a huge difference and it's maybe something
that we need to address.
3:38:18 PM
DR. LOGAN said:
Yes, dental office and dental facility are meant, the,
the containment of the dental office and any common
areas it shares with adjacent, generally, other dental
offices; but, I guess, conceivably, they have a break
room or something like that, that is shared with a
non-dental office. But, yes.
REPRESENTATIVE ROSES said he would be offering an amendment.
3:38:29 PM
CHAIR WILSON moved that the committee adopt Amendment 1 that
read [original punctuation provided]:
Conceptual amendment to require all Dental Assistants
that wish to become certified to perform coronal
polishing or to perform restorative functions must be
Certified Dental Assistants (CDA).
Certified Dental Assistant - CDA means a dental
assistant that has registered with the board, passed
the Dental Assisting National Board Exam (DANB), and
maintains the credential (CDA) by meeting DANB
recertification requirements.
3:39:34 PM
REPRESENTATIVE FAIRCLOUGH objected.
3:39:40 PM
CHAIR WILSON explained that the DANB offers three ways to become
a CDA. In addition to having a cardiopulmonary resuscitation
(CPR) certification the candidate must: graduate from a dental
assisting program; or, graduate from a high school and have two
years experience in a dental office; or, have current or former
certification. She noted that much of the continuing education
can be done online by those who have work experience.
3:41:14 PM
REPRESENTATIVE GARDNER expressed her understanding that Alaska
has working dental assistants that are not certified. The bill
proposes to allow assistants to get a certification to do two
functions: coronal polishing and restorative placement. She
opined that this amendment will require additional certification
to become a CDA.
3:42:06 PM
CHAIR WILSON explained the three different pathways to CDA
certification.
3:42:49 PM
REPRESENTATIVE GARDNER clarified that there is a second level of
achievement, the CDA certification would be first and then the
coronal polishing certification.
3:43:03 PM
CHAIR WILSON read the following:
This conceptual amendment would make it a requirement
for a dental assistant to be certified by the Dental
Assisting National Board before they become certified
for coronal polishing and the restorative function as
defined in the bill. It will just make sure that
every dental assistant that is going to provide these
additional services will have met the same
qualifications.
CHAIR WILSON stated that her intent was that the certification
would require an "extra step."
3:43:59 PM
REPRESENTATIVE GARDNER asked whether the conceptual amendment
would require an overreaching CDA certification for a dental
assistant's other functions, and then, in addition, the bill
requires that they get the two specific certifications.
CHAIR WILSON said, " ... that's true."
3:44:20 PM
REPRESENTATIVE GARDNER observed that if the committee does not
know exactly what is certified now, it is doubling the
requirements.
3:44:40 PM
CHAIR WILSON explained that dental assistants do not have to be
certified now, and if they want to stay uncertified, that will
not be a problem. However, they will have to be certified to do
the extra functions.
3:44:56 PM
REPRESENTATIVE GARDNER advised that is what the bill does
without the CDA requirements.
3:45:06 PM
REPRESENTATIVE ROSES questioned the need for Amendment 1. He
pointed out that the original bill in Section 3, AS 08.36.315,
talks about the revocation of a license, reading:
The board may revoke or suspend the license of a
dentist or may reprimand, censure or discipline a
dentist, or both, if the board finds that, after
hearing, the dentist engaged in the performance of
patient care or permitted the performance of patient
care by persons under the dentist's supervision that
does not conform to the minimum professional standards
of dentistry regardless, of whether actual injury to
the patient occurred.
REPRESENTATIVE ROSES asked for the need of the certification
when the dentist is not allowed to have someone perform a duty
for which they are not qualified to perform. He opined that the
purpose of the amendment is taken care of in existing statute.
3:46:22 PM
REPRESENTATIVE FAIRCLOUGH asked for a brief at-ease.
3:48:22 PM
The committee took an at-ease from 3:46 p.m. to 3:48 p.m.
