Legislature(2005 - 2006)BUTROVICH 205
04/06/2005 01:30 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB125 | |
| SB150 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 125 | TELECONFERENCED | |
| *+ | SB 150 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 10 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
April 6, 2005
1:36 p.m.
MEMBERS PRESENT
Senator Fred Dyson, Chair
Senator Lyda Green
Senator Kim Elton
Senator Donny Olson
MEMBERS ABSENT
Senator Gary Wilken, Vice Chair
COMMITTEE CALENDAR
SENATE BILL NO. 125
"An Act relating to the licensing, regulation, enforcement, and
appeal rights of ambulatory surgical centers, assisted living
homes, child care facilities, child placement agencies, foster
homes, free-standing birth centers, home health agencies,
hospices or agencies providing hospice services, hospitals,
intermediate care facilities for the mentally retarded,
maternity homes, nursing facilities, residential child care
facilities, residential psychiatric treatment centers, and rural
health clinics; relating to criminal history requirements, and a
registry, regarding certain licenses, certifications, approvals,
and authorizations by the Department of Health and Social
Services; making conforming amendments; and providing for an
effective date."
HEARD AND HELD
SENATE BILL NO. 150
"An Act repealing the limits on grants awarded from the Alaska
children's trust fund."
HEARD AND HELD
SENATE BILL NO. 10
"An Act relating to liability for destruction of property by
unemancipated minors; and providing for an effective date."
SCHEDULED BUT NOT HEARD
PREVIOUS COMMITTEE ACTION
BILL: SB 125
SHORT TITLE: LICENSING MEDICAL OR CARE FACILITIES
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
03/02/05 (S) READ THE FIRST TIME - REFERRALS
03/02/05 (S) HES, JUD, FIN
03/14/05 (S) HES AT 1:30 PM BUTROVICH 205
03/14/05 (S) Heard & Held
03/14/05 (S) MINUTE(HES)
04/06/05 (S) HES AT 1:30 PM BUTROVICH 205
BILL: SB 150
SHORT TITLE: ALASKA CHILDREN'S TRUST FUND GRANTS
SPONSOR(s): HEALTH, EDUCATION & SOCIAL SERVICES
03/21/05 (S) READ THE FIRST TIME - REFERRALS
03/21/05 (S) HES, FIN
04/06/05 (S) HES AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
Dr. Richard Mandsager, Director
Division of Public Health
Department of Health & Social Services
PO Box 110601
Juneau, AK 99801-0601
POSITION STATEMENT: Supported SB 125.
Virginia Stonkus
Certification and Licensing
Division of Public Health
Department of Health & Social Services
PO Box 110601
Juneau, AK 99801-0601
POSITION STATEMENT: Supported SB 125.
Stacie Kraly, Senior Assistant Attorney General
Department of Law
PO Box 110300
Juneau, AK 99811-0300
POSITION STATEMENT: Commented on SB 125.
Margo McCabe, Chair
Trustees for the Alaska Children's Trust
POSITION STATEMENT: Supported SB 150.
ACTION NARRATIVE
CHAIR FRED DYSON called the Senate Health, Education and Social
Services Standing Committee meeting to order at 1:36:40 PM.
Present were Senators Kim Elton, Lyda Green, Donny Olson, and
Chair Fred Dyson.
1:37:00 PM
SB 125-LICENSING MEDICAL OR CARE FACILITIES
CHAIR DYSON announced SB 125 to be up for consideration.
DR. RICHARD MANDSAGER, Director, Division of Public Health, said
SB 125 would consolidate licensing background checks for
certifications by the Department of Health and Social Services
(DHSS).
1:41:51 PM
SENATOR OLSON asked whether there had been complaints or a
problem with licensing some facilities.
DR. MANDSAGER answered that there had been no complaints, but
the issue is that there is a myriad of different rules governing
different care providers. Assisted living homes and for-profit
hospices have most of their rules defined in statute and
everything else has most of their rules defined in regulation.
