04/07/2011 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic | 
|---|---|
| Start | |
| SCR7 | |
| HB209 | |
| HB61 | |
| HB33 | |
| Adjourn | 
+ teleconferenced
= bill was previously heard/scheduled
| + | SCR 7 | TELECONFERENCED | |
| *+ | HB 209 | TELECONFERENCED | |
| *+ | HB 61 | TELECONFERENCED | |
| *+ | HB 33 | TELECONFERENCED | |
| + | TELECONFERENCED | 
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         April 7, 2011                                                                                          
                           3:07 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Wes Keller, Chair                                                                                                
Representative Alan Dick, Vice Chair                                                                                            
Representative Bob Herron                                                                                                       
Representative Paul Seaton                                                                                                      
Representative Beth Kerttula                                                                                                    
Representative Charisse Millett                                                                                                 
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Bob Miller                                                                                                       
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE CONCURRENT RESOLUTION NO. 7                                                                                              
Proclaiming  September   9,  2011,  as  Fetal   Alcohol  Spectrum                                                               
Disorders Awareness Day.                                                                                                        
                                                                                                                                
     - MOVED OUT OF COMMITTEE                                                                                                   
                                                                                                                                
HOUSE BILL NO. 209                                                                                                              
"An Act requiring  a health care insurer to  provide coverage for                                                               
tobacco cessation treatment."                                                                                                   
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 61                                                                                                               
"An  Act  relating   to  a  registry  for   advance  health  care                                                               
directives."                                                                                                                    
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 33                                                                                                               
"An  Act  relating to  the  procedures  and jurisdiction  of  the                                                               
Department  of  Health  and  Social  Services  for  the  care  of                                                               
children   who  are   in  state   custody;   relating  to   court                                                               
jurisdiction  and  findings pertaining  to  children  who are  in                                                               
state  custody;  and  modifying the  licensing  requirements  for                                                               
foster care."                                                                                                                   
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SCR 7                                                                                                                   
SHORT TITLE: FETAL ALCOHOL SPECTRUM DISORDERS DAY                                                                               
SPONSOR(s): SENATOR(s) MEYER                                                                                                    
                                                                                                                                
03/22/11       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/22/11       (S)       HSS                                                                                                    
03/30/11       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/30/11       (S)       Moved SCR  7 Out of Committee                                                                          
03/30/11       (S)       MINUTE(HSS)                                                                                            
04/01/11       (S)       HSS RPT 5DP                                                                                            
04/01/11       (S)       DP: DAVIS, MEYER, ELLIS, EGAN, DYSON                                                                   
04/04/11       (S)       BEFORE THE SENATE ON FINAL PASSAGE                                                                     
04/04/11       (S)       TRANSMITTED TO (H)                                                                                     
04/04/11       (S)       VERSION: SCR  7                                                                                        
04/05/11       (H)       READ THE FIRST TIME - REFERRALS                                                                        
04/05/11       (H)       HSS                                                                                                    
04/07/11       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 209                                                                                                                  
SHORT TITLE: INSURANCE COVERAGE FOR TOBACCO CESSATION                                                                           
SPONSOR(s): REPRESENTATIVE(s) HERRON                                                                                            
                                                                                                                                
03/25/11       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/25/11       (H)       HSS, L&C                                                                                               
04/07/11       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 61                                                                                                                   
SHORT TITLE: ADVANCE HEALTH CARE DIRECTIVES REGISTRY                                                                            
SPONSOR(s): REPRESENTATIVE(s) HOLMES, KAWASAKI, OLSON, GARDNER                                                                  
                                                                                                                                
01/18/11       (H)       PREFILE RELEASED 1/7/11                                                                                
01/18/11       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/18/11       (H)       HSS, JUD, FIN                                                                                          
04/07/11       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 33                                                                                                                   
SHORT TITLE: FOSTER CARE LICENSING/STATE CUSTODY                                                                                
SPONSOR(s): REPRESENTATIVE(s) GARA, THOMAS, HERRON, GARDNER                                                                     
                                                                                                                                
01/18/11       (H)       PREFILE RELEASED 1/7/11                                                                                
01/18/11       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/18/11       (H)       HSS, JUD, FIN                                                                                          
02/25/11       (H)       SPONSOR SUBSTITUTE INTRODUCED                                                                          
02/25/11       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/25/11       (H)       HSS, JUD, FIN                                                                                          
04/07/11       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
SENATOR KEVIN MEYER                                                                                                             
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Introduced SCR 7 as the sponsor of the                                                                   
bill.                                                                                                                           
                                                                                                                                
JEANNE GERHARDT CYRUS                                                                                                           
Kiana, Alaska                                                                                                                   
POSITION STATEMENT:  Testified in support of SCR 7.                                                                           
                                                                                                                                
KATE BURKHARDT, Executive Director                                                                                              
Advisory Board on Alcoholism & Drug Abuse                                                                                       
Division of Behavioral Health                                                                                                   
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of SCR 7.                                                                           
                                                                                                                                
JANE ANN BOER, Intern                                                                                                           
Representative Bob Herron                                                                                                       
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Introduced HB 209 on behalf of the sponsor,                                                              
Representative Bob Herron.                                                                                                      
                                                                                                                                
EMILY NENON, Alaska Government Relations Director                                                                               
American Cancer Society Cancer Action Network (ACSCAN)                                                                          
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 209 and HB 61.                                                                
                                                                                                                                
REPRESENTATIVE LINDSEY HOLMES                                                                                                   
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Introduced HB 61 as a joint prime sponsor                                                                
of the bill.                                                                                                                    
                                                                                                                                
