Legislature(1993 - 1994)

03/19/1993 01:35 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
txt
                                                                               
     SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE                    
                         March 19, 1993                                        
                            1:35 p.m.                                          
                                                                               
                                                                               
  MEMBERS PRESENT                                                              
                                                                               
  Senator Steve Rieger, Chairman                                               
  Senator Bert Sharp, Vice-Chairman                                            
  Senator Loren Leman                                                          
  Senator Mike Miller                                                          
  Senator Jim Duncan                                                           
  Senator Johnny Ellis                                                         
  Senator Judy Salo                                                            
                                                                               
  MEMBERS ABSENT                                                               
                                                                               
  All Members Present                                                          
                                                                               
  COMMITTEE CALENDAR                                                           
                                                                               
  SPONSOR SUBSTITUTE FOR SENATE BILL NO. 91                                    
  "An Act  providing for  coverage of  midwife services  under                 
  Medicaid;  reordering  the  priority  of  optional  services                 
  provided by the state  under Medicaid; and providing  for an                 
  effective date."                                                             
                                                                               
  SENATE BILL NO. 45                                                           
  "An Act relating to persons under 21 years of age; providing                 
  for  designation  of `safe  homes'  for runaway  minors; and                 
  providing for an effective date."                                            
                                                                               
  SB  61 (IMPLEMENT ALASKA 2000 RECOMMENDATIONS) WAS SCHEDULED                 
        BUT NOT HEARD THIS DATE.                                               
                                                                               
  PREVIOUS SENATE COMMITTEE ACTION                                             
                                                                               
  SB 91 - No previous action to record.                                        
                                                                               
  SB 45 - See HESS minutes dated 3/5/93.                                       
                                                                               
  SB 61 - See HESS minutes dated 2/8/93, 2/10/93, 2/17/93,                     
          2/24/93, 3/3/93, 3/8/93 and 3/17/93.                                 
                                                                               
  WITNESS REGISTER                                                             
                                                                               
  Annette Kreitzer, Legislative Staff                                          
    to Senator Leman                                                           
  State Capitol Building, Room 113                                             
  Juneau, Alaska 99801                                                         
  POSITION STATEMENT:  Explained SSSB 91.                                      
                                                                               
                                                                               
  Kaye Kanne, Certified Direct-Entry Midwife                                   
  Chair, Certified Direct-Entry Midwifery Board                                
  P.O. Box 22624                                                               
  Juneau, Alaska 99802                                                         
  POSITION STATEMENT:  Testified in support of SSSB 91.                        
                                                                               
  Stacie Mendez                                                                
  710 Willow Street                                                            
  Kodiak, Alaska 99615                                                         
  POSITION STATEMENT:  Testified in support of SSSB 91.                        
                                                                               
  Karren Shine-Audett, Certified Direct-Entry Midwife                          
    and Regional Director, Midwive's Association                               
  P.O. Box 287                                                                 
  Girdwood, Alaska                                                             
  POSITION STATEMENT:  Testified in support of SSSB 91.                        
                                                                               
  Grace Elliott-DeAngles                                                       
  8124 Dogwood Lane                                                            
  Juneau, Alaska                                                               
  POSITION STATEMENT:  Testified in support of SSSB 91.                        
                                                                               
  Sally Bryne, Midwife                                                         
  P.O. Box 2110                                                                
  Kodiak, Alaska 99615                                                         
  POSITION STATEMENT:  Testified in support of SSSB 91.                        
                                                                               
  Charlotte O'Shirley-Davis                                                    
  14870 Snowshoe Lane                                                          
  Anchorage, Alaska 99516                                                      
  POSITION STATEMENT:  Testified in support of SSSB 91.                        
                                                                               
  Sherrill Malone                                                              
  Certified Direct-Entry Midwife                                               
  2000 East 66th Avenue                                                        
  Anchorage, Alaska 99507                                                      
  POSITION STATEMENT:  Testified in support of SSSB 91.                        
                                                                               
  Sharon Evans, Certified Direct-Entry Midwife                                 
  President, of Midwives Association of Alaska                                 
  1655 Sitka, Number 204                                                       
  Anchorage, Alaska 99501                                                      
  POSITION STATEMENT:  Testified in support of SSSB 91.                        
                                                                               
  Sally Pessage                                                                
  Anchorage, Alaska                                                            
  POSITION STATEMENT:  Testified in support of SSSB 91.                        
                                                                               
  Dave Williams, Planner                                                       
  Project CHOICE                                                               
  Division of Medical Assistance                                               
  Department of Health and Social Services                                     
  P.O. Box 110660                                                              
  Juneau, Alaska 99811-0660                                                    
                                                                               
                                                                               
  POSITION STATEMENT:  Testified in support of SSSB 91.                        
                                                                               
  Jerry Burnett, Legislative Staff                                             
    to Senator Randy Phillips                                                  
  State Capitol Building, Room 113                                             
  Juneau, Alaska 99801                                                         
  POSITION STATEMENT:  Answered questions on SB 45.                            
                                                                               
  Senator Randy Phillips                                                       
  State Capitol Building, Room 113                                             
  Juneau, Alaska 99801                                                         
  POSITION STATEMENT:  Sponsor of SB 45.                                       
                                                                               
  Randall Hines, Acting Social Services                                        
    Program Officer                                                            
  Division of Family and Youth Services                                        
  Department of Health and Social Services                                     
  Box 110630                                                                   
  Juneau, Alaska 99811                                                         
  POSITION STATEMENT:  Answered questions on SB 45.                            
                                                                               
  Pat O'Brien, Program Officer                                                 
  ALPS License and Regulations                                                 
  Division of Family and Youth Services                                        
  Department of Health and Social Services                                     
  Box 110630                                                                   
  Juneau, Alaska 99811                                                         
  POSITION STATEMENT:  Answered questions on SB 45.                            
                                                                               
  ACTION NARRATIVE                                                             
                                                                               
  TAPE 93-27, SIDE A                                                           
  Number 001                                                                   
                                                                               