Since regulations are developed over time, the rules for appeals
are all a little different. SB 125 simplifies and standardizes
the processes.
SENATOR OLSON asked whether the burdens on care providers would
be greater or lesser with the passage of the bill.
DR. MANDSAGER replied that care providers generally like the
bill.
SENATOR OLSON asked whether the bill would put some entities out
of business.
DR. MANDSAGER answered if the entities are competent, they would
remain in business. If they end up going out of business, it
would be for reasons other than this bill.
1:45:50 PM
CHAIR DYSON said he heard that due to a shortage of doctors
licensed to perform abortions in Alaska, doctors not licensed in
Alaska were flying in to perform those services. He asked if
they were in compliance with the abortion statute, AS 18.16.010,
that says:
Abortion may not be performed unless (1) the abortion
is performed by a physician licensed by the State
Medical Board; or (2) the abortion is performed in a
hospital or a facility approved for the purpose by the
Department of Health and Social Services.
VIRGINIA STONKUS, Certification and Licensing, Division of
Public Health, Department of Health and Social Services (DHSS),
responded that physicians are licensed by the Board of Medical
Examiners and that the division does not license the services
that are provided in hospitals. The decisions about what is
performed or available in the institutions are determined by its
Board of Governors.
1:48:01 PM
CHAIR DYSON noted that abortions performed outside of a hospital
is the issue.
MS. STONKUS replied that the division does not license
individual physicians or individual physician clinics.
DR. MANDSAGER said he didn't think the Board licensed for
abortion specifically, but he would have to research whether
doctors are asked what procedures they perform.
CHAIR DYSON said he has raised the issue numerous times and has
never been satisfied that the DHSS is in compliance with state
law. He asked if it was true that doctors not licensed in Alaska
were flying up here to practice and who would investigate that.
MR. MANDSAGER replied that that issue would be investigated by
the Board of Medical Examiners.
CHAIR DYSON asked whether their investigation would happen only
because of a complaint rather than just being asked by him to do
it.
DR. MANDSAGER responded that the board responds to complaints.
MS. STONKUS added that SB 125 was intended to provide a minimal
framework, which would allow the agency to work with the number
of different of programs that would be subject to licensure so
that facilities and programs are not accidentally excluded. An
example is that they need to accommodate children differently
than adults.
CHAIR DYSON asked if any of the waivers or exceptions would
threaten the health of the patients.
MS. STONKUS replied no, accommodations would have to be made.
1:50:36 PM
CHAIR DYSON asked whether he could assume that none of the
waivers or exceptions would affect the health of patients
undergoing care.
MS. STONKUS replied that was correct.
1:52:17 PM
CHAIR DYSON asked why the criminal background check includes
both charges and convictions.
DR. MANDSAGER replied that including the language "charged with
a crime" has been discussed internally for a while and the issue
is when someone is charged with a crime, often they will leave
employment; it might not get prosecuted and it vanishes. In the
interest of trying to a get full picture of an individual, the
bill includes "charged with a crime" so the department can
determine whether it should consider barring a suspect from
employment. It doesn't necessary mean that they will be barred
from employment if they were charged, but it might in some
cases.
CHAIR DYSON asked who would have access to that information.
1:53:58 PM
STACIE KRALY, Senior Assistant Attorney General, Department of
Law (DOL), said that criminal information is all public
information if someone is an adult although juveniles have a
different standard. However, the premise for information on the
civil registry is that it would be restricted to the department
and individuals who need it to determine whether it is pertinent
to the application and should be entered onto the civil abuse
registry. The department is still fleshing out the due process
mechanism that would be available to people on the list for
cases of a vindictive employer.
1:56:51 PM
CHAIR DYSON asked if an applicant would be informed that the
results of a background check could be public and placed on a
registry.
MS. KRALY replied that the results of the check would probably
not be on the registry, but the information they relied upon
would be in a repository. Applicants would be told about the
background check process and the possibility that the
information could be placed on a public registry.
CHAIR DYSON said for the record that it is his contention that
it must be clear to an applicant that such information could be
placed on a public registry.
