03/29/2022 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB392 | |
| HB292 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 292 | TELECONFERENCED | |
| *+ | HB 392 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 29, 2022
3:07 p.m.
MEMBERS PRESENT
Representative Liz Snyder, Co-Chair
Representative Tiffany Zulkosky, Co-Chair (via teleconference)
Representative Ivy Spohnholz (via teleconference)
Representative Zack Fields
Representative Ken McCarty
Representative Christopher Kurka (via teleconference)
MEMBERS ABSENT
Representative Mike Prax
COMMITTEE CALENDAR
HOUSE BILL NO. 392
"An Act relating to advanced practice registered nurses; and
relating to death certificates, do not resuscitate orders, and
life sustaining treatment."
- HEARD & HELD
HOUSE BILL NO. 292
"An Act relating to home and community-based services; and
providing for an effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 392
SHORT TITLE: EXPAND ADV. PRAC. REG. NURSE AUTHORITY
SPONSOR(s): REPRESENTATIVE(s) SNYDER
02/22/22 (H) READ THE FIRST TIME - REFERRALS
02/22/22 (H) HSS, L&C
03/24/22 (H) HSS AT 3:00 PM DAVIS 106
03/24/22 (H) -- MEETING CANCELED --
03/29/22 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 292
SHORT TITLE: HOME AND COMMUNITY-BASED WAIVER SERVICES
SPONSOR(s): REPRESENTATIVE(s) SNYDER
01/27/22 (H) READ THE FIRST TIME - REFERRALS
01/27/22 (H) HSS, FIN
02/24/22 (H) HSS AT 3:00 PM DAVIS 106
02/24/22 (H) <Bill Hearing Canceled>
03/03/22 (H) HSS AT 3:00 PM DAVIS 106
03/03/22 (H) Heard & Held
03/03/22 (H) MINUTE(HSS)
03/10/22 (H) HSS AT 3:00 PM DAVIS 106
03/10/22 (H) Heard & Held
03/10/22 (H) MINUTE(HSS)
03/17/22 (H) HSS AT 3:00 PM DAVIS 106
03/17/22 (H) <Bill Hearing Canceled>
03/22/22 (H) HSS AT 3:00 PM DAVIS 106
03/22/22 (H) Scheduled but Not Heard
03/29/22 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
ALLIANA SALANGUIT, Staff
Representative Liz Snyder
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis for HB
392, on behalf of Representative Snyder, prime sponsor.
MARIANNE JOHNSTONE-PETTY
Alaska Advance Practice Registered Nurses (APRN) Alliance
Anchorage, Alaska
POSITION STATEMENT: Offered invited testimony during the
hearing on HB 392.
STEPHANIE BIRCH
Anchorage, Alaska
POSITION STATEMENT: Offered invited testimony during the
hearing on HB 392.
SHANNON HILTON
American Association of Nurse Practitioners
Anchorage, Alaska
POSITION STATEMENT: Offered invited testimony during the
hearing on HB 392.
PRIYA KEANE, representing self
Anchorage, Alaska
POSITION STATEMENT: Offered invited testimony during the
hearing on HB 392.
CHRISTINE KRAMER, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 392.
JOHN LEE, Director
Division of Senior and Disabilities Services
Department of Health and Social Services
Palmer, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
292.
ACTION NARRATIVE
3:07:25 PM
CO-CHAIR LIZ SNYDER called the House Health and Social Services
Standing Committee meeting to order at 3:07 p.m.
Representatives Fields, Zulkosky (via teleconference), Spohnholz
(via teleconference), Kurka (via teleconference), and Snyder
were present at the call to order. Representative McCarty
arrived as the meeting was in progress.
HB 392-EXPAND ADV. PRAC. REG. NURSE AUTHORITY
3:09:23 PM
CO-CHAIR SNYDER announced that the first order of business would
be HOUSE BILL NO. 392, "An Act relating to advanced practice
registered nurses; and relating to death certificates, do not
resuscitate orders, and life sustaining treatment."
3:10:51 PM
CO-CHAIR SNYDER, as prime sponsor of HB 392, began by providing
the motivation behind HB 392. She explained that there have
been concerns over delays in government benefits that require
death certificates, as well as an increased cost of those
services to families. She mentioned further concern for
obstruction of care for the seriously ill and patient harm
resulting from inadequate documentation of care preferences.