JAMES WALDO, Staff                                                                                                              
Representative Lindsey Holmes                                                                                                   
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 61 on behalf of the joint                                                                   
prime sponsor, Representative Holmes.                                                                                           
                                                                                                                                
MARIE DARLIN, Coordinator                                                                                                       
AARP Capital City Task Force                                                                                                    
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 61.                                                                           
                                                                                                                                
DR. WARD HURLBURT, Chief Medical Officer/Director                                                                               
Division of Public Health                                                                                                       
Central Office                                                                                                                  
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Answered questions during the discussion of                                                              
HB 61.                                                                                                                          
                                                                                                                                
REPRESENTATIVE LES GARA                                                                                                         
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Introduced SSHB 33 as a joint prime sponsor                                                              
of the bill.                                                                                                                    
                                                                                                                                
AMANDA METIVIER, Statewide Coordinator                                                                                          
Facing Foster Care in Alaska (FFCA)                                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of SSHB 33.                                                                         
                                                                                                                                
JAN RUTHERDALE, Senior Assistant Attorney General                                                                               
Child Protection Section                                                                                                        
Civil Division (Juneau)                                                                                                         
Department of Law (DOL)                                                                                                         
POSITION STATEMENT:  Testified during discussion of SSHB 33.                                                                  
                                                                                                                                
TRACY SPARTZ-CAMPBELL, Deputy Director                                                                                          
Central Office                                                                                                                  
Office of Children's Services                                                                                                   
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during discussion of SSHB 33.                                                                  
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:07:50 PM                                                                                                                    
                                                                                                                                
CHAIR  WES KELLER  called the  House Health  and Social  Services                                                             
Standing   Committee    meeting   to    order   at    3:07   p.m.                                                               
Representatives Keller,  Kerttula, Dick  Herron, and  Seaton were                                                               
present at the call to  order.  Representative Millett arrived as                                                               
the meeting was in progress.                                                                                                    
                                                                                                                                
           SCR 7-FETAL ALCOHOL SPECTRUM DISORDERS DAY                                                                       
                                                                                                                                
3:08:13 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER announced that the  first order of business would be                                                               
SENATE  CONCURRENT RESOLUTION  NO.  7,  Proclaiming September  9,                                                               
2011, as Fetal Alcohol Spectrum Disorders Awareness Day.                                                                        
                                                                                                                                
3:08:40 PM                                                                                                                    
                                                                                                                                
SENATOR  KEVIN MEYER,  Alaska  State  Legislature, reported  that                                                               
families with children with  FASD were recognized internationally                                                               
on September 9,  at 9:09 a.m.  He explained  that FASD was caused                                                               
by  pre-natal  exposure  to alcohol,  and  its  effects  included                                                               
permanent  brain damage,  birth  defects, learning  disabilities,                                                               
and  behavioral  problems.   He  confirmed  that Alaska  had  the                                                               
highest known rate of FASD in  the United States, although it was                                                               
totally  preventable.   He  heralded  the  goal of  not  drinking                                                               
alcohol while pregnant.                                                                                                         
                                                                                                                                
3:12:04 PM                                                                                                                    
                                                                                                                                
JEANNE GERHARDT  CYRUS shared that  she was a parent  of multiple                                                               
children with  prenatal exposure to  alcohol.  She  expressed her                                                               
support for SCR  7.  She emphasized the  importance for partners,                                                               
co-workers, and  families of pregnant  women to  support sobriety                                                               
during  pregnancy,  as  the  sole   cause  of  FASD  was  alcohol                                                               
exposure, which resulted in a  lifelong disability.  She observed                                                               
that although  it was  the most common  cause of  retardation, it                                                               
did not qualify for developmental  disability services or special                                                               
education in  the schools.   She listed  many of the  problems to                                                               
include  mental health  problems,  disruptive school  experience,                                                               
inappropriate  sexual behavior,  and alcohol  and drug  problems.                                                               
She  declared the  best  strategies to  be  prevention and  early                                                               
intervention.                                                                                                                   
                                                                                                                                
3:15:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KERTTULA asked for the  reasons that FASD kids did                                                               
not qualify for special education.                                                                                              
                                                                                                                                
MS. CYRUS  replied that diagnosis  was not  available everywhere,                                                               
especially in  the rural  communities, and  that often  there was                                                               
not awareness  by the schools  or the  parents.  She  pointed out                                                               
that FASD had to be recognized,  and then it was often classified                                                               
as "other health impaired."   She recounted that many FASD issues                                                               
were behavioral, and were treated as a discipline issue.                                                                        
                                                                                                                                
3:17:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HERRON expressed his agreement.                                                                                  
                                                                                                                                
3:18:19 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER  acknowledged the Advisory  Board on  Alcoholism and                                                               
Drug Abuse study,  "Economic Costs of Alcohol and  Other Drugs in                                                               
Alaska, 2005 update."  [Included in members' packets]                                                                           
                                                                                                                                
3:18:47 PM                                                                                                                    
                                                                                                                                
KATE BURKHARDT, Executive Director,  Advisory Board on Alcoholism                                                               
& Drug Abuse,  Division of Behavioral Health,  explained that the                                                               
Advisory  Board   was  also  a   founding  member  of   the  FASD                                                               
Partnership, and  that both organizations supported  proposed SCR
7.   She declared that SCR  7 was not just  about prevention, but                                                               
also  about identification  of and  improvement  for those  lives                                                               
affected by  FASD.  She  spoke about an annual  partnership event                                                               
with   the  Alaska   Cabaret,  Hotel,   Restaurant  &   Retailers                                                               
Association  (CHARR),   the  alcohol  industry,   and  individual                                                               
alcohol  retailers for  distribution  of educational  information                                                               
and  non-alcoholic  beverages.    She  applauded  efforts  for  a                                                               
permanent declaration of FASD day.                                                                                              
                                                                                                                                
