Legislature(1997 - 1998)
04/25/1997 09:06 AM Senate HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION & SOCIAL SERVICES COMMITTEE
April 25, 1997
9:06 a.m.
MEMBERS PRESENT
Senator Gary Wilken, Chairman
Senator Loren Leman, Vice Chairman
Senator Lyda Green
Senator Jerry Ward
Senator Johnny Ellis
MEMBERS ABSENT
All members present.
COMMITTEE CALENDAR
SENATE BILL NO. 170
"An Act relating to financial assistance for students attending
certain graduate education programs; and providing for an effective
date."
- HEARD AND HELD
SENATE BILL NO. 116
"An Act relating to welfare to work tax credits under the Alaska
Net Income Tax Act; and providing for an effective date."
- MOVED SB 116 OUT OF COMMITTEE
CS FOR SENATE BILL NO. 152(L&C)
"An Act relating to certified nurse aides; and providing for an
effective date."
- MOVED CSSB 152(L&C) OUT OF COMMITTEE
PREVIOUS SENATE COMMITTEE ACTION
SB 170 - No previous Senate action to record.
SB 116 - See Senate State Affairs Committee minutes dated 3/25/97,
3/27/97. See Senate Health, Education & Social Services
minutes dated 4/23/97.
SB 152 - See Labor and Commerce minutes dated 4/15/97.
WITNESS REGISTER
Joe Ambrose, Staff
Senator Taylor
State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Read the Sponsor Statement.
Laura Burleson, UAF Pre-Med Student
4758 Glasgow #1
Fairbanks, Alaska 99709
POSITION STATEMENT: Supported SB 170.
Wendy Redman, Vice President
University of Alaska Statewide System
PO Box 755000
Fairbanks, Alaska 99775
POSITION STATEMENT: Urged the committee to continue WAMI.
Diane Barrans, Executive Director
Postsecondary Education Commission
3030 Vintage Boulevard
Juneau, Alaska 99801-7109
POSITION STATEMENT: Answered questions.
Jim Nordlund, Director
Division of Public Assistance
Department of Health & Social Services
PO Box 110640
Juneau, Alaska 99811-0640
POSITION STATEMENT: Explained SB 116.
Joseph Friedman, Director
Trade Dollar Exchange
3820 Lake Otis Parkway
Anchorage, Alaska 99508
POSITION STATEMENT: Discussed the Trade Dollar Exchange.
Pam LaBolle
Alaska State Chamber of Commerce
POSITION STATEMENT: Supported SB 116.
Annette Krietzer, Staff
Senator Leman
State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Reviewed SB 152.
Teresa Lyons, Registered Nurse
PO Box 477
Ester, Alaska 99725
POSITION STATEMENT: Supported SB 152.
Gail McGuill, President
Alaska Nurses Association
237 E 3rd Avenue
Anchorage, Alaska 99501
POSITION STATEMENT: Supported SB 152.
Ron Cowan
Division of Medical Assistance
Department of Health & Social Services
PO Box 110660
Juneau, Alaska 99811-0660
POSITION STATEMENT: Supported SB 152.
Catherine Reardon, Director
Division of Occupational Licensing
Department of Commerce & Economic Development
PO Box 110806
Juneau, Alaska 99811-0806
POSITION STATEMENT: Supported SB 152.
ACTION NARRATIVE
TAPE 97-43, SIDE A
SB 170 REPAY GRADUATE EDUCATION AID
Number 001
CHAIRMAN WILKEN called the Senate Health, Education & Social
Services Committee (HES) to order at 9:06 a.m. and introduced
SB 170 as the first order of business before the committee.
JOE AMBROSE , Staff to Senator Taylor, read the following Sponsor
Statement into the record:
Senate Bill 170 was introduced at the request of constituents
interested in preserving the WAMI Medical Education Program. This
is a companion measure to House Bill 193 and its introduction is
intended to compliment that effort. These bills would convert the
Alaska program into a loan program. The state of Montana has
already made this conversion.
WAMI has been a program of financial assistance named for the
participating states of Washington, Alaska, Montana, and Idaho. It
is intended to facilitate the education of medical professionals.
Alaska participated to the tune of $1,309,000 in FY97.
WAMI has been criticized because there has been no real incentive
for a student to return to the state upon completion of their
education.
By converting this program to a loan program and including a
provision for loan forgiveness, proponents feel young Alaskans will
be more likely to bring their new skills back to Alaska.