She described the purpose of the bill as expanding the signature
authority for death certificates, do not resuscitate (DNR)
orders, and physician orders for life-sustaining treatment
(POLST) to advance practice registered nurses (APRNs). She
explained that APRNs are registered nurses with additional,
specialized training that have been able to practice
independently as primary care practitioners in Alaska since
1984. She highlighted that although APRNs regularly oversee end
of life care and help families make important care decisions,
they cannot sign any of the documents finalizing those choices.
In current statute, only licensed physicians were able to sign
this paperwork, which she reported has caused administrative
delays and undue stress for the families. She emphasized that
HB 392 will simply allow ARPNs to sign off on a type of care
that they have provided for years.
3:14:41 PM
ALLIANA SALANGUIT, Staff, Representative Liz Snyder, Alaska
State Legislature, on behalf of Representative Snyder, prime
sponsor, gave the sectional analysis for HB 392 [included in the
committee packet], which read as follows [original punctuation
provided]:
Sec. 1: Amends AS 08.68.700(a) Determination of death
by registered nurse by allowing a Registered Nurse
(RN) to pronounce or determine a death of a person if
a physician or advanced practice registered nurse
(APRN) has documented in the person's medical or
clinical record that the person's death is
anticipated.
Sec. 2: Amends AS 08.68.700(b) by allowing an RN to
sign a determination of death if a physician or APRN
has previously documented the person's condition.
Sec. 3: Amends AS 08.68.700(c) by allowing an APRN to
certify a death determined by an RN within 24 hours of
the determination of death.
Sec. 4: Amends to 08.68.700(d) by adding "an advanced
practice registered nurse" as a conforming change to
statute regarding health care facilities' policies and
procedures for determination and pronouncement of
death by a registered nurse.
Sec. 5: Amends AS 13.62.065 Do not resuscitate
protocol and identification requirements (a) by
allowing APRNs to issue a do not resuscitate order.
Sec. 6 & 7: Adds conforming language to AS 13.62.065
Do not resuscitate protocol and identification
requirements to ensure APRNs are subject to the same
rules and protocols as physicians.
Sec. 8: Adds language to AS 13.62.065(f) Do not
resuscitate protocol and identification requirements
allowing APRNS to revoke a do not resuscitate order.
Sec. 9: Adds "or an advanced practice registered
nurse" to 13.52.080(a)(5) Immunities as a conforming
change.
Sec. 10: Amends AS 13.52.100(c) Capacity by adding "an
advanced practice registered nurse" to language
regarding protocols and how do not resuscitate orders
govern decisions regarding cardiopulmonary
resuscitation and other life-sustaining procedures.
Sec. 11: Amends AS 13.52.300 Optional Form by adding
"an advanced practice registered nurse" to the
Advanced Health Care Directive Form.
Sec. 12: Amends AS 13.52.390(12) Definitions by adding
"an advanced practice registered nurse" to language
defining "do not resuscitate order."
Sec. 13: Amends AS 13.52.390(23) Definitions by adding
n advanced practice registered nurse" to language
defining "life-sustaining procedures."
Sec. 14: Adds a new paragraph to AS 13.52.390(38)
defining an "advanced practice registered nurse" by
referring to the definition in AS 08.68 Nursing.
Sec. 15: Amends AS 18.15.230(c) by adding an "advanced
practice registered nurse" to the instructions for
completing a death certificate.
3:16:28 PM
CO-CHAIR SNYDER proceeded with invited testimony.
3:17:02 PM
MARIANNE JOHNSTONE-PETTY, Alaska Advance Practice Registered
Nurses (APRN) Alliance, explained that "APRN" was an umbrella
term for a variety of practitioners, including certified nurse
practitioners (CNPs), adding that all APRN's must have a
master's or doctorate degree and additional specialty training.