3:22:04 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER closed public testimony.                                                                                           
                                                                                                                                
3:22:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE DICK moved  to report SCR 7 out  of committee with                                                               
individual recommendations.  There being  no objection, SCR 7 was                                                               
reported  from  the House  Health  and  Social Services  Standing                                                               
Committee.                                                                                                                      
                                                                                                                                
        HB 209-INSURANCE COVERAGE FOR TOBACCO CESSATION                                                                     
                                                                                                                                
3:23:34 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER announced  that the next order of  business would be                                                               
HOUSE BILL  NO. 209, "An Act  requiring a health care  insurer to                                                               
provide coverage for tobacco cessation treatment."                                                                              
                                                                                                                                
JANE ANN BOER, Intern, Representative Bob Herron, Alaska State                                                                  
Legislature, paraphrased the sponsor statement for HB 209:                                                                      
                                                                                                                                
     Tobacco dependence  is a chronic and  lasting condition                                                                    
     that negatively  affects the health,  productivity, and                                                                    
     overall well being of Alaskans and their loved ones.                                                                       
                                                                                                                                
     Statistics  show that  tobacco  is a  leading cause  of                                                                    
     death  in   Alaska.    Tobacco  addiction   kills  more                                                                    
     Alaskans   each  year   than  suicide,   motor  vehicle                                                                    
     crashes,   chronic   liver   disease   and   cirrhosis,                                                                    
     homicide, and  HIV/AIDS combined. In 2007,  tobacco use                                                                    
     cost   Alaskans   $314   million  in   direct   medical                                                                    
     expenditures  and an  additional $177  million in  lost                                                                    
     productivity due to tobacco-related deaths.                                                                                
                                                                                                                                
     This  bill gives  Alaskans  the  resources and  support                                                                    
     they  need  to  end  tobacco addiction.    It  requires                                                                    
     insurance  companies   to  provide   smoking  cessation                                                                    
     programs to aid those who  wish to be free from tobacco                                                                    
     addiction.  With the implementation  of House Bill 209,                                                                    
     insurance  companies  would   provide  coverage  for  a                                                                    
     minimum of  two courses of treatment  during each year.                                                                    
     Two  courses  allow  for multiple  attempts  for  those                                                                    
     smokers who continue to  work towards ending addiction.                                                                    
     Coverage  provides for  not less  than four  counseling                                                                    
     sessions in each course as  well as over the counter or                                                                    
     proscribed medication approved by the USFDA.                                                                               
                                                                                                                                
     While   coverage    includes   both    counseling   and                                                                    
     medication,  counseling  is   not  a  precondition  for                                                                    
     medication so  that treatment  is flexible  to personal                                                                    
     preferences.      Data   show   that   programs   where                                                                    
     participants   may   tailor   treatment   to   personal                                                                    
     preferences and needs are the most effective.                                                                              
                                                                                                                                
     This bill  provides the  assistance many  Alaskans need                                                                    
     to  end  tobacco  addiction  and  live  healthy,  long,                                                                    
     productive lives.  The long  term effects of House Bill                                                                    
     209  will  be  cost savings  in  medical  expenditures,                                                                    
     increased productivity  in the work place,  lower long-                                                                    
     term  insurance  costs  for  insurance  providers,  and                                                                    
     healthier, happier Alaskans.                                                                                               
                                                                                                                                
                                                                                                                                
3:27:15 PM                                                                                                                    
                                                                                                                                
MS. BOER opined that a lack  of mandates could increase costs for                                                               
insurers,  as  conditions  not  covered  by  insurance  often  go                                                               
unchecked, and  cost more in the  long term.  She  stated that HB
209 was  an inexpensive, preventative  measure for  the extremely                                                               
expensive long term addiction to tobacco.                                                                                       
                                                                                                                                
3:28:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HERRON  asked  if  any  other  states  had  these                                                               
programs.                                                                                                                       
                                                                                                                                
MS.  BOER replied  that,  of  the five  other  states with  these                                                               
programs, Oregon had shown the  greatest success, with a decrease                                                               
of 26 percent.                                                                                                                  
                                                                                                                                
3:29:29 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER asked how much it would cost to quit smoking.                                                                      
                                                                                                                                
MS. BOER  replied that the cost  could range from $0.66  to $1.20                                                               
per year.                                                                                                                       
                                                                                                                                
CHAIR KELLER  asked specifically  about the treatments  and those                                                               
costs.                                                                                                                          
                                                                                                                                
3:30:10 PM                                                                                                                    
                                                                                                                                
MS. BOER  explained some of  the treatments, which  included gum,                                                               
patches, inhalers, nasal sprays, and lozenges.                                                                                  
                                                                                                                                
3:31:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE DICK asked about the rates of success.                                                                           
                                                                                                                                
MS.  BOER, in  response  to Representative  Dick,  said that  she                                                               
would  supply  those statistics.    She  reported that  the  bill                                                               
allowed  for   two  courses,   which  included   four  counseling                                                               
sessions, to attempt to quit.                                                                                                   
                                                                                                                                
3:31:47 PM                                                                                                                    
                                                                                                                                
CHAIR  KELLER asked  who  would  be covered  by  this  bill.   He                                                               
pointed  out  that  legislation  had  no  jurisdiction  over  the                                                               
Employee  Retirement Income  Security Act  (ERISA), Medicaid,  or                                                               
Medicare.                                                                                                                       
                                                                                                                                
