Legislature(1999 - 2000)

03/15/1999 01:39 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 15, 1999                                                                                        
                            1:39 p.m.                                                                                           
                                                                                                                                
MEMBERS PRESENT                                                                                                                 
                                                                                                                                
Senator Mike Miller, Chairman                                                                                                   
Senator Pete Kelly, Vice-Chairman                                                                                               
Senator Gary Wilken                                                                                                             
Senator Drue Pearce                                                                                                             
Senator Kim Elton                                                                                                               
                                                                                                                                
MEMBERS ABSENT                                                                                                                  
                                                                                                                                
All members were present                                                                                                        
                                                                                                                                
COMMITTEE CALENDAR                                                                                                              
                                                                                                                                
SENATE JOINT RESOLUTION NO. 7                                                                                                   
Relating to prohibiting federal claims against funds obtained by                                                                
settlement of tobacco litigation.                                                                                               
                                                                                                                                
     -HEARD AND HELD                                                                                                            
                                                                                                                                
CS FOR HOUSE JOINT RESOLUTION NO. 12(FIN)                                                                                       
Relating to federal claims against funds obtained by settlement of                                                              
state tobacco litigation.                                                                                                       
                                                                                                                                
     -MOVED CSHJR 12(FIN) OUT OF COMMITTEE                                                                                      
                                                                                                                                
 SENATE BILL NO. 56                                                                                                             
"An Act allowing the disclosure of reports with regard to                                                                       
inspection and investigations of certain health care facilities,                                                                
home health agencies, hospice programs, and assisted living homes;                                                              
authorizing the Department of Health and Social Services to license                                                             
home health agencies; and providing for an effective date."                                                                     
                                                                                                                                
     -MOVED CSSB 56(HES) OUT OF COMMITTEE                                                                                       
                                                                                                                                
SENATE BILL NO. 57                                                                                                              
"An Act relating to vulnerable adults; and providing for an                                                                     
effective date."                                                                                                                
                                                                                                                                
     -MOVED SB 57 OUT OF COMMITTEE                                                                                              
                                                                                                                                
SENATE BILL NO. 58                                                                                                              
"An Act establishing an in-home and community-based services                                                                    
program for certain adults with long-term care needs; and providing                                                             
for an effective date."                                                                                                         
                                                                                                                                
     -MOVED SB 58 OUT OF COMMITTEE                                                                                              
                                                                                                                                
SENATE BILL NO. 59                                                                                                              
"An Act relating to the certificate of need program for nursing                                                                 
care facilities and other facilities; and providing for an                                                                      
effective date."                                                                                                                
                                                                                                                                
     -MOVED SB 59 OUT OF COMMITTEE                                                                                              
                                                                                                                                
PREVIOUS SENATE COMMITTEE ACTION                                                                                                
                                                                                                                                
SJR 7 - See HESS minutes dated 03/10/99                                                                                         
                                                                                                                                
CSHJR 12(FIN) - See HESS minutes dated 03/10/99                                                                                 
                                                                                                                                
SB 56 - See HESS minutes dated 03/03/99 and 03/08/99                                                                            
                                                                                                                                
SB 57 - See HESS minutes dated 03/03/99 and 03/08/99                                                                            
                                                                                                                                
SB 58 - See HESS minutes dated 03/03/99 and 03/08/99                                                                            
                                                                                                                                
SB 59 - See HESS minutes dated 03/03/99 and 03/08/99                                                                            
                                                                                                                                
WITNESS REGISTER                                                                                                                
                                                                                                                                
Representative John Harris                                                                                                      
Alaska State Capitol                                                                                                            
Juneau, AK  99811-1182                                                                                                          
POSITION STATEMENT:  Sponsor of HJR 12                                                                                          
                                                                                                                                
Ms. Laraine Derr, Director                                                                                                      
Alaska State Hospital & Nursing                                                                                                 
  Home Association                                                                                                              
426 Main Street                                                                                                                 
Juneau, AK  99801                                                                                                               
POSITION STATEMENT:  Commented on SB 56, SB 57, SB 58 and SB 59                                                                 
                                                                                                                                
Ms. Linda Fink, Assistant Director                                                                                              
Alaska State Hospital & Nursing                                                                                                 
  Home Association                                                                                                              
426 Main Street                                                                                                                 
Juneau, AK  99801                                                                                                               
POSITION STATEMENT:  Commented on SB 56, SB 57, SB 58 and SB 59                                                                 
                                                                                                                                