The House sponsor has been working with the Postsecondary Education
Commission and has developed a committee substitute. Senator
Taylor recommends adopting the same language as a substitute for
SB 170.
SENATOR GREEN moved that CSSB 170(HES) be placed before the
committee. Without objection, CSSB 170(HES) was before the
committee.
SENATOR LEMAN inquired as to the impact on the borrower. When does
the pay back schedule for the WAMI loan begin? JOE AMBROSE pointed
out the language on page 2, lines 7-9 "Interest imposed under this
subsection begins to accrue when the person terminates studies
under the graduate education program." Mr. Ambrose believed the
legislation allows for the internship. Mr. Ambrose directed
Senator Leman to page 2, lines 27-29 "A person employed in a
medical residency program is not required to begin repayment to the
state as long as the person remains in the medical residency
program." With regard to the impact on the borrower, Mr. Ambrose
deferred to the Postsecondary Education Commission.
Number 115
LAURA BURLESON , UAF Pre-Med student, supported SB 170. WAMI is
important to Alaskan pre-med students because WAMI gives Alaskans
preference for admission and tuition. WAMI treats Alaskan pre-med
students as residents for admission purposes. Ms. Burleson
informed the committee that a school to which she recently applied
had received over 10,000 applicants for 113 positions while another
school had 8,000 applicants for 32 out of state positions. With
those odds, Alaskan students do not have much of a chance because
Alaska does not have a medical school to provide in state admission
preference. SB 170 is a compromise to the alternative of
eliminating the program. Without WAMI, the challenge of the
numbers of getting into a medical school out of state would be very
difficult. Furthermore, this bill could help WAMI students
applying for the program. In the past the return rate for students
returning to the state is relatively low. The return or repayment
clause in SB 170 would help those students who do intend to return
to the state and practice.
WENDY REDMAN , Vice President of the University of Alaska statewide
system, thanked Representative Bunde and Senator Taylor for their
work on this issue. WAMI is very important to the university. The
University of Alaska-Anchorage offers the first year of the medical
program which provides the basis of a biomedical program. Ms.
Redman was supportive of this legislation if it is a means to
maintain WAMI. Ms. Redman hoped that the Senate action deleting
WAMI will be worked out. Ms. Redman suggested that the pay back
provision for the first year be eliminated. The first year of the
program is offered in Alaska and is important to the university and
the state by drawing medical research here. Ms. Redman recognized
that the WAMI program is an expensive program, but it is
substantially less expensive than having a medical school. The
decision to bring back WAMI students to Alaska is a policy call
which SB 170 addresses. Currently, 48 percent of the WAMI
participants do return to Alaska which is higher than the national
average for other medical schools. The WAMI program is a bargain
for Alaska and Alaskan students. Ms. Redman urged the committee to
continue the WAMI program and consider an amendment that would
provide that the first year of pay back be eliminated.
Number 263
SENATOR ELLIS asked if the return rate was expected to
substantially increase with the Sisters of Providence family
practice residency program. Senator Ellis projected that a
substantial increase in the return rate would occur due to the
availability of the residency program within the state. WENDY
REDMAN agreed with Senator Ellis that students tend to become
permanent residents in the community in which the student did
residency. Therefore, the family practice residency in Alaska
would make a big difference.
SENATOR ELLIS inquired as to the average debt load of a student
after seven years of medical training. WENDY REDMAN informed
everyone that the average loan is $45,000 to $80,000 per the
information of the Postsecondary Commission. With SB 170, $56,000
would be added if all four years pay back are included or $44,000
if the first year of pay back is eliminated. That would total
about $100,000 to $130,000 of debt. Ms. Redman pointed out that
these are family practitioners, not cardiac surgeons which could
possibly absorb that debt.
SENATOR ELLIS stated that the higher the debt load, the more likely
someone is to specialize and practice in a major urban center in
order to pay off the debt. The lower the debt load, the more
likely someone would choose to deliver babies in a rural setting.
SENATOR GREEN noted that students could accumulate $50,000 in post
graduate debt before beginning the WAMI program as well as the debt
the WAMI program would incur. When does repayment begin for the
debt incurred in the post graduate education? WENDY REDMAN
explained that the Postsecondary Commission would provide deferment
on the baccalaureate loans while the student is attending medical
school on a loan. Ms. Redman pointed out that the loans are
additive. If a student has a loan from Alaska, the first
baccalaureate loan would be deferred while the student continues
his/her education. At the time the student graduates from medical
school and one year afterwards, the entire loan would begin
repayment.