She mentioned that the bill focuses on CNPs in their role as
independent practitioners. As independent practitioners in the
state, she explained that CNPs were able to give diagnoses,
initiate and manage treatment plans, and prescribe medication,
all under their own license without need for supervision or a
collaborative agreement. She listed the many places throughout
the state's medical system where APRNs practice, including the
many practitioners who own their own clinics as trusted primary
care providers. However, she reported that APRNs with clients
facing severe illness were unable to sign off on DNRs, POLST, or
death certificates, and must instead coordinate with a physician
to do so for them. She stated that out of the 24 states that
license ARPNs as independent practitioners, Alaska was the only
one without signature authority for those three documents. She
explained that a POLST was a medical order that requires
emergency care providers be informed of DNR orders, and that it
was a new program for Alaska that has been worked on by many
members of the state's medical community to incorporate it into
the national POLST program. She said that national POLST policy
actively encourages APRNs to have the ability to sign POLST
orders to increase patient access. She voiced her belief that
the bill would align APRN signature authority with already
existing licensure and statue, which she opined would decrease
costs and reduce other barriers to proper health care, including
untimely processing of death certificates, obstruction of
serious illness care for those living rurally, and inadequate
document completion. She emphasized her support for HB 329 and
the importance of correcting statute so that ARPNs have the
appropriate signing authority to care for their patients with
serious illnesses.
3:22:26 PM
STEPHANIE BIRCH, as a practicing APRN, explained that the
primary care clinic she works for has a focus on adults with
chronic illness, many of whom are elderly and relying on
Medicaid or Medicare. She shared that Alaskans facing chronic
illness have to navigate a complex healthcare system and often
struggle to get appropriate care. She explained that because
her clinic is run entirely by APRNs, when a patient passes away,
the APRNs are unable to sign the necessary documents, even
though they may have been that person's primary provider for
many years. She noted that there is reluctance from consulting
physicians to sign death certificates due to their limited
involvement with the patient, which forces the APRN to pay out
of pocket for a physician to sign the certificate. She
described the extra time and cost this takes as a burden on both
the families and the practitioners. She urged the committee to
pass HB 392 out of committee to allow APRNs to provide the care
that Alaska families deserve.
3:26:11 PM
SHANNON HILTON, American Association of Nurse Practitioners,
stated that APRNs served a critical role in providing high
quality care across the state and that outdated statutes
preventing signing authority on end-of-life documents impeded
the work APRN's already do. She described the importance of
these documents in providing care that aligned with the
patient's wishes and emphasized that the lack of signing
authority for nurse practitioners (NPs) created undue stress and
delay of process. She opined that the disconnect between the
statute-given ability to treat patients and inability to sign
these important documents meant that her extensive knowledge and
advanced care planning expertise was unrecognized by the law.
She emphasized her belief that passing HB 392 would honor the
autonomy of Alaskans and respect patient choice. She reiterated
that other states have seen great success in giving APRNs the
additional signing authority and urged the State of Alaska to do
the same.
3:29:26 PM
PRIYA KEANE, Doctor of Nursing Practice, informed the committee
that she is a CRN that specializes in hospice and palliative
care in a hospital setting. She explained that in this setting,
she cares for patients and their families who are either newly
receiving serious diagnoses or dealing with an exacerbation of
an existing illness, and that her team often liaisons with
primary care physicians to navigate the difficult discussions
around patients' goals of care, including DNRs and POLST. She
described these conversations as "nuanced and understandably
emotional" and expressed her firm belief that as the participant
in these conversations, she should also be the one responsible
for signing and preparing the orders. She said that there is an
undue burden of wasted time and rehashing emotional
conversations placed on physicians and families by this outdated
law. She voiced her belief that the bill would streamline care
for all Alaskans and asked for an expeditious passing of HB 392.
3:31:38 PM
CO-CHAIR SNYDER opened public testimony on HB 392.
3:32:04 PM
CHRISTINE KRAMER, representing self, testified in support of HB
392, as an ARPN working in an intensive care unit. She
explained that part of her role is to converse with patients and
their families upon admission to determine their preferred "code
status," which includes DNR orders. She reported that NPs are a
critical part of a patient's care team and are usually the ones
who care for a patient if their condition worsens and document
their passing with a "death summary" report. She stated that
passing HB 392 would allow the person responsible for
documenting a patient's death to sign the death certificate.
She restated her support for the proposed bill.