3:32:29 PM                                                                                                                    
                                                                                                                                
MS. BOER reported  that about 15 percent of state  insured and 34                                                               
percent of  self insured  populations were  smokers, but  she did                                                               
not  know  if all  the  individual  plans  would be  required  to                                                               
comply.    She  shared  that  ERISA  insurance  already  included                                                               
tobacco  cessation treatment.   She  noted that  HB 209  provided                                                               
further details to the programs.                                                                                                
                                                                                                                                
3:33:06 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked  if the bill would  include the state                                                               
insurance and the retiree insurance policies.                                                                                   
                                                                                                                                
MS. BOER replied that both plans were included.                                                                                 
                                                                                                                                
3:34:03 PM                                                                                                                    
                                                                                                                                
EMILY  NENON,  Alaska  Government  Relations  Director,  American                                                               
Cancer  Society  Cancer  Action  Network  (ACSCAN),  stated  that                                                               
ACSCAN  supported  HB 209,  and  she  directed attention  to  its                                                               
letter of  support.  [Included  in members' packets]   She shared                                                               
that  each  additional piece  of  support  for tobacco  cessation                                                               
increased  the  chances  for  success.     She  pointed  out  the                                                               
difficulty to  quit smoking,  noting that it  took an  average of                                                               
seven attempts to quit permanently.                                                                                             
                                                                                                                                
3:35:49 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER asked  where in HB 209 coverage was  declared by the                                                               
State of  Alaska insurance plan.   He  asked to clarify  that the                                                               
Legislature had the jurisdiction over all health care plans.                                                                    
                                                                                                                                
3:36:21 PM                                                                                                                    
                                                                                                                                
MS.  BOER,  in   response,  said  that  she   would  supply  that                                                               
information.                                                                                                                    
                                                                                                                                
3:37:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON, referring to page  2, lines 2-4, asked for                                                               
the purpose of the provision.                                                                                                   
                                                                                                                                
MS.  BOER replied  that this  provision guaranteed  that everyone                                                               
could receive  the treatment,  as pre-authorization  could result                                                               
in some exclusions.                                                                                                             
                                                                                                                                
REPRESENTATIVE SEATON,  referring to  page 2, lines  9-11, opined                                                               
that pre-authorization was  for the knowledge of the  cost of co-                                                               
payments   and  deductibles.     He   asked  for   more  specific                                                               
information on the necessity for pre-authorization.                                                                             
                                                                                                                                
3:39:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KERTTULA, pointing  to page 1, lines  9-11, and to                                                               
page 2,  lines 7-8, asked  about the conflicting  statements that                                                               
coverage must include  the cost of counseling  sessions, but then                                                               
later in the bill it stated that  it was not required.  She asked                                                               
about  the  program  in  other  states, and  if  there  were  any                                                               
statistics for the success of each approach.                                                                                    
                                                                                                                                
MS. BOER  replied that the  programs varied throughout  the other                                                               
five states,  and that in the  model legislation used by  HB 209,                                                               
there was the choice for either treatment.                                                                                      
                                                                                                                                
[HB 209 was held over.]                                                                                                         
                                                                                                                                
         HB 61-ADVANCE HEALTH CARE DIRECTIVES REGISTRY                                                                      
                                                                                                                                
3:40:19 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER announced  that the next order of  business would be                                                               
HOUSE BILL  NO. 61, "An  Act relating  to a registry  for advance                                                               
health care directives."                                                                                                        
                                                                                                                                
3:41:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   LINDSEY   HOLMES,  Alaska   State   Legislature,                                                               
explained that HB  61 dealt with advance  health care directives,                                                               
or  living wills,  which detailed  end  of life  and health  care                                                               
wishes,  as  well   as  designating  a  decision   maker  if  the                                                               
individual  was  not  able.    She offered  an  example  for  the                                                               
difficulties encountered  when a living will  was not accessible.                                                               
She explained  that HB 61  created a secure, voluntary,  24 hour,                                                               
on line  registry for living  wills, housed in the  Department of                                                               
Health and Social Services (DHSS),  which was accessible by other                                                               
hospitals and health  care facilities.  She pointed  out that out                                                               
of state access would also be available during business hours.                                                                  
                                                                                                                                
3:44:02 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER asked how many states had implemented this.                                                                        
                                                                                                                                
REPRESENTATIVE  HOLMES  replied  that  Legislative  Research  had                                                               
researched a  company to  set this up  more efficiently  and less                                                               
costly than DHSS.                                                                                                               
                                                                                                                                
REPRESENTATIVE  HOLMES, in  response to  Chair Keller,  said that                                                               
the initial set  up cost would be $194,800;  in subsequent years,                                                               
the cost would  be $82,400 for a part time  employee and the cost                                                               
of the on line registry.                                                                                                        
                                                                                                                                
3:45:33 PM                                                                                                                    
                                                                                                                                
JAMES WALDO,  Staff, Representative Lindsey Holmes,  Alaska State                                                               
Legislature,  shared  that  Legislative Research  did  prepare  a                                                               
report on the  advanced health care directives  and registries of                                                               
various  states.     He  reported   that  seven   states  already                                                               
participated or had central state registries.                                                                                   
                                                                                                                                