CHAIR WILSON withdrew Amendment 1.
3:48:38 PM
REPRESENTATIVE FAIRCLOUGH warned that there is a reason to have
caution when the Medical Board receives a financial benefit.
She recalled the previous testimony regarding the difficulty of
having a successful dental practice in a rural area. She opined
that the three requirements for CDA accreditation are good
standards.
3:49:43 PM
CHAIR WILSON cautioned that there is a need to very careful when
there will be a monetary gain. She advised that she would
contact the chair of the next committee of referral.
3:50:18 PM
CHAIR WILSON offered Amendment 2, as follows [original
punctuation provided]:
After board insert "that do not require the
professional skill of a licensed dentist or licensed
dental hygienist, including those provided in AS
08.32.110(c) and this chapter."
CHAIR WILSON said that this amendment is offered to tighten up
the language in the bill. Hearing no objection, Amendment 2 was
adopted.
3:51:20 PM
REPRESENTATIVE ROSES moved that the committee adopt Conceptual
Amendment 3, as follows:
Page 3, line 11;
Delete "dental facility"
Insert "dental office"
3:51:49 PM
REPRESENTATIVE GARDNER objected, and then removed her objection.
Hearing no further objection, Conceptual Amendment 3 was
adopted.
3:52:23 PM
REPRESENTATIVE FAIRCLOUGH observed that the next committee of
referral is the author of the bill. Therefore, she said that
she will not offer her amendment on a sunset and measurable
goals, but will talk with the sponsor to confirm whether the
intent of the bill is to provide additional services to Medicare
and Medicaid recipients. If so, a sunset is needed; however, if
this bill is to address business practice measures, a sunset is
not needed.
3:54:02 PM
CHAIR WILSON indicated that she will also talk with the sponsor.
3:54:28 PM
REPRESENTATIVE KELLER observed that the bill will expand the
scope of the responsibilities of the lowest paid professionals
and allow dentists to compete economically.
3:55:06 PM
REPRESENTATIVE FAIRCLOUGH surmised that the holders of the
lowest paid positions can qualify for a certificate and elevate
their value.
3:55:31 PM3:56:05 PM
CHAIR WILSON opined that dentists in urban areas will also use
this capability, as well.
3:56:05 PM
REPRESENTATIVE ROSES expressed his hope that the bill
accomplishes its objective. The intent was to allow dentists to
see more patients and, thereby, extend care to Medicaid
recipients. However; the testimony was that the bill will not
change the issues with Medicaid. He advised that if the sunset
amendment is not offered in committee, he will offer it on the
floor. Representative Roses opined that the responsibility of
the legislature is to increase care and access to dental care
for everyone, not necessarily to increase the profitability of
the dental practices.
3:58:04 PM
REPRESENTATIVE FAIRCLOUGH clarified that the committee's support
of good business practices will result in an increase of
accessibility to care in rural communities.
3:58:23 PM
REPRESENTATIVE FAIRCLOUGH moved to report HB 319, Version 25-
LS1281\K, Bullard, 2/11/08, as amended, out of committee with
individual recommendations and the accompanying fiscal notes.
Hearing no objection, CSHB 319(HES) was reported out of the
House Health, Education and Social Services Standing Committee.
HB 276-EXTEND ALASKA COMMISSION ON AGING
[Contains discussion of HB 279]
3:59:31 PM
CHAIR WILSON announced that the next order of business would be
HOUSE BILL NO. 276, "An Act extending the termination date of
the Alaska Commission on Aging; and providing for an effective
date."
4:00:41 PM
REPRESENTATIVE ANDREA DOLL, Alaska State Legislature, speaking
as the sponsor of HB 276, informed the committee that HB 276
will extend the sunset provision for the Alaska Commission on
Aging (ACoA). She advised that, five years ago, the ACoA was
moved from the Department of Administration (DOA) to the
Department of Health and Social Services (DHSS) and some of the
commission's responsibilities were changed. Representative Doll
added that HB 279 was recommended by the auditors and was
written to enact the conforming language to reflect this move.
