Legislature(1993 - 1994)

02/16/1994 01:42 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                     
                       February 16, 1994                                       
                           1:42 p.m.                                           
                                                                               
  MEMBERS PRESENT                                                              
                                                                               
 Senator Steve Rieger, Chairman                                                
 Senator Bert Sharp, Vice-Chairman                                             
 Senator Mike Miller                                                           
 Senator Jim Duncan                                                            
 Senator Johnny Ellis                                                          
 Senator Judy Salo                                                             
                                                                               
  MEMBERS ABSENT                                                               
                                                                               
 Senator Loren Leman                                                           
                                                                               
  COMMITTEE CALENDAR                                                           
                                                                               
 SENATE BILL NO. 248                                                           
 "An Act relating to services for and protection of vulnerable                 
 adults; and providing for an effective date."                                 
                                                                               
 SENATE BILL NO. 249                                                           
 "An Act relating to assisted living homes; repealing references to            
 residential facilities for dependent adults; and providing for an             
 effective date."                                                              
                                                                               
 SENATE BILL NO. 250                                                           
 "An Act relating to the Older Alaskans Commission and staff of the            
 commission; changing the name of the Older Alaskans Commission to             
 the Alaska Commission on Aging and extending the termination date             
 of the commission; relating to the Alaska Pioneers' Homes Advisory            
 Board; relating to services and programs for older Alaskans; and              
 providing for an effective date."                                             
                                                                               
                                                                               
  PREVIOUS SENATE COMMITTEE ACTION                                             
                                                                               
 SB 248 - See Health, Education & Social Services minutes dated                
        2/2/94 and 2/4/94.                                                     
                                                                               
 SB 249 - See Health, Education & Social Services minutes dated                
          2/2/94 and 2/4/94.                                                   
                                                                               
 SB 250 - See Health, Education & Social Services minutes dated                
          2/2/94 and 2/4/94.                                                   
                                                                               
  WITNESS REGISTER                                                             
                                                                               
 Connie Sipe                                                                   
 Executive Director, Division of Senior Services                               
 Department of Administration                                                  
 P.O. Box 110209                                                               
 Juneau, Alaska 99811-0209                                                     
 POSITION STATEMENT:  Reviewed SB 248, SB 248, SB 250.                         
                                                                               
 Dave Williams                                                                 
 Division of Medical Assistance                                                
 Department of Health and Social Services                                      
 P.O. Box 660                                                                  
 Juneau, Alaska                                                                
 POSITION STATEMENT:  Reviewed SB 249.                                         
                                                                               
  ACTION NARRATIVE                                                             
                                                                               
 TAPE 94-9, SIDE A                                                             
 Number 008                                                                    
 CHAIRMAN RIEGER called the Senate Health, Education and Social                
 Services (HESS) Committee to order at 1:42 p.m.  He introduced  SB
 250  (REVISE OLDER ALASKANS COMMISSION) as the first order of                 
 business before the committee.  He asked if there was any testimony           
 or amendments for SB 250.                                                     
                                                                               
 SENATOR MILLER moved SB 250 out of committee with individual                  
 recommendations.  Hearing no objections, it was so ordered.                   
                                                                               
 Number 020                                                                    
 CHAIRMAN RIEGER introduced  SB 248  (ASSIST & PROTECT VULNERABLE              
 ADULTS) as the next order of business before the committee.  He               
 offered his proposed amendment, Lauterbach 8-GS2001\A.1, as                   
 Amendment 1.  He explained that his amendment was a type of                   
 indemnification so that the state can provide services to                     
 vulnerable adults without creating additional liability.  Chairman            
 Rieger moved to adopt Amendment 1.                                            
                                                                               
 AMENDMENT 1                                                                 
                                                                               
 Page 3, line 25, after ".":                                                   
  Insert " A person may not bring an action for damages against               
  a police     officer, village public safety officer, the state,   te,  
  a political subdivision of the state based on a decision under               
  this subsection to take or not to take immediate action to                   
  protect a vulnerable adult.  If a decision is made under this                
  subsection to take immediate action to protect a vulnerable                  
  adult, a person may not bring an action for damages based on                 
  the protective actions taken unless the protective actions                   
  were performed with gross negligence or intentional                          
  misconduct; damages awarded in the action may include only                   
  direct economic compensatory damages for personal injury."                  
                                                                               
 Page 7, line 22:                                                              
  Insert new subsections to read:                                              
   "(e) A person may not bring an action for damages based                     
   on   a decision under this section to offer or not to offer               
   protective services to a vulnerable adult.                                  
   (f) A person may not bring an action for damages based on                   
   the provision of protective services under this section                     
   unless the action is based on gross negligence or                           
   intentional       misconduct.  The damages awarded in an actio   tio  
   under this section may include only direct economic                         
   compensatory damages for personal injury."                                  
                                                                               
