Legislature(2015 - 2016)BUTROVICH 205

04/10/2015 01:30 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ HB 8 POWERS OF ATTORNEY TELECONFERENCED
Heard & Held
*+ SB 72 DESIGNATED CAREGIVERS FOR PATIENTS TELECONFERENCED
Heard & Held
Bills Previously Heard/Scheduled:
*+ SB 74 MEDICAID REFORM/PFD/HSAS/ER USE/STUDIES TELECONFERENCED
Moved CSSB 74(HSS) Out of Committee
*+ SB 53 ADVANCED PRACTICE REGISTERED NURSES TELECONFERENCED
Moved SB 53 Out of Committee
*+ SB 90 MEDICAID: USED DURABLE MEDICAL EQUIPMENT TELECONFERENCED
Moved SB 90 Out of Committee
*+ HB 4 AUTOMATED EXTERNAL DEFIBRILLATOR TELECONFERENCED
Moved HB 4 Out of Committee
*+ SB 78 MEDICAL ASSISTANCE COVERAGE; REFORM TELECONFERENCED
Moved SB 78 Out of Committee
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         April 10, 2015                                                                                         
                           1:32 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Bert Stedman, Chair                                                                                                     
Senator Cathy Giessel, Vice Chair                                                                                               
Senator Bill Stoltze                                                                                                            
Senator Johnny Ellis                                                                                                            
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Senator Pete Kelly                                                                                                              
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE BILL NO. 78                                                                                                              
"An Act relating to medical  assistance reform measures; relating                                                               
to  eligibility  for  medical assistance  coverage;  relating  to                                                               
medical assistance  cost containment  measures by  the Department                                                               
of Health  and Social  Services; and  providing for  an effective                                                               
date."                                                                                                                          
                                                                                                                                
     - MOVED SB 78 OUT OF COMMITTEE                                                                                             
                                                                                                                                
SENATE BILL NO. 74                                                                                                              
"An  Act relating  to  permanent fund  dividends;  relating to  a                                                               
medical  assistance  reform   program;  establishing  a  personal                                                               
health   savings   account   program   for   medical   assistance                                                               
recipients; relating  to the duties  of the Department  of Health                                                               
and    Social   Services;    establishing   medical    assistance                                                               
demonstration  projects;   and  relating   to  a  study   by  the                                                               
Department of Health and Social Services."                                                                                      
                                                                                                                                
     - MOVED CSSB 74(HSS) OUT OF COMMITTEE                                                                                      
                                                                                                                                
SENATE BILL NO. 90                                                                                                              
"An Act  relating to  the purchase  of durable  medical equipment                                                               
under Medicaid; and providing for an effective date."                                                                           
                                                                                                                                
     - MOVED SB 90 OUT OF COMMITTEE                                                                                             
                                                                                                                                
SENATE BILL NO. 53                                                                                                              
"An Act relating to advanced practice registered nursing;                                                                       
relating to certified direct- entry midwifery; and providing for                                                                
an effective date."                                                                                                             
                                                                                                                                
     - MOVED SB 53 OUT OF COMMITTEE                                                                                             
                                                                                                                                
HOUSE BILL NO. 4                                                                                                                
"An Act relating to automated external defibrillators."                                                                         
                                                                                                                                
     - MOVED HB 4 OUT OF COMMITTEE                                                                                              
                                                                                                                                
COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 8(JUD) AM                                                                               
"An  Act relating  to  powers of  attorney  and other  substitute                                                               
decision-making documents; relating to  the uniform probate code;                                                               
relating  to  notaries public;  and  providing  for an  effective                                                               
date."                                                                                                                          
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
SENATE BILL NO. 72                                                                                                              
"An Act relating to caregivers of patients after release or                                                                     
departure from a hospital; and providing for an effective date."                                                                
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                              
BILL: SB 78                                                                                                                   
SHORT TITLE: MEDICAL ASSISTANCE COVERAGE; REFORM                                                                                
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
                                                                                                                                
03/18/15       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/18/15       (S)       HSS, FIN                                                                                               
03/30/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/30/15       (S)       Heard & Held                                                                                           
03/30/15       (S)       MINUTE(HSS)                                                                                            
04/01/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
04/01/15       (S)       Heard & Held                                                                                           
04/01/15       (S)       MINUTE(HSS)                                                                                            
04/03/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
04/03/15       (S)       -- Testimony <Invitation Only> --                                                                      
04/10/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
BILL: SB 74                                                                                                                   
SHORT TITLE: MEDICAID REFORM/PFD/HSAS/ER USE/STUDIES                                                                            
SPONSOR(s): SENATOR(s) KELLY                                                                                                    
                                                                                                                                