  CHAIRMAN  RIEGER  called the  Senate  Health,  Education and                 
  Social Services (HESS) Committee to order at 1:35 p.m.                       
  The first order  of business was SSSB  91 (MEDICAID COVERAGE                 
  OF MIDWIFE SERVICES),  sponsored by Senator Leman.   ANNETTE                 
  KREITZER, legislative staff to  Senator Leman, explained the                 
  bill  would  add  midwives  to   the  category  of  optional                 
  providers  to be  covered  under Medicaid.    It would  also                 
  realign  the  priority of  payments  under Medicaid  so that                 
  midwives  are  the  lowest  priority   when  the  funds  are                 
  distributed.                                                                 
                                                                               
  KAYE KANNE, Certified Direct-Entry Midwife, Chair, Certified                 
  Direct-Entry  Midwifery Board,  said the improvement  in the                 
  outcome of  pregnancies resulting  from the  greater use  of                 
  well trained midwives has become  increasingly evident.  She                 
  discussed the  benefits and  the use  of midwifery  in other                 
  countries.    Ms. Kanne  said it  is  obvious from  the good                 
  outcomes  of  infants delivered  by  midwives that  we could                 
  reduce the numbers  of new born infants  requiring intensive                 
                                                                               
                                                                               
  care by increasing  the number of midwives and expanding the                 
  services offered  by them.   She noted a  1989 study  by the                 
  Health  Insurance Association  of  America  (HIAA) sights  a                 
  number of  ways that the U.S. can save money in health care.                 
  A midwife's  fee typically  covers more  time  spent with  a                 
  woman during pregnancy and  after the birth, and the  fee is                 
  much lower than that of  a physician's fee.  Ms. Kanne  said                 
  midwives  rely  much less  on  technical procedures  but can                 
  access  them if  necessary.   She  continued to  discuss the                 
  savings in dollars if midwives are used and urged passage of                 
  the legislation.                                                             
                                                                               
  Number 080                                                                   
                                                                               
  STACIE MENDEZ, mother  of two,  indicated her children  were                 
  born under the  Medicaid Program.   She said she would  have                 
  liked to have  been able to choose the type  of prenatal and                 
  infant care that would  have better met her needs  and those                 
  of her family.  Care offered by midwives should be allowable                 
  to  all  low  risk  women and  their  families,  Ms.  Mendez                 
  concluded.                                                                   
                                                                               
  KARREN  SHINE-AUDETT,  Certified  Direct-Entry  Midwife  and                 
  Regional  Director, Midwive's  Association,  said she  feels                 
  there are many benefits, not only to the state but people on                 
  Medicaid, by  passing SSSB  91.   She said  there are  other                 
  states  that have  allowed midwives for  Medicaid recipients                 
  and it has  saved taxpayers millions  of dollars.   Midwives                 
  charge a fraction of the  price that individuals on Medicaid                 
  are paying currently.  Ms. Shine-Audett said there are women                 
  who were  on Medicaid who  wanted to have  a home birth  but                 
  didn't because midwives are not covered.  There are also low                 
  income women who have gone into  debt by paying out of their                 
  own pockets for midwives as they  strongly believe that home                 
  births  are  the  best  care.    Ms.  Shine-Audett said  she                 
  believes that  statistics will improve immensely through the                 
  individual  attention  clients receive.    We need  to offer                 
  babies  and their  mothers the  right to  choose their  care                 
  providers no matter where the compensation comes  from.  She                 
  said the key  to preventing  premature babies and  unhealthy                 
  mothers is  good nutrition  and individual  attention.   She                 
  continued to give testimony in  favor of the legislation and                 
  encouraged the members to support the bill.                                  
                                                                               
  GRACE  ELLIOTT-DEANGLES,  testifying  as a  former  Medicaid                 
  mother, said eight years ago when she was pregnant she chose                 
  midwife services.   She  paid for  the services  out of  her                 
  pocket with money  she made during  the fishing season as  a                 
  deck hand.   Ms. Elliott-DeAngles said  she moved to  Juneau                 
  after the fishing  season and became  an AFDC recipient.   A                 
  person receives very little  money on AFDC, and it  was very                 
  difficult for her  to pay her  bill.  She explained  that if                 
  you  borrow money and you are on AFDC, you are penalized and                 
  the AFDC check  is lowered.  Ms.  Elliott-DeAngles explained                 
                                                                               
                                                                               
  that a midwife will  spend about an hour with a  patient per                 
  visit.  She said during her  last pregnancy her doctor spent                 
  about six to  eight minutes with her each  visit.  She urged                 
  the committee to pass the legislation.                                       
                                                                               
  Number 171                                                                   
                                                                               
  SALLY  BRYNE, Midwife, said women in  Alaska who qualify for                 
  Medicaid  need  to  be  in  a  position to  make  their  own                 
  decisions  regarding  their own  health  care.   The medical                 
  establishment would like us to  believe that the change from                 
  home to  hospital  is the  reason for  improved outcomes  of                 
  pregnancies.  Going  into the hospital  is not the cause  of                 
  the improvements.  Improved outcomes is a result of improved                 
  hygiene, economic  status, nutrition, and access to prenatal                 
  care.  She  urged that Alaska  become a state where  quality                 
  prenatal care is available to all low income women and their                 
  families.    Families will  all  benefit from  the intensive                 
  individualized attention  given to  them by  midwives.   She                 
  thanked the committee for listening to her.                                  
                                                                               
  CHARLOTTE  O'SHIRLEY-DAVIS, testifying  from Anchorage, said                 
  midwifery allows  women to make choices for themselves.  The                 
  essence of midwifery is flexibility.  Medicaid reimbursement                 
  allows  women  more choices  and flexibility  in care.   Ms.                 
  O'Shirley-Davis said  midwives oversee  women's choices  and                 
  they   assist  them.    There  is  also  more  whole  family                 
  involvement.  She urged that there be Medicaid reimbursement                 
  for midwifery.                                                               
                                                                               