 Hearing no objections, Amendment 1 was adopted.                               
                                                                               
 CONNIE SIPE, Director of the Division of Senior Services,                     
 introduced her February 15 markup of SB 248.  She discussed her               
 first amendment, Amendment 2, which would restore the language on             
 lines 1 and 2 of page 2.                                                      
                                                                               
                                                                               
 Number 093                                                                    
                                                                               
 CHAIRMAN RIEGER moved to adopt Amendment 2.                                   
                                                                               
  AMENDMENT 2                                                                
                                                                               
 Page 2, lines 1, after "AS 47.30.915(11)":                                    
  Insert "and including a marital and family therapist licensed                
  under AS 08.63"                                                              
                                                                               
 Hearing no objections, Amendment 2 was adopted.                               
                                                                               
 CONNIE SIPE explained that the next amendment, Amendment 3, gives             
 a degree of behavior to judge their harm against not a rectifiable            
 civil cause.                                                                  
                                                                               
 SENATOR MILLER stated that the problem was not corrected due to the           
 previous change of "shall" to " may "  on line 22 of page 3.  He            
 pointed out that Amendment 3 would specify "serious physical harm",           
 but the reporting to the police is still optional due to line 22.             
                                                                               
 CONNIE SIPE said that Kristen Bomengen of the Department of Law               
 felt that " may " should remain because that subsection refers to th    th  
 average citizen not a person who is required to report.  She                  
 proposed changing line 17 to "a person required to report under               
 this section" and the " may " would become "shall."                         
                                                                               
 SENATOR MILLER did not have a preference regarding this issue.  He            
 asked what the penalties are if those required to report do not.              
 CONNIE SIPE noted that there are no specific penalties, but there             
 is a penalty if a required reporter does not make the initial                 
 report.  If shall was put back in line 22, civil liability would              
 come into play.  She did agree that it would be acceptable to                 
 restrict line 17 to required reporters.                                       
                                                                               
 SENATOR MILLER preferred restricting the section to required                  
 reporters.  CONNIE SIPE stated that to restrict Subsection (e) to             
 required reporters, the language on line 1 of page 3 would be                 
 parallel to line 17.                                                          
                                                                               
 Number 170                                                                    
                                                                               
 SENATOR SALO expressed concern with changing line 17.  She                    
 explained that the change would speak twice to those required to              
 report and not at all to others who may report.  CONNIE SIPE stated           
 that Subsection (d) eliminates some of the elaboration on other               
 people reporting, but lines 6 and 7 are an invitation for others to           
 report.                                                                       
                                                                               
 SENATOR SALO questioned the difference in Subsection (c) and (e) if           
 line 17 is changed to speak to those required to report.  CONNIE              
 SIPE noted that Subsection (e) with the change of line 17 would               
 speak to those required to report in the event " of   serious physi   ysi  
 harm " when the department cannot be accessed.  In such a case those    se   
 required to report can report to the police who can take immediate            
 action to protect the vulnerable adult from the harm.  SENATOR SALO           
 said that this subsection was cumbersome.                                     
                                                                               
 CONNIE SIPE informed the committee that this subsection was the               
 result of insertions by the Legal Drafting.  She suggested breaking           
 the subsection into separate sentences to address the required                
 reporter with shall and the other persons with may.                           
                                                                               
 SENATOR MILLER suggested leaving the language as changed in                   
 Amendment 3, but that the individual's packet should explain the              
 options and requirements.                                                     
                                                                               
 Number 230                                                                    
                                                                               
 CHAIRMAN RIEGER moved to adopt   Amendment 3.                               
                                                                               
  AMENDMENT 3                                                                
                                                                               
 Page 3, line 19, after " risk ":                                            
  Insert " of serious physical harm "                                        
                                                                               
 Hearing no objection, Amendment 3 was adopted.                                
                                                                               
 CONNIE SIPE explained that Amendment 4 came about due to concerns             
 with the possibility that the state would have the ability to                 
 unduly take over these vulnerable adults based on the surrogate               
 decision maker.  She stated that Amendment 4 should explain the               
 limits of the surrogate decision maker.                                       
                                                                               
 SENATOR SHARP proposed changing the language of Amendment 4 from              
 " is no longer unable to consent " to "regains the ability to               
 consent."                                                                     
                                                                               
 CHAIRMAN RIEGER inquired if the phrase " regains decision-making             
 capacity " has some legal appropriateness and would be all that              
 should be used.                                                               
                                                                               
 CONNIE SIPE explained the differences in the legal meaning of                 
 decision-making capacity and the inability to consent.  She said              
 that both should remain, but that the amendment could be redrafted            
 as Senator Sharp had suggested.  SENATOR MILLER suggested changing            
 " no longer unable   to consent   " to "able to consent."               
                                                                               
 CHAIRMAN RIEGER suggested having the legal drafter correct the                
 phrase if Amendment 4 was adopted with the conceptual change.                 
                                                                               
