04/01/2010 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SCR13 | |
| SB238 | |
| HB282 | |
| HB126 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | SCR 13 | TELECONFERENCED | |
| + | SB 238 | TELECONFERENCED | |
| + | HB 282 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 126 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 1, 2010
3:04 p.m.
MEMBERS PRESENT
Representative Bob Herron, Co-Chair
Representative Wes Keller, Co-Chair
Representative Tammie Wilson, Vice Chair
Representative Bob Lynn
Representative Paul Seaton
Representative Sharon Cissna
Representative Lindsey Holmes
MEMBERS ABSENT
All members present
MEMBERS PRESENT
Representative Nancy Dahlstrom
COMMITTEE CALENDAR
CS FOR SENATE CONCURRENT RESOLUTION NO. 13(HSS)
Supporting senior caregivers and encouraging the Department of
Health and Social Services to provide additional education on
the effects of aging and the importance of senior caregivers.
- MOVED CS SCR 13 (HSS) OUT OF COMMITTEE
SENATE BILL NO. 238
"An Act amending the eligibility threshold for medical
assistance for persons in a medical or intermediate care
facility."
- MOVED SB 238 OUT OF COMMITTEE
HOUSE BILL NO. 282
"An Act relating to naturopaths and to the practice of
naturopathy; establishing an Alaska Naturopathic Medical Board;
authorizing medical assistance program coverage of naturopathic
services; amending the definition of 'practice of medicine'; and
providing for an effective date."
- HEARD & HELD
HOUSE BILL NO. 126
"An Act relating to continuing the secondary public education of
a homeless student; relating to the purpose of certain laws as
they relate to children; relating to tuition waivers, loans, and
medical assistance for a child placed in out-of-home care by the
state; relating to foster care; relating to children in need of
aid; relating to foster care transition to independent living;
and relating to juvenile programs and institutions."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SCR 13
SHORT TITLE: SUPPORTING SENIOR CAREGIVERS
SPONSOR(s): SENATOR(s) BUNDE
02/24/10 (S) READ THE FIRST TIME - REFERRALS
02/24/10 (S) HSS
03/15/10 (S) HSS AT 1:30 PM BUTROVICH 205
03/15/10 (S) Moved CSSCR 13(HSS) Out of Committee
03/15/10 (S) MINUTE(HSS)
03/16/10 (S) HSS RPT CS 5DP SAME TITLE
03/16/10 (S) DP: DAVIS, ELLIS, THOMAS, PASKVAN,
DYSON
03/18/10 (S) BEFORE THE SENATE ON FINAL PASSAGE
03/18/10 (S) TRANSMITTED TO (H)
03/18/10 (S) VERSION: CSSCR 13(HSS)
03/19/10 (H) READ THE FIRST TIME - REFERRALS
03/19/10 (H) HSS
04/01/10 (H) HSS AT 3:00 PM CAPITOL 106
BILL: SB 238
SHORT TITLE: MEDICAID FOR MEDICAL & INTERMEDIATE CARE
SPONSOR(s): SENATOR(s) DAVIS
01/22/10 (S) READ THE FIRST TIME - REFERRALS
01/22/10 (S) HSS, FIN
02/01/10 (S) HSS AT 1:30 PM BUTROVICH 205
02/01/10 (S) Moved CSSB 238 Out of Committee
02/01/10 (S) MINUTE(HSS)
02/03/10 (S) HSS RPT 5DP
02/03/10 (S) DP: DAVIS, ELLIS, THOMAS, DYSON,
PASKVAN
03/15/10 (S) FIN AT 9:00 AM SENATE FINANCE 532
03/15/10 (S) Heard & Held
03/15/10 (S) MINUTE(FIN)
03/22/10 (S) FIN RPT 2DP 3NR
03/22/10 (S) DP: HOFFMAN, EGAN
03/22/10 (S) NR: STEDMAN, HUGGINS, OLSON
03/22/10 (S) FIN AT 9:00 AM SENATE FINANCE 532
03/22/10 (S) Moved SB 328 Out of Committee
03/22/10 (S) MINUTE(FIN)
03/23/10 (S) TRANSMITTED TO (H)
03/23/10 (S) VERSION: SB 238
03/24/10 (H) READ THE FIRST TIME - REFERRALS
03/24/10 (H) HSS, FIN
04/01/10 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 282
SHORT TITLE: NATUROPATHS
SPONSOR(s): REPRESENTATIVE(s) MUNOZ
01/15/10 (H) PREFILE RELEASED 1/15/10
01/19/10 (H) READ THE FIRST TIME - REFERRALS
01/19/10 (H) L&C, HSS, JUD, FIN
01/25/10 (H) JUD REFERRAL REMOVED
03/01/10 (H) L&C AT 3:15 PM BARNES 124
03/01/10 (H) Heard & Held
03/01/10 (H) MINUTE(L&C)
03/10/10 (H) L&C AT 3:15 PM BARNES 124
03/10/10 (H) Heard & Held
03/10/10 (H) MINUTE(L&C)
03/19/10 (H) L&C AT 3:15 PM BARNES 124
03/19/10 (H) Moved CSHB 282(L&C) Out of Committee
03/19/10 (H) MINUTE(L&C)
03/22/10 (H) L&C RPT CS(L&C) 1DP 1DNP 3NR
03/22/10 (H) DP: BUCH
03/22/10 (H) DNP: LYNN
03/22/10 (H) NR: T.WILSON, HOLMES, OLSON
04/01/10 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 126
SHORT TITLE: FOSTER CARE/CINA/EDUCATION OF HOMELESS
SPONSOR(s): REPRESENTATIVE(s) GARA
02/11/09 (H) READ THE FIRST TIME - REFERRALS
02/11/09 (H) EDC, HSS, FIN
02/25/09 (H) EDC AT 8:00 AM CAPITOL 106
02/25/09 (H) Heard & Held
02/25/09 (H) MINUTE(EDC)
03/02/09 (H) EDC AT 8:00 AM CAPITOL 106
03/02/09 (H) Heard & Held
03/02/09 (H) MINUTE(EDC)
03/09/09 (H) EDC AT 8:00 AM CAPITOL 106
03/09/09 (H) Heard & Held
03/09/09 (H) MINUTE(EDC)
03/11/09 (H) EDC AT 8:00 AM CAPITOL 106
03/11/09 (H) Moved CSHB 126(EDC) Out of Committee
03/11/09 (H) MINUTE(EDC)
03/12/09 (H) EDC RPT CS(EDC) NT 2DP 2NR
03/12/09 (H) DP: GARDNER, BUCH
03/12/09 (H) NR: KELLER, SEATON
04/14/09 (H) HSS AT 3:00 PM CAPITOL 106
04/14/09 (H) Heard & Held
04/14/09 (H) MINUTE(HSS)
04/01/10 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
SENATOR CON BUNDE
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced SCR 13 as the prime sponsor of
the bill.