SENATOR GREEN asked if the student's record was clean with a
deferment; is there a bad debt record being assessed against the
student or the institution?
Number 322
DIANE BARRANS , Executive Director of Postsecondary Education
Commission (PSEC), stated that there are provisions for deferment
that do not damage a student's credit history.
SENATOR LEMAN inquired as to the tax consequences of WAMI; is the
program treated like a scholarship which is nontaxable? DIANE
BARRANS explained that it would be categorized as gift aid. Since
the loan is not associated directly with an individual, there is
simply a contractual fee paid to the University of Washington.
Therefore, the WAMI loan would not relate to an individual's
scholarship or loan limits. SENATOR LEMAN ascertained then that
there is no obligation by the party benefiting to pay the IRS any
portion of that benefit. DIANE BARRANS replied no.
SENATOR LEMAN asked if a loan program with forgiveness was created,
would that be a taxable benefit? DIANE BARRANS understood that in
the past, the tax code made some provisions for those receiving a
benefit related to specific employment or service. In the early
1990s, the IRS did contact PSEC and required the disclosure of
forgiveness benefits upon which people were taxed. However, Ms.
Barrans said that at that time there was no provision in the tax
code for people to receive a benefit simply because the person
resided in a particular area. Ms. Barrans said that it is
difficult to receive tax advice from the IRS, therefore a tax
accountant or tax attorney should be contacted. SENATOR LEMAN did
not want to inadvertently establish a cash drain away from Alaska
or Alaskans to the IRS. Senator Leman expressed the need to make
the tax consequences benefit Alaska or Alaskans who participated.
Number 370
In answer to the first half of Senator Leman's question, DIANE
BARRANS explained that the student with a WAMI loan would be
borrowing the differential between the resident and the non-
resident University of Washington School of Medicine rate of
tuition. Currently, the student pays the resident rate of tuition
which is about $8,000 per year. The student would be borrowing the
additional amount that is charged to residents. Ms. Barrans
pointed out that was calculation 2 in the committee packet.
SENATOR LEMAN determined then that the student is responsible for
the resident tuition rate and may borrow that under other loan
programs, but not specifically under the WAMI loan program. DIANE
BARRANS agreed with that assessment.
CHAIRMAN WILKEN requested that the concerns with SB 170 be
addressed and the Chair held SB 170.
SB 116 WELFARE TO WORK TAX CREDITS
CHAIRMAN WILKEN announced that SB 116 was the next order of
business before the committee.
Number 402
JIM NORDLUND , Director of the Division of Public Assistance,
informed the committee that he was present to testify on the behalf
of the Administration in support of SB 116. SB 116 will provide
tax credits to Alaska corporate employers who hire disadvantaged
workers. Mr. Nordlund has a particular interest in SB 116 because
of the challenge of the division and the state as a whole to find
work opportunities for up to 4,000 individuals in the next year due
to state and federal mandates. This is a multi-departmental
effort. Mr. Nordlund noted his work with the employer community to
review incentives for employers to hire welfare recipients and
SB 116 is a key to this goal. Mr. Nordlund mentioned that a
representative from the Department of Revenue and the Department of
Labor are present for questions regarding the respective
departments.
SB 116 is modeled after federal legislation that provides a tax
credit on the federal income tax to businesses that hire welfare
recipients. SB 116 would require a state tax credit of up to
$1,000 per employee and an additional $500 if the employer provides
job training to the recipient. The employee must be on the job for
180 days or 400 hours, and those need not be consecutive days which
recognizes the seasonal employment in Alaska. Mr. Nordlund
mentioned that the federal law and SB 116 are not limited to
welfare recipients, but are available to other categories of
disadvantaged workers. For the number of employers who hire
recipients, there is a significant cost savings in terms of welfare
benefits that would have otherwise been paid offsetting the cost to
the Treasury of providing that tax credit to employers. Mr.
Nordlund noted that SB 116 makes it as administratively simple for
employers as possible.
SENATOR LEMAN said that he liked the idea. Senator Leman noted
that a few years ago, he introduced a welfare reform bill which
included a provision similar to the concept of SB 116. Senator
Leman was concerned with limiting the tax credit to the corporate
income tax. Perhaps, there is a way in which to broaden the base
to include more employers to participate in employing welfare
recipients. The number of corporate tax payers in Alaska is small
in comparison to the number of business licenses.