 Number 287                                                                    
                                                                               
 SENATOR SHARP moved to adopt Amendment 4 with the conceptual                  
 change.                                                                       
                                                                               
  AMENDMENT 4                                                                
 Page 8, after line 27:                                                        
  Insert new subsection:                                                       
   "(d)     When the vulnerable adult regains the ability to                
   consent or decision-making capacity, the department may                     
   no longer use the consent given by the surrogate decision                   
   maker as a basis for continuation of protective services                    
   to the vulnerable adult."                                                  
                                                                               
                                                                               
 CHAIRMAN RIEGER objected and explained that SB 248 should have a              
 judicial referral due to the complexities that may be triggered               
 with the surrogate decision maker issue.  CHAIRMAN RIEGER removed             
 his objection.    Hearing no objections Amendment 4 was adopted.            
                                                                               
 SENATOR MILLER moved SB 248 as amended out of committee with                  
 individual recommendations.  Hearing no objections, it was so                 
 ordered.                                                                      
                                                                               
 Number 312                                                                    
 CHAIRMAN RIEGER introduced  SB 249  (REGULATION OF ASSISTED LIVING            
 HOMES) as the final order of business.                                        
                                                                               
 DAVE WILLIAMS, Department of Health and Social Service in the                 
 Division of Medical Assistance, stated that SB 249 is a good bill             
 and should move forward.  SB 249 offers individuals the opportunity           
 to chose something other than an institution.  He noted that SB 249           
 would increase access to Medicaid.  He informed the committee that            
 he owed them a fiscal note.  He believed that the fiscal note for             
 1995 would be zero and no impact on this year.                                
                                                                               
 Mr. Williams pointed out that line 29, page 2 will not allow                  
 assisted living homes to come under the rate setting methodology of           
 the Medicaid Rate Advisory Commission.  He referred to Section                
 47.33.430 on page 18 which he believed authorizes the Division of             
 Medical Assistance to draft regulation specifically addressing                
 assisted living facilities.  He proposed a per day rate to be set             
 rather than billing services separately; this would assure                    
 reasonable payment.  He noted that Section 11 which speaks to                 
 certificates of need, is addressed in Amendment 1.  CONNIE SIPE               
 agreed with Amendment 1.                                                      
                                                                               
 Number 377                                                                    
                                                                               
 CHAIRMAN RIEGER moved to adopt Amendment 1, Lauterbach 8-                     
 GS2002\A.1.                                                                   
                                                                               
  AMENDMENT 1                                                                
                                                                               
 Page 1, line 1, after ";"                                                     
  Insert " relating to the conversion of an assisted living home               
  t  o a nursing home; and "                                                   
                                                                               
 Page 25, after line 16:                                                       
  Insert a new bill section to read:                                           
  "* Sec. 2.  AS 18.07.031 is amended by adding a new subsection               
  to read:                                                                     
   (b) A person may not convert a building or part of a                        
   building that is licensed as an assisted living facility                    
   under AS 47.33 to a nursing home that requires licensure                    
   under AS 18.20.020 unless authorized under the terms of                     
   a certificate of need issued by the office."                                
                                                                               
 Renumber the following bill sections accordingly.                             
                                                                               
 Page 28, line 16:                                                             
  Delete "16"                                                                  
  Insert"17"                                                                   
                                                                               
 Page 28, line 20:                                                             
  Delete "14"                                                                  
  Insert "15"                                                                  
                                                                               
 Page 28, line 21:                                                             
  Delete "1-13"                                                                
  Insert "1-14"                                                                
                                                                               
 Hearing no objections, Amendment 1 was adopted.                               
                                                                               
 CONNIE SIPE introduced her February 13, 1994 markup #1 of SB 249.             
 She suggested that the changes in the definition of an assisted               
 living facility spoke to the concern of assisted living facilities            
 becoming nursing homes.  She felt that the modifier on HEALTH-                
 RELATED SERVICES would create a more distinct dividing line.                  
                                                                               
 Number 430                                                                    
                                                                               
 SENATOR ELLIS moved to adopt Amendment 2.                                     
                                                                               
  AMENDMENT 2                                                                
                                                                               
 Page 2, line 20 and 21, after "obtain,":                                      
  Delete "one or more or the following"                                        
  Insert " either "                                                          
                                                                               
 Page 2, line 22, after ";":                                                   
  Insert " or "                                                              
                                                                               
 Page 2, line 23, after "assistance":                                          
  Delete ";"                                                                   
  Insert " . "                                                               
                                                                               
 Page 2, line 24:                                                              
  Delete "(C) health-related services."                                        
                                                                               
 Page 3, line 2, after "SERVICES":                                             
  Insert " ALLOWED IN ASSISTED LIVING HOMES " and                            
                                                                               