TREVOR FULTON, Staff
to Senator Con Bunde
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions on behalf
of Senator Con Bunde, prime sponsor of SCR 13.
KEVIN TURKINGTON, President
Senior Care of Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SCR 13.
ANGELA SALERNO, Systems Developer
Division of Senior and Disabilities Services
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified in support of SCR 13.
MARIANNE MILLS, President
AgeNet
Alaska's Association of Senior Service Provider Agencies
Juneau, Alaska
POSITION STATEMENT: Testified in support of SCR 13 and SB 238.
MARIE DARLIN
AARP Capital City Task Force
Juneau, Alaska
POSITION STATEMENT: Testified in support of SCR 13 and SB 238.
DENISE DANIELLO, Executive Director
Alaska Commission on Aging
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of SCR 13 and
SB 238.
SENATOR BETTYE DAVIS
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced SB 238 as the prime sponsor of
the bill.
TOM OBERMEYER, Staff
to Senator Davis
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of SB 238 on
behalf of the prime sponsor, Senator Bettye Davis.
KEN OZMENT
Homer, Alaska
POSITION STATEMENT: Testified in support of SB 238.
HOLLY HANDLER, Attorney
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of SB 238.
VANCE SANDERS, Attorney
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 238.
AMY ONEY
Assisted Living
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 238.
SHERRY METTLER
Assisted Living
POSITION STATEMENT: Testified in support of SB 238.
JON SHERWOOD, Medicaid Special Projects
Office of the Commissioner
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of SB 238.
REPRESENTATIVE CATHY MUNOZ
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HB 282 as the prime sponsor of
the bill.
KENDRA KLOSTER, Staff
to Representative Cathy Munoz
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions about the
proposed CSHB 282, Version W, on behalf of the prime sponsor of
the bill, Representative Cathy Munoz.
WAYNE ADERHOLD
Homer, Alaska
POSITION STATEMENT: Testified in support of HB 282.
ASHLEY MAY, Naturopathic Doctor
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 282.
PATRICK NEARY, Naturopathic Doctor
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 282.
DAVID OTTOSON
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 282.
REPRESENTATIVE LES GARA
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced the proposed Committee
Substitute (CS) for HB 126, as the prime sponsor of the bill.
MIKE LESMANN, Program Coordinator
Office of Children's Services (OCS)
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of HB 126.
ACTION NARRATIVE
3:04:57 PM
CO-CHAIR BOB HERRON called the House Health and Social Services
Standing Committee meeting to order at 3:04 p.m.
Representatives Herron, Keller, T. Wilson, and Seaton were
present at the call to order. Representatives Cissna, Lynn, and
Holmes arrived as the meeting was in progress.
SCR 13-SUPPORTING SENIOR CAREGIVERS
3:05:22 PM
CO-CHAIR HERRON announced that the first order of business would
be CS FOR SENATE CONCURRENT RESOLUTION NO. 13(HSS), Supporting
senior caregivers and encouraging the Department of Health and
Social Services to provide additional education on the effects
of aging and the importance of senior caregivers.
3:06:01 PM
SENATOR CON BUNDE, Alaska State Legislature, expressed his
desire to draw attention to the escalating senior demographics
in Alaska. He pointed out that Alaska had the fastest growing
senior population in the U.S. and was projected to grow by 150
percent in the next 20 years. He directed attention to the
increased need for senior caregiving, and predicted that 25
percent of all seniors would need some level of daily
assistance. He noted that the longer a senior can take care of
themselves at home, the less of an impact it would have on the
public systems. He stated that SCR 13 was supported by
Department of Health and Social Services, AARP, and Alzheimer's
Resource of Alaska.
3:08:04 PM
REPRESENTATIVE SEATON referred to page 2, line 15, and asked if
"recognizes senior caregiving as a profession" indicated that
this would become a profession permitted by occupational
licensing. He asked if there were criteria for this.
3:08:34 PM
TREVOR FULTON, Staff to Senator Con Bunde, Alaska State
Legislature, in response to Representative Seaton, stated that,
as a resolution, this had no weight to change statute, and would
not place any profession under licensing organization. He
explained that the resolution was to draw attention to the
importance of the profession.
3:09:15 PM
CO-CHAIR KELLER asked if it was possible to resolve not to get
older.
3:09:49 PM
KEVIN TURKINGTON, President, Senior Care of Alaska, stated that
he was testifying in support of SCR 13. [Due to technical
difficulties, much of the testimony was difficult to hear
clearly.] He stated his support for SCR 13. He read [page 2,
lines 12 - 13], and pointed out the financial impact of seniors
providing for themselves.