03/13/15       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/13/15       (S)       HSS, STA, FIN                                                                                          
03/13/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/13/15       (S)       -- MEETING CANCELED --                                                                                 
03/23/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/23/15       (S)       Heard & Held                                                                                           
03/23/15       (S)       MINUTE(HSS)                                                                                            
04/01/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
04/01/15       (S)       Heard & Held                                                                                           
04/01/15       (S)       MINUTE(HSS)                                                                                            
04/02/15       (S)       STA AT 9:00 AM BUTROVICH 205                                                                           
04/02/15       (S)       <Pending Referral>                                                                                     
04/03/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
04/03/15       (S)       -- MEETING CANCELED --                                                                                 
04/08/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
04/08/15       (S)       Heard & Held                                                                                           
04/08/15       (S)       MINUTE(HSS)                                                                                            
                                                                                                                                
BILL: SB 90                                                                                                                   
SHORT TITLE: MEDICAID:  USED DURABLE MEDICAL EQUIPMENT                                                                          
SPONSOR(s): SENATOR(s) STOLTZE                                                                                                  
                                                                                                                                
03/25/15       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/25/15       (S)       HSS, FIN                                                                                               
04/08/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
04/08/15       (S)       Heard & Held                                                                                           
04/08/15       (S)       MINUTE(HSS)                                                                                            
                                                                                                                                
BILL: SB 53                                                                                                                   
SHORT TITLE: ADVANCED PRACTICE REGISTERED NURSES                                                                                
SPONSOR(s): SENATOR(s) GIESSEL                                                                                                  
                                                                                                                                
02/18/15       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/18/15       (S)       L&C, HSS                                                                                               
03/10/15       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                      
03/10/15       (S)       Heard & Held                                                                                           
03/10/15       (S)       MINUTE(L&C)                                                                                            
03/12/15       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                      
03/12/15       (S)       Moved  SB 53 Out of Committee                                                                          
03/12/15       (S)       MINUTE(L&C)                                                                                            
03/13/15       (S)       L&C RPT 4DP 1NR                                                                                        
03/13/15       (S)       DP: COSTELLO, GIESSEL, MEYER, STEVENS                                                                  
03/13/15       (S)       NR: ELLIS                                                                                              
04/08/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
04/08/15       (S)       Heard & Held                                                                                           
04/08/15       (S)       MINUTE(HSS)                                                                                            
                                                                                                                                
BILL: HB 4                                                                                                                    
SHORT TITLE: AUTOMATED EXTERNAL DEFIBRILLATOR                                                                                   
SPONSOR(s): REPRESENTATIVE(s) WILSON                                                                                            
                                                                                                                                
01/21/15       (H)       PREFILE RELEASED 1/9/15                                                                                
01/21/15       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/21/15       (H)       JUD                                                                                                    
02/04/15       (H)       JUD AT 1:00 PM CAPITOL 120                                                                             
02/04/15       (H)       Moved  HB 4 Out of Committee                                                                           
02/04/15       (H)       MINUTE(JUD)                                                                                            
02/06/15       (H)       JUD RPT 4DP 1NR                                                                                        
02/06/15       (H)       DP: KELLER, MILLETT, CLAMAN, LEDOUX                                                                    
02/06/15       (H)       NR: GRUENBERG                                                                                          
02/11/15       (H)       TRANSMITTED TO (S)                                                                                     
02/11/15       (H)       VERSION: HB 4                                                                                          
02/13/15       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/13/15       (S)       HSS, JUD                                                                                               
04/08/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
04/08/15       (S)       Heard & Held                                                                                           
04/08/15       (S)       MINUTE(HSS)                                                                                            
                                                                                                                                
BILL: HB 8                                                                                                                    
SHORT TITLE: POWERS OF ATTORNEY                                                                                                 
SPONSOR(s): REPRESENTATIVE(s) HUGHES                                                                                            
                                                                                                                                