1:59:31 PM
CHAIR DYSON noted that people in custody and divorce proceedings
sometimes file abuse and other charges that are sometimes
motivated by spite and asked how those would be considered.
MS. KRALY replied that the department wants to give applicants
the ability to include information that may affect an employer's
perception of culpability in a given circumstance such as
divorce proceedings.
CHAIR DYSON asked if criminal information would be on the
registry.
MS. KRALY replied that criminal information is already
accessible to the public, but the board will have to make
decisions about an applicant being terminated when no
adjudicatory act took place and that information is more
difficult to get because it is not necessarily on record
anywhere.
2:03:44 PM
CHAIR DYSON remarked that there are lots of spurious cases these
days against medical professionals and consequently medical
costs are getting so expensive that many prefer to settle suits
and the decision is never made whether they are guilty or not.
DR. MANDSAGER responded that the civil registry language on page
28, line 5, is limited to "the applicant or the employee
committed abuse, neglect or exploitation under certain
statutes." It's limited to things that are pertinent to these
kinds of facilities.
2:05:21 PM
SENATOR ELTON said his concern was that the registry could be
used by an employer to force an employee to leave.
The hammer would be if you don't do it, your name
could end up on the abuse registry, but, if in fact,
abuse happened, instead of going through a protracted
personnel kind of battle, this person might decide to
leave and go to work someplace else.
DR. MANDSAGER replied that cases needed to be captured where
people leave employment before they are reported to the police.
The question is how to get that information. He would like
regulations requiring employers to report to the department if
someone leaves in lieu of getting reported to the police because
of some abusive act they had committed.
2:07:11 PM
MS. KRALY added that he thought that Dr. Mandsager's response
was carefully crafted. They want to encourage employers to make
good decisions about bad employees.
SENATOR ELTON commented that it is not unknown for employers to
threaten their employees.
DR. MANDSAGER said that he would take the Senator's comments
under advice.
2:09:45 PM
CHAIR DYSON asked DR. MANDSAGER if he read ASHNHA's position
paper. His first question is why anyone would file on time if
there weren't a penalty for not doing so.
DR. MANDSAGER replied yes, he had read the paper. With respect
to the concern about timely filing, the intent is that the
department receives an application, but if it doesn't get its
work done on time, the entity remains licensed until it does.
CHAIR DYSON asked if his amendments fix that.
DR. MANDSAGER replied that he thought the statute already said
that, but the lawyers didn't. Another amendment says that the
commissioner would have to authorize the closure of a facility
and accommodations would have to be made for its residents or
patients.
2:12:52 PM
MS. KRALY said the ASHNHA letter said the state should not be
immune from compensating for economic consequences of department
actions ultimately found to be excessive in the courts. She said
the immunity language on page 13 was drafted using the best of
the 13 or 14 statutory frameworks for licensure. It does not
expand nor diminish the immunities under current law. With
respect to ASHNHA's comments, there is currently no such
immunity for things like that and no statutes that would
preclude the possibility of recovery.
2:15:20 PM
DR. MANDSAGER said that the current definition of 'assisted
living home' resulted from issues emerging from the overlap
between assisted living services and medical services. He
disagreed that this overlap was problematic and felt that if a
family and a doctor decide that an elder should have medical
care in an assisted living home and is willing to be liable for
that decision, they should have a right to do so.
2:18:03 PM
CHAIR DYSON asked if a federal law precludes a person being in
possession of a firearm on the parking lot of a federally
licensed childcare center.
MS. STONKUS replied no.
2:20:04 PM
SENATOR GREEN remarked that this seems to be an expansion of the
prohibition of previous language regarding firearms in federally
licensed childcare centers and she wanted assurance that this
bill does not create a further expansion of the aforementioned
prohibition.
2:21:46 PM
DR. MANDSAGER asked if she thought it would be appropriate to
test this language.
SENATOR GREEN responded that she thought that would be
appropriate.
MS. KRALY said that she would take Senator Green's concerns
under advisement, but emphasized that the department had taken
special care not to create an expansion.