3:14:42 PM
ANGELA SALERNO, Systems Developer, Division of Senior and
Disabilities Services, Department of Health and Social Services,
stated that the administration supported SCR 13. She pointed
out the value of senior caregivers and voiced appreciation for
their service.
3:15:42 PM
MARIANNE MILLS, President, AgeNet, Alaska's Association of
Senior Service Provider Agencies, stated her support of SCR 13.
She acknowledged the hard work of unpaid family caregivers,
which was valued at $140 million. She directed attention to the
care and support of family members in providing for seniors.
She pointed out that SCR 13 heightened the awareness of aging
issues and the need for planning ahead.
3:17:19 PM
MARIE DARLIN, AARP Capital City Task Force, stated that AARP was
in full support of SCR 13. She confirmed the changing
demographics that would require an increased role for family
care givers. She emphasized that SCR 13 was a necessary part of
the health care plan.
3:19:09 PM
DENISE DANIELLO, Executive Director, Alaska Commission on Aging,
Department of Health and Social Services, explained that the
Commission advocated on behalf of older Alaskans and she
explained some of its programs. She stated support for SCR 13.
She pointed out that Alaska was a maturing state, with a quickly
growing senior population that had resided here for many years.
She noted that seniors were living longer. She mentioned the
importance of family caregivers. She referenced the Senior
Snapshot, contained in the FY 2009 Annual Report, which was
available on line.
3:23:47 PM
REPRESENTATIVE T. WILSON asked if the Alaska Commission on Aging
would supply the additional education that was mentioned in SCR
13.
MS. DANIELLO replied that a goal of the state plan for senior
services was for increased education.
REPRESENTATIVE T. WILSON asked why a resolution was necessary.
MS. DANIELLO offered her belief that SCR 13 did not authorize
the educational campaign. She deferred to Senator Bunde for his
reasons to the resolution, but she pointed out that it had
heightened awareness toward the aging population.
3:25:12 PM
REPRESENTATIVE CISSNA encouraged people to go to the meetings of
the Alaska Commission on Aging.
MS. DANIELLO, in response to Representative Cissna, said that
the commission met quarterly, and that there was currently an
educational series on senior community forums. She pointed out
that family support was necessary for senior care, but that
family dynamics were changing, with more divorce and fewer
children. She stressed the importance of supporting family
caregivers.
3:27:05 PM
CO-CHAIR HERRON closed public testimony.
3:27:17 PM
SENATOR BUNDE, in response to Representative T. Wilson,
explained that SCR 13 offered encouragement for family
caregivers, even though it lacked enforcement.
3:27:36 PM
CO-CHAIR KELLER moved to report CS SCR 13 (HSS) out of committee
with individual recommendations.
There being no objection, CS SCR 13 (HSS) was reported from the
House Health and Social Services Standing Committee.
SB 238-MEDICAID FOR MEDICAL & INTERMEDIATE CARE
CO-CHAIR HERRON announced that the next order of business would
be SENATE BILL NO. 238, "An Act amending the eligibility
threshold for medical assistance for persons in a medical or
intermediate care facility."
3:29:07 PM
SENATOR BETTYE DAVIS, Alaska State Legislature, mentioned that
the members should all be able to identify with this bill.
3:29:36 PM
TOM OBERMEYER, Staff to Senator Davis, Alaska State Legislature,
read from the sponsor statement: [original punctuation
provided] [Included in the committee packets.]
This bill amends and restores the Medicaid income
eligibility threshold for individuals who reside in a
medical or intermediate care facility from a specified
monthly income limit to 300% of the Social Security
income benefit rate. This threshold is also used for
people who receive home and community-based waiver
services. In 2003 the Legislature froze the Medicaid
long-term services income eligibility limit for
persons in medical or intermediate care facilities at
$1,656 per month which was 300% Supplemental Security
Income (SSI) at that time. This change created an
income ceiling for waiver eligibility, effectively
freezing the eligibility limit for the last seven
years, rather than allowing the limit to adjust
annually in tandem with the SSI, the income equivalent
of which in 2009 was $2,022. The result was that
small Social Security cost of living adjustments have
disqualified many needy disabled people from the
program.
Alternatives for preserving eligibility, particularly
for those requiring lifetime or long-term care,
include creation of a Medicaid qualifying income
trust, also known as a Miller Trust. Trusts, however,
have procedural drawbacks, including numerous
responsibilities and restrictions, limited access to
income, assistance of an attorney, and a trustee to
manage trust assets.
As background, the Supplemental Security Income (SSI)
program is a federal needs-based disability program
for low income adults over age 65, blind, or disabled.
For an adult, the SSI disability requirement is based
on the ability to work. An adult is considered
disabled if the person cannot do the work that he/she
performed before the disability occurred or cannot do
alternate work because of a severe physical or mental
condition. For a child to be eligible, he/she must
suffer from serious physical and/or mental problems.
For both adults and children, the disability must
last, or be expected to last for at least a year.
Medicaid services are critical to the well-being of
Alaska's most vulnerable citizens. Supporting SB 238
will ensure that eligible Alaskans can continue to
receive nursing home care and in-home services. It
also will save the Legislature from amending statutes
every year or two as the Federal Poverty Level
guidelines and Supplemental Security Income levels
increase with the cost of living.
3:32:44 PM
CO-CHAIR HERRON asked if research had reflected the
justification for establishing the ceiling in 2003.
3:33:14 PM
MR. OBERMEYER explained that there had been a fiscal problem at
that time, and that both this and Denali KidCare were shifted to
fixed dollar amounts. He opined that the value of these fixed
amounts had been diluted as the cost of living had increased.
He pointed out that this affected Alaska's most vulnerable
citizens.
3:33:59 PM
CO-CHAIR HERRON asked why this would have happened.
3:34:22 PM
MR. OBERMEYER said that he did not know.