3:46:53 PM                                                                                                                    
                                                                                                                                
MR. WALDO, directing  attention to Section 1 of HB  61, said that                                                               
it  protected  health  care   facilities  against  liability  for                                                               
accessing or not accessing the registry.   He moved on to Section                                                               
2, which dictated  into statute how the registry would  work.  He                                                               
reported that each subsection explained  a piece of the bill: (a)                                                               
created  the  authorization for  the  registry  within DHSS;  (b)                                                               
established   that  it   was   voluntary;   (c)  reiterated   the                                                               
confidentiality to the hospitals in  the state; (d) discussed its                                                               
availability on  line within the  state; (e) clarified  the legal                                                               
parameters; (f)  addressed the  removal of  a directive  from the                                                               
registry;  whereas (h)  stated that  a fee  could be  charged for                                                               
filing a directive,  but not for removing it;  (g) clarified that                                                               
filing  the  directive or  not  filing  it,  did not  affect  the                                                               
validity   of  a   directive;  (i)   authorized  DHSS   to  write                                                               
regulations to  protect the cyber-security  of the  registry; (j)                                                               
identified who could  access a directive: (k)  exempted DHSS from                                                               
liability; and  (l) contained definitions  for terms  used within                                                               
the bill.                                                                                                                       
                                                                                                                                
3:52:04 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER asked for clarification to page 2, lines 3-4.                                                                      
                                                                                                                                
MR. WALDO replied that this  referred to one individual, not two.                                                               
He pointed to  lines 12-13, which defined someone  other than the                                                               
individual.                                                                                                                     
                                                                                                                                
3:54:03 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER,  referring to  page 2,  lines 14  and 15,  asked if                                                               
this should be more specific.                                                                                                   
                                                                                                                                
3:55:24 PM                                                                                                                    
                                                                                                                                
MR. WALDO  replied that  it required that  the request  must come                                                               
from the  facility where the  individual was a patient,  and most                                                               
likely, the patient's doctor would request the directive.                                                                       
                                                                                                                                
3:56:04 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER, referring  to subsection (c) on page  2, lines 5-8,                                                               
asked for clarity to the word "use."                                                                                            
                                                                                                                                
3:57:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON, directing attention  to page 3, lines 7-8,                                                               
asked to clarify  that the fee would not be  any greater than its                                                               
cost to the department.                                                                                                         
                                                                                                                                
3:58:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HOLMES  replied  that   the  department  was  not                                                               
required to charge a fee but that  it was allowed.  The fee could                                                               
not exceed the  actual administrative cost, as the  intent was to                                                               
keep the cost low.                                                                                                              
                                                                                                                                
3:58:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON asked  about the  costs incurred  by other                                                               
states.                                                                                                                         
                                                                                                                                
3:59:05 PM                                                                                                                    
                                                                                                                                
MR. WALDO replied that three  of the seven states participated in                                                               
a  national data  base, which  was significantly  more expensive,                                                               
and that the Arizona centralized  registry was more comprehensive                                                               
than the one proposed in HB 61.                                                                                                 
                                                                                                                                
4:00:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON, noting that  the information form would be                                                               
scanned  into the  registry, asked  to verify  that DHSS  was not                                                               
responsible for checking the validity of the information.                                                                       
                                                                                                                                
MR. WALDO agreed.                                                                                                               
                                                                                                                                
4:01:36 PM                                                                                                                    
                                                                                                                                
MARIE  DARLIN,   Coordinator,  AARP  Capital  City   Task  Force,                                                               
testified in  support of  HB 61.   She stated  that this  was the                                                               
next necessary  step for the  access to advance directives.   She                                                               
pointed out that  some hospitals had joined a  registry group, as                                                               
a way  for other hospitals  to access  your records.   She opined                                                               
that HB 61 had covered all the points for concern.                                                                              
                                                                                                                                
4:04:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KERTTULA  asked to clarify that  Bartlett Hospital                                                               
could  release  the advance  directive  to  any hospital  in  the                                                               
nation.                                                                                                                         
                                                                                                                                
MS. DARLIN offered her belief  that Bartlett Hospital would place                                                               
your advance directive on this national registry.                                                                               
                                                                                                                                
4:06:00 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER  asked how many  national registers there  were, and                                                               
if AARP sponsored a registry.                                                                                                   
                                                                                                                                
4:06:53 PM                                                                                                                    
                                                                                                                                
MS. DARLIN, in response to  Representative Herron, said that AARP                                                               
had worked hard to get the advanced directives into statute.                                                                    
                                                                                                                                
4:07:34 PM                                                                                                                    
                                                                                                                                
MS. NENON testified  in support of HB 61.   She shared a personal                                                               
story  of  her father  and  his  problems of  advance  directives                                                               
without registries.                                                                                                             
                                                                                                                                
4:10:58 PM                                                                                                                    
                                                                                                                                
DR. WARD  HURLBURT, Chief  Medical Officer/Director,  Division of                                                               
Public Health,  Central Office, Department  of Health  and Social                                                               
Services, said  that the administration  did not have  a position                                                               
on  the bill.   He  opined, as  a Public  Health clinician,  that                                                               
everyone should have a living will.                                                                                             
                                                                                                                                
4:11:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  asked how many hospitals  inquired whether                                                               
a patient had a living will on file.                                                                                            
                                                                                                                                
DR.  HURLBURT replied  that he  did  not know  that specific  for                                                               
Alaska.   He offered  his belief that  every hospital  should ask                                                               
that question, but  that even with this  legislation the question                                                               
might not  be asked.   He  pointed to  this as  a failing  of the                                                               
health care system.                                                                                                             
                                                                                                                                
4:13:24 PM                                                                                                                    
                                                                                                                                
CHAIR  KELLER   remarked  that  all  the   necessary  forms  were                                                               
available in the statute.                                                                                                       
                                                                                                                                