JIM NORDLUND recognized that SB 116 would only benefit Alaskan
corporations because corporations are the only businesses that pay
income taxes. Mr. Nordlund emphasized that SB 116 is one of
several incentives being utilized to encourage employers to hire
welfare recipients. Mr. Nordlund informed the committee that a
program modeled after the Green Star program is being reviewed.
The Work Star program which recognizes businesses hiring
disadvantaged workers or welfare recipients is also being reviewed.
Under SB 98 from last year, the actual welfare benefit can be used
as a wage subsidy to businesses not limited to corporations hiring
welfare recipients. Mr. Nordlund pointed out that most who work
outside of government work for a corporation. The bigger
businesses who hire more are generally corporations.
SENATOR LEMAN inquired as to the numbers of employees hired by the
corporations covered under the corporate income tax versus the
total number of employees in Alaska. JIM NORDLUND said that could
be provided.
Number 489
SENATOR GREEN inquired as to how the wage subsidy would work. JIM
NORDLUND explained that for a business, such as KMART, who pays $7
an hour and who hires a welfare recipient for six months to a year;
the business would receive $2 an hour. The welfare benefit would
be utilized to subsidize $2 an hour of the wage. Mr. Nordlund
pointed out that the program has been used in other states. Due to
the combination of the residual benefit and the wage, the person
would do better than with the welfare benefit alone. The employer
experiences a reduced payroll cost. The wage subsidy is good for
the State Treasury because the needs of the family are being
provided for partially through wages as opposed to 100 percent
through the welfare benefit. Mr. Nordlund noted that the wage
subsidy will be placed in regulation by October 1997.
SENATOR GREEN asked if this would be part of the training component
or the work requirement. How does this impact the two year and
five year time limit with regard to the individual's participation
in the tax credit? JIM NORDLUND said that presuming the individual
is working, the individual would not be subject to the two year
time limit which is the requirement for people to be in a job. If
the job has a low wage and the individual is eligible for welfare,
the individual would receive a reduced benefit. Between now and
five years, hopefully the individual would be at a point to support
themselves without any assistance.
SENATOR GREEN asked if this could be construed to be a disincentive
to get off welfare. JIM NORDLUND did not think so. This is
invisible to the recipient, except that employers would be willing
to hire the recipient.
SENATOR LEMAN asked if the Work Star program is a recognition
program and there is no money involved. JIM NORDLUND agreed that
the Work Star program is a recognition program that is being tested
with employers. A steering committee of employers has been formed
in order to receive advice from employers.
SENATOR LEMAN encouraged Mr. Nordlund to recognize businesses who
help programs such as Bootstraps which is designed to move folks
from welfare to work.
Number 539
JOSEPH FRIEDMAN , Director of the Trade Dollar Exchange, informed
the committee that he represented about 100 small businesses in
Alaska. The Trade Dollar Exchange is a program allowing small
businesses to actively participate in the hiring of persons through
trade. Mr. Friedman pointed out that the Tax Equity & Fiscal
Responsibility Act of 1982 said that trading or bartering must be
declared as income, but businesses can deduct the income as it is
spent for business expenses. The Trade Dollar Exchange provides a
forum for low income persons to trade skills amongst each other and
are awarded trade dollars. With those trade dollars, the
individual can go to participating businesses and redeem the trade
dollars for goods and services. For example, the People Mover in
Anchorage will provide bus passes for trade dollars. The YMCA is
part of the Trade Dollar Exchange. The Trade Dollar Exchange is a
debit-credit banking system. Mr. Friedman noted that the Trade
Dollar Exchange comes from the Time Dollar Programs. In St. Louis,
the largest Time Dollar Program has over 8,000 people trading
skills. If those 8,000 people participated 10 hours a week, that
results in 80,000 of hours of services delivered without asking for
money from the government. If those hours were paid at $10 an
hour, that would result in $800,000 in savings. Mr. Friedman noted
that in Michigan and Missouri, the state has paid for services that
cannot be provided by the system itself.
Mr. Friedman said that the Trade Dollar Exchange makes Alaskan
businesses more competitive and profitable. Businesses can
employee these people using trade dollars. This program allows the
private industry group to present the program to small businesses
and enlist support. SB 116 is important in that it moves
corporations into the arena. Mr. Friedman noted that the Trade
Dollar Exchange had contacted the Democratic and Republican State
Parties and inquired as to donations of time and skill.