4:01:55 PM
CHAIR WILSON noted that HB 276 extends the sunset to 2016.
4:02:36 PM
REPRESENTATIVE FAIRCLOUGH asked when the last time the statewide
plan was adopted.
4:02:47 PM
KEN ALPER, Staff to Representative Andrea Doll, Alaska State
Legislature, stated that the plan was adopted in 2007 and is a
four-year plan dated 2008 to 2011.
4:03:10 PM
REPRESENTATIVE FAIRCLOUGH noted that there is support in the
legislature for shorter timeframes so that the effectiveness of
programs can be measured; nevertheless, she said that she
supports the reauthorization of the ACoA. She then recalled
that a former member of the commission raised the question of
access to facilities for the aging population. She asked
whether the commission's planning process addresses access to
facilities and long-term care.
4:03:58 PM
REPRESENTATIVE DOLL referred the question to the executive
director.
4:04:10 PM
CHAIR WILSON asked for a motion.
4:04:19 PM
REPRESENTATIVE GARDNER moved to report HB 276 out of committee
with individual recommendations and the accompanying fiscal
notes.
The committee took an at-ease from 4:04 p.m. to 4:05 p.m.
There being no objection, HB 276 was reported out of the House
Health, Education and Social Services Standing Committee.
HB 279-COMMISSION ON AGING
CHAIR WILSON announced that the next order of business would be
HOUSE BILL NO. 279, "An Act relating to the duties and powers of
the Alaska Commission on Aging and the Department of Health and
Social Services."
4:05:34 PM
REPRESENTATIVE ANDREA DOLL, Alaska State Legislature, speaking
as one of the joint prime sponsors, remarked:
From 1982, when it was created through 2003, the
Alaska Commission on Aging was located within the
Department of Administration, and because the
Department of Administration did not have an
independent grant making authority, the Commission on
Aging was given granting power so they could
distribute federal money targeted at seniors. In 2003
Governor Murkowski signed Executive Order 108, we have
a copy of that with us. This moved the Commission on
Aging to the Department of Health and Social Services.
However, they already did have grant making power so
the executive order also moved those functions, grant
making, to the Division of Senior and Disabilities
Services at HSS, h, s, s. The statutes were never
changed and this current law is written ... Alaska
Commission on Aging in the Department of
Administration writing their own grants. In 2006,
when ACoA went through the sunset audit, from
legislative audit, the auditors discovered this
discrepancy. The auditors recommended making the
statuary changes conforming to the changes made by the
Governor Murkowski. HB 279 was written for this
purpose. It was written with the cooperation and
participation of the Alaska Commission on Aging staff
and the senior officials at DHSS. The bill, if
passed, would codify the current situation. The
Commission on Aging is responsible for planning and
advocacy for Alaska's seniors. The Division of Senior
and Disabilities Services is responsible for
administering and distributing federal funds.
4:08:02 PM
REPRESENTATIVE ROSES moved to adopt CSHB 279, Version 25-
LS1106\E, Mischel, 2/11/08, as a working document. There being
no objection, Version E was before the committee.
REPRESENTATIVE ROSES then observed that the bill takes away a
considerable amount of authority from the ACoA, and asked what
the commission is left to do.
4:09:27 PM
REPRESENTATIVE DOLL responded that the ACoA is responsible for
education and advocacy; in fact, it has many functions for
seniors as outlined in the state plan.
4:09:51 PM
CHAIR WILSON added that this is a housecleaning bill to put in
state statute what is already happening.
4:09:55 PM
MR. ALPER informed the committee that the only change in the
committee substitute is in Section 3, on page 4, that clarifies
that the ACoA is the primary agency responsible for writing the
state plan.
4:10:17 PM
REPRESENTATIVE ROSES asked whether the commission members are in
support of the bill.