DR. HURLBURT reminded the committee  that the ethical default was                                                               
to  keep  people  alive,  although   the  result  of  that  could                                                               
sometimes be tragic.                                                                                                            
                                                                                                                                
4:14:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  asked the bill  sponsor to survey  for the                                                               
default  position of  the individual  hospitals regarding  living                                                               
wills.                                                                                                                          
                                                                                                                                
4:15:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MILLETT reflected  that end  of life  issues were                                                               
very  difficult and  emotional decisions.   She  opined that  the                                                               
registry offered support for these decisions.                                                                                   
                                                                                                                                
[HB 61 was held over.]                                                                                                          
                                                                                                                                
           HB 33-FOSTER CARE LICENSING/STATE CUSTODY                                                                        
                                                                                                                                
4:16:34 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER announced that the  final order of business would be                                                               
SPONSOR SUBSTITUTE  FOR HOUSE  BILL NO. 33,  "An Act  relating to                                                               
the procedures and  jurisdiction of the Department  of Health and                                                               
Social  Services  for the  care  of  children  who are  in  state                                                               
custody; relating  to court jurisdiction and  findings pertaining                                                               
to  children  who  are  in   state  custody;  and  modifying  the                                                               
licensing requirements for foster care."                                                                                        
                                                                                                                                
4:17:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  LES  GARA,  Alaska State  Legislature,  explained                                                               
that SSHB 33 did not have  a fiscal note, and that the Department                                                               
of Health and Social Services  (DHSS) had worked closely with the                                                               
joint  prime sponsors  on the  language of  the bill.   Directing                                                               
attention  to  the  proposed   amendment  [Included  in  members'                                                               
packets],  he confirmed  its  request by  the  Department of  Law                                                               
(DOL) as  there had been  technical changes to prior  foster care                                                               
legislation.     He   established  that   SSHB  33   created  the                                                               
presumption that  siblings live together, with  a requirement for                                                               
case  worker explanation  and  supervisorial  agreement to  allow                                                               
otherwise.  Reflecting on the  rural code requirements for foster                                                               
care housing,  he shared that  those requirements not  in federal                                                               
law could be waived  if it was in the best  interest of the child                                                               
and the  home was safe.   He endorsed a  goal of foster  care for                                                               
permanency, to  get children  into a permanent  home.   He opined                                                               
that  the DHSS  would  "give  up on  permanency  sometimes."   He                                                               
confirmed  that  SBHB33 stated:    "unless  there's a  compelling                                                               
reason, you  have to keep  looking for  a permanent for  a child.                                                               
You  can't just  give up  and say  we'll put  you in  bounce able                                                               
foster care."  He defined  APPLA to be "another planned permanent                                                               
living arrangement," and explained it to  be the act of giving up                                                               
on finding  permanent placement  for a child.   He  stressed that                                                               
this  was  not  acceptable  without  a  compelling  reason.    He                                                               
analyzed the last provision of  the bill, requiring that at least                                                               
30 days  notice be given to  the youth and the  guardian ad litem                                                               
for  transfer out  of foster  care, unless  agreement by  all the                                                               
parties.   He  explained the  various post  foster care  benefits                                                               
which  included  assistance  for   college  tuition,  work  force                                                               
training, and rent.                                                                                                             
                                                                                                                                
4:22:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARA  shared that  the Director  of the  Office of                                                               
Children's Services  (OCS) had recently  written in  a newsletter                                                               
that DHSS used APPLA too much.                                                                                                  
                                                                                                                                
CHAIR KELLER asked  if the APPLA definition was  included in SSHB
33.                                                                                                                             
                                                                                                                                
REPRESENTATIVE GARA  replied that the definition  was included in                                                               
the proposed amendment on page 4, line 24.                                                                                      
                                                                                                                                
4:24:16 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER reflected  that it was "an  alternative to permanent                                                               
placement  with an  adult family  member, and  an alternative  to                                                               
reunification, adoption, and legal guardianship."   He asked if a                                                               
living  arrangement  could  be  more  than  "a  mom  and  a  dad,                                                               
siblings..."                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GARA  replied  that APPLA  simply  meant  keeping                                                               
someone in  foster care with no  guarantee of not being  moved to                                                               
another  home.   He  stated  that  the  goal  was for  parent  or                                                               
guardian permanence.                                                                                                            
                                                                                                                                
4:25:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KERTTULA  asked  to  clarify  that  children  had                                                               
foster care terminated with no notice.                                                                                          
                                                                                                                                
REPRESENTATIVE GARA  observed that  although DHSS tried  to avoid                                                               
it, cases existed  of children receiving notice one  day prior to                                                               
the end  of foster care.   He  endorsed a statute  which required                                                               
DHSS and OCS to do better.                                                                                                      
                                                                                                                                
REPRESENTATIVE KERTTULA  offered her belief that  this change was                                                               
necessary.                                                                                                                      
                                                                                                                                
4:26:24 PM                                                                                                                    
                                                                                                                                
AMANDA  METIVIER, Statewide  Coordinator, Facing  Foster Care  in                                                               
Alaska (FFCA),  responding to  questions regarding  APPLA, stated                                                               
that this was  supportive of long term foster care.   She pointed                                                               
out that SSHB  33 would restrict the use of  APPLA, so that youth                                                               
would not  "age out"  and the search  for permanency  would never                                                               
stop.   She  stressed  the never  ending need  for  family.   She                                                               
highlighted  the  difficulties that  arose  with  a release  from                                                               
custody  without  notice.   She  spoke  about  the need  to  keep                                                               
siblings together.                                                                                                              
                                                                                                                                