3:34:31 PM
SENATOR DAVIS, in response to Co-Chair Herron, explained that
the administration at that time had cut budgets, and that this
had not since been adjusted.
3:34:58 PM
REPRESENTATIVE T. WILSON asked how this could have a zero fiscal
note.
3:35:15 PM
SENATOR DAVIS replied that there was not a cost to the state.
3:35:27 PM
REPRESENTATIVE CISSNA pointed out that the people most affected
by SB 238 more often relied on emergency room visits, which were
more costly to the state.
3:35:47 PM
MR. OBERMEYER agreed, and he added that many of the affected
seniors would not receive any services. He pointed out the
savings to the state from assistance in home care services.
3:36:23 PM
REPRESENTATIVE CISSNA requested an analysis of the cost benefits
for these programs.
3:36:53 PM
KEN OZMENT stated his support of SB 238. He relayed that he had
been denied Medicaid a few years prior. He was able to procure
a supplemental health insurance policy. He pointed out the
difficulties to those on a fixed income.
3:38:33 PM
HOLLY HANDLER, Attorney, directed attention to the small cost of
living increases at the end of December, 2008, which would have
terminated 50 - 60 people in Juneau from Medicaid. She said
that the necessary legal steps to these individuals for
establishing a Medicaid qualifying income [Miller] trust were
very difficult. She opined that a very critical aspect was the
requirement that, in order to establish this trust, the Medicaid
recipient must release the power over their finances to a
separate trustee. She advocated support for SB 238, which would
allow income eligibility to be based on social security limits,
instead of the current fixed amount.
3:42:25 PM
MS. HANDLER, in response to Co-Chair Herron, said that the
Office of Public Advocacy dealt with issues of elder fraud and
exploitation.
REPRESENTATIVE T. WILSON asked about Medicaid eligibility with a
Miller Trust.
3:43:07 PM
MS. HANDLER explained that the Miller Trust allowed for a
special trust account which would distribute the Medicaid income
to the recipient, but that upon death, the remaining money in
the Miller Trust was returned to the state.
3:43:36 PM
VANCE SANDERS, Attorney, relayed that he was also the President
of Alaska Legal Services, which worked closely with seniors and
other disabled people. He noted that many people throughout
Alaska would be affected by SB 238, as the fixed income ceiling
had limited eligibility. He opined that the fixed income had
been introduced without an understanding of how the systems
worked together. He explained that as social security limits
increased, this increase to income affected the fixed
eligibility income levels. He explained the difficulties with
an irrevocable trust, which included the necessity for a
trustee, provisions to allow for change of living environment,
and registration with the court. He reported that only death or
a court order could terminate the trust. He reflected on the
difficulty of finding qualified, knowledgeable trustees. He
urged support for SB 238.
3:47:01 PM
AMY ONEY, Assisted Living, stated her support for SB 238. She
directed attention to the fiscal note, and opined that there
would be a cost savings from passage of SB 238, as the current
system was very costly to monitor and administer.
3:49:14 PM
MARIANNE MILLS, President, AgeNet, Alaska's Association of
Senior Service Provider Agencies, pointed out that SB 238 would
allow elder Alaskans access to cost effective home and community
based services. She explained the two requirements for
eligibility to the home and community based waiver program:
financial need and medical necessity for nursing home level of
care. She reflected that the annual cost of living increase to
social security benefits would often make a person ineligible
for the Medicaid waiver program. She pointed out that SB 238
would change the income eligibility relative to the cost of
living increases. She reported that this would allow older
Alaskans to remain longer in their own homes. She stated her
support for SB 238.
3:51:47 PM
MARIE DARLIN, AARP Capital City Task Force, stated support for
SB 238 as it would correct the current problems. She pointed
out the cost increases in the seven years since the change.
3:53:17 PM
SHERRY METTLER offered her support of SB 238. She stated her
belief that the Miller Trust was extremely complicated.
3:55:54 PM
DENISE DANIELLO, Executive Director, Alaska Commission on Aging,
Department of Health and Social Services, said that the
commission became aware of this situation in December, 2008,
when the cost of living allowance was increased, and eligibility
for services was then threatened. She opined that every cost of
living increase would jeopardize more individual eligibilities.
She pointed out that managing personal finances was a matter of
personal dignity, and that when the Miller Trust removed this
control and gave it to a trustee, it became a humiliating
process for the senior.
3:58:55 PM
REPRESENTATIVE SEATON asked if the one time federal payment of
$250 would affect eligibility.
4:00:00 PM
JON SHERWOOD, Medicaid Special Projects, Office of the
Commissioner, Department of Health and Social Services,
discussed the impact of the bill. He stated that it would raise
the income standard for eligibility of people in nursing homes
or recipients of the home and community based waivers. He did
not anticipate that raising the eligibility limit would increase
the number of nursing home or waiver recipients. He explained
the cost of care calculation which called for a contribution of
income toward the cost of care. This was income that was in
excess of personal needs and other allowed deductions, and was a
separate calculation done after the eligibility determination.
He opined that the cost of care calculation would not change.
He clarified that the Miller Trust was still available for those
people who had income in excess of the maximum allowable income,
300 percent of SSI. He said that those people with income
between the current fixed amount and the proposed 300 percent of
SSI would not need to have a Miller Trust.
4:03:11 PM
CO-CHAIR KELLER asked to clarify that the zero fiscal note was
because of the Miller Trust.
4:03:31 PM
MR. SHERWOOD agreed. He directed attention to the large cost of
living increase in 2009, and noted that everyone was able to
retain Medicaid eligibility. He allowed that it was difficult
to set up a Miller Trust, especially on short notice.
4:04:06 PM
CO-CHAIR KELLER asked if the Miller Trust was a federal trust.
He inquired about any criteria or qualifications for the
trustees.