Ms. Mary Weymiller                                                                                                              
Alzheimer Association                                                                                                           
Fairbanks, AK  99701                                                                                                            
POSITION STATEMENT:  Commented on SB 57, SB 58, and SB 59                                                                       
                                                                                                                                
Ms. Teresa Lyons                                                                                                                
Alaska Nurses Association                                                                                                       
Fairbanks, AK  99701                                                                                                            
POSITION STATEMENT:  Commented on SB 57, SB 58 and SB 59                                                                        
                                                                                                                                
Ms. Sonya Smith                                                                                                                 
PO Box 23108                                                                                                                    
Juneau, AK  99802                                                                                                               
POSITION STATEMENT:  Commented on SB 57 and SB 58                                                                               
                                                                                                                                
Ms. Tiffany Shaquanie                                                                                                           
PO Box 35652                                                                                                                    
Juneau, AK 99803                                                                                                                
POSITION STATEMENT:  Commented on SB 57 and SB 58                                                                               
                                                                                                                                
Mr. Don Williams Sr.                                                                                                            
P.O. Box 20154                                                                                                                  
Juneau, AK  99802                                                                                                               
POSITION STATEMENT:  Commented on SB 57                                                                                         
                                                                                                                                
Mr. Jonathan T. Smith                                                                                                           
271 Switzer Village                                                                                                             
Juneau, AK  99801                                                                                                               
POSITION STATEMENT:  Commented on SB 57 and SB 58                                                                               
                                                                                                                                
Senator Lyda Green                                                                                                              
Alaska State Capitol                                                                                                            
Juneau, AK  99811-1182                                                                                                          
POSITION STATEMENT:  Presented Amendment to SB 57                                                                               
                                                                                                                                
Ms. Marveen Coggins, Staff                                                                                                      
Senator Lyda Green                                                                                                              
Alaska State Capital                                                                                                            
Juneau, AK  99811-1182                                                                                                          
POSITION STATEMENT:  Commented on Amendment to SB 57                                                                            
                                                                                                                                
Mr. David Pierce, Coordinator                                                                                                   
Certificate of Need                                                                                                             
Department of Health & Social Services                                                                                          
350 Main St.                                                                                                                    
Juneau, AK  99801                                                                                                               
POSITION STATEMENT:  Commented on SB 59                                                                                         
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                                
                                                                                                                                
TAPE 99-11, SIDE A                                                                                                              
Number 001                                                                                                                      
                                                                                                                                
CHAIRMAN MILLER called the Senate Health, Education and Social                                                                  
Services (HESS) Committee to order at 1:39 p.m. and announced the                                                               
first order of business would be the consideration of HJR 12 and                                                                
SJR 7 which both relate to the tobacco litigation settlement.                                                                   
                                                                                                                                
                                                                                                                                
        HJR 12-NO FED. CLAIM ON STATE TOBACCO SETTLEMENT                                                                        
                              and                                                                                               
              SJR  7-TOBACCO LITIGATION SETTLEMENT                                                                              
                                                                                                                                
Number 013                                                                                                                      
                                                                                                                                
REPRESENTATIVE JOHN HARRIS, sponsor of HJR 12, explained that the                                                               
resolution asks that the federal government not take any of the                                                                 
monies allocated to the states in the tobacco settlement.  There is                                                             
concern that the President's budget includes some Medicaid money                                                                
previously allocated to states which could be withheld.  The                                                                    
resolution doesn't determine how the state will spend the money; it                                                             
strictly asks Congress to ensure that those states involved in the                                                              
litigation receive 100% of their entitlements.                                                                                  
                                                                                                                                
CHAIRMAN MILLER asked if anyone from Senator Ward's office was                                                                  
present to testify on SJR 7.  No one came forward, and he stated                                                                
that no one else had signed up to testify on the legislation.                                                                   
                                                                                                                                
CHAIRMAN MILLER asserted that the Department of Law supports the                                                                
legislation, and he received a nod of agreement from a department                                                               
representative.  He explained that the two joint resolutions are                                                                
identical in wording, and the tradition of the Legislature has been                                                             
to move forward the vehicle passing the other body.  In this case,                                                              
the House Joint Resolution passed into the Senate before the Senate                                                             
Joint Resolution passed into the House.  Traditionally, therefore,                                                              
the House vehicle should move forward, but CHAIRMAN MILLER would                                                                
leave it to the will of the committee.                                                                                          
                                                                                                                                