01/21/15       (H)       PREFILE RELEASED 1/9/15                                                                                
01/21/15       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/21/15       (H)       JUD                                                                                                    
02/13/15       (H)       JUD AT 1:00 PM CAPITOL 120                                                                             
02/13/15       (H)       Heard & Held                                                                                           
02/13/15       (H)       MINUTE(JUD)                                                                                            
02/23/15       (H)       JUD AT 1:00 PM CAPITOL 120                                                                             
02/23/15       (H)       Moved  CSHB 8(JUD) Out of Committee                                                                    
02/23/15       (H)       MINUTE(JUD)                                                                                            
02/25/15       (H)       JUD RPT CS(JUD) 2DP 4NR                                                                                
02/25/15       (H)       DP: LYNN, KELLER                                                                                       
02/25/15       (H)       NR: MILLETT, CLAMAN, GRUENBERG, FOSTER                                                                 
03/09/15       (H)       TRANSMITTED TO (S)                                                                                     
03/09/15       (H)       VERSION: CSHB 8(JUD) AM                                                                                
03/11/15       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/11/15       (S)       HSS, JUD                                                                                               
04/10/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
BILL: SB 72                                                                                                                   
SHORT TITLE: DESIGNATED CAREGIVERS FOR PATIENTS                                                                                 
SPONSOR(s): SENATOR(s) GIESSEL                                                                                                  
                                                                                                                                
03/11/15       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/11/15       (S)       HSS, L&C                                                                                               
04/10/15       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
REPRESENTATIVE SHELLEY HUGHES                                                                                                   
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Sponsor of HB 8.                                                                                          
                                                                                                                                
GINGER BLAISDELL, Staff                                                                                                         
Representative Shelley Hughes                                                                                                   
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Explained the sectional analysis of HB 8 on                                                               
behalf of the sponsor.                                                                                                          
                                                                                                                                
THERESA HOPE, State Long-term Care Ombudsman                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of HB 8.                                                                             
                                                                                                                                
DEBORAH BEHR, Chair                                                                                                             
Alaska Uniform Law Commission                                                                                                   
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of HB 8.                                                                             
                                                                                                                                
MARIE DARLIN                                                                                                                    
AARP of Alaska                                                                                                                  
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of HB 8.                                                                             
                                                                                                                                
DENISE DANIELLO, Executive Director                                                                                             
Alaska Commission on Aging                                                                                                      
POSITION STATEMENT: Testified in support of HB 8 and SB 72.                                                                   
                                                                                                                                
JANE CONWAY, Staff                                                                                                              
Senator Cathy Giessel                                                                                                           
Alaska State Legislature                                                                                                        
POSITION STATEMENT: Explained the sectional analysis of SB 72 on                                                              
behalf of the sponsor.                                                                                                          
                                                                                                                                
ANN LOVEJOY                                                                                                                     
Mountain Pacific Improvement                                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 72.                                                                            
                                                                                                                                
DEBBY RETHERFORD, representing herself                                                                                          
Mat-Su, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 72.                                                                            
                                                                                                                                
VICTORIA MARTIN, representing herself                                                                                           
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 72.                                                                            
                                                                                                                                
TERRY SNYDER, State President                                                                                                   
AARP                                                                                                                            
Palmer, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 72.                                                                            
                                                                                                                                
ED ZASTROW, representing himself                                                                                                
Ketchikan, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 72.                                                                            
                                                                                                                                
KEN HELANDER, Advocacy Director                                                                                                 
AARP Alaska                                                                                                                     
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 72.                                                                            
                                                                                                                                
BECKY HULTBERG, CEO                                                                                                             
Alaska State Hospital and Nursing Home Association                                                                              
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in opposition to SB 72.                                                                         
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:32:25 PM                                                                                                                    
CHAIR BERT STEDMAN  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:32 p.m.  Present at the                                                               
call to  order were Senators  Ellis, Stoltze, Giessel,  and Chair                                                               
Stedman.                                                                                                                        
                                                                                                                                
           SB 78-MEDICAL ASSISTANCE COVERAGE; REFORM                                                                        
                                                                                                                                
1:33:43 PM                                                                                                                    
CHAIR STEDMAN announced that the first order of business would                                                                  
be SB 78.                                                                                                                       
                                                                                                                                
SENATOR GIESSEL moved to report SB 78 from committee with                                                                       
individual recommendations and attached fiscal note(s). There                                                                   
being no objection, the motion carried.                                                                                         
                                                                                                                                