  Insert new subsection to read:                                               
   " (a) An assisted living home may provide or obtain, or                    
   offer to provide or obtain one or more of the following                     
   health-related services for the residents of the home,                      
   as a supplemental service to the long-term provision by                     
   the home to residents of assistance with the activities                     
   of daily living or personal assistance. "                                  
                                                                               
 Renumber the subsections accordingly.                                         
                                                                               
 Hearing no objections, Amendment 2 was adopted.                               
                                                                               
 CONNIE SIPE explained that the changes on page 3, lines 23-25                 
 deletes the reference to a nurse aide because a nurse aide never              
 does a task alone, they only do tasks nurses delegate to them.                
 Such a delegation of a task is already addressed in the renumbered            
 subsection (e).                                                               
                                                                               
 SENATOR SALO commented that this new language broadens the scope of           
 who can do the health-related tasks.  CONNIE SIPE clarified that              
 there is no opposition to unlicensed individuals to get training              
 and be delegated tasks.  Ms. Sipe asserted that a nurse aide would            
 not be doing nursing tasks.                                                   
                                                                               
 CHAIRMAN RIEGER asked if nursing services was defined in statutes.            
 CONNIE SIPE stated that nursing services are defined by the Board             
 of Nursing.                                                                   
                                                                               
 CHAIRMAN RIEGER asked if any statutes say that only nurses can                
 provide nursing services.  CONNIE SIPE noted that the regulations             
 in the Board of Nursing which specify the differences between a               
 registered nurse and a licensed practical nurse.  Only the                    
 registered nurse can make an evaluation, carry out a physician's              
 diagnosis, monitor, and plan a plan of care for an individual.                
                                                                               
 CHAIRMAN RIEGER asked if the Board of Nursing could hypothetically            
 say that only a nurse could bring a patient a glass of water.                 
 CONNIE SIPE said that theoretically they could, but that is not the           
 direction the Board of Nursing is taking.  The general trend in               
 nursing is to reserve the role of the evaluator and care planner              
 for the nurse, while still having the ability to delegate.  Ms.               
 Sipe responded to Chairman Rieger's questioning if brain surgery              
 could be permitted by the Board of Nursing.  Ms. Sipe pointed out             
 the reference that nursing is not the practice of medicine.  There            
 are licensure requirements for nurses and to do surgery there are             
 Medical Board testing requirements.                                           
                                                                               
 Number 510                                                                    
                                                                               
 SENATOR SALO moved to adopt Amendment 3.                                      
                                                                               
  AMENDMENT 3                                                                
                                                                               
 Page 3:                                                                       
  Delete lines 24 and 24                                                       
  Insert " an individual to whom a nursing task has been                      
  delegated under subsection (e) below. "                                     
                                                                               
 Hearing no objections, Amendment 3 was adopted.                               
                                                                               
 CONNIE SIPE stated that the insertion on page 5, line 2 only                  
 clarifies the contract; the rental period is decided by the                   
 resident in their contract.  CHAIRMAN RIEGER clarified the change             
 further and suggested additional language.  CONNIE SIPE agreed with           
 that Chairman Rieger's language should be incorporated.                       
                                                                               
 SENATOR MILLER moved to adopt Amendment 4.                                    
                                                                               
  AMENDMENT 4                                                                
                                                                               
 Page 5, line 2, after "period":                                               
  Insert " as the rental period is defined in the contract "                 
                                                                               
 Hearing no objections, Amendment 4 was adopted.                               
                                                                               
 CONNIE SIPE pointed out that Amendment 5 modifies the medical tone            
 of SB 249.                                                                    
                                                                               
 CHAIRMAN RIEGER moved to adopt Amendment 5.                                   
                                                                               
  AMENDMENT 5                                                                
                                                                               
 Page 6, line 1, after "a":                                                    
  Delete "bed"                                                                 
  Insert " space "                                                           
                                                                               
 Hearing no objections, Amendment 5 was adopted.                               
                                                                               
 CONNIE SIPE stated that Amendment 6 also tones down the medical               
 tone of the bill.                                                             
                                                                               
 SENATOR SHARP moved to adopt Amendment 6.                                     
                                                                               
  AMENDMENT 6                                                                
                                                                               
 Page 3, line 12:                                                              
  Delete "'s admission to"                                                     
  Insert " enters into a residential services contract with "                
                                                                               
 Hearing no objections, Amendment 6 was adopted.                               
                                                                               
 CONNIE SIPE indicated that the changes in subsection (c) address              
 landlords' concerns that they not be limited under House rules.               
                                                                               
 SENATOR SALO asked if subsection (d) speaks to reasonableness of              
 the rules.  CONNIE SIPE said yes.                                             
                                                                               
 CHAIRMAN RIEGER moved to adopt Amendment 7.                                   
  AMENDMENT 7                                                                
                                                                               