Number 059                                                                                                                      
                                                                                                                                
SENATOR ELTON brought up that the department voiced a preference                                                                
for the House version in their testimony last week.  For that                                                                   
reason and the protocols involved, he suggested the committee pass                                                              
the House Joint Resolution.                                                                                                     
                                                                                                                                
CHAIRMAN MILLER agreed, but he said they are now identical word-                                                                
for-word with Senator Ward's new sponsor substitute.                                                                            
                                                                                                                                
SENATOR ELTON moved CSHJR 12(FIN).  Hearing no objection, it passed                                                             
from the committee with individual recommendations.                                                                             
         SB  56-HOME HEALTH AGENCIES/HOSPITALS/HOSPICES                                                                         
                              and                                                                                               
               SB  57-CARE FOR VULNERABLE ADULTS                                                                                
                              and                                                                                               
        SB  58-SERVICES FOR ADULTS WITH LONG-TERM NEEDS                                                                         
                              and                                                                                               
        SB  59-CERTIFICATES OF NEED FOR HEALTH FACILITY                                                                         
                                                                                                                                
                                                                                                                                
CHAIRMAN MILLER brought up SB 56, SB 57, SB 58 and SB 59, the                                                                   
legislation resulting from the Long-Term Care Task Force meetings                                                               
last summer.  He thanked the committee members for their hard work                                                              
on the bills during his absence.  He stated the committee is under                                                              
a time constraint because the Majority Caucus is scheduled to meet                                                              
at 3:00 in the committee room.  CHAIRMAN MILLER said he would hear                                                              
first from people who have not yet testified on the legislation,                                                                
and limit each speaker to 3 minutes to meet the committee's time                                                                
frame.  He would prefer to consider the four bills as a package so                                                              
he asked the witnesses to address all of their concerns at once in                                                              
their testimony.                                                                                                                
                                                                                                                                
SENATOR WILKEN brought up the Committee Substitute for SB 56 and                                                                
moved to adopt it as a working document.  Without objection, CSSB
56(HES), Lauterbach Version H, was adopted.                                                                                     
                                                                                                                                
Number 116                                                                                                                      
                                                                                                                                
MS. LARAINE DERR, Alaska State Hospital & Nursing Association                                                                   
(ASHNA), introduced Linda Fink, the Assistant Director, and stated                                                              
the association supports the four bills overall.  However, ASHNA                                                                
has some concerns that it addressed in its letter to the committee.                                                             
                                                                                                                                
One real concern in the CS to SB 56 relates to the disclosure of                                                                
reports in Section 3 on page 5, line 19.  Their primary question                                                                
regards the public disclosure of reports of annual inspections and                                                              
investigations by the department. She asked for clarification of                                                                
what "public" means, and whether it means available at the                                                                      
department, posted at the facilities, or published on the Web.  She                                                             
asked, when does 14 days begin, explaining this became a national                                                               
issue last year with the joint commission that accredits hospitals.                                                             
It brought forward the issue of putting the results of                                                                          
accreditation reviews on the Web, and hospitals across the nation                                                               
rose up in opposition to it.  State hospitals oppose that section                                                               
of the bill.                                                                                                                    
                                                                                                                                
SENATOR WILKEN asked Ms. Derr what she would suggest for line 19 on                                                             
page 5.  She responded that ASHNA would prefer the reports of                                                                   
investigations not be made public.  Nursing homes already make                                                                  
their inspection reports public but hospitals do not.                                                                           
                                                                                                                                
SENATOR WILKEN asked why they would not want it made public.  MS.                                                               
DERR explained  there are several types of errors with joint                                                                    
accreditation which hospitals feel would be subject to                                                                          
interpretation if made public.                                                                                                  
                                                                                                                                
SENATOR WILKEN asked if it would be better to have a longer time                                                                
frame for hospitals than nursing homes to work out those                                                                        
differences.                                                                                                                    
                                                                                                                                
MS. LINDA FINK, Assistant Director of ASHNA, replied it might                                                                   
depend on when the 14-day period begins.  It is unclear whether it                                                              
is when each part of the inspection is complete, when the survey is                                                             
done, or when the plan is approved.                                                                                             
                                                                                                                                