3:33:33 PM
CO-CHAIR SNYDER, after ascertaining that there were no one else
who wished to testify, closed public testimony on HB 392.
[HB 392 was held over.]
3:35:32 PM
The committee took a brief at-ease.
HB 292-HOME AND COMMUNITY-BASED WAIVER SERVICES
3:35:38 PM
CO-CHAIR SNYDER announced that the final order of business would
be HOUSE BILL NO. 292, "An Act relating to home and community-
based services; and providing for an effective date."
CO-CHAIR SNYDER provided a quick recap of HB 292. She explained
that the bill would help the state meet the growing need for
home and community-based care within Alaska by addressing some
of the challenges the Department of Health and Social Services
(DHSS) is facing and aiding the department in providing these
required services. She listed the three main components of the
bill: increasing the threshold for reducing services, providing
a pathway for restoring previously cut hours and services, and
allowing family members to be compensated for providing care.
She highlighted those available online to answer questions and
proceeded to the consideration of amendments.
3:38:31 PM
The committee took a brief at-ease.
3:38:37 PM
CO-CHAIR SNYDER noted that Amendment 1 would not be offered.
3:39:05 PM
CO-CHAIR SNYDER moved to adopt Amendment 2 to HB 292, labeled
32-LS1344\B.4, Foote, 3/19/22, which read:
Page 1, line 14, through page 2, line 1:
Delete ", reduce payment for services,"
Page 2, lines 23 - 31:
Delete all material and insert:
"(3) for purposes of a reduction in the
level of personal care and chore services under 42
U.S.C. 1396n(k) or Medicaid personal care services
under 42 U.S.C. 1396 - 1396p (Title XIX, Social
Security Act), the annual assessment must find that
the recipient's condition has materially improved
since the previous assessment; in [FOR PURPOSES OF]
this paragraph, "materially improved" means that a
recipient who has previously qualified for services is
able to function in a home setting with the reduced
level of services;
(4) for purposes of a termination of
payment for services, the annual assessment must find
that the recipient's condition has materially improved
since the previous assessment; in this paragraph,
"materially improved" means that a recipient who has
previously qualified for a service [A WAIVER] for"
Page 3, line 8:
Delete "and live independently"
Delete "waiver"
Insert "[WAIVER]"
Page 3, line 13:
Delete "and live independently"
Delete "waiver"
Insert "[WAIVER]"
Page 3, line 15:
Delete "(4)"
Insert "(5)"
Page 3, lines 25 - 27:
Delete "a person who is qualified to provide
personal care services under the 1915(k) state plan
option under 42 U.S.C. 1396n or"
Page 4, line 19:
Delete "payment for services or"
Page 4, line 23:
Delete "a reduction in payment for services or"
REPRESENTATIVE ZULKOSKY objected for the purpose of discussion.
3:39:12 PM
CO-CHAIR SNYDER listed the changes proposed in the amendment,
which reflected requests from the department and stakeholders.
First, she explained that the amendment would remove language
concerning payment for services that requires the department to
do [time consuming] individual evaluations and does not align
with the current structure for payment rate. She stated that a
forthcoming amendment may give the committee the opportunity to
address the rate setting process. She continued to the next
change in Amendment 2 which would replace language around
service level reductions to narrow the scope of the bill to only
personal care services, as these were the services most used by
stakeholders. She referred to conversations with the department
that support the change as it would lessen the administrative
cost associated with implementation. She moved on to the next
component of the amendment which would remove the language "live
independently" from the section of the bill describing the
services to be provided by the state. She explained that while
it is the intent of her office as the bill's sponsor to support
Alaskans' access to services that allow them to live
independently, she had received feedback from the department and
other stakeholders that more research into assessment and the
development of an inclusive definition of "living independently"
would be prudent before including that language in statute.
Last, she explained that the amendment would clarify language
defining "independent healthcare providers" to remove the
"certified" requirement, since registered nurses and APRNs are
qualified to provide independent assessments.
3:44:02 PM
REPRESENTATIVE ZULKOSKY removed her objection. There being no
further objection, Amendment 2 was adopted.