4:30:57 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KERTTULA,  referring to the termination  of foster                                                               
care, asked if there was a  requirement to give notice, or if OCS                                                               
had failed to give notice.                                                                                                      
                                                                                                                                
MS. METIVIER replied that OCS was  supposed to give notice to all                                                               
parties,  but she  was unsure  of the  lead time  required.   She                                                               
agreed that it could be difficult  to contact youth, as they were                                                               
mobile.                                                                                                                         
                                                                                                                                
4:32:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KERTTULA  moved to adopt Amendment  1, labeled 27-                                                               
LS0203\E.1, Mischel, 4/6/11, which read:                                                                                        
                                                                                                                                
     Page 3, line 6, following "blood":                                                                                         
          Insert ", marriage, or adoption"                                                                                      
                                                                                                                                
     Page 3, lines 16 - 17:                                                                                                     
          Delete "[AN] additional  one-year periods [PERIOD]                                                                
     of supervision past  [AGE] 19 years of age  that do not                                                                
     extend beyond the person's 21st birthday if continued"                                                                 
          Insert "an  additional one-year period  of custody                                                                
     or  supervision   past  [AGE]  19  years   of  age  and                                                            
     additional  one-year periods  of  custody  that do  not                                                                
     extend beyond  the person's 21st birthday  if continued                                                                
     custody or"                                                                                                            
                                                                                                                                
     Page 3, line 20:                                                                                                           
          Delete "minor"                                                                                                        
          Insert "child [MINOR]"                                                                                            
                                                                                                                                
     Page 4, lines 3 - 5:                                                                                                       
          Delete "[AN] additional  one-year periods [PERIOD]                                                                
     of supervision past  [AGE] 19 years of age  that do not                                                                
     extend beyond the person's 21st birthday if continued"                                                                 
          Insert "an  additional one-year period  of custody                                                                
     or  supervision   past  [AGE]  19  years   of  age  and                                                            
     additional  one-year periods  of  custody  that do  not                                                                
     extend beyond  the person's 21st birthday  if continued                                                                
     custody or"                                                                                                            
                                                                                                                                
     Page 4, line 8, following "placed":                                                                                        
          Insert "in the custody or"                                                                                        
                                                                                                                                
     Page 4, lines 10 - 12:                                                                                                     
          Delete "[AN] additional  one-year periods [PERIOD]                                                                
     of supervision past  [AGE] 19 years of age  that do not                                                                
     extend beyond the person's 21st birthday if continued"                                                                 
          Insert "an  additional one-year period  of custody                                                                
     or  supervision   past  [AGE]  19  years   of  age  and                                                            
     additional  one-year periods  of  custody  that do  not                                                                
     extend beyond  the person's 21st birthday  if continued                                                                
     custody or"                                                                                                            
                                                                                                                                
     Page 4, line 31, following "recommend":                                                                                    
          Insert "to the court"                                                                                                 
                                                                                                                                
     Page 5, following line 1:                                                                                                  
          Insert  "(1)  the child  is  16  years of  age  or                                                                    
     older;"                                                                                                                    
                                                                                                                                
     Renumber the following paragraphs accordingly.                                                                             
                                                                                                                                
     Page 5, line 3, following "child;":                                                                                        
          Insert "and"                                                                                                          
                                                                                                                                
     Page 5, line 8:                                                                                                            
          Delete "; and"                                                                                                        
          Insert "."                                                                                                            
                                                                                                                                
     Page 5, lines 9 - 10:                                                                                                      
          Delete all material.                                                                                                  
                                                                                                                                
     Page 5, lines 11 - 12:                                                                                                     
          Delete "who is under 19 years of age"                                                                                 
                                                                                                                                
     Page 5, line 12, following "department":                                                                                   
          Insert ", before the date custody is ordered to                                                                       
     end,"                                                                                                                      
                                                                                                                                
     Page 5, line 13, following "child":                                                                                        
          Insert ", if the child is over 16 years of age                                                                        
     and available,"                                                                                                            
                                                                                                                                
     Page 5, line 14:                                                                                                           
          Delete "petition for release is filed"                                                                                
          Insert "motion for release is filed, unless the                                                                       
     parties agree to a shorter notice period"                                                                                  
                                                                                                                                
     Page 5, line 15:                                                                                                           
          Delete "petition with the court for termination"                                                                      
          Insert "motion with the court for release"                                                                            
                                                                                                                                
     Page 5, line 16:                                                                                                           
          Delete "and release"                                                                                                  
                                                                                                                                
     Page 5, following line 19:                                                                                                 
          Insert a new subsection to read:                                                                                      
          "(r)  When custody of a child who has been                                                                            
     committed to  the custody of  the department is  due to                                                                    
     expire, the  department shall file a  notice of release                                                                    
     with  the court  30  days before  the  date of  release                                                                    
     unless  the parties  agree to  a shorter  notice period                                                                    
     and  distribute the  notice to  the parties,  including                                                                    
     the child if the child is  16 years of age or older and                                                                    
     available."                                                                                                                
                                                                                                                                
     Reletter the following subsections accordingly.                                                                            
                                                                                                                                
     Page 5, lines 20 - 21:                                                                                                     
          Delete "all reasonable efforts to place siblings                                                                      
     who are  in the custody  of the department in  the same                                                                    
     placement"                                                                                                                 
          Insert "reasonable efforts to place siblings in                                                                       
     the same placement if the  siblings are residing in the                                                                    
     same  home   when  taken  into   the  custody   of  the                                                                    
     department"                                                                                                                
                                                                                                                                