SENATOR WILKEN read "after the information is made available to the                                                             
facility or entity being reviewed."  MS. DERR interjected they need                                                             
clarification of what is meant by that section and what the                                                                     
department intends to do with it.                                                                                               
                                                                                                                                
MS. DERR stated the association supports SB 57 and has no questions                                                             
regarding the bill.                                                                                                             
                                                                                                                                
She brought up SB 58 and referenced several sections of the bill                                                                
that are outlined in the ASHNA letter, stating she couldn't address                                                             
all the issues in three minutes.                                                                                                
                                                                                                                                
CHAIRMAN MILLER stated that because the committee has heard a lot                                                               
of testimony, he intends to move the bills out today and on to                                                                  
Senate Finance where Senator Wilken is a member.  He said the bills                                                             
are "an evolving project and certainly not in their final form                                                                  
right now," but since the association had not testified before, it                                                              
would be good to address their concerns now.                                                                                    
                                                                                                                                
MS. DERR proceeded to outline their concerns about SB 58.  She                                                                  
referred to Sec. 47.24.205, Adults to be served, line 9 and                                                                     
suggested following "long-term care need," the insertion of "which                                                              
does not require hospitalization for an acute illness or injury or                                                              
a subacute program for restorative care."  The language is                                                                      
essentially limiting that a person is eligible if they have long-                                                               
term care and do not have to go to the hospital.                                                                                
                                                                                                                                
In Section 47.24.220, Delivery of services, she questioned how the                                                              
public can be assured that anybody can provide this service across                                                              
the rural and urban areas of the state, and what standards will be                                                              
used.  Their concern is equity.                                                                                                 
                                                                                                                                
In Section 47.24.235, Comprehensive data system, she suggested                                                                  
adding the words "and private" after "local" on line 25. She stated                                                             
this would provide further assurance that everyone can access the                                                               
data.                                                                                                                           
                                                                                                                                
In Section 47.24.240, Assessment and care coordination services, on                                                             
line 28, change the word "may" to "shall."  She said this was also                                                              
recommended by the Long-Term Care Task Force.                                                                                   
                                                                                                                                
MS. DERR then referred to SB 59, asking for more definition under                                                               
the Certificate of Need.  On page 2, line 26, insert the word                                                                   
"unnecessary" after "foster," to read "foster unnecessary reliance                                                              
on the state general fund.."                                                                                                    
                                                                                                                                
In SB 59, Section 4, page 3, MS. DERR stated there needs to be a                                                                
definition of "non-nursing home beds and services."  She asked if                                                               
it means hospitals.  Since it comes under the section of the law                                                                
just addressing Certificate of Need, ASHNA thinks it applies to                                                                 
hospitals, and that concerns them.                                                                                              
                                                                                                                                
Number 255                                                                                                                      
                                                                                                                                
SENATOR WILKEN asked Ms. Derr if any organizations were excluded by                                                             
inserting the word "private," in SB 58, page 5, line 26.                                                                        
                                                                                                                                
MS. FINK replied ASHNA hoped to include everyone with that language                                                             
change.                                                                                                                         
                                                                                                                                
CHAIRMAN MILLER brought up his concern about Section 4, asking for                                                              
clarification of whether entry to the program is a facility of $1                                                               
million dollars or more; he assumed a $200.0 structure for assisted                                                             
living in North Pole would not run under the Certificate of Need                                                                
program.                                                                                                                        
                                                                                                                                
MS. DERR agreed, saying her understanding is that the $1 million                                                                
dollar figure would trigger the Certificate of Need program.                                                                    
                                                                                                                                
Number 282                                                                                                                      
                                                                                                                                
SENATOR ELTON referred to Section 3 of CSSB 56 and asked why there                                                              
would be objection to a consumer like himself accessing information                                                             
in a final report kept by the department and shared two weeks                                                                   
previously with the institution.  He could understand why it might                                                              
be dangerous to share partial information.                                                                                      
                                                                                                                                
MS. FINK repeated that one of the ASHNA's concerns is when the 14                                                               
days kick in. In response to Senator Elton, MS. DERR said depending                                                             
on how it was worded and defined, they might become willing to                                                                  
release a final report to the public.                                                                                           
                                                                                                                                