3:44:21 PM
REPRESENTATIVE SPOHNHOLZ moved to adopt Amendment 3 to HB 292,
labeled 32-LS1344\B.5, Foote, 3/16/22, which read:
Page 4, following line 15:
Insert a new bill section to read:
"* Sec. 5. The uncodified law of the State of
Alaska is amended by adding a new section to read:
REPORT TO THE LEGISLATURE. Not later than one
year after the effective date of secs. 1 - 4 this Act,
the Department of Health and Social Services shall
submit a report to the senate secretary and chief
clerk of the house of representatives and notify the
legislature that the report is available. The report
must
(1) include an assessment of the payment
rates for home and community-based services in the
state under a waiver or 1915(k) state plan option
under 42 U.S.C. 1396n(k); the assessment must address
the adequacy of those rates to ensure sufficient
workforce needs for independent qualified health care
professionals; and
(2) assess and identify the adequacy of
services under AS 47.07.045(a); this analysis shall
include the number of individuals eligible for
services, the number of individuals receiving
services, the average length of time for which an
individual is placed on a waitlist for services, and
the average hours of service each recipient receives
annually, monthly, and weekly; and
(3) assess and recommend additional changes
to state statute, regulations, and payment for
services to enhance the delivery of services under
AS 47.07.045(a) to individuals eligible to receive
care, particularly changes involving decreasing
waitlists, reducing services, and addressing workforce
shortages."
Renumber the following bill sections accordingly.
Page 5, line 3:
Delete "Section 5"
Insert "Section 6"
Page 5, line 12:
Delete "sec. 6"
Insert "sec. 7"
Page 5, line 17:
Delete "sec. 8"
Insert "sec. 9"
Page 5, line 18:
Delete "Sections 5 and 7"
Insert "Sections 6 and 8"
CO-CHAIR SNYDER objected for the purpose of discussion.
3:44:26 PM
REPRESENTATIVE SPOHNHOLZ explained that Amendment 3 would
require the department to create a one-time report on the
payment rates for home- and community-based services. She
referred to testimony from the public that low wages for
caregivers may be contributing to the lack of access to needed
services. She stated that Alaska is facing a crisis in elderly
care that will only get worse as the population ages, and the
proposed report would provide the legislature with visibility
into the issue and recommendations on how to improve service
availability.
CO-CHAIR SNYDER removed her objection. There being no further
objection, Amendment 3 was adopted.
3:46:16 PM
The committee took an at-ease from 3:46 p.m. to 3:56 p.m.
3:56:05 PM
CO-CHAIR SNYDER asked Representative McCarty to confirm whether
the adopted Amendment 2 accurately reflected the proposed
changes in Amendments 4 and 6. She mentioned her understanding
that Amendment 4 mirrored changes already occurring in Amendment
2, but that it included the removal of additional language about
reducing service levels.
3:58:29 PM
The committee took an at-ease from 3:58 p.m. to 4:03 p.m.
4:04:06 PM
REPRESENTATIVE MCCARTY moved to adopt Amendment 4 to HB 292,
labeled 32-LS1344\B.6, Foote, 3/17/22, which read:
Page 1, line 14, through page 2, line 1:
Delete ", reduce payment for services, or reduce
the level of services"
Page 2, lines 23 - 31:
Delete all material and insert:
"(3) the annual assessment must find that
the recipient's condition has materially improved
since the previous assessment; for purposes of this
paragraph, "materially improved" means that a
recipient who has previously qualified for a waiver
for"
Page 4, lines 16 - 25:
Delete all material.
Renumber the following bill sections accordingly.
Page 5, lines 1 - 3:
Delete all material.
Renumber the following bill sections accordingly.
Page 5, line 12:
Delete "sec. 6"
Insert "sec. 5"
Page 5, line 17:
Delete "sec. 8"
Insert "sec. 6"
Page 5, line 18:
Delete all material.
CO-CHAIR SNYDER objected for the purpose of discussion.
4:04:11 PM
REPRESENTATIVE MCCARTY confirmed that Amendment 2 addressed most
of Amendment 4, aside from the removal of the language regarding
reducing of the level of service. He shared that leaving this
language in the bill may prohibit a reduction of service level
if the "medical necessity" of the patient were to decrease or
the patient were to request a service level reduction. He
offered his understanding that removing the language would
increase flexibility.