4:04:32 PM
MR. SHERWOOD said that there was a state statute regarding
compliance with the federal statute for Miller Trusts. He
explained that federal law dictated that states which operate
Medicaid programs have to recognize these trusts for determining
Medicaid eligibility. He reported that income entering the
trust was disregarded during the eligibility determination, but
was included in the cost of care calculation. He pointed out
that under ordinary circumstances most income trusts for people
with disabilities did not accrue much money, as the cost of care
calculation "cleans them out every month, if they are
administered correctly."
4:06:00 PM
CO-CHAIR HERRON asked if the new federal health reform law
contained any eligibility criteria.
4:06:30 PM
MR. SHERWOOD replied that he was still analyzing its effect on
Medicaid eligibility. He reported that the newly added
categories would use different income calculations than were
traditionally used for Medicaid populations. He noted that
there were exceptions to the existing Medicaid populations. He
shared that an analysis to the impact was still necessary.
4:07:19 PM
REPRESENTATIVE T. WILSON asked if the seniors would have more
money without the trusts.
MR. SHERWOOD said that was not the case. He explained that
after the eligibility determination there was a cost of care
calculation to determine the individual contribution. He
reiterated that the cost of care calculation was irrelevant to
the trust. He listed the cost of care to include prescriptions
not covered by Medicaid or Medicare, a personal needs allowance,
and non-covered dependent medical expenses.
4:08:35 PM
CO-CHAIR HERRON closed public testimony.
4:08:45 PM
REPRESENTATIVE SEATON shared that he had watched the burden on
recipients increase since the shift to the fixed dollar amount.
He noted that the intent had been to save money, but that time
had shown that it did not. He expressed support for SB 238.
4:09:59 PM
CO-CHAIR KELLER stated his support for maintaining the dignity
of the seniors. He reiterated that it may become necessary to
revisit this issue in the future when the federal health care
reform bill was better analyzed.
4:10:39 PM
REPRESENTATIVE T. WILSON moved to report SB 238 out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, SB 238 was reported from the
House Health and Social Services Standing Committee.
4:11:03 PM
[The committee took a brief at-ease.]
HB 282-NATUROPATHS
4:12:35 PM
CO-CHAIR HERRON announced that the next order of business would
be HOUSE BILL NO. 282, "An Act relating to naturopaths and to
the practice of naturopathy; establishing an Alaska Naturopathic
Medical Board; authorizing medical assistance program coverage
of naturopathic services; amending the definition of 'practice
of medicine'; and providing for an effective date." [In front
of the committee was CSHB 282 (L&C), 26-LS1208\T.]
REPRESENTATIVE CATHY MUNOZ, Alaska State Legislature, said that
HB 282 would establish a naturopathic board, and she paraphrased
the sponsor statement [original punctuation provided] [Included
in the committee packets.] which read:
House Bill 282 creates a Naturopathic Medical Board
for the purpose of expanding allowed practices and
procedures of Naturopathic Doctors (NDs) and regulates
the practice of naturopathic medicine. The board will
consist of three naturopaths, one licensed pharmacist,
and one public member. The board will work with the
Division of Occupational Licensing to issue licenses,
and will have authority to investigate and discipline
as required. In addition, the state will authorize
prescription endorsement which will be offered for the
first time for NDs who have practiced for five years;
participated in 60 hours of pharmacology education
from an approved program; and met all the requirements
relating to administration and prescription of drugs,
vaccinations, hormones, and medical devices. The
prescription endorsement must be renewed every two
years. The bill mandates continuing medical education
of 35 hours bi-annually, 15 of which must be in
pharmacy education. Prescribing authority will give
flexibility to NDs to provide necessary medical
treatment to patients. Prescription rights, which are
already permitted for advanced nurse practitioners,
will allow access to a range of commonly prescribed
medicines that can be used in correlation with
naturopathic treatment to improve patient care.
HB 282 will align the definition of a naturopathic
physician with the U.S. Department of Labor which
released a new definition of naturopathic physician to
include job titles of "Naturopathic Doctor, Physician,
and Doctor of Naturopathic Medicine." This is an
important step in recognizing NDs as qualified doctors
and primary care physicians.
Naturopathic doctors are highly trained medical
professionals. NDs attend a four-year post-graduate
professional naturopathic medical program and are
educated in the same basic sciences as conventional
medical students. Studies concentrate on holistic and
traditional approaches to therapy with a strong
emphasis on disease prevention and optimization of
wellness. Naturopathic doctors take similar rigorous
professional board exams for licensure and continue
educational training each year.
As Alaska continues to face shortages in the
healthcare professions, HB 282 provides an avenue to
help fill the gap of primary care physicians. This
bill will reasonably expand the services of
naturopaths and follow the responsibilities set forth
by the board while providing the important services
for keeping Alaskans healthy.
4:16:32 PM
CO-CHAIR HERRON asked to clarify that Representative Munoz had
requested to adopt a proposed Committee Substitute (CS) for HB
282.
4:17:23 PM
CO-CHAIR KELLER moved to adopt proposed Committee Substitute
(CS) for HB 282, 26-LS1208\W, Bullard, 3/30/10, as the working
draft.
REPRESENTATIVE SEATON objected for discussion.
4:17:55 PM
KENDRA KLOSTER, Staff to Representative Cathy Munoz, Alaska
State Legislature, explained the differences between CSHB 282
(L&C), Version T, and the proposed Committee Substitute (CS) for
HB 282, Version W. She referred to Version T, and directed
attention to page 3, line 13, which she pointed out had been
moved to page 5, line 14 in Version W. She stated that the
language, "establish a list of prescription drugs", was removed.
She explained that it would have been problematic for a
pharmacist to refer to a list of medications, but that it still
included the prescription rights for non-controlled legend
drugs.
4:19:41 PM
MS. KLOSTER, in response to Representative Seaton, said that the
proposed prescription rights were not more expansive, but the
wording and the placement in the bill had required editing. She
explained that the original intent had included the non-
controlled legend drugs.