CHAIRMAN MILLER stated four people are on-line to testify, in                                                                   
Anchorage and in Fairbanks.  Mr. Shelby Larsen, Anchorage, said he                                                              
had previously testified on SB 56 and would stay on-line to answer                                                              
questions.                                                                                                                      
                                                                                                                                
MR. LARSEN replied to MS. DERR's earlier question regarding the                                                                 
disclosure of information in SB 56 on page 5, line 19.  The                                                                     
department's intention is that survey reports of state licensure of                                                             
hospitals and nursing homes and other facilities  be made available                                                             
to the public.  After the facility has had an opportunity to                                                                    
respond with a plan of correction, which is 10 days after receiving                                                             
the report, the survey reports would be available to the public                                                                 
upon request.                                                                                                                   
                                                                                                                                
Number 324                                                                                                                      
                                                                                                                                
SENATOR ELTON asked if the facility's response would then be part                                                               
of the final report.  MR. LARSEN answered yes. SENATOR ELTON asked                                                              
if there are provisions for extensions.  MR. LARSEN said there is                                                               
latitude under the licensure allowing for extensions.                                                                           
                                                                                                                                
SENATOR ELTON asked if the language on line 19 would interfere with                                                             
providing an extension, and if the 14-day time frame interferes                                                                 
with  releasing a full report.  MR. LARSEN said he would not oppose                                                             
language allowing for informal dispute.                                                                                         
                                                                                                                                
Number 348                                                                                                                      
                                                                                                                                
MS. MARY WEYMILLER, representing the Alzheimer Association, stated                                                              
her support for SB 56, SB 57, SB 58 and SB 59.  She related that                                                                
her mother was diagnosed with Alzheimer's disease two years                                                                     
earlier.  When they could no longer care for her safely at home,                                                                
they looked for placement.  The five assisted living homes in                                                                   
Fairbanks were not equipped to deal with the behaviors her mother                                                               
displayed.  The two-year waiting list for the Pioneers Homes, as                                                                
well as unaffordable private nursing home care forced the family to                                                             
move her mother out of state.  She had never lived outside Alaska.                                                              
MS. WEYMILLER said she found it invaluable to be able to access the                                                             
investigation reports of hospitals while researching a home for her                                                             
mother's placement and care.  For that reason she supports SB 56.                                                               
Later, an opening at the Fairbanks Pioneers Home allowed her mother                                                             
to return home.  She described her mother's worsening condition                                                                 
that she attributes to her time in the nursing home, and her loss                                                               
of residency and resulting loss of the Longevity Bonus and PFD.                                                                 
MS. WEYMILLER stated that if a program like the one proposed in SB
58 had been in place, her mother could have remained in her home                                                                
with her family.                                                                                                                
                                                                                                                                
Number 373                                                                                                                      
                                                                                                                                
SENATOR WILKEN thanked Ms. Weymiller for her work with the                                                                      
Alzheimers Association in Fairbanks and around the state, and for                                                               
her testimony today.                                                                                                            
                                                                                                                                
MS. KAY BURROWS, Director of the Division of Human Services, stated                                                             
that she would remain on-line to answer questions regarding SB 57                                                               
and SB 58.                                                                                                                      
                                                                                                                                
MS. TERESA LYONS, representing the Alaska Nurses Association (ANA),                                                             
stated that the ANA in general supports all four of the bills.                                                                  
Regarding SB 56, she requested that the record reflect the American                                                             
Nurses Association and the ANA support the consumer's right to                                                                  
information about the quality of care provided in the health care                                                               
industry. She urged appropriate language to avoid misinter-                                                                     
pretation.                                                                                                                      
                                                                                                                                
Regarding SB 58, MS. LYONS said their concerns were voiced by the                                                               
ASHNA earlier.  Referring to Section 47.24.205, on line 9, she                                                                  
asked that the language provide that adults with long-term needs                                                                
don't lose access around the need for hospitalization. On the issue                                                             
of public assurance and equity in Section 47.24.220, page 4, line                                                               
14, the ANA would like more definition regarding public assurance                                                               
of who will provide services.                                                                                                   
                                                                                                                                
CHAIRMAN MILLER invited several people in Juneau who had previously                                                             
testified to do so again, and requested that they combine their                                                                 
remarks on more than one bill and limit their testimony to three                                                                
minutes.                                                                                                                        
                                                                                                                                