 Page 6, line 14, after "address":                                             
  Insert " various issues, including but not limited to "                    
                                                                               
 Page 6, line 20                                                               
  Delete "and"                                                                 
                                                                               
 Page 6, line 21, after "alcohol"                                              
  Insert " ;and "                                                            
                                                                               
 Page 6                                                                        
  Insert new paragraph to read:                                                
   " (7) physical, verbal, or other abuse of other residents                  
   or staff. "                                                                
                                                                               
 Hearing no objections, Amendment 7 was adopted.                               
                                                                               
 CONNIE SIPE offered Amendment 8.                                              
                                                                               
  AMENDMENT 8                                                                
                                                                               
 Page 7, line 3:                                                               
  Delete "admission"                                                           
  Insert " residential services "                                            
                                                                               
 Page 7, line 24:                                                              
  Delete "is discharged from"                                                  
  Insert " terminates residency at "                                         
                                                                               
 SENATOR SALO moved to adopt Amendment 8.  Hearing no objections,              
 Amendment 8 was adopted.                                                      
                                                                               
 CONNIE SIPE noted that the changes on lines 7 and 8 of page 8 are             
 awkward.  She clarified that this section refers to when the                  
 individual moves into an assisted living home.                                
                                                                               
 TAPE 94-9, SIDE B                                                             
                                                                               
 Number 581                                                                    
                                                                               
 CHAIRMAN RIEGER moved to adopt Amendment 9.                                   
                                                                               
  AMENDMENT 9                                                                
                                                                               
 Page 8, line 7:                                                               
  Delete "ADMISSIONS"                                                          
  Insert " COMMENCEMENT OF RESIDENCY "                                       
                                                                               
 Page 8, line 8:                                                               
  Delete "ADMISSION"                                                           
  Insert " COMMENCEMENT OF RESIDENCY "                                       
                                                                               
 Page 8, line 8:                                                               
  Delete "be admitted to"                                                      
  Insert " commence to reside in "                                           
 Hearing no objections, Amendment 9 was adopted.                               
                                                                               
 CONNIE SIPE explained that Amendment 10 clarifies that an                     
 individual comes in for assisted living and the physician's                   
 statement is addressed elsewhere.                                             
                                                                               
 SENATOR SALO moved to adopt Amendment 10.                                     
                                                                               
  AMENDMENT 10                                                               
                                                                               
 Page 8:                                                                       
  Delete lines 11-13                                                           
                                                                               
 Hearing no objections, Amendment 10 was adopted.                              
                                                                               
 CONNIE SIPE noted that Amendment 11 was mainly language changes.              
 CHAIRMAN RIEGER moved to adopt Amendment 11.                                  
                                                                               
  AMENDMENT 11                                                               
                                                                               
 Page 8, line 14:                                                              
  Delete "ADMISSION CONTRACTS"                                                 
  Insert " RESIDENTIAL SERVICE "                                             
                                                                               
  Delete "not be"                                                              
  Insert " take up "                                                         
                                                                               
 Page 8, line 15:                                                              
  Delete "admitted as a resident of"                                           
  Insert " residency in "                                                    
                                                                               
 Page 8, line 16:                                                              
  Delete "an admission"                                                        
  Insert " residential services "                                            
                                                                               
 Page 8, line 17:                                                              
  Delete "admission"                                                           
  Insert " residential services "                                            
                                                                               
 Page 8, line 20:                                                              
  Delete "An admission"                                                        
  Insert " A residential services "                                          
                                                                               
 Page 8, line 26:                                                              
  Delete "discharge"                                                           
  Insert " termination "                                                     
                                                                               
  Delete "resident'                                                            
  Insert " residential services contract "                                   
                                                                               
 Page 8, line 31:                                                              
  Delete "discharge"                                                           
  Insert " termination of the contract "                                     
                                                                               
 Hearing no objections, Amendment 11 was adopted.                              
                                                                               
 CONNIE SIPE explained that the changes in Section 47.33.230 address           
 concerns with the assisted living home's liability.                           
                                                                               
 CHAIRMAN RIEGER moved to adopt Amendment 12.                                  
                                                                               
  AMENDMENT 12                                                               
                                                                               
 Page 9, line 13:                                                              
  Delete "and"                                                                 
                                                                               
 Page 9, line 14, after "responsibility":                                      
  Insert " and right "                                                       
  Delete "shared" and "the home and"                                           
                                                                               
 Page 9, line 15, after "evaluate":                                            
  Insert "   and choose, after discussion with all relevant parties    es   
  including the home  ; "                                                   
                                                                               
 Page 9, line 16:                                                              
  Delete "."                                                                   
  Insert " ; and "                                                           
                                                                               
 Page 9, after line 16:                                                        
  Insert new paragraph to read:                                                
  " (3) recognize the right of the home to evaluate and to either             
  consent or refuse to accept the resident's choice of risks as                
  described in (2) above; "                                                   
                                                                               