TAPE 97-43, SIDE B
Mr. Friedman stated that the program is looking for the
opportunity, amendment to SB 116, to have the trade dollars be
disregarded for income analysis for AFDC, ATAP and SSI.
SENATOR LEMAN asked if there are other similar exchange programs in
Alaska. If so, why would those programs not be eligible for income
disregard as Mr. Friedman suggested for the Trade Dollar Exchange.
JOSEPH FRIEDMAN explained that exchanges work by a profit
incentive. Moving low income people from welfare to work does not
appeal to many. Mr. Friedman pointed out that the Trade Dollar
Exchange is a program that offers training in order that people
would come in for four of the six weeks and become part of a
community and then move to a job. Within the trading industry many
do not view this as a business opportunity.
Number 561
PAM LABOLLE , Alaska State Chamber of Commerce, informed the
committee that the chamber represents about 700 employers and
businesses statewide who support SB 116. SB 116 would encourage
businesses to hire persons without current experience and would
alleviate some of the on the job training costs. Ms. LaBolle
believed that the costs of on the job training is a major deterrent
for hiring persons on the welfare rolls.
SENATOR LEMAN inquired as to how many of the 700 members of the
chamber were corporate taxpayers. PAM LABOLLE said that she could
survey the members. Ms. LaBolle believed that at a recent chamber
breakfast, Mike Abbott indicated that about 3,500 corporations pay
corporate taxes in Alaska. A huge percentage of that is paid by 11
corporations. SB 116 is an opportunity to join in a partnership
with the state and there is an incentive to do so.
SENATOR LEMAN asked Ms. LaBolle how she viewed expanding this to
other costs that businesses incur such as fuel taxes and business
license fees to those that are employers, but are not corporate tax
payers. PAM LABOLLE believed that could be explored amongst the
membership of the chamber. The cost-benefit relationship may be an
obstacle.
SENATOR WARD asked if the chamber has a position on carrying the
credit for 2-3 years. PAM LABOLLE replied no.
CHAIRMAN WILKEN stated that he would like to move SB 116 to Senate
Finance.
SENATOR GREEN moved to report SB 116 out of committee with
individual recommendations and accompanying fiscal notes. Without
objection, it was so ordered.
SB 152 CERTIFIED NURSE AIDES
CHAIRMAN WILKEN introduced CSSB 152(L&C) as the final order of
business before the committee.
ANNETTE KRIETZER , staff to Senator Leman, said that the legislation
is introduced at the request of the Alaska Nurses Association. Ms.
Krietzer reviewed the sectional analysis included in the packet.
She noted that the sectional analysis for Section 2 had a mistake
the statute referenced, AS 08.68.33(c), should actually be AS
08.68.333(c). In Section 5 Sec. 08.68.333(b), Ms. Krietzer pointed
out that the revocation of a nurse aide's certification can occur
if the board finds "abuse, neglect, or misappropriation of property
in connection with employment as a nurse aide"; the "in connection
with employment as a nurse aide" was added to be specific.
Therefore, a CNA can be placed on the registry one of two ways. A
CNA can be placed on the registry due to "abuse, neglect, or
misappropriation of property in connection with employment" which
is governed by the Administrative Procedure Act (APA). However
under subsection (c), upon a notice of finding from DHSS, a CNA can
be placed on the registry under AS 47.05.055 which is not subject
to APA.
Ms. Krietzer expressed concern with Section 10 and directed the
committee to page 6, lines 20-21. If DHSS has reason to believe a
CNA in a facility licensed by DHSS has committed abuse, neglect, or
misappropriation of property, DHSS investigates to determine
whether a finding should be made. As the legislation is currently
written, these proceedings are exempt from APA. Ms. Krietzer
directed the committee to page 3, lines 28-31 which states that the
board can revoke a nurse aide's certification without a hearing and
enter the finding in the registry and notify the nurse aide of the
actions taken by the department. The department does not have a
procedure in place. In conversations with DHSS, the department
indicated that it will probably follow APA, but would look for an
alternate procedure. This is of concern and the committee may want
to contemplate whether these proceedings should be exempt from APA.
Ms. Krietzer noted that Sections 14-16 are conforming amendments
that add this agency investigation into statutes where necessary to
comply with federal law.
Number 400
SENATOR LEMAN understood that those sections addressing the
exemption from APA were suggested by DHSS during the department's
assistance in drafting. Senator Leman requested that DHSS inform
the committee as to why those suggestions were made.