Number 411                                                                                                                      
                                                                                                                                
MS. SONYA SMITH stated she would continue returning to the                                                                      
legislature because there is a strong lack of support on a tribal                                                               
level for these bills.  She was unsure of the federal                                                                           
appropriations for this type of service. She asked if there is any                                                              
kind of funding available to assist the many individuals with                                                                   
disabilities.  She encouraged support on these issues which other                                                               
communities are looking into.  She had been informed that there are                                                             
no funding resources, and she mentioned state waiver contracts for                                                              
$180.0 per client to private nonprofits.  She asked where else she                                                              
could look. She knows of several families facing economic hardship                                                              
as a result of not having money to care for elders and the                                                                      
disabled.  She stated the vulnerable adult laws have appropriations                                                             
at a state level, but because of tension, there hasn't been a                                                                   
resolution between the state and tribal agencies.                                                                               
                                                                                                                                
Number 441                                                                                                                      
                                                                                                                                
CHAIRMAN MILLER informed Ms. Smith that the HESS members share her                                                              
concerns,  and the bills would go to Finance Committee next.  He                                                                
said he does not have an answer on the funding question, but he                                                                 
hoped to get some answers before the bills are scheduled in                                                                     
Finance.                                                                                                                        
                                                                                                                                
MS. SMITH stated she wouldn't like to see the bills passed without                                                              
tribal representation in these areas.  She asserted that there is                                                               
too much politics interfering with the issues.                                                                                  
                                                                                                                                
Number 459                                                                                                                      
                                                                                                                                
MS. TIFFANY SHAQUANIE told a parable she had written about a                                                                    
mentally ill student who had no one to help him with his                                                                        
disability. She then described the student's real situation and                                                                 
learning disabilities. She asked, "In the constitutional law of the                                                             
disabled youth population in discrimination, what are the public                                                                
funds  being used for?"  She continued, "Where does the                                                                         
representation come in for a mentally ill student? Because there is                                                             
not being appropriated through federal mandates in support of                                                                   
Native children in public schools."  She asked the committee to                                                                 
define specifically what is meant by "mental illness."                                                                          
                                                                                                                                
Referring to the Gavel to Gavel programming, MS. SHAQUANIE asserted                                                             
that the Native legislators up north have asked for funding to help                                                             
improve these situations and have been denied their funding right                                                               
on television.  She asked what the federal funds are for, and who                                                               
is in receipt of those funds.  Regarding federal Indian education,                                                              
she asked where the tribal representation  can come in to help with                                                             
the solution.                                                                                                                   
                                                                                                                                
MS. SHAQUANIE stated she is not here to be politicked.  She knows                                                               
these facts, and she would appreciate it if the committee would                                                                 
answer her family's questions in person by appointment or by phone,                                                             
rather than being politicked through the media.                                                                                 
                                                                                                                                
Number 520                                                                                                                      
                                                                                                                                
CHAIRMAN MILLER asked Ms. Shaquanie to leave a written copy of her                                                              
testimony for the record.                                                                                                       
                                                                                                                                
MS. SHAQUANIE said that her family requested some answers in their                                                              
last testimony that haven't been brought to them, so she would not                                                              
feel comfortable leaving her testimony knowing that their questions                                                             
aren't going to be answered again.                                                                                              
                                                                                                                                
CHAIRMAN MILLER replied his staff has contacted the division and                                                                
they are working on the funding questions, explaining that this was                                                             
brought up just last week "and some things take time."  As soon as                                                              
his office gets some information, they will give it to her.  MS.                                                                
SHAQUANIE answered  "it does take time but it still only takes a                                                                
second to inform."  CHAIRMAN MILLER responded he would inform as                                                                
soon as he can, explaining to her that he wants to give the right                                                               
information, rather than just informing.                                                                                        
                                                                                                                                
Number 532                                                                                                                      
                                                                                                                                
SENATOR WILKEN told Ms. Shaquanie that there are specific examples                                                              
of money flowing directly to the Native children for education.  In                                                             
one example, the state receives over $50 million dollars in federal                                                             
money in lieu of being able to tax federal lands.  Of that $50                                                                  
million dollars, $11 million dollars off the top  goes directly to                                                              
Native education needs; it doesn't go into the state's K-12                                                                     
Formula.  The balance of the $50 million dollars is distributed                                                                 
throughout the entire state, so that in essence, those who qualify                                                              
for the $11 million receive all of it, as well as a portion of the                                                              
remaining $39 million dollars.  It is one example of money going                                                                
directly to the things Ms. Shaquanie has been talking about.                                                                    
                                                                                                                                