SENATOR STOLTZE commented  that the bill would  be accompanied by                                                               
cost containment reform measures.                                                                                               
                                                                                                                                
         SB 74-MEDICAID REFORM/PFD/HSAS/ER USE/STUDIES                                                                      
                                                                                                                                
1:34:24 PM                                                                                                                    
CHAIR STEDMAN announced the consideration of SB 74.                                                                             
                                                                                                                                
1:34:32 PM                                                                                                                    
SENATOR GIESSEL moved to report  CSSB 74(HSS) from committee with                                                               
individual  recommendations and  attached  fiscal note(s).  There                                                               
being no objection, the motion carried.                                                                                         
                                                                                                                                
         SB 90-MEDICAID: USED DURABLE MEDICAL EQUIPMENT                                                                     
                                                                                                                                
1:34:58 PM                                                                                                                    
CHAIR STEDMAN announced the consideration of SB 90.                                                                             
                                                                                                                                
SENATOR  STOLTZE  moved  to  report SB  90  from  committee  with                                                               
individual  recommendations and  attached  fiscal note(s).  There                                                               
being no objection, the motion carried.                                                                                         
                                                                                                                                
           SB 53-ADVANCED PRACTICE REGISTERED NURSES                                                                        
                                                                                                                                
1:35:17 PM                                                                                                                    
CHAIR STEDMAN announced the consideration of SB 53.                                                                             
                                                                                                                                
SENATOR  GIESSEL  moved  to  report SB  53  from  committee  with                                                               
individual  recommendations and  attached  fiscal note(s).  There                                                               
being no objection, the motion carried.                                                                                         
                                                                                                                                
HB 4                                                                                                                            
             HB 4-AUTOMATED EXTERNAL DEFIBRILLATOR                                                                          
                                                                                                                                
1:35:37 PM                                                                                                                    
CHAIR STEDMAN announced the consideration of HB 4.                                                                              
                                                                                                                                
SENATOR  GIESSEL  moved  to  report  HB  4  from  committee  with                                                               
individual  recommendations and  attached  fiscal note(s).  There                                                               
being no objection, the motion carried.                                                                                         
                                                                                                                                
CHAIR STEDMAN noted previous public  hearings for all five bills.                                                               
He thanked the committee for their work.                                                                                        
                                                                                                                                
1:36:43 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
1:39:04 PM                                                                                                                    
CHAIR STEDMAN brought the meeting back to order.                                                                                
                                                                                                                                
                    HB 8-POWERS OF ATTORNEY                                                                                 
                                                                                                                                
1:39:39 PM                                                                                                                    
CHAIR STEDMAN announced the consideration of HB 8.                                                                              
                                                                                                                                
1:39:47 PM                                                                                                                    
REPRESENTATIVE SHELLEY HUGHES,  Alaska State Legislature, sponsor                                                               
of  HB 8,  related that  the bill  has approval  by AARP  and the                                                               
Association of Mature Americans.  She shared stories of financial                                                               
scams that  targeted vulnerable adults  due to problems  with the                                                               
Power  of   Attorney.  Last  year   there  were  more   than  600                                                               
allegations of  financial exploitation  in Alaska as  reported by                                                               
Adult  Protective   Services,  the   Office  of   Long-Term  Care                                                               
Ombudsman,  and the  Office of  Public Advocacy  and Elder  Fraud                                                               
Unit. She shared statistics related to Power of Attorney abuse.                                                                 
                                                                                                                                
She  stated that  HB  8 strengthens  Alaska's  existing Power  of                                                               
Attorney  statutes  by  clarifying the  responsibilities  of  the                                                               
person receiving  the Power  of Attorney  and approving  the form                                                               
itself.  The statute  remains customized  for  Alaska and  aligns                                                               
some of the  wording with other states, which is  helpful in this                                                               
day and age.                                                                                                                    
                                                                                                                                