TERESA LYONS , registered nurse, supported SB 152. Ms. Lyons
informed the committee that she has worked as a registered nurse
throughout Alaska and the nation and has worked with many certified
nursing assistants and aides. Of those CNAs, some did prey upon
the vulnerable populations being served. Ms. Lyons pointed out
that the lack of public oversight for CNAs in home care agencies
and hospitals leaves the policing to the employer. Unfortunately
because of the structure, people move from agency to agency or
hospital to hospital and the abuse continues.
SENATOR ELLIS asked if some specific event spurred this legislation
because this has been discussed for a number of years. ANNETTE
KRIETZER noted that there have been some changes in federal law
requiring that each state establish procedures to deal with the
revocation of certificates of CNAs.
SENATOR ELLIS asked if there were any problems through the board
that could not be dealt with through the existing statute. ANNETTE
KRIETZER understood that the current program does not have any
statutory authority in existing statute to deal with what the board
is required to under federal law. SENATOR ELLIS asked if there
have been any problems. ANNETTE KRIETZER said that currently, CNAs
are issued certificates not licenses. Ms. Krietzer understood that
there have been some problems, but the board does not have the
ability to deal with them.
Number 349
GAIL MCGUILL , President of the Alaska Nurses Association(ANA),
informed the committee that she is also a registered nurse, a
licensed nursing home administrator and Director of quality
management at Columbia Alaska Regional. Ms. McGuill supported SB
152. For seven years, ANA has worked with the Alaska Board of
Nursing to achieve the public protection encompassed in SB 152.
In 1989, the Governor signed EO 115 which called for the Department
of Commerce to take responsibility for the training, certification,
and registration of nurse aides that is required by the federal
government. The ANA believes that the statutory and regulatory
authority for nurse aides should rest with the Board of Nursing,
the state agency responsible for regulating nursing care in Alaska.
SB 152 will strengthen the board's ability to protect the public
and will allow the board to establish standards for certification
for defining competency for nurse aides. SB 152 provides the board
with the ability to discipline nurse aides and revoke certification
when appropriate. Although the board has had standards for
education and competency testing for nurse aides since 1989, the
board has been unable to perform any disciplinary actions due to
its lack of statutory authority. DHSS has had the responsibility
to do investigations, but only when the allegations involve client
abuse, neglect, or misappropriation of funds. Over the past seven
years, the Board of Nursing has provided professional consultation
to DHSS and the senior ombudsman in investigation of complaints
related to CNAs and nursing care of senior citizens. SB 152
provides protection to the public from all CNAs.
RON COWAN , Division of Medical Assistance, supported the comments
related to the need for this legislation. Mr. Cowan reiterated Ms.
McGuill's comments regarding the history of CNAs and the process
that has led to this legislation. EO 115 provided limited
authority to the state and Occupational Licensing in the Board of
Nursing to develop certain standards. Those standards were limited
to the federal government, the only statutory authority available
at that time, which was limited to nursing homes. The CNA
population has increased and are working in many other settings
besides nursing homes. The problem has been that when a hearing
takes place, the department does not have statutory authority to
enact any disciplinary actions.
Mr. Cowan directed the committee to Section 9, lines 7-9 and
Section 10, lines 18-19 of the bill when discussing the exemption
from APA. The department will ensure protection of the due process
rights of individuals the department takes action against. Mr.
Cowan explained that an APA hearing for a CNA utilizes the same
criteria used to revoke a physician's license or that of a higher
practitioner. In the APA hearing, malpractice and the like are the
subject, while CNA hearings revolve around physical abuse. The
burden of proof under the APA is of such stringent nature that it
is difficult to take action against someone that should not be a
CNA. Mr. Cowan said that this exemption is not a breaker for the
department, but something more effective than APA for this type
hearing should be reviewed. There is a difference between the
revocation of the certification of a CNA versus that of a
physician. Mr. Cowan supported SB 152.
Number 230
SENATOR GREEN inquired as to the training of a nurse aide. RON
COWAN explained that a minimum of 75 hours is required of which
certain skills are learned and competency tests must be passed.
There is a didactic test requirement and continuing education is
also required.
SENATOR GREEN asked if certification is the only method available
to discipline these people. RON COWAN pointed out that even
certification cannot be used. The only basis for discipline is
found in federal statutes which says that an individual cannot
continue to work in a nursing home if the individual was found to
have committed violations. Therefore, that individual can go any
place else in the state and work as a CNA. Unless the action falls
into criminal activity, there is no further recourse available.