 Hearing no objections, Amendment 12 was adopted.                              
                                                                               
 CONNIE SIPE noted that Amendment 13 clarifies that the resident can           
 take care of their own needs to the extent that was possible.                 
                                                                               
 SENATOR SALO moved to adopt Amendment 13.                                     
                                                                               
  AMENDMENT 13                                                               
                                                                               
 Page 9, line 29, after "home":                                                
  Insert " or the resident "                                                 
                                                                               
 Hearing no objections, Amendment 13 was adopted.                              
                                                                               
 Number 539                                                                    
                                                                               
 CONNIE SIPE explained that the changes in Amendment 14 reflect the            
 assisted living home's ability to choose what level of services it            
 would provide.                                                                
                                                                               
 SENATOR SALO asked if there was any other category of professional            
 who could review and approve the health care plan.  CONNIE SIPE               
 stated that evaluating a health care plan is only in the scope of             
 practice of registered nurses which includes nurse practitioners.             
 Ms. Sipe noted that the task could be delegated up to a physician,            
 but physicians usually do not know much about daily plans of care.            
 Nurses are trained in daily plans of care.                                    
                                                                               
 SENATOR SALO moved to adopt Amendment 14.                                     
                                                                               
  AMENDMENT 14                                                               
                                                                               
 Page 10, line 7, after "(c)":                                                 
  Insert " If the assisted living home provides or arranges for               
  health-related services to be provided to a resident, the "                 
  Delete "assisted living home"                                                
                                                                               
 Page 10, line 9, after ",":                                                   
  Insert " and shall ensure that a physician's statement about                
  the resident is included in the plan. "                                     
                                                                               
 Hearing no objections, Amendment 14 was adopted.                              
                                                                               
 CONNIE SIPE pointed out that changes in Amendment 15 take the                 
 burden of preparing the plan from the assisted living home and                
 place the responsibility on the person preparing the plan.                    
                                                                               
 CHAIRMAN RIEGER expressed concern with the word prepared because              
 that would be a mandate.  He suggested deleting "prepared."  CONNIE           
 SIPE stated that would be acceptable.  In response to Chairman                
 Rieger, Ms. Sipe noted that "language that can be understood by the           
 resident" covers illiterate persons.                                          
                                                                               
 CHAIRMAN RIEGER moved to adopt Amendment 15 with his change.                  
                                                                             
  AMENDMENT 15                                                               
                                                                               
 Page 10, line 10:                                                             
  Delete "An assisted living home shall prepare a"                             
  Insert " The "                                                             
                                                                               
 Page 10, line 10, after "plan":                                               
  Insert " must be "                                                         
                                                                               
 Hearing no objections, Amendment 15 was adopted.                              
                                                                               
 CONNIE SIPE said that Amendment 16 cleans up the language.                    
 CHAIRMAN RIEGER pointed out that the contract would have to be                
 voluntarily entered into by the individual and the home.  He                  
 suggested inserting language to that effect.                                  
                                                                               
 CHAIRMAN RIEGER moved to adopt Amendment 16.                                  
                                                                               
  AMENDMENT 16                                                               
                                                                               
 Page 10, line 13:                                                             
  Delete "admit"                                                               
  Insert " enter into a residential services contract between "              
                                                                               
 Page 10, line 13, after "individual"                                          
  Delete "to that"                                                             
  Insert " and the "                                                         
                                                                               
 Hearing no objections, Amendment 16 was adopted.                              
                                                                               
 CONNIE SIPE explained that the evaluation of assisted living homes            
 no longer focuses on an individual being admitted for health-                 
 related services, but rather it focuses on if the assisted living             
 home provides health-related services.                                        
                                                                               
 SENATOR SALO stated that the language in Amendment 17 which speaks            
 to "other residents" is confusing.  CONNIE SIPE suggested more                
 specific language.  Senator Salo also offered more specific                   
 language.                                                                     
                                                                               
 CHAIRMAN RIEGER questioned the need for line 28 regarding                     
 evaluations being done as frequently as the resident requests.                
 CONNIE SIPE believed that deleting line 28 would not hurt the                 
 bill due to the one year required evaluation and the previously               
 discussed contract negotiations.                                              
                                                                               
 CHAIRMAN RIEGER clarified the changes Amendment 17 entailed.                  
                                                                               
 SENATOR SHARP moved to adopt Amendment 17.                                    
                                                                               
  AMENDMENT 17                                                               
                                                                               
 Page 10, line 25:                                                             
  Delete "For a resident admitted for health problems"                         
  Insert " If the assisted living home provides or arranges for               
  health-related services to be provided to the resident, "                   
                                                                               
 Page 10, line 26:                                                             
  Delete "a"                                                                   
  Insert " other "                                                           
                                                                               