4:20:52 PM
REPRESENTATIVE MUNOZ added that the intent was to allow
naturopaths to prescribe common, non-addictive pharmaceuticals,
including antibiotics, immunizations, and hormones.
4:21:57 PM
REPRESENTATIVE T. WILSON relayed that she had received a lot of
letters from doctors who were upset about the bill, and she
inquired if there would be the opportunity to work with the
sponsor to resolve these issues.
4:22:37 PM
CO-CHAIR HERRON asked Representative Munoz about the physician
concerns.
4:23:07 PM
REPRESENTATIVE MUNOZ, in response, said that they were referred
to as naturopathic physicians under federal law. She opined
that there was some misinformation and some fear of the
expansion of prescriptive rights. She directed attention to
advanced nurse practitioners, who were now also allowed "to
prescribe commonly prescribed drugs that has resulted in better
opportunities, easier working relationship with their patients,
broader access to care for Alaskans." She pointed out that
naturopathic physicians had considerably more training, so that
it was appropriate to offer limited prescriptions of
pharmaceuticals. She opined that Alaskans would benefit.
4:24:44 PM
REPRESENTATIVE MUNOZ asked Representative T. Wilson if the
concern was for the term "physician" or about the prescriptive
rights.
REPRESENTATIVE T. WILSON replied that it was both.
REPRESENTATIVE MUNOZ explained that the original bill had been
more expansive for the ability to prescribe, but that this was
refined to commonly used prescriptions, and that the proposed CS
was much more restrictive.
REPRESENTATIVE T. WILSON, in response, said that the comments
had been about the proposed CS as well.
REPRESENTATIVE MUNOZ recalled that they were probably opposed to
the advanced nurse practitioners prescriptive rights, as well.
4:26:29 PM
REPRESENTATIVE SEATON removed his objection. There being no
further objection, Version W was adopted as the working draft.
REPRESENTATIVE CISSNA pointed to the shortage of caregivers in
Alaska and opined that this was another solution for care.
4:27:59 PM
REPRESENTATIVE MUNOZ related a personal story about her son and
a naturopathic physician.
4:30:09 PM
WAYNE ADERHOLD, read from his submitted written testimony
[Included in the committee packets.]:
Most people can agree that our medical system is
broken and in need of an overhaul, but getting
agreement on the solution is another story. HB 282 is
one step in the right direction and should be pushed
through into law now. According to the March 8th
issue of Newsweek in a piece titled, "We the Problem,"
"our leaders are paralyzed by the very thought of
asking their constituents to make short term
sacrifices for long term benefits. They cannot bring
themselves to raise taxes on the middle class or cut
social security and medical benefits to the elderly.
They'd get clobbered at the polls. So, any day of
reckoning gets put off and put off again, and debts
pile up." I agree with this assessment that a
majority of the populace seems locked into an
entitlement and instant gratification mentality and
believe that it applies equally to our medical and
financial woes. I don't envy your job when most of
the right decisions nowadays involve sacrifice, but I
have some good news for you. There is a significant
and growing segment of your constituents who are
willing to take responsibility for their own medical
issues and deal with the root causes of their
problems. They neither respect nor trust a quick fix.
This same attitude carries over into finances, so
please know that some of us understand your need to
make unpopular decisions just as we may take the
harder road toward better overall health. We are the
patients who choose our primary care doctor based on
their ability to teach us how to take better care of
ourselves, not simply dole out the latest sample of
something that a magazine ad says we should ask about,
and will only bury our symptoms. We work with
naturopathic physicians in a collaborative way, and to
go in knowing that we will be given homework and the
medicines prescribed will be paid for out of own
pockets. So we pay attention and use them
judiciously, because we truly believe we are doing
ourselves some good. When I checked recently with the
office of the two ND's who serve us here on the Kenai
Peninsula there were approximately 1200 active
patients at the Homer practice and 1800 in the Kenai-
Soldotna office. These are very significant numbers
and they are growing steadily. These are everyday
working people who are only different because they
make a conscious decision to take personal
responsibility for their health and commit to delayed
gratification, if necessary. My own personal journey
that has taken me from the allopathic to the
naturopathic model of treatment began in 1993 with the
slow but very successful treatment of the herniated
lumbar disc which avoided surgery. Seventeen years
later, and sixty years old, I will add, I'm mobile and
active in all sports I care to participate in, which
is basically bicycling and cross country skiing. In
the meantime, I have dealt with an array of the
mundane, like flu, to the more complicated, anxiety
and adrenal fatigue, to the downright scary, malignant
melanoma, ie. cancer. All with a near total and ever
increasing reliance on ND's and naturopathic medicine.
And when I say ND, by the way, I'm thinking physician
for that previous discussion. I'd be happy to share
specific details with anyone who wants to know more
about my experiences and how it consciously committed
to naturopathic treatment, particularly if you are at
all skeptical of the need to pass HB 282. The last
thing I want to speak to the safety and the "first do
no harm" aspect, for this is the strongest argument
for allowing ND's to deal with minor surgery and
prescription drugs, if anyone is going to use them. I
would much rather trust these tools to someone who
would use them as a last resort than have had
firsthand experience with both MDs and NDs. Please do
not be swayed by last minute scare tactics from the
ASMA that usually come under the guise of "patient
safety." ASMA is mainly concerned with the safety of
the members' financial status, not my health. When I
sat on the board of my local hospital a few years ago,
and we were in the process of instituting a
requirement for malpractice insurance for the medical
staff, I learned that the insurers were charging about
ten times more for MDs versus NDs. Our local hospital
doesn't credential NDs so it was a moot point, and
that's another story. It certainly spoke to how
insurers viewed risk and practitioners likelihood for
doing harm. The recent $1.8 million jury verdict in a
trial here in Homer which found malpractice against
both the MD and the hospital tells me that the Alaska
State Medical Board and ASMA could devote more time to
governing their own membership. The naturopaths
deserve their own board and governance. Please move
HB 282 out of committee and pass it into law this
session. Thank you.