4:10:54 PM
CHAIR WILSON asked for testimony from DHSS and the ACoA.
4:11:19 PM
BILL HOGAN, Deputy Commissioner, Family, Community, and
Integrated Services, Office of the Commissioner, DHSS, stated
that one of his responsibilities is to act as the primary
liaison with many of the boards and commissions that work with
DHSS. He reiterated that the language in HB 279 is intended to
put in statute what has been in practice since the first of
July, 2003. Mr. Hogan highlighted that the bill gives DHSS the
responsibility for establishing state policy for, and
administering the requirements of, the Older Americans Act of
1965, and the authority for administering grants to service
providers that serve older Alaskans, adult day care, and family
and respite care. He explained that he works very closely with
ACoA, and meets with the executive director and commission
members on a regular basis. In addition, the language for the
bill was developed in conjunction with the ACoA. The most
recent change is to acknowledge that the ACoA still has the
primary responsibility for formulating the state plan; however,
DHSS is the state entity on aging and has a number of
responsibilities in that regard. Mr. Hogan concluded by saying
that DHSS is very supportive of HB 279.
4:13:55 PM
DENISE DANIELLO, Executive Director, Alaska Commission on Aging,
expressed the commission's support for HB 279. This bill is a
reflection of current practice; in fact, the bill was crafted
primarily by the former commission chair. She assured the
committee that the ACoA plays an undiminished role for older
Alaskans. Because it does not serve as a grant making body, the
ACoA is now able to focus on statewide planning and to act as a
strong advocate for caregivers and seniors. Ms. Daniello told
the committee that the ACoA hosts quarterly meetings with
caregivers and providers to talk about senior issues. Its
members also advocate before legislators, the governor, and
DHSS, regarding issues concerning older Alaskans such as:
legislation to strengthen the senior benefits program; the
creation of the office of Advocacy; strengthening laws to
prevent crimes of identify theft against seniors; and supporting
stable funding for many senior services. The ACoA also
advocates to the congressional delegation on federal issues such
as workforce development and Medicare reimbursement rates. Its
other responsibilities are to provide recommendations to DHSS
and to the Alaska Mental Health Trust Authority, and to provide
local community education. Ms. Daniello assured the committee
that the ACoA supports HB 279.
4:17:30 PM
BANARSI LAL, Chair, ACoA, DHSS, expressed his belief that the
concerns about the changes brought by Executive Order 108 were
unfounded. He opined that grant making took a lot of time away
from the ACoA's primary functions: to be the eyes and ears of
seniors in Alaska; to educate seniors about the availability of
existing services; and to advocate for their needs. Instead,
the ACoA is now able to solicit seniors for information about
their needs and to produce the state plan. The state plan is
submitted to the commissioner of the DHSS, the governor's
office, and to the Region 10 office of the Older Americans
Program. Mr. Lal noted that the small board and staff of the
ACoA have the drive and interest to produce the state plan. In
2006, the White House Conference on Aging sponsored forums
throughout the state and the commission gathered more
information from seniors. He then spoke of the value of the
legislative audit report and said that he is very supportive of
HB 279. Mr. Lal encouraged the committee to take a long-term
position on the growing needs of the senior population and to
study the recommendations in the ACoA's state plan and annual
report.
4:22:40 PM
CHAIR WILSON asked for concurrence from the Legislative Audit
Division.
4:23:09 PM
PAT DAVIDSON, Legislative Auditor, Legislative Audit Division,
Legislative Agencies & Offices, informed the committee that she
was representing the Division of Legislative Audit as it relates
to HB 279. She stated that the audit recommends that the
statutes be changed for those areas that represent
administration of the grants. The sections in the bill that
reflect changes to the grants support the audit recommendations.
CHAIR WILSON closed testimony.