 Page 10, line 26,:                                                            
  Delete "admitted for reasons other than health problems"                     
  Insert " who do not receive health services from the assisted               
  living home "                                                               
                                                                               
 Page 10, line 27:                                                             
  Delete ","                                                                   
  Insert " . "                                                               
  Delete line lines 28 and 29                                                  
                                                                               
   Hearing no objections, Amendment 17 was adopted.                          
                                                                               
 Number 402                                                                    
 CONNIE SIPE explained the clean up language of Amendment 18.                  
                                                                               
 SENATOR SHARP moved to adopt Amendment 18.                                    
                                                                               
  AMENDMENT 18                                                               
                                                                               
 Page 12, line 13:                                                             
  Delete "involuntary discharge"                                               
  Insert " the intent of the home to terminate the residential                
  services contract "                                                         
                                                                               
 Page 12, line 27:                                                             
  Delete "is admitted as a resident of"                                        
  Insert " takes up residency in "                                           
                                                                               
 Hearing no objections, Amendment 18 was adopted.                              
                                                                               
 CONNIE SIPE noted that the deletions of Amendment 19 were due to              
 their broad nature.  She emphasized that this section spoke to                
 guaranteed access to the home.                                                
                                                                               
 SENATOR SHARP moved to adopt Amendment 19.                                    
                                                                               
  AMENDMENT 19                                                               
                                                                               
 Page 13, line 12:                                                             
  Delete "representatives, of community organizations"                         
                                                                               
 Hearing no objections, Amendment 19 was adopted.                              
                                                                               
 CONNIE SIPE stated that Amendment 20 clarifies the consent involved           
 when services are provided by the home.                                       
                                                                               
 CHAIRMAN RIEGER moved to adopt Amendment 20.                                  
                                                                               
  AMENDMENT 20                                                               
                                                                               
 Page 13, line 30:                                                             
  Delete ";or"                                                                 
  Insert " to provide services specified in the residential                   
  services contract; "                                                        
                                                                               
 Hearing no objections, Amendment 20 was adopted.                              
                                                                               
 CONNIE SIPE introduced Amendment 21.                                          
                                                                               
 CHAIRMAN RIEGER moved to adopt Amendment 21.                                  
                                                                               
  AMENDMENT 21                                                               
                                                                               
 Page 14, line 25:                                                             
  Delete "is admitted as a resident of"                                        
  Insert " takes up residency in "                                           
                                                                               
 Hearing no objections, Amendment 21 was adopted.                              
                                                                               
 CONNIE SIPE noted that all the changes were language changes except           
 the change regarding the termination of the contract.  The                    
 exception inserts "the resident's self" due to liability concerns.            
                                                                               
 SENATOR MILLER moved to adopt Amendment 22.                                   
                                                                               
  AMENDMENT 22                                                               
 Page 15, line 14:                                                             
  Delete "Discharge"                                                           
  Insert "   Termination "                                                 
                                                                               
 Page 15, line 14, after "resident":                                           
  Insert " 's contract "                                                     
                                                                               
 Page 15, line 17:                                                             
  Delete "is admitted as a resident of"                                        
  Insert " takes up residency in "                                           
                                                                               
 Page 15, line 20:                                                             
  Delete "DISCHARGE"                                                           
  Insert " TERMINATION OF CONTRACT "                                         
                                                                               
 Page 15, line 21:                                                             
  Delete "discharge"                                                           
  Insert " terminate a residential services contract with "                  
                                                                               
 Page 15, line 23, after "to":                                                 
  Insert " the resident's self, to "                                         
                                                                               
 Page 15, line 25:                                                             
  Delete "discharge"                                                           
  Insert " transfer out of the home "                                        
                                                                               
 Page 15, line 31:                                                             
  Delete "discharge"                                                           
  Insert " terminating the contract of "                                     
                                                                               
 Hearing no objections, Amendment 22 was adopted.                              
                                                                               
 CONNIE SIPE said that Amendment 23 was a continuation of language             
 changes.  Subsection (c) was felt to be too much like a nursing               
 home.  She pointed out that the change allows for a case conference           
 as  part of a dispute resolution without requiring all the                    
 previously suggested assessments.                                             
                                                                               
 Number 303                                                                    
                                                                               
 SENATOR SALO expressed concern with eliminating the details of                
 terminating a contract.  CONNIE SIPE asserted that this section               
 speaks to involuntary termination with various reasons the bill               
 addresses.  Ms. Sipe noted that the homes were concerned that lines           
 14-22 would mandate that the home take on those assessment                    
 responsibilities, especially regarding line 18.                               
                                                                               
 SENATOR SALO asked what would the resident do when their contract             
 was terminated and they had no place to go.  CONNIE SIPE suggested            
 that such individuals would probably turn to the Pioneer's Home,              
 Home and Community Care Services, or calling Adult Protective                 
 Social Services.  Ms. Sipe noted the requirement to discuss the               
 alternatives.                                                                 
                                                                               