  SHERRILL MALONE, Certified  Direct-Entry Midwife,  testified                 
  from Anchorage.  She said she  feels that any woman, in  any                 
  walk of life, no matter what her financial status, should be                 
  able  to  choose where  she  would  like to  have  her baby.                 
  Midwives give excellent care and are  able to take more time                 
  with  each women.   They  give  the much  needed nutritional                 
  counseling to alleviate a number of complications that could                 
  arise should  the woman's  nutrition be  less than  optimum,                 
  which in turn causes women to fall into a high risk category                 
  and necessitate more medical  intervention, thus causing the                 
  cost of premium  care to  become greater.   Ms. Malone  said                 
  midwife fees usually cost less than  half of what a doctor's                 
  hospital birth would cost.  If  midwives had the opportunity                 
  to bill Medicaid they would save the state many thousands of                 
  dollars.  The transport records are low and any need for any                 
  other medical  attention is  very minimal.   The passing  of                 
  SSSB 91 would  benefit all  on both sides  of the  spectrum.                 
  Ms. Malone said she would appreciate the committee's support                 
  of SSSB 91.                                                                  
                                                                               
  SENATOR SALO asked Ms. Malone what the training requirements                 
  are for direct-entry  midwives in Alaska.   Ms. Malone  said                 
  for a  person to  become a  midwife they  must complete  two                 
  years  of apprenticeship and  a midwifery course.   She said                 
                                                                               
                                                                               
  the course is a written course that must be taken during the                 
  two years and covers the study of every area  of the aspects                 
  of midwifery focusing on the prenatal period, nutrition, and                 
  any  complications that  may  arise.    The course  ends  in                 
  extensive testing by examination.                                            
                                                                               
  Number 251                                                                   
                                                                               
  SHARON EVANS,  Certified Direct-Entry Midwife  and President                 
  of the Midwives Association of  Alaska, said her association                 
  has kept  statistics on the  families that they  have served                 
  over  the last several  years.   The statistics  have proved                 
  that pregnant  women under a midwife's care  have fewer low-                 
  weight babies,  premature  births,  and  neonatal  mortality                 
  rates  than  the average  for the  State  of Alaska  and the                 
  nation.  According to information received from the State of                 
  Alaska, Department of  Vital Statistics, of the  babies born                 
  at home under midwive's care, from 1989 to 1991, less than 1                 
  percent of them were  transferred to a hospital.   Ms. Evans                 
  continued  to give the committee members statistics relating                 
  to the information  received from  the state.   Direct-Entry                 
  Midwives, licensed in  the state, propose  that if they  are                 
  put  on the  list of  Medicaid providers, the  education and                 
  nutritional counseling that  they give  to low income  women                 
  will help immensely to decrease the premature birth rate and                 
  the  problems  associated  with  low  birth  weight  babies,                 
  thereby, dramatically reducing the cost of care to the State                 
  of Alaska.  Ms. Evans urged the committee to please consider                 
  passing SSSB 91.                                                             
                                                                               
  DAVE WILLIAMS, Planner, Project  CHOICE, Division of Medical                 
  Assistance, Department  of Health and  Social Services, said                 
  the  committee  has  a  position paper  in  support  of  the                 
  legislation.  The department believes the bill is reasonable                 
  legislation and women  should have this choice  available to                 
  them.  He said  he would answer any questions  the committee                 
  may have.                                                                    
                                                                               
  Number 289                                                                   
                                                                               
  SALLY PESSAGE, testifying  from Anchorage, said she  has had                 
  two births  and is currently  pregnant.  She  explained that                 
  she saw a doctor while pregnant  with her first child.   Ms.                 
  Pessage said the care  she received with a midwife  was much                 
  better, far  superior than  a doctor's care,  and there  was                 
  more personal contact.   Ms. Pessage informed  the committee                 
  that she is currently  on Medicaid.  She indicated  she will                 
  not be covered by Medicaid if the baby is born at home.  Ms.                 
  Pessage said it is  important to her, her unborn  child, and                 
  her  family  that she  goes through  a  home birth  with her                 
  midwife.  She  asked that  people on Medicaid  be given  the                 
  option of having a home birth.                                               
                                                                               
  Number 308                                                                   
                                                                               
                                                                               
  CHAIRMAN  RIEGER referred  to  the fiscal  note  and said  a                 
  physician  birth would cost  $2,000 as opposed  to a midwife                 
  birth at  $1,480.   He asked  if those  numbers seem  right.                 
  SENATOR LEMAN said he has had  three children and the $2,000                 
  for the physician  assisted birth  seems to be  a lot  lower                 
  than what he paid.                                                           
                                                                               
  MR. WILLIAMS explained that the $2,000 is physician only and                 
  if a hospital were included it would be another $3,000.                      
                                                                               
  SENATOR  LEMAN indicated he  had a  proposed amendment.   He                 
  moved Amendment #1 which follows:                                            
                                                                               
  Page 1, line 1, after "Act":                                                 
       Insert "prohibiting unfair  discrimination against                      
       direct-entry midwives who perform  services within                      
       the scope of their certification;"                                      
                                                                               
  Page 1, after line 4:                                                        
       Insert a new bill section to read:                                      
       "* Section 1.  AS 21.36.090(d) is amended to read:                      
            (d) Except to the extent necessary  to comply                      
       with AS 21.42.365,  a person  may not practice  or                      
       permit unfair discrimination against  a person who                      
       provides   a  service   covered   under  a   group                      
       disability  policy  that  extends coverage  on  an                      
       expense incurred basis,  or under a group  service                      
       or indemnity type contract  issued by a  nonprofit                      
       corporation, if the service is within the scope of                      
       the  provider's  occupational  license.   In  this                      
       subsection,  "provider"  means  a  state  licensed                      
       physician,   dentist,    osteopath,   optometrist,                      
       chiropractor,   nurse   midwife,   advanced  nurse                      
       practitioner,   naturopath,  physical   therapist,                      
       occupational        therapist,       psychologist,                      
       psychological  associate,  [OR]  licensed clinical                      
       social worker, or certified direct-entry midwife."                      
                                                                               