MR. DON WILLIAMS SR. explained he is taking Dilantin,  and his                                                                  
doctor advised him to be more socially active but he doesn't have                                                               
the funds, only enough to get by.  He said he's getting support                                                                 
from a variety of sources, and he feels comfortable at home now.                                                                
                                                                                                                                
TAPE 99-11, SIDE B                                                                                                              
Number 001                                                                                                                      
                                                                                                                                
MR. WILLIAMS continued, stating his accident was in December of                                                                 
1990 and he unable to talk or walk, so he's come a long way.  The                                                               
Provider Assistance Program has been beneficial to him.                                                                         
                                                                                                                                
CHAIRMAN MILLER informed Mr. Williams that Sharon Clark, committee                                                              
aide, would help him call the Ombudsman who deals with these                                                                    
situations to see if anything else can be done to further assist                                                                
him.                                                                                                                            
                                                                                                                                
Number 573                                                                                                                      
                                                                                                                                
SENATOR ELTON also offered that his office would help Mr. Williams.                                                             
He suggested that under current law and under the proposal in SB
58, the Department of Health & Social Services might outline what                                                               
can be done now with tribal governments and nonprofits, and what                                                                
may change under SB 58. He said he would try to get that                                                                        
information to Sonya Smith.                                                                                                     
                                                                                                                                
CHAIRMAN MILLER thanked Mr. Williams for his testimony.  He asked                                                               
Mr. Williams to work with Ms. Clark to contact the Ombudsman.                                                                   
                                                                                                                                
Number 555                                                                                                                      
                                                                                                                                
MR. JONATHAN SMITH stated he lives at 271 Switzer Village.  He said                                                             
a lot of the support Don Williams receives is from Jonathan's                                                                   
family, and from Kake, Hoonah, Angoon, Sitka and Klawock.  His                                                                  
mother plays the biggest role in Mr. Williams' care. His family is                                                              
"living to fight this bill," because they need Mr. Williams in                                                                  
their lives, and they are afraid he'll be taken away from them.                                                                 
                                                                                                                                
Number 497                                                                                                                      
                                                                                                                                
CHAIRMAN MILLER invited Senator Green to offer her amendment, and                                                               
mentioned someone offnet would testify on it, if the committee                                                                  
wishes.  Senator Green said her staff is also present to answer                                                                 
questions.                                                                                                                      
                                                                                                                                
SENATOR LYDA GREEN explained that it came to her attention that the                                                             
office of the Long-Term Care Ombudsman needs separation from the                                                                
division it oversees.  The amendment proposes the Long-Term Care                                                                
Ombudsman be moved to the Legislature where the current Ombudsman                                                               
is situated.  The amendment language primarily moves the current                                                                
Long-Term Care Ombudsman statute defining duties and reappointment                                                              
to the Legislature.  Currently it's a hired position but the two                                                                
Ombudsman positions would work side-by-side and their method of                                                                 
appointment should be similar.  The amendment would make it a                                                                   
position appointed by a committee composed of senators and house                                                                
members.                                                                                                                        
                                                                                                                                
CHAIRMAN MILLER asked if the amendment moves the office from one                                                                
agency of government to another but does not change the duties or                                                               
powers of the position.                                                                                                         
                                                                                                                                
MS. MARVEEN COGGINS, staff to Senator Green, answered that is                                                                   
correct.  The amendment makes the position side-by-side with the                                                                
State Ombudsman's Office but not a part of it.  The State Ombudsman                                                             
oversees all the state agencies, and if the Long-Term Care                                                                      
Ombudsman (LTCO) was placed in that office, a conflict of interest                                                              
would develop if the LTCO ever needed investigation.                                                                            
                                                                                                                                
Number 462                                                                                                                      
                                                                                                                                
Frances Purdy, offnet in Girdwood, said she would answer questions                                                              
on Senator Green's amendment.                                                                                                   
                                                                                                                                