4:24:10 PM
REPRESENTATIVE KELLER moved to report HB 279, Version 25-
LS1106\E, Mischel, 2/11/08, out of committee with individual
recommendations and the accompanying zero fiscal notes. There
being no objection, CSHB 279(HES) was reported out of the House
Health, Education and Social Services Standing Committee.
^Presentation on Alzheimer's disease
4:25:10 PM
CHAIR WILSON announced that the final order of business would be
a presentation on Alzheimer's disease. She said that it is
important to know that in the future the biggest population will
be the senior population.
4:25:54 PM
CONNIE SIPE, Executive Director, Center for Community, informed
the committee that she was representing the Alzheimer's Resource
of Alaska. She explained that ADRD stands for Alzheimer's
Disease and Related Dementias (ADRD). Alzheimer's Resource of
Alaska is a beneficiary of the Alaska Mental Health Trust
Authority because ADRD was originally treated as mental illness.
Ms. Sipe told the committee that dementia is an irreversible
cognitive disease of the brain and there are many kinds,
although they are usually all called Alzheimer's. Alzheimer's
is usually diagnosed by the following symptoms: the loss of
short term memory, the loss of spoken and written language, the
loss of the ability to plan, and the loss of the ability to
process visual information. She continued to explain that many
other diseases have components of dementia, and diagnosis and
competent medical care is important at the early stage of the
disease. Alzheimer's is a fatal disease and the average life
lived after diagnosis is eight years. Ms. Sipe pointed out that
one in two of every person over the age of eighty-five is
affected; there are approximately five thousand Alaskans with
some dementia, and seventy-five percent are in their family's
care. Alzheimer's and Related Dementias patients are
particularly difficult to care for due to the complexity of the
disease and the possibility of violent behavior. Alaska's
Pioneer Homes are experts in the care of patients with
dementias. Families and patients use state services, when
available, such as: day care; assisted living homes; and Meals
on Wheels. Family care is often the only choice as many nursing
homes can not handle Alzheimer's patients. She stated that
dementia is a broad spectrum disease, and there is no
prevention, cure, or treatment. However, some medications can
help to slow the worsening of symptoms, or to relieve anxiety
and depression. Ms. Sipe stressed the high level of importance
of Medicaid waiver coverage for people with Alzheimer's; she
stated her hope that members will follow the progress of waivers
and will fund the proposed first increase in senior grants in
ten years. She opined that $1.5 million put in the general fund
will fund the grants to families.
4:36:11 PM
DEBBIE NEWSHAM, Member, Alzheimer's Resource of Alaska Board,
explained that she is a caregiver; her father has Alzheimer's.
She described her experiences with her father who suffers from
violent and destructive outbursts. She said that she had to
leave work to care for him, at the loss of her benefits and
insurance, and listed the many difficulties her family has
endured, without respite or a suitable alternative for housing,
in order to provide his care. She now gets ten hours per week
of respite relief. However, she must be with him constantly and
the cost of his care takes ten percent of the family income;
this has led to significant money difficulties for her family.
4:46:50 PM
MS. NEWSHAM continued to relate the difficulty of life for her
family while she is providing her father's care. She pointed
out that the median income for caregivers is $44,000 per year
and average expenses to care for a person, disabled in this or a
similar way, is $5,500 per year. Ms. Newsham said that $700 per
year from the state is a small price to pay to enable her to
continue to care for her father. Her choice is to do this for
her family but she needs state support to continue.
4:49:49 PM
MS. SIPE explained that the state can help families fulfill this
role with Medicaid waivers and a higher level of respite care.
4:50:53 PM
MS. NEWSHAM told of her experiences that are similar to those of
other caregivers.
4:52:09 PM
CHAIR WILSON related her personal experience with dementia
patients.
4:53:38 PM
MS. NEWSHAM noted that the health of caregivers, due to sleep
deprivation and other issues, is also a problem. She concluded
by encouraging the committee to restore the proposed budget
increase to the Alaska Mental Health Trust Authority.
4:54:58 PM
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 4:55:21 PM.
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