     Page 5, line 22:                                                                                                           
          Delete "state or regional director of"                                                                                
          Insert "case supervisor for"                                                                                          
                                                                                                                                
     Page 5, lines 23 - 24:                                                                                                     
          Delete "provide a written explanation in the file                                                                     
     of"                                                                                                                        
          Insert "document in the file"                                                                                         
                                                                                                                                
     Page 5, line 26, following "blood":                                                                                        
          Insert ", adoption,"                                                                                                  
                                                                                                                                
     Page 5, line 30:                                                                                                           
          Delete "is more than 15 years of age and"                                                                             
                                                                                                                                
     Page 6, line 4:                                                                                                            
          Delete ";"                                                                                                            
          Insert "."                                                                                                            
                                                                                                                                
     Page 6, lines 5 - 6:                                                                                                       
          Delete all material.                                                                                                  
                                                                                                                                
     Page 6, following line 6:                                                                                                  
     Insert a new subsection to read:                                                                                           
          "(u)  In this section, "another planned permanent                                                                     
     living   arrangement"   means    a   permanent   living                                                                    
     arrangement  for  a  child  who  is  committed  to  the                                                                    
     custody  of  the  department  under  AS 47.10.080(c)(1)                                                                    
     that is  an alternative to permanent  placement with an                                                                    
     adult  family member,  and to  reunification, adoption,                                                                    
     and legal guardianship."                                                                                                   
                                                                                                                                
     Page 6, lines 8 - 9:                                                                                                       
          Delete "ensure that"                                                                                                  
          Insert "streamline"                                                                                                   
                                                                                                                                
     Page 6, lines 10 - 11:                                                                                                     
          Delete "is not unduly complex and is as short and                                                                     
     straightforward as necessary to protect a child's best                                                                     
     interests"                                                                                                                 
          Insert "to the extent consistent with federal                                                                         
     law"                                                                                                                       
                                                                                                                                
     Page 6, lines 15 - 17:                                                                                                     
          Delete all material.                                                                                                  
                                                                                                                                
     Renumber the following paragraphs accordingly.                                                                             
                                                                                                                                
There being no objection, it was so ordered.                                                                                    
                                                                                                                                
4:34:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   KERTTULA,   asking   about   the   process   for                                                               
termination of foster  care, requested assurance that  it did not                                                               
happen on a moment's notice.                                                                                                    
                                                                                                                                
JAN   RUTHERDALE,  Senior   Assistant  Attorney   General,  Child                                                               
Protection  Section, Civil  Division (Juneau),  explained that  a                                                               
child can  leave the system  at 18 years of  age, if the  term of                                                               
custody had  ended or  a motion  to be let  out early  was filed.                                                               
She  pointed out  that  the  bill addressed  the  end of  custody                                                               
provision, and  required that notice  be given.  She  offered her                                                               
belief  that more  of the  surprises  occurred when  the term  of                                                               
custody expired, as only the court  could end custody early.  She                                                               
declared that DHSS  was required by statute to  notify the foster                                                               
parents, but that SSHB 33  also required notification to an older                                                               
child, if  they were available.   She confirmed that,  in Juneau,                                                               
the local  practice was for notification  of the end of  the term                                                               
for custody  to be sent  30 days in  advance to both  the parties                                                               
and the  courts.  She  declared that the  bill would make  this a                                                               
state-wide practice.                                                                                                            
                                                                                                                                
4:38:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked the  reasons for different lengths of                                                               
custody.                                                                                                                        
                                                                                                                                
MS. RUTHERDALE explained  that the term of custody  could only be                                                               
for two years, and  then up to one year for  each extension.  She                                                               
pointed out  that, as a  term of  custody could often  begin mid-                                                               
year of a child's chronological  age, the custody could then last                                                               
beyond the age of 18.                                                                                                           
                                                                                                                                
4:39:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked if the  normal procedure was based on                                                               
calendar year extensions and not on age of the child.                                                                           
                                                                                                                                
MS. RUTHERDALE replied that it  could vary, though always for the                                                               
best interest of the child.                                                                                                     
                                                                                                                                
4:40:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HERRON  asked if  the "best practice"  was defined                                                               
as 30 days.                                                                                                                     
                                                                                                                                
MS. RUTHERDALE  replied that the  actual notice was more  than 30                                                               
days to  allow time for  motion and possible opposition,  so that                                                               
it was actually closer to 60 days.                                                                                              
                                                                                                                                
4:41:09 PM                                                                                                                    
                                                                                                                                
TRACY  SPARTZ-CAMPBELL, Deputy  Director, Central  Office, Office                                                               
of  Children's   Services,  Department   of  Health   and  Social                                                               
Services,  in response  to  Chair Keller,  said  that about  1200                                                               
children were  in foster care in  Alaska.  She opined  that about                                                               
100 of them were over the age of 18.                                                                                            
                                                                                                                                
CHAIR KELLER, reflecting  on children over 18 years  but under 21                                                               
years of age, pondered the amount of loving adult supervision.                                                                  
                                                                                                                                
4:42:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KERTTULA  asked for the percentage  of foster care                                                               
kids in foster homes.                                                                                                           
                                                                                                                                
MS. SPARTZ-CAMPBELL  replied that  most of  them, if  in custody,                                                               
would  be   in  some   type  of  placement.     In   response  to                                                               
Representative Kerttula,  she confirmed that there  were hundreds                                                               
and hundreds of foster homes.                                                                                                   
                                                                                                                                
[SSHB 33 was held over.]                                                                                                        
                                                                                                                                
4:42:48 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 4:42 p.m.