CATHERINE REARDON , Director of the Division of Occupational
Licensing in the DCED, supported SB 152. Ms. Reardon informed the
committee that the department already certifies approximately 2,000
nurse aides and SB 152 allows the existing program to work better.
The bill establishes a two track system which is mandated by
federal law. The federal law required nursing homes to hire CNAs
and if a CNA was found to have committed abuse, neglect, or
misappropriation of funds that CNA could no longer work in a
nursing home. Since that time, the nurse aide system has expanded.
Therefore, SB 152 would allow the discipline of nurses in other
settings and revocation of the nurse's certificate. The federal
law only places names on a registry and the nurse retains the
certificate. Ms. Reardon pointed out that there are other types of
incompetencies that the department would like to investigate and
possibly take disciplinary corrective action. SB 152 allows the
board to place a nurse aide on suspension, probation, or monitoring
for other offenses that do not fall under abuse, neglect or
misappropriation of funds. Ms. Reardon explained that by federal
law DHSS deals with findings of abuse or neglect in nursing homes
while the Board of Nursing will deal with allegations against nurse
aides in other settings and for reasons besides the three
specified. The second half of the bill makes the nurse aide system
conform to the requirements of other agencies. SB 152 does not
mandate licensure nor certification.
Number 117
SENATOR WARD inquired as to Ms. Reardon's impression of the lack of
process for the revocation of a license. CATHERINE REARDON pointed
out that all of the Board of Nursing and the Department of Commerce
activities fall under APA with one exception. In the case that
DHSS has had a due process hearing and reports the results to the
Board of Nursing, a second hearing would be redundant. The policy
issue is whether DHSS should fall under APA for its hearing. In
further response, Ms. Reardon said that under APA one can appeal to
Superior Court.
SENATOR WARD noted the growth of nurses aides when asking if any
consideration had been given to the upcoming nurses aides to have
their own surety bonds and be self supporting. Senator Ward noted
that the fiscal note indicates that someone will be hired.
CATHERINE REARDON explained that the cost of that employee is being
paid by the license fees of the nurse aide. SB 152 references AS
08.01.065 which is the self-sufficiency mandate. SENATOR WARD
asked if there will be enough fees collected to cover the cost of
grievances, proceedings and other projected costs. CATHERINE
REARDON expected fees will be between $100-$135 every two years.
The division will establish those fees based on cost. The increase
from $30 to $100-$135 in the fees is due to the increased activity
provided.
SENATOR WARD ascertained then that this system would allow the
public to believe that those holding licenses are reliable and can
be trusted. CATHERINE REARDON specified that this will assure the
public that the nurse aide completed the training program and that
no complaints against the nurse aide resulted in disciplinary
action. In further response to Senator Ward, Ms. Reardon said that
physicians are not mandated to carry insurance and SB 152 does not
include an insurance requirement either. Ms. Reardon noted that
most health care professions do not have insurance requirements.
SENATOR LEMAN remained convinced that the APA provisions need not
be changed and the APA provisions are actually incorporated
earlier. CATHERINE REARDON explained that when the Department of
Commerce receives the complaint, the individual has already
received due process from DHSS.
TAPE 97-44, SIDE A
Number 011
In response to Senator Ward, RON COWAN said that any administrative
procedures or appeals process provided is under APA. DHSS wanted
the opportunity to explore other systems incorporated by other
states with the CNA program which were found to more effective than
under APA in protecting due process. There will be circumstances
in which DHSS will not take action against a CNA unless that CNA in
question happens to be working with an entity that has licenses or
certification under Medicaid. Otherwise, the action would be taken
by the Board of Nursing and under APA per the board's request. Mr.
Cowan said that the APA due process provisions will be followed
until the time another procedure is approved.
SENATOR LEMAN expressed the need to hear from a CNA regarding the
CNA. GAIL MCGUILL said that in discussions with colleagues there
has been no concern expressed by CNAs or the employer.
CHAIRMAN WILKEN said that question would be worked on as it passed
on to Senate Finance.
SENATOR LEMAN moved to report CSSB 152(L&C) out of committee with
individual recommendations and accompanying fiscal notes. Without
objection, it was so ordered.
There being no further business before the committee, the meeting
was adjourned at 10:45 a.m.
| Document Name | Date/Time | Subjects |
|---|