CO-CHAIR SNYDER voiced her belief that protecting the ability to
appeal a reduction of services was a key component of the bill
and opined that the amendment would "gut" that component. She
mentioned that another section of the amendment would prevent
retroactive assistance for people who have had their services
reduced in the recent past. She stated that she could not
support the proposed amendment.
REPRESENTATIVE MCCARTY reiterated his concern that by not
removing the language about the level of service from the bill,
those receiving care could not receive less service if their
needs lessened.
CO-CHAIR SNYDER maintained her objection.
A roll call vote was taken. Representative McCarty voted in
favor of Amendment 4 to HB 292. Representatives Snyder,
Zulkosky, Sponholz, and Fields voted against it. Therefore,
Amendment 4 failed by a vote of 1-4.
4:10:06 PM
REPRESENTATIVE MCCARTY moved to adopt Amendment 5 to HB 292,
labeled 32-LS1344\B.7, Foote, 3/17/22, which read:
Page 2, lines 3 - 4:
Delete "an annual"
Insert "a biennial [AN ANNUAL]"
Page 2, line 7:
Delete "annual"
Insert "biennial"
Page 2, line 24:
Delete "annual"
Insert "biennial [ANNUAL]"
Page 2, line 30:
Delete "annual"
Insert "biennial"
CO-CHAIR SNYDER objected for the purpose of discussion.
REPRESENTATIVE MCCARTY shared his understanding that to continue
to qualify for care services though DHSS, recipients must
provide an annual assessment through an independent
practitioner. He referred to testimony that had revealed
service recipients were struggling to find practitioners who
could provide these assessments. He asked for a statement from
DHSS about its reaction to the proposed amendment.
4:11:24 PM
JOHN LEE, Director, Division of Senior and Disabilities
Services, Department of Health and Social Services, introduced
himself for the record.
REPRESENTATIVE MCCARTY asked whether changing from an annual to
a biennial assessment would be helpful for the department.
MR. LEE explained that there was a classification of people who
receive personal care services that require facility level
treatment, and annual assessments for this population helps
reduce the risk of institutionalization. Comparatively, he
explained that people who are being served using Personal Care
Attendants (PCAs) are at a lower risk for institutionalization,
so rather than assessing all recipients annually, the department
does an assessment on 10 percent of requests for renewal of
services. A drastic change in a person's condition may also
trigger an assessment, but he reported that there is no
statutory requirement for DHSS to assess annually, and it would
be a labor-intensive process to change from assessing 10 percent
of recipients to testing all recipients biennially.
REPRESENTATIVE MCCARTY withdrew Amendment 5.
4:14:19 PM
REPRESENTATIVE MCCARTY moved to adopt Amendment 6 to HB 292
labeled, 32-LS1344\B.8, Foote, 3/17/22, which read:
Page 2, line 26:
Delete "and live independently"
Page 3, line 8:
Delete "and live independently"
Page 3, line 13:
Delete "and live independently"
CO-CHAIR SNYDER objected for the purpose of discussion.
REPRESENTATIVE MCCARTY explained that Amendment 6 would remove
an occurrence of the "or live independently" language that
Amendment 2 had missed. He confirmed that the rest of Amendment
6 was covered by Amendment 2.
4:15:15 PM
The committee took a brief at-ease.
4:15:20 PM
REPRESENTATIVE MCCARTY clarified that the necessary language was
included in Amendment 2 and withdrew Amendment 6.
[HB 292 was held over.]
4:19:09 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:19 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| 5. HB 392 Research - POLST FAQ 3.28.22.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 4. HB 392 Research - One Pager, 3.28.22.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 6. HB 392 Research - POLST Signature Requirement by state 3.28.22.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 3. HB 392 Sectional Analysis version A.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 2. HB 392 Sponsor Statement version A.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 8. HB 392 LOS since 3.28.22.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 7.HB 392 Research - APRN Practice Maps 3.28.22.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 1. HB 392 version A.PDF |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| HB 292 Amendment Packet, 3.22.22.pdf |
HHSS 3/22/2022 3:00:00 PM HHSS 3/29/2022 3:00:00 PM |
HB 292 |
| HB 292 Amendments with votes.pdf |
HHSS 3/29/2022 3:00:00 PM |
HB 292 |