4:35:52 PM
ASHLEY MAY, Naturopathic Doctor, said that he supported HB 282
as it would better provide naturopathic doctors (ND) in Alaska
the access to the tools necessary to be efficient, primary care
doctors. He opined that more primary care NDs would now
practice in Alaska, which will be vital to Alaskan health care.
He pointed out that currently only about 30 percent of medical
doctors entered primary care. He noted the significance for
Alaska, as 15 percent of Alaskans had difficulty finding primary
care doctors, which was twice the national average. He said
that this was where NDs would fill that gap. He declared
support for a naturopathic board, in order to implement
continuing education requirements and adopt regulations
necessary to provide a high level of medical care to Alaskans.
He opined that the current bill was an "extraordinary compromise
on the part of naturopathic doctors." He compared the proposed
naturopathic board membership to that of the Alaska State
Medical Board and the Alaska Board of Pharmacy, both of which
had a higher medical membership on its boards. He stated his
support for HB 282.
4:38:27 PM
PATRICK NEARY, ND, read from his prepared testimony. [Included
in the committee packets.] He stated that HB 282 clarified the
Naturopathic licensing statutes, and would bring Alaska up to
the current standard of Naturopathic medical care offered in the
other licensed states. He pointed out that HB 282 would provide
Alaskan families with increased access to care and increased
freedom of choice to health treatment while also increasing
safety and oversight of the profession. He clarified that the
bill included Naturopathic Medical services within Medicaid and
Denali KidCare, would align the prescriptive authority of
Naturopaths in Alaska with the national norms, and would create
a Naturopathic Medical board to protect public safety. He spoke
about the shortage of primary healthcare providers both
nationally and in Alaska, and that Naturopaths would help assist
those unmet needs. He spoke about the opposition to licensure
for 15 classes of midlevel providers, which included
naturopaths, by the American Medical Association (AMA). He
explained the current educational standard for an ND, which
included a 4-5 year doctoral program of basic and clinical
medical sciences from nationally accredited Naturopathic medical
colleges, in addition to a Bachelors degree. He spoke about the
limits to Naturopathic training and knowledge, and agreed that
the prescription abilities were not meant to be on a par with
MDs. He spoke about the excellent safety record of NDs and that
searches of the legal databases for both Oregon and Washington
revealed no legal cases against Naturopaths. He stated the
benefits to Alaskans, especially low income Alaskans, for more
freedom of medical choice and access to care. He stated his
support for HB 282.
4:47:22 PM
CO-CHAIR HERRON asked that the committee hold its questions
until the next meeting.
4:48:00 PM
DAVID OTTOSON, paraphrased from his submitted written testimony
[original punctuation provided]: [Included in the committee
packet.]
I am testifying as a consumer of health care. For the
last 25 years, the primary health care providers for
my family have been naturopathic doctors. We have
been successfully treated for numerous ailments,
including sinus infections, earaches, urinary tract
infections, and insomnia. I have worked with a number
of naturopaths and have found them all to be extremely
competent and highly professional.
As far as I am concerned, this legislation should be
completely non-controversial. Every other state on
the West Coast has a Naturopathic Board. Naturopaths
are highly trained health care providers whose focus
is on wellness, education and prevention. It seems to
me that this is exactly the kind of health care that
we need more of.
I have heard that some members of the medical
community are concerned that ND's might practice
outside of their area of competence. I think this is
a red herring. There is no evidence this has been a
problem in other states. And I am not aware that it
has been a problem in Alaska either.
I can tell you from my own experience that the NDs I
have worked with are well aware of their limitations,
and have referred me to other providers when that was
appropriate.
In fact, a few years ago, I came back from a trip to
Africa with a bad case of what I thought was
traveler's diarrhea. I had been staying in a place
with notoriously bad water and had gotten the runs
from drinking the water earlier in my trip.
After several days, I wasn't getting any better and
was experiencing alternating fever and chills. It was
a naturopathic doctor, Emily Kane, who recognized that
I might have something more serious. So she came over
to my house during her lunch hour and drew my blood
and sent it away to be tested for malaria. It came
back positive the next day.
I went to Bartlett hospital and ultimately ended up at
the University of Washington Hospital in Seattle to be
treated for a nasty case of cerebral malaria. It was
because of Dr. Kane's alert intervention that I was
diagnosed with a life threatening condition in time to
be successfully treated.
Two things about this. Number one, it illustrates the
highly personalize form of medical care that is
typical of the naturopathic profession. How many
doctors do you know who make house calls? Yet Dr.
Kane is not the first naturopath to make a house call
at my house.
Number two, it is an example of a naturopath making a
correct diagnosis and referring a patient to
appropriate care. Dr. Kane did not suggest that I
treat my cerebral malaria with colloidal silver or
wormwood. She urged me to go to the hospital and get
treated. and when it turned out that Bartlett
Hospital did not have the appropriate drugs or
expertise to treat my condition, I was transferred to
the University of Washington, where I had the good
fortune to be treated by one of the leading malaria
experts in North America.
ND's clearly have a role to play in our health care
system. They are primary care providers who can treat
many if not most of the common conditions that people
go to a doctor for. The care they provide is
personalized, cost effective, and prevention oriented.
Perhaps most important, it is focused on individuals
taking responsibility for their own wellness. I
firmly believe that we will never get medical costs
under control until we acknowledge that all of us need
to start taking better care of ourselves. Helping
people do this is one thing NDs do best.
I urge you to support this legislation.
4:51:56 PM
[HB 282 was held over.]