  CHAIRMAN RIEGER objected  to Senator Leman's motion  for the                 
  purpose of an explanation.  SENATOR LEMAN said the amendment                 
  adds certified direct-entry  midwives to  the list of  those                 
  protected  from   unfair  discrimination.     He  said   his                 
  understanding is that this was an oversight when legislation                 
  was  passed   during  the  Seventeenth  Legislature.     The                 
  insurance companies would  have to provide payment  for them                 
  to the same extent they do for others.                                       
                                                                               
  Chairman Rieger asked  if all the  providers in the  section                 
  are mandatory  providers.   He said  if you  are offering  a                 
  health  insurance policy  you would  have to  cover all  the                 
  things listed.                                                               
                                                                               
  MS.  KREITZER said she  doesn't believe that  it is mandated                 
                                                                               
                                                                               
  that the insurance  companies cover  all the people  listed,                 
  but means that they may not be discriminated against.                        
                                                                               
  Number 379                                                                   
                                                                               
  Chairman Rieger  removed  his  objection  to  Amendment  #1.                 
  There being no further objection to the motion, Amendment #1                 
  was adopted.                                                                 
                                                                               
  SENATOR SHARP asked  how many other states allow midwives to                 
  be covered under  Medicaid.   SENATOR LEMAN said  it is  his                 
  understanding that there is one other state  which does, New                 
  Mexico.                                                                      
                                                                               
  Number 389                                                                   
                                                                               
  Senator Leman moved to pass SSSB  91, as amended, out of the                 
  HESS Committee with individual recommendations.  Hearing  no                 
  objection, the motion carried.                                               
  Number 396                                                                   
  The next  piece of legislation to come  before the committee                 
  was SB  45 (MISC.  LAWS RELATING  TO  MINORS), sponsored  by                 
  Senator Randy  Phillips.  Chairman  Rieger said there  was a                 
  proposed  committee  substitute. JERRY  BURNETT, legislative                 
  staff to Senator  Randy Phillips,  referred to the  proposed                 
  committee  substitute and said it makes a number of changes.                 
  The largest changes  are in Sections 1, 13, and  17, as they                 
  incorporate an amendment  offered by  Senator Duncan at  the                 
  last hearing  on the  bill.   The amendment  relates to  the                 
  detention and incarceration of minors.  He said it would put                 
  state law in conformity with federal  law.  Mr. Burnett said                 
  another change is in  Section 2.  The department  asked that                 
  the term "protect" be changed to "reduce the risk to."  That                 
  was  for the  purpose  of reducing  their liability  as they                 
  don't believe that  they are able to adopt  regulations that                 
  can  absolutely  protect a  juvenile in  a  safe home.   Mr.                 
  Burnett  referred to  Section 14  and said  a provision  was                 
  added that if a runaway is known to be in the custody of the                 
  state and is evading the custody of the state, the safe home                 
  operator would have to  notify state authorities.  There  is                 
  also a provision that  a safe home operator must  notify the                 
  parents within forty-eight  hours of a  runaway coming to  a                 
  safe home.   He referred to Section 19 and  said the wording                 
  was  changed  in  AS  47.35.085(b)(2),  by  request  of  the                 
  Department of  Health and  Social Services.   Section 9  was                 
  removed which referred  to the possession and  purchase of a                 
  firearm by persons under the age of twenty-one.                              
                                                                               
  SENATOR ELLIS asked Mr. Burnett if  there was a new name for                 
  "safe home"  as there is  confusion of existing  safe homes.                 
  Mr. Burnett indicated  they have not  come up with a  better                 
  name.                                                                        
                                                                               
                                                                               
  Number 452                                                                   
                                                                               
  SENATOR DUNCAN moved to adopt the CSSB 45 (HES).  Hearing no                 
  objection, the motion carried.                                               
                                                                               
  Chairman Rieger referred to page 3,  line 5, and said at the                 
  last meeting, a  witness indicated that  they had a  problem                 
  with the  wording "having control."   The witness  stated it                 
  was a problem  for non-custodial parents.  Mr.  Burnett said                 
  he spoke briefly with  the drafter and there was  a question                 
  as  to whether  or  not  to open  up  the  question of  non-                 
  custodial parents.                                                           
                                                                               
  SENATOR  ELLIS  indicated concern  about not  addressing the                 
  concerns of custodial and non-custodial parents.  He said he                 
  believes it should be clarified.                                             
                                                                               
  Number 481                                                                   
                                                                               
  Chairman  Rieger referred to page  4, lines 4  - 7, and said                 
  there  was a question  relating to  liability.   MR. BURNETT                 
  said the section  makes it  a crime of  contributing to  the                 
  delinquency  of  a  minor  for  someone who  aids,  induces,                 
  causes,  or  encourages a  child  to  be absent  from  their                 
  parents.  A question came up as to whether or not this would                 
  mean  that   a  person  in   a  runaway  shelter   was  then                 
  contributing to the delinquency of a minor.  He said that is                 
  dealt with on page 7.                                                        
                                                                               
  Chairman Rieger referred to page 4,  line 18, and said there                 
  is reference to "after 10:00 p.m. on the night before school                 
  is in session."  He said  he assumes that is the school  the                 
  minor is attending.   Chairman  Rieger asked if  there is  a                 
  need for clarifying language.  Mr. Burnett said that concern                 
  has  not been  brought  to his  attention.   Chairman Rieger                 
  moved  to  insert "the  minor's"  before the  word "school."                 
  There being no objection to the motion, the new language was                 
  adopted.                                                                     
                                                                               