CHAIR DYSON said he could not support this bill if any Alaskan
who stops to pick up his child or visit a parent in a nursing
home on the way to or from a hunting trip with a weapon is
guilty. That included people who had been assaulted or someone
who delivered someone who had just been injured to a hospital.
2:24:25 PM
SENATOR ELTON said that an abuse registry creates the kinds of
actions that could be heard by the Office of Administrative
Hearings and therefore assumed there would be a fiscal impact
and a fiscal note.
MS. KRALY responded that the due process mechanism for
determining placement on the civil registry had not yet been
developed, so a fiscal note couldn't be determined.
SENATOR ELTON asked how "volunteer of an entity" is defined on
page 26. He used dog handlers for an example.
DR. MANDSAGER replied that "volunteer" is not defined in the
statute at this point, but the larger facilities have lists of
volunteers with special training and a small organization like
an assisted living home doesn't have volunteer lists and that is
a good question.
He said he had prepared two sets of amendments and had hoped
that a CS version would have already incorporated them - most
are conforming amendments. He said that conceptual Amendment 1
was written primarily because the initial draft of the law
interpreted a starting date that won't happen. So, it renumbers
everything to allow for a starting date after this bill would
pass.
2:29:40 PM
SENATOR GREEN moved to adopt conceptual Amendment 1 and then
objected for discussion purposes.
CONCEPTUAL AMENDMENT 1
1) Amend section 47.32.900(1)(B) [page 15, line 24] -
before "services" insert "or other invasive diagnostic
or therapeutic". (This would have allowed the
department to license medical centers that conduct
procedures that are intrusive and pose increased risk
to the patient, such as cardiac catheterization.)
2) Add a new Section 47 - "Section 17 of this Act
takes effect upon the effective date of the
implementing regulations, or March 1, 2006, whichever
occurs sooner."
MS. STONKUS explained that the whole concept was to implement
the bill as of July 1, 2005 and then further construct the
registry and the background check piece. That timeframe was
ambitious and changing that date required eight pages of
conforming language. The March date was set because of their
federal grant timeframe.
DR. MANDSAGER explained that the second part of Amendment 1
allows flexibility in statute to accommodate improvements in
technology that may allow certain procedures to be performed
outside of a hospital.
SENATOR GREEN asked for an example of a therapeutic service.
DR. MANDSAGER replied a linear accelerator for radiation therapy
or chemotherapy. In Alaska, those things exist within a
hospital, a licensed entity. In other states, they have moved
outside the hospital.
2:35:20 PM
CHAIR DYSON asked if invasive diagnostic is considered imaging.
DR. MANDSAGER replied that it could be imaging, but he didn't
know if those words were exactly right yet.
CHAIR DYSON asked him if barium was invasive.
DR. MANDSAGER replied no and that's why he was not currently
satisfied with the language of the Amendment 1. He didn't want
to get into doctor's offices or ordinary X-ray units.
CHAIR DYSON announced that he would hold action on Amendment 1
pending modifications by the sponsor.
SENATOR ELTON moved to adopt conceptual Amendment 2.
CHAIR DYSON objected for the purpose of discussion.
DR. MANDSAGER explained that Amendment 2 adds a new section,
(e), that requires the commissioner to be involved if the
department has to take over a facility. Everything else is
renumbering. The other part corrects a drafting error on the
bottom of page 13, line 1.
2:38:54 PM
CHAIR DYSON thanked everyone for their comments and said he
would hold the bill in committee.
SB 150-ALASKA CHILDREN'S TRUST FUND GRANTS
CHAIR DYSON announced SB 150 to be up for consideration.
MARGO McCABE, Chairman, Trustees for the Alaska Children's
Trust, related that the Trust was created by the Legislature in
1988 to help fund programs across the state aimed at preventing
child abuse and neglect. She said:
Under current law, the Trust may spend the net income
earned by the trust on community-based prevention
programs. Last year it awarded a total of $217,000 in
grants to 16 non-profit organizations across the
state. Current statute limits the size of grants to
$50,000 and provides a specific funding formula for
funding grants. SB 150 removes the $50,000 cap and
calls for the elimination of the funding formula.