HB 126-FOSTER CARE/CINA/EDUCATION OF HOMELESS
4:52:30 PM
CO-CHAIR HERRON announced that the final order of business would
be HOUSE BILL NO. 126, "An Act relating to continuing the
secondary public education of a homeless student; relating to
the purpose of certain laws as they relate to children; relating
to tuition waivers, loans, and medical assistance for a child
placed in out-of-home care by the state; relating to foster
care; relating to children in need of aid; relating to foster
care transition to independent living; and relating to juvenile
programs and institutions." [In front of the committee was the
proposed Committee Substitute (CS) for HB 126, 26-LS0309\C,
Mischel, 4/9/09, adopted as the working draft on 4/14/09.]
CO-CHAIR KELLER pointed out that there were proposed changes to
the bill. He asked to refrain from having a side by side
comparison.
4:53:03 PM
CO-CHAIR KELLER moved to adopt the proposed Committee Substitute
(CS) for HB 126, 26-LS0309\O, Mischel, 3/30/10 as the working
document. [There being no objection, Version O was adopted as
the working draft.]
4:53:36 PM
REPRESENTATIVE LES GARA, Alaska State Legislature, explained
that Version O was a pared down version of the foster care bill
presented earlier. He noted that there were two sections. He
referred to page 1, lines 11-13, and relayed that foster care
could now be extended to 21 years of age. He reported that this
had resulted in higher academic achievement and outcomes for the
youth. He pointed to page 2, line 3, and explained that youth
could now re-enter foster care. He explained the re-entry
parameters to include: "in the best interest of the child" and
that Office of Children's Services (OCS) could ask the court for
conditions to reentry. He explained that Sections 2 and 3 would
be amended or removed. He referred to a proposed amendment to
re-write the reentry provision so that OCS had the discretion to
present the court with reasonable conditions for reentry.
4:58:31 PM
REPRESENTATIVE SEATON moved to adopt Amendment 1, 26-LS0309\O.3,
Mischel, 4/1/10, which read:
Page 2, line 12:
Delete "and"
Insert "in this sub-subparagraph, "parent" means
a biological or adoptive parent or a legal guardian of
the person;"
Page 2, lines 14 - 17:
Delete ", homelessness, or economic hardship, or
to enhance the person's ability to continue the
person's education or training or otherwise improve
the person's successful transition to independent
living;"
Insert "or homelessness or for any other reason
identified by the court that is in the person's best
interest; and
(iv) if requested by the department, agrees
to reasonable terms for resuming state custody that
may include matters relating to the person's
education, attainment of a job or life skills, or
other terms found by the court to be reasonable and in
the person's best interest;"
CO-CHAIR KELLER objected for discussion.
4:59:12 PM
CO-CHAIR KELLER referred to proposed Amendment 1, lines 6-11,
and he asked the reason for the deletion of the phrase
describing the successful transition to independent living. He
opined that this narrowed the focus.
5:00:44 PM
MIKE LESMANN, Program Coordinator, Office of Children's Services
(OCS), Department of Health and Social Services, said that OCS
tried to make the requirements more specific to the steps toward
successful, independent living.
5:01:30 PM
CO-CHAIR HERRON asked if the amendment was what OCS needed.
MR. LESMANN replied that ultimately the court would make the
decision whether the youth could extend or reenter foster care.
5:02:24 PM
CO-CHAIR KELLER said that he was just trying to understand the
amendment.
5:02:45 PM
CO-CHAIR HERRON asked that any questions be brought forward now.
He asked Representative Gara if Amendment 1 addressed both his
and OCS concerns.
5:03:39 PM
REPRESENTATIVE GARA clarified that there was not a controversy
between himself and OCS. He stated that Amendment 1 attempted
to allow re-entry where it was in the best interest of the
child. He explained that the definition of "best interest"
included homelessness, economic hardship, and enhancement of the
child's ability to succeed. He pointed to line 12 of Amendment
1, which allowed OCS discretion to request conditions on the
reentry plan.
5:05:54 PM
CO-CHAIR HERRON asked to clarify that this was language that was
not found anywhere else in the statutes.
REPRESENTATIVE GARA agreed, and explained that currently reentry
was not allowable.
CO-CHAIR HERRON asked if there was currently an opportunity for
a dialogue with the courts, if OCS requested it.
5:06:45 PM
REPRESENTATIVE GARA pointed to Amendment 1, line 15, which
stated that the court would decide what was in the best interest
of the child.
5:07:12 PM
REPRESENTATIVE T. WILSON asked about a plan for transitioning
the kids out of foster care. She asked for an explanation to
the fiscal note of $508,000 for transitioning out of state
custody. She asked for an explanation of the fiscal note for
$93,600 for special needs costs which included extraordinary
clothing, family vacations, and biological family visitations.
5:08:37 PM
REPRESENTATIVE CISSNA opined that if the policy issues were made
on existing data, it would be easier to quantify dollar amounts
in the fiscal notes. She expressed a need to compare the fiscal
notes with the reasons why the costs were rising.
5:10:43 PM
[HB 126 was held over.]
5:11:03 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:11 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| CS HB 282 support letter - Tom Laing 03.30.2010.doc |
HHSS 4/1/2010 3:00:00 PM |
HB 282 |
| CS HB 282 support letter - Center for Natural Medicine 03.23.2010.pdf |
HHSS 4/1/2010 3:00:00 PM |
HB 282 |
| CS HB 282 - 26-LS1208.W - for intro into (H) HSS.pdf |
HHSS 4/1/2010 3:00:00 PM |
HB 282 |
| SCR 13 support letter - K. Turkington 03.15.2010.pdf |
HHSS 4/1/2010 3:00:00 PM |
|
| DCCED fiscal note for CS HB 282 - 26-LS1208.W.pdf |
HHSS 4/1/2010 3:00:00 PM |
HB 282 |