 CHAIRMAN RIEGER asked who an "involved party" refers to in the new            
 language in Amendment 23.  CONNIE SIPE said that it referred to               
 those listed after that sentence.  She suggested changing the                 
 language to "the resident or the resident's representative."                  
                                                                               
 SENATOR SALO moved to adopt Amendment 23.                                     
                                                                               
  AMENDMENT 23                                                               
                                                                               
 Page 16, line 2:                                                              
  Delete "discharge"                                                           
  Insert " contract termination "                                            
                                                                               
 Page 16, line 4:                                                              
  Delete "discharge"                                                           
  Insert " termination of the contract "                                     
                                                                               
 Page 16, line 5:                                                              
  Delete "discharge"                                                           
  Insert " contract termination "                                            
                                                                               
 Page 16, line 6:                                                              
  Delete "admission"                                                           
  Insert " residential services "                                            
                                                                               
  Delete "; and,"                                                              
  Insert " which must include the offer by the home to                        
  participate in a "                                                          
                                                                               
 Page 16, line 7:                                                              
  Delete "(3) the time and date of the"                                        
                                                                               
  Delete "required"                                                            
  Insert " as described "                                                    
                                                                               
 Page 16, line 9:                                                              
  Delete "discharging"                                                         
  Insert " terminating the contract of "                                     
                                                                               
 Page 16, line 10:                                                             
  Delete "hold"                                                                
  Insert " participate in "                                                  
                                                                               
  Delete "in which"                                                            
  Insert " if a conference is requested by the resident or the                
  resident's representative "                                                 
                                                                               
 Page 16, line 12:                                                             
  Delete "determine"                                                           
  Insert "   who may   discuss "                                           
 Page 16, line 13:                                                             
  Delete "discharge based on an assessment of"                                 
  Insert " contract termination. "                                           
                                                                               
 Page 16:                                                                      
  Delete lines "14-22"                                                         
                                                                               
 Page 16, line 23:                                                             
  Delete "discharge"                                                           
  Insert " terminates the residential services contract with "               
                                                                               
 Hearing no objections, Amendment 23 was adopted.                              
                                                                               
 CONNIE SIPE stated that the change in Amendment 24 was a                      
 clarification of language.                                                    
                                                                               
 SENATOR SHARP moved to adopt Amendment 24.                                    
                                                                               
  AMENDMENT 24                                                               
                                                                               
 Page 19, line 15, after "home":                                               
  Insert " which are relevant to the investigation "                         
                                                                               
 Hearing no objections, Amendment 24 was adopted.                              
                                                                               
 CONNIE SIPE explained that Amendment 25 allows restriction of the             
 ability of an individual to give certain care or to take in                   
 residents with certain kinds of care needs.                                   
                                                                               
 SENATOR SALO stated that Amendment 25 was a good change.  SENATOR             
 SALO moved to adopt Amendment 25.                                             
                                                                               
  AMENDMENT 25                                                               
                                                                               
 Page 20, line 22:                                                             
  Delete "suspend admissions"                                                  
  Insert " suspend the ability of the home "                                 
                                                                               
  Delete "an"                                                                  
  Insert " take in "                                                         
                                                                               
 Page 20, line 23:                                                             
  Delete "assisted living home"                                                
  Insert "  new residents or to take in residents' with specified             
  conditions, restrict the type of care which the home may                     
  provide to residents, "                                                     
                                                                               
 Hearing no objections, Amendment 25 was adopted.                              
                                                                               
 Number 203                                                                    
                                                                               
 CHAIRMAN RIEGER referred to page 11 and Residents' Rights when he             
 suggested changing the section to Residents' Standards.  He then              
 referred to page 12 line 26 when he suggested adding the clause               
 that states "the above mentioned standards shall be set out in                
 writing as part of the assisted living plan and shall be considered           
 a contractual right."  He explained that he was not sure what                 
 defining something as a right would entail.  He expressed his                 
 preference for contractual rather than statutory rights.                      
                                                                               
 CONNIE SIPE inquired if one side of the contract feels that the               
 contract has been breached, can the standards or rights be stopped.           
 She mentioned the State Landlord Tenant Law which lists tenants'              
 rights that regardless of landlord tenant contract disputes, the              
 rights still stay in place.                                                   
                                                                               
 SENATOR SALO stated that moving towards standards shifts the                  
 discussion from the individual or the contract to the assisted                
 living home.  That could change the dynamics of the section.                  
                                                                               
 CHAIRMAN RIEGER reiterated his concern with the rights issue.  He             
 stated that a CS will be provided incorporating today's changes and           
 the two remaining changes suggested by Connie Sipe.                           
                                                                               
 There being no further business before the committee, the meeting             
 was adjourned at 3:06 p.m.                                                    
                                                                               
                                                                               

Document Name Date/Time Subjects