  Chairman  Rieger  referred   to  the  committee   substitute                 
  language  offered by  Senator  Duncan on  page  5, line  10,                 
  "however, detention in  a correctional  facility under  this                 
  paragraph may not exceed the lesser of (A) six hours; or (B)                 
  the time necessary to arrange the minor's transportation..."                 
  He questioned whether  it should say "lesser"  or "greater."                 
  SENATOR DUNCAN  said the  language should  limit the time  a                 
  minor may be  held in an adult facility  to six hours except                 
  in certain cases.                                                            
                                                                               
  RANDALL  HINES,  Acting  Social  Services  Program  Officer,                 
  Division of Family and Youth  Services, Department of Health                 
  and Social Services, said  the reason there are  two options                 
  is to  try to limit the  amount of time a child  can be held                 
  under these  circumstances recognizing that the  ideal under                 
                                                                               
                                                                               
  federal law  is that kids not be held there at all.  He said                 
  they are trying motivate the process of getting them into an                 
  appropriate juvenile  facility rather than holding  them for                 
  extended periods of time.                                                    
                                                                               
  Chairman  Rieger  asked what  would  happen  if a  minor  is                 
  arrested in a  rural village and  there isn't a plane  until                 
  the next morning which is eight hours away.  Mr.  Hines said                 
  federal law recognizes  that there  are conditions, acts  of                 
  God, where you wouldn't be able to move a child.  He said it                 
  has been under discussion in  the federal regulatory process                 
  to  try and get  federal regulations amended  to allow those                 
  kinds of situations to be exempt under law.   Mr. Hines said                 
  the section in the bill that speaks to this was accepted  by                 
  the federal government.   It would have to be  documented as                 
  to why the time had to exceed six hours.                                     
                                                                               
  Number 533                                                                   
                                                                               
  Chairman Rieger referred  to page 6,  line 23, "A safe  home                 
  may not shelter  a runaway  minor for more  than seven  days                 
  unless the department determines that..."  He said there had                 
  been testimony requesting longer periods  of time.  Chairman                 
  Rieger asked what the issue is.                                              
                                                                               
  PAT O'BRIEN, Program Officer,  ALPS License and Regulations,                 
  Division of Family and Youth  Services, Department of Health                 
  and Social Services,  said in the current  licensing statute                 
  there is a ninety day exemption  for a twenty-four hour care                 
  facilities.  She said if a person is offering their  home as                 
  a safe home, then they would  have to fall under regulation.                 
  Ms. O'Brien said last year the department had asked that the                 
  90 day clause be removed.  Chairman Rieger said if a runaway                 
  shows up at  a safe home and  is there for seven  days, what                 
  would happen  on the eighth  day.  Ms.  O'Brien said  if the                 
  department hears about  it, the people would be  informed of                 
  the law, they  would be given  an application and told  that                 
  they need to become a licensed safe home.                                    
                                                                               
  Chairman  Rieger  asked  what  is  involved  with  the  time                 
  limitation.  MR. HINES said the intent is to bring the child                 
  and family back together and not allow a long period of time                 
  without some kind of intervention.   The department's intent                 
  is,  under  existing  runaway  laws,  to  get  families  and                 
  children back  together as  soon as possible  and not  leave                 
  them in  an alternate  placement without  some kind of  case                 
  plan.                                                                        
                                                                               
  SENATOR DUNCAN asked if the  department has the capabilities                 
  to respond in seven days.  MR. HINES said the department has                 
  the  capability to  respond in  seven days,  but what  those                 
  alternatives are may be limited,  depending on the community                 
  where this is occurring.  In larger communities  where there                 
  are more foster homes and services available, there would be                 
                                                                               
                                                                               
  more alternatives.   MS. O'BRIEN said the  other alternative                 
  is that the home  could convert to an emergency  foster home                 
  license and keep the child for a longer period of time.  She                 
  noted that would mean a more extensive review.                               
                                                                               
  TAPE 93-27, SIDE B                                                           
  Number 001                                                                   
                                                                               
  Senator Duncan said  he thinks there  should be a period  of                 
  time where the  department would be required to evaluate the                 
  child and  get involved at  a case level.   He said  90 days                 
  seems like a long period of time.  Mr. Hines said if a child                 
  is  placed in a home and  reaches the seven day time period,                 
  and it is  determined that is  the best alternative for  the                 
  child, the department  can take alternative action,  such as                 
  an emergency license,  to be sure  that child stays in  that                 
  home if that is the best place for the child to be.                          
                                                                               
  SENATOR ELLIS indicated concern on line 26, "A safe home may                 
  not shelter a runaway minor for  more than seven days unless                 
  the  department determines  that... (2)  another appropriate                 
  setting is not  available for the minor."  He  said it seems                 
  like that  is a tremendous disincentive to ever getting more                 
  permanent foster homes  on line.   It is  a disincentive  to                 
  having  adequate  runaway shelters  that  have some  sort of                 
  therapeutic counseling component services.                                   
                                                                               
  MR.  HINES  said  the  initiative   that  the  division  has                 
  undertaken to  go  to  family  preservation/family  centered                 
  services  and to train  a staff  in shifting  their thinking                 
  about removal and the rescue based model, etc. is  something                 
  that the  division is moving  forward in with  some success.                 
  He said he  believes that the  shift in philosophy would  be                 
  another safeguard.                                                           
                                                                               
  Senator Ellis asked  if kids would  go through some kind  of                 
  review  process other than  the department's internal foster                 
  care review process.   Mr. Hines said kids in  court ordered                 
  custody will go through the review  process.  If a youth was                 
  in a safe home and under the state's  custody, then the same                 
  kind of review  process would occur.   If they  were not  in                 
  court ordered custody,  it would  be his understanding  that                 
  the internal review process would not occur.                                 
                                                                               
  Senator Ellis indicated  concern with  including "(2)."   If                 
  the safe home can be used beyond seven days, the home should                 
  be part of a review process.  He said there needs to be some                 
  kind of a review and we need to work with the  department to                 
  figure  out a  review  that  is  reasonable and  within  the                 
  department's given  resources so  that kids  that aren't  in                 
  foster care aren't lost in the system.                                       
                                                                               