The Alaska Children's Trust is seeking these changes
for a couple of reasons. The changes would give
trustees the possibility to set maximum grant awards
and funding formulas based on need rather than a
predetermined amount set in statute. The intent is not
to eliminate caps of funding formulas completely, but
rather the trust would outline maximum grant awards
and funding formulas with the issuance of each new
RFP. More importantly, the changes will allow the
trust to be better positioned to receive larger grants
from private foundations and charitable trusts. Large
grants could then be more easily redistributed to
[indisc.] programs around the state. In closing, the
rate of child abuse and neglect in this state remains
higher in Alaska than anywhere else in the nation...
She said the Alaska Children's Trust will continue to fund small
community grants, but would like the opportunity to consider
larger projects that may truly "move the needle."
2:42:06 PM
CHAIR DYSON said that he thought that the Alaskan Children's
Trust was initially established to fund small community based
programs to enable organizations that were serving children to
get going and establish themselves and establish other funding
streams.
MS. McCABE responded that is true and they still have that
vision, but would like to be able to receive larger grants.
CHAIR DYSON asked if she intended to become a perennial funding
stream for some organizations that can't get alternative
funding.
MS. McCABE replied no, that there would still be funding limits
and a rule that recipients would be self-sustaining after four
years. Each new RFP would have that requirement. She explained:
Last year legislation proposed 75 percent of the
program's total funding in the first year; in the
second year 50 percent and in the third and fourth
final year, 25 percent. I think the Board of Trustees
still likes those numbers and if it has the
flexibility if this statute was removed, it would
implement that language in its RFP.
CHAIR DYSON asked if she is trying to delete all the statutory
limitations on the length of funding and trust the board's
judgment to carry forward the general gist of the legislative
intent.
2:46:47 PM
CHAIR DYSON asked if her organization wants to follow the
legislative intent of last year's bill, but without the
oversight of the Legislature.
MS. McCABE replied, "Absolutely.... I think that is what we
would be doing." She said the board unanimously supports the
legislation as it is drafted today. She said they are trying to
have more flexibility in being able to implement funding
formulas that are more appropriate to perform their mission.
2:49:10 PM
CHAIR DYSON asked if this bill removes the restriction on
spending the earnings of the trust.
MS. McCABE replied that the language just removes the $50,000
cap and the funding formula.
CHAIR DYSON commented that he thought she answered yes. He asked
if she has donors who don't want to contribute to the principle,
but want their donation to flow through directly to a particular
organization.
MS. McCABE acknowledged that was correct.
SENATOR GREEN asked why the donor could not just give their
donation directly to their favorite organization as opposed to
funneling it through the Children's Trust.
MS. MCCABE replied that a number of larger trusts exist that do
larger grants - in the $1 million to $2 million range. It might
be hard to find some of the smaller non-profits that would like
some of those monies and it would also be easier to find a
number of grantees at once that would benefit from a large
grant.
CHAIR DYSON asked if all of her grants are non-profit
organizations.
MS. McCABE replied that they are all non-profit organizations
that would qualify as a charitable gift recipient under federal
tax law.
SENATOR GREEN said that this bill seems to defeat the original
intent of the Children's Trust, which was to amass donations and
live off that endowment and it would become less effective
without contributions to the endowment. She remembered creating
the limitation to prevent a single organization from receiving
an inappropriate proportion of the trust's fund.
MS. McCABE responded that the trust is committed to increasing
principle, but it receives grants that prohibit it from
increasing its principle and she wants to be able to receive
those grants. The rate of child abandonment in this state is
unbearably high and she wants to do as much as she can.
2:54:45 PM
CHAIR DYSON thanked everyone for their testimony and said that
SB 150 would be held in committee.
There being no further business to come before the committee,
Chair Dyson adjourned the meeting at 2:55:58 PM.
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