SENATOR WILKEN asked how the Long-Term Care Ombudsman is selected                                                               
now.                                                                                                                            
                                                                                                                                
MS. COGGINS said selection is by the Alaska Commission on Aging.                                                                
The amendment models it on the selection of the State Ombudsman                                                                 
by a panel of three senators and three representatives.  The                                                                    
removal procedure is also similar.                                                                                              
                                                                                                                                
SENATOR WILKEN asked the expected fiscal impact of the proposed                                                                 
change. MS. COGGINS said the existing federal funding would                                                                     
follow the transfer of the Long-Term Care Ombudsman's Office.                                                                   
                                                                                                                                
CHAIRMAN MILLER put his name to the amendment to bring it before                                                                
the committee.  He moved the amendment, then objected for the                                                                   
purpose of further discussion.                                                                                                  
                                                                                                                                
Number 442                                                                                                                      
                                                                                                                                
SENATOR ELTON wondered aloud if efficiencies would arise from                                                                   
combining the two Ombudsman offices and their administrative                                                                    
staff. One person on the staff with long-term care expertise                                                                    
could be hired and designated to deal with those issues.  He                                                                    
asked if the Chairman planned to adopt the amendment today,                                                                     
because he would like to have time to assimilate the issues.                                                                    
                                                                                                                                
SENATOR WILKEN asked Senator Green if the Administration had seen                                                               
the amendment.  She responded no.  He asked how it ties into any                                                                
of the four bills which the committee wants to move as a package.                                                               
He suggested it is an issue that could be a separate piece of                                                                   
legislation.                                                                                                                    
                                                                                                                                
SENATOR GREEN said it is designated as part of SB 57.                                                                           
                                                                                                                                
CHAIRMAN MILLER stated some valid concerns have been raised by                                                                  
members.  He supported the concept and would be willing to adopt                                                                
the amendment now, but it is a legitimate concern and a major                                                                   
shift to move the office out of one department to another.  He'd                                                                
like to move the bill today, and Senator Green is a member of                                                                   
Finance, the next referral for SB 57.                                                                                           
                                                                                                                                
SENATOR GREEN agreed to address those concerns in Finance                                                                       
Committee.  She offered to find answers in the meantime if any                                                                  
members have questions.  She said the Ombudsman "must be at arms-                                                               
length" from the person being assessed or evaluated, and that                                                                   
doesn't happen with the Long- Term Care office.                                                                                 
                                                                                                                                
SENATOR ELTON suggested that Maria Moya, the State Ombudsman,                                                                   
could meet with himself and other members, if the committee is                                                                  
not going to vote on the amendment.                                                                                             
                                                                                                                                
CHAIRMAN MILLER moved and asked unanimous consent to withdraw his                                                               
amendment.  Without objection, it was withdrawn.                                                                                
                                                                                                                                
CHAIRMAN MILLER brought up his earlier question about Section 4                                                                 
of SB 59 regarding Certificate of Need. He asked if the language                                                                
wouldn't affect the assisted living homes if they don't meet the                                                                
$1 million dollar threshold.                                                                                                    
                                                                                                                                
Number 393                                                                                                                      
                                                                                                                                
MR. DAVID PIERCE, Coordinator of Certificate of Need Program,                                                                   
explained  the intent of Section 4 is to ensure that there are                                                                  
home and community-based services in place first when new nursing                                                               
home beds are contemplated.  This would not affect assisted                                                                     
living in any way because the homes are currently not required to                                                               
have a Certificate of Need because they are not considered a                                                                    
health care facility.  No matter the cost of assisted living, at                                                                
this point in time they are not required to have a Certificate of                                                               
Need.                                                                                                                           
                                                                                                                                
CHAIRMAN MILLER asked the wish of the committee.                                                                                
                                                                                                                                
SENATOR WILKEN moved SB 56, SB 57, SB 58 and SB 59 be reported                                                                  
from committee with individual recommendations and their                                                                        
respective fiscal notes.  Hearing no objection, the four bills                                                                  
moved from committee.                                                                                                           
                                                                                                                                
CHAIRMAN MILLER announced that on Wednesday, March 17 Commiss-                                                                  
ioner Perdue would present an overview and the committee would                                                                  
take up SB 73, assisted living homes.  The meeting adjourned at                                                                 
2:55 p.m.                                                                                                                       
                                                                                                                                
                                                                                                                                

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