  Number 105                                                                   
                                                                               
                                                                               
  CHAIRMAN RIEGER referred  to page 6,  line 23, and asked  if                 
  "seven days" means seven consecutive days.  He asked what if                 
  a  runaway goes to  a safe home,  is placed back  with their                 
  family, and then three months later they go back to the safe                 
  home.    SENATOR  RANDY PHILLIPS  said  he  wouldn't  have a                 
  problem  with  saying  "seven consecutive  twenty-four  hour                 
  periods."  Chairman  Rieger said two different  time periods                 
  couldn't be added together for the total of seven days.  MR.                 
  HINES  said  the  question hasn't  been  discussed  with the                 
  drafter of the legislation.                                                  
                                                                               
  Chairman  Rieger  referred  to  page 6,  line  27,  "(b) The                 
  provider of a safe home shall promptly inform the department                 
  of a runaway minor in the home..."  He asked if the verbiage                 
  "promptly inform" when talking about child abuse is the same                 
  type of verbiage that applies to  other people who are under                 
  duty to  report.  SENATOR SALO  referred to page 7,  line 7,                 
  and said it defines it by saying "but within 48 hours."  She                 
  said she  was reading  that as  the definition of  "promptly                 
  inform."                                                                     
                                                                               
  CHAIRMAN RIEGER  referred to  page 9,  lines 11  - 13,  "The                 
  department  shall  also  offer  counseling  services to  the                 
  person having legal custody of the  minor and to the members                 
  of the minor's  household if  it determines that  counseling                 
  services  would  be  appropriate   in  the  situation,"  and                 
  questioned what is being mandated.   MS. O'BRIEN said if the                 
  department is involved, it could be anything from short term                 
  intervention to allow  a cooling off period  to very serious                 
  issues that might require outside  counseling.  She said  if                 
  the  issues  become more  serious,  then the  department may                 
  become involved in a legal way.                                              
                                                                               
  SENATOR ELLIS referred  to page  6 and page  7, relating  to                 
  "promptly inform" and the "48 hours," and said his staff has                 
  informed  him that the  suggestion was putting  "48 hours in                 
  both  places  -  "(b)"  and  "(c)."    MR.  HINES  said  the                 
  department wouldn't have an objection.                                       
                                                                               
  Number 170                                                                   
                                                                               
  Senator Ellis moved  that on page  6, line 27, after  "shall                 
  promptly" insert  "but within  48 hours."   Chairman  Rieger                 
  asked if  there was  an objection  to the  motion.   SENATOR                 
  LEMAN objected.  He said if a minor is taken into custody on                 
  a Friday night, the 48 hours would expire on a Sunday night.                 
  Senator Ellis  asked if  it is  the Division  of Family  and                 
  Youth Services' testimony  that they never work  on weekends                 
  and that there  is no way  to respond to  a child in  crises                 
  over the  weekend.   He said  he didn't  think that  was the                 
  case.   Mr. Hines said that is not the case.  There is a way                 
  to get in touch with on call staff.  MS. O'BRIEN said within                 
  communities where the department isn't able to have a person                 
  on call, there  is always  the ability to  work through  the                 
                                                                               
                                                                               
  local police to  make sure  there is some  kind of  contact.                 
  Where there  are on  call workers,  they are  used to  being                 
  called  on  the   weekends.    Senator  Leman   removed  his                 
  objection.  Hearing  no further objection to  Senator Ellis'                 
  motion, the amendment passed.                                                
                                                                               
  CHAIRMAN  RIEGER  said there  was  a question  regarding the                 
  designation of "safe home" and finding a different name.  He                 
  moved  that every  place where  "safe  home" appears  in the                 
  bill,  change the word to  "shelter" or "shelters."  Hearing                 
  no objection, it was so ordered.                                             
                                                                               
  He asked the  department if  any changes in  the bill  would                 
  require new fiscal notes.  MS. O'BRIEN said "no."                            
                                                                               
  Number 218                                                                   
                                                                               
  SENATOR ELLIS said  a witness raised concern about  the term                 
  "runaway" and whether it covers those children who are known                 
  as "throwaways."   The suggestion was  made to use the  term                 
  "homeless  youth."    Senator Ellis  asked  if  "runaway" is                 
  inclusive of kids who  runaway and kids who are  thrown out.                 
  Ms. O'Brien said the way the department  sees it is the idea                 
  covers all of the various files.   In the committee member's                 
  files there is a memorandum dated  March 13, which discusses                 
  federal definitions.   Senator Ellis  asked if  kids of  any                 
  classifications  would have a right to the protections.  Ms.                 
  O'Brien said they would.                                                     
                                                                               
  Senator Ellis said there was a  point raised about a current                 
  court  challenge  to  the immunity  from  liability  statute                 
  relating  to page  7, line  24, and  asked if that  has been                 
  addressed.   He  said he  assumes that  the court  challenge                 
  hasn't been resolved, and so there isn't a way to anticipate                 
  anything with the  legislation.  Mr. Burnett  indicated that                 
  is correct.                                                                  
                                                                               
  Number 263                                                                   
                                                                               
  Senator  Ellis   said  he  had  some   proposed  amendments.                 
  Amendment  #1 would  delete  the section  of  the bill  that                 
  allows parents  to petition the  court to sever  their legal                 
  responsibilities for  a minor  which is  called "Removal  of                 
  Disabilities of a Minor."  Amendment #1 follows:                             
                                                                               
       Page 1, line 12:                                                        
            Delete "16 - 19"                                                   
            Insert "10 - 13"                                                   
                                                                               
       Page 2, line 4, through page 3, line 7:                                 
            Delete all material                                                
                                                                               
       Renumber the following bill sections accordingly.                       
                                                                               
                                                                               
  Senator  Ellis  said  his  amendments  were drafted  to  the                 
  original bill.   It was  indicated that the  amendment would                 
  remove sections 3 - 8 of the committee substitute.                           
                                                                               
  CHAIRMAN RIEGER objected  to the adoption of  Senator Ellis'                 
  Amendment #1.  A roll call vote was taken.  Senators Rieger,                 
  Sharp,  Leman,  and  Miller voted  against  the  adoption of                 
  Amendment #1.   Senators Duncan,  Ellis, and  Salo voted  in                 
  favor  of  the adoption  of  Amendment  #1.   So  the motion                 
  failed.                                                                      
                                                                               
  SENATOR ELLIS moved Amendment #2.  He said it would set some                 
  standards.  Since Amendment #1 wasn't  adopted and if we are                 
  going to allow people to divorce their difficult children at                 
  the age of 16, the  amendment sets out some standards  to be                 
  used by the  courts and others  to determine if the  divorce                 
  should be allowed to proceed.  Amendment #2 follows:                         
                                                                               
       Page 3, lines 15-19:                                                    
            Delete all material and insert:                                    
       "*Sec.  8.    AS  09.55.590(f)   is  repealed  and                      
       reenacted to read:                                                      
            (f) If  the  petition under  this section  is                      
       filed  by  a  minor,  the  court  may  remove  the                      
       disabilities  of  minority  as  requested  in  the                      
       petition if the court finds on the record  after a                      
       hearing that the minor is a resident of the state,                      
       at  least  16 years  of  age, living  separate and                      
       apart from the  parent or  guardian of the  minor,                      
       and  capable  of  self-support  and  managing  the                      
       minor's own  financial affairs.   If  the petition                      
       under this section is filed by the legal custodian                      
       of a minor, the court  may remove the disabilities                      
       of minority as  requested in the petition  only if                      
       the  court,  in  addition  to   making  the  other                      
       findings  required  under  this subsection  for  a                      
       petition filed by  a minor, makes a finding on the                      
       record  that  there   is  interpersonal   conflict                      
       involving the  legal custodian and  the minor that                      
       the custodian and  the minor  have been unable  to                      
       resolve  satisfactorily  through other  means; the                      
       finding must include an estimate based on evidence                      
       in the record of  when the interpersonal  conflict                      
       began and a  description of the efforts  that were                      
       made  by  the  legal   custodian  to  resolve  the                      
       interpersonal conflict before the  custodian filed                      
       the petition under this section."                                       
                                                                               
  SENATOR LEMAN said he agrees that it shouldn't be easy for a                 
  parent to divorce their child.  He said he doesn't know what                 
  the current court standards are, but indicated he hopes they                 
  are not easy standards.                                                      
                                                                               
  SENATOR  ELLIS  asked  if  any  other  states  allow  parent                 
                                                                               
                                                                               
  instituted emancipation from  a difficult kid.   MS. O'BRIEN                 
  indicated she doesn't know the answer but would try and find                 
  out.   Senator Ellis  referred to  "tough love"  parents and                 
  said they  are extraordinary  people who  are going  through                 
  enormous  pain.   He  continued to  discuss  the tough  love                 
  parents.                                                                     
                                                                               
  SENATOR RANDY  PHILLIPS said his  concern is  the length  of                 
  time it  will take to go through the  court system.  He said                 
  if a parent  is seeking relief, would there be a time limit.                 
  Senator Ellis said the court will take the time they want to                 
  take.  He said he doesn't think that the amendment is asking                 
  for any certifications  that could be used  as justification                 
  for a long extended period of time.                                          
                                                                               
  Number 446                                                                   
                                                                               
  CHAIRMAN  RIEGER referred to  the two references  of "on the                 
  record"  in  Senator  Ellis' amendment  and  asked  what the                 
  meaning is.  SENATOR ELLIS said he doesn't know exactly what                 
  the meaning is.   Chairman Rieger said he would  feel better                 
  if those references  were deleted.   He said  he is  worried                 
  that there  might be  a conflict  with some  confidentiality                 
  provisions.   Senator Ellis said  he doesn't think  that "on                 
  the record" betrays any kind  of private information because                 
  things that the court does all the time, in terms of minors,                 
  is confidential.  SENATOR RANDY  PHILLIPS indicated the next                 
  committee  of  referral is  Judiciary  and said  legal could                 
  address the concern there.                                                   
                                                                               
  Chairman Rieger asked  what the meaning  is of "the  finding                 
  must include an estimate based on  evidence in the record of                 
  when the interpersonal  conflict began and a  description of                 
  the efforts that were made by the legal custodian to resolve                 
  the interpersonal conflict  before the  custodian filed  the                 
  petition under this section."                                                
                                                                               
  Senator  Ellis  said  by  including   that  wording  in  the                 
  amendment, he wants to  make sure that the judge  knows what                 
  the nature of the conflict is.                                               
                                                                               
  SENATOR MILLER said  they will have  to show that they  have                 
  tried  to  do  something  in  the   process  whether  it  is                 
  counseling, etc.  Senator Miller moved to change the wording                 
  to  say  "the finding  must  include  a  description of  the                 
  efforts that were made by the legal custodian to resolve the                 
  interpersonal  conflict  before  the  custodian  filed   the                 
  petition under this section."                                                
                                                                               
  TAPE 93-28, SIDE A                                                           
  Number 001                                                                   
                                                                               
  CHAIRMAN RIEGER  asked if there  was an  objection to  amend                 
  Amendment #2.   Hearing  no objection,  the motion  carried.                 
                                                                               
                                                                               
  Chairman Rieger asked  if there was an objection to adopting                 
  Amendment #2 as amended.  Hearing no objection, Amendment #2                 
  was adopted.                                                                 
                                                                               
  Number 029                                                                   
                                                                               
  SENATOR ELLIS moved  for the adoption  of Amendment #3.   He                 
  explained that the  amendment would add new  subsections for                 
  the  department  to   provide  appropriate   preemancipation                 
  services to a  minor.  Currently, we  allow 16 year  olds to                 
  petition and justify  why they ought to  be emancipated from                 
  their parents through  the court system.   He said we  don't                 
  provide any services to make sure those young people  become                 
  self sufficient and not  welfare cases.  Senator Ellis  said                 
  both  parties  will be  able  to  petition the  court  so he                 
  believes there will be  an increase in the number  of people                 
  being  emancipated  at  the  age  of  16  unless  there  are                 
  preemancipation  services  for  the  kids.    Amendment   #3                 
  follows:                                                                     
                                                                               
       Page 1, line 12:                                                        
            Delete "16 - 19"                                                   
            Insert "17 - 20"                                                   
                                                                               
       Page 5, after line 14:                                                  
            Insert a new bill section to read:                                 
       *Sec. 13.   AS 47.10.230 is amended by  adding new                      
       subsections to read:                                                    
         (h)   The department  shall provide  appropriate                      
       preemancipation services  to  a minor  who  is  16                      
       years of  age or older and who  wishes to petition                      
       the court for emancipation under AS 09.55.590,  or                      
       to a child  16 years of age or older  who has been                      
       committed to the custody of the department and for                      
       whom  the  department  finds that  preemancipation                      
       services are  appropriate or needed.  The services                      
       may include                                                             
            (1)  assistance  in  completing  academic  or                      
       vocational  training designed  to  make the  child                      
       employable;                                                             
            (2)  assistance  in  acquiring  and  managing                      
       suitable housing; assistance under  this paragraph                      
       may include financial assistance to the child;                          
            (3) training and supervision in skills needed                      
       for independent living;                                                 
            (4) assistance in petitioning  for removal of                      
       the disabilities of minority; and                                       
            (5) social support and services coordination.                      
                                                                               
         (i)  The  department  may award  a  grant  to or                      
       contract with  a  municipality or  with an  entity                      
       incorporated under  AS 10.20 or licensed  under AS                      
       47.35.085  to  provide   preemancipation  services                      
       under (h) of this section.  The commissioner shall                      
                                                                               
                                                                               
       adopt  regulations  establishing criteria  for the                      
       award of grants under this subsection.                                  
         (j) If the child is committed to  the custody of                      
       the  department,  the department  may  recruit and                      
       train  foster  parents to  provide preemancipation                      
       services under (h) of this section."                                    
                                                                               
       Renumber the following bill sections accordingly.                       
                                                                               
  SENATOR MILLER objected  to Senator  Ellis' motion to  adopt                 
  Amendment  #3.   He  said in  some ways  it  is contrary  to                 
  Amendment #2, as  it says that in  order for the parents  to                 
  file for  emancipation, the  minor  has to  be separate  and                 
  apart  from the  parent  or guardian  and  capable of  self-                 
  support and managing their own financial affairs.                            
                                                                               
  SENATOR ELLIS said  he wouldn't have an  objection rewording                 
  the   amendment  to   say,   "The  department   may  provide                 
  preemancipation  services..."    Senator   Miller  indicated                 
  concern with the fiscal  note.  Senator Ellis said  "you pay                 
  here or you  pay in the welfare  rolls that everybody  is so                 
  concerned about."                                                            
                                                                               
  SENATOR SALO said by changing "shall" to "may," it answers a                 
  lot  of  the  concerns regarding  the  fiscal  note.   There                 
  basically  isn't  a fiscal  note  unless the  department can                 
  afford  it.  The department may choose  to look at trying to                 
  afford it based on the "pay now or pay more later" theory.                   
                                                                               
  SENATOR DUNCAN said  he thinks it  is a good amendment.   By                 
  changing "shall" to  "may" means it  will never happen.   He                 
  suggested using  the wording, "The  department shall provide                 
  appropriate preemancipation services  to a  minor who is  16                 
  years of age or older when requested..."                                     
                                                                               
  SENATOR MILLER said he doesn't have an objection to changing                 
  the wording  from "shall" to "may."   He said  he will still                 
  probably  oppose the  amendment because  when an  individual                 
  files for  emancipation,  they have  to show  that they  are                 
  already living separately and apart.   Senator Ellis pointed                 
  out the  wording is  "preemancipation services."   It  would                 
  cover  the  time from  when the  minor  is in  state custody                 
  leading up to when they are going to be on their own.                        
                                                                               
  Number 174                                                                   
                                                                               
  SENATOR ELLIS said  his motion to  amend Amendment #3 is  in                 
  "(h)" on the first line delete "shall" and insert "may," and                 
  on  the  second line  after  the word  "minor"  insert "upon                 
  request."  CHAIRMAN RIEGER  asked if there was an  objection                 
  to amend  Amendment #3.   Hearing  no objection,  the motion                 
  carried.    Chairman  Rieger said  amended  Amendment  #3 is                 
  before the committee.  A roll call vote was taken.  Senators                 
  Rieger, Sharp, Miller  and Leman voted against  the adoption                 
                                                                               
                                                                               
  of Amendment #3.   Senators Duncan, Ellis and Salo  voted in                 
  favor  of  the adoption  of  Amendment  #3.   So  the motion                 
  failed.                                                                      
                                                                               
  Number 201                                                                   
                                                                               
  SENATOR  MILLER  moved to  pass CSSB  45  (HES), out  of the                 
  Senate HESS  Committee with  individual recommendations  and                 
  with the accompanying fiscal notes.   SENATOR ELLIS objected                 
  to  the motion.   A  roll  call vote  was  taken.   Senators                 
  Rieger, Sharp,  Duncan, Leman and  Miller voted in  favor of                 
  the  motion.    Senators  Ellis and  Salo  were  against the                 
  motion.    So CSSB  45 (HES),  moved  out of  committee with                 
  individual recommendations and accompanying fiscal notes.                    
  Number 218                                                                   
                                                                               
  CHAIRMAN RIEGER adjourned the Senate HESS Committee  meeting                 
  at 3:25 p.m.                                                                 
                                                                               

Document Name Date/Time Subjects