She noted  new terminology in  the bill  - the principal,  or the                                                               
person granting the Power of  Attorney, and the agent, the person                                                               
who  is granted  the  Power  of Attorney.  There  is  also a  new                                                               
definition  for   "signing."  The  current  form   instructs  the                                                               
principal to  assign everything to the  agent unless specifically                                                               
crossing out items.  The bill changes that so  the principal must                                                               
mark  yes or  no for  every category.  The bill  separates out  a                                                               
special section  of items deemed  "hot powers,"  more significant                                                               
than  routine  financial  actions.  There is  a  new  section  on                                                               
judicial  relief allowing  a list  of qualified  persons who  can                                                               
petition the court  to review the agent's conduct.  There is also                                                               
a new  section about substitute decision-making  documents, which                                                               
allows  for   recognition  of  documents  between   states  on  a                                                               
temporary basis.                                                                                                                
                                                                                                                                
She  concluded that  HB 8  allows  better definitions,  clarifies                                                               
areas  of  concern,  and  will help  the  principal  make  better                                                               
decisions   when   it   comes  to   assigning   these   important                                                               
responsibilities of  their finances and property  to someone. She                                                               
said  the  bill  will  strengthen  existing  statutes  to  better                                                               
protect  vulnerable adults  and to  better guide  those who  help                                                               
care for them.                                                                                                                  
                                                                                                                                
GINGER  BLAISDELL, Staff,  Representative Shelley  Hughes, Alaska                                                               
State Legislature,  explained the sectional  analysis of HB  8 on                                                               
behalf of the sponsor. She explained version N.A of the bill:                                                                   
                                                                                                                                
Section 1 replaces the current definition of an "agent."                                                                        
                                                                                                                                
Section 2  corrects the  definition of  "state" by  including the                                                               
United States Virgin Islands.                                                                                                   
                                                                                                                                
Section  3  adds  new definitions  for  "durable",  "electronic",                                                               
"power of  attorney", "principal",  "record", and "sign,  as they                                                               
pertain to the Act.                                                                                                             
                                                                                                                                
Section 4 states  that an agent is the person  granted powers and                                                               
the finances  belong to  the principal.  It contains  the agent's                                                               
acceptance  and liability  and describes  the agent's  duties. It                                                               
also  pertains to  the  acceptance and  termination  of Power  of                                                               
Attorney.                                                                                                                       
                                                                                                                                
1:50:49 PM                                                                                                                    
Section 5  is amended to  recognize a Power of  Attorney executed                                                               
in another state.                                                                                                               
                                                                                                                                
Section 6  edits the actual form  of the Power of  Attorney (POA)                                                               
and requires  the principal to  mark a  box in each  category and                                                               
provides optional  grant of specific authority  to create, amend,                                                               
revoke,  or terminate  a trust;  make  a gift;  create or  change                                                               
beneficiaries;  or revoke  a transfer  on a  death deed.  It also                                                               
deals with how a notary can witness a signature.                                                                                
                                                                                                                                
Section 7 adds additional optional provisions.                                                                                  
                                                                                                                                
1:55:06 PM                                                                                                                    
Section 8 deals with the applicability of provisions.                                                                           
                                                                                                                                
CHAIR  STEDMAN  requested  further  clarification  of  Section  7                                                               
regarding the notary provision.                                                                                                 
                                                                                                                                
REPRESENTATIVE HUGHES  commented that the provision  only applies                                                               
to the notary's signing of this document.                                                                                       
                                                                                                                                
CHAIR STEDMAN said he has concerns about it.                                                                                    
                                                                                                                                
MS.  BLAISDELL said  that  the notary  provision  was brought  to                                                               
attention by the Office of Public Advocacy.                                                                                     
                                                                                                                                
1:56:34 PM                                                                                                                    
She continued:                                                                                                                  
                                                                                                                                
Sections 9 -  11 removes the option to revoke,  create, or modify                                                               
a trust and includes it in a separate selection on the POA form.                                                                
                                                                                                                                
Section 12  allows the agent to  use credit and debit  cards, and                                                               
electronic transactions.                                                                                                        
                                                                                                                                
Section  13 adds  additional  responsibilities and  clarification                                                               
responsibilities  of  the agent  to  manage  the affairs  of  the                                                               
principal's businesses.                                                                                                         
                                                                                                                                
1:59:02 PM                                                                                                                    
Section  14  provides  for  the  exercise  of  investment  powers                                                               
available under a contract of insurance or annuity.                                                                             
                                                                                                                                
Section 15  repealed section with  respect to gifts  and replaced                                                               
with instructions regarding retirement plans.                                                                                   
                                                                                                                                
Section 16  amends the section regarding  personal relationships,                                                               
such as child support under HIPAA rules.                                                                                        
                                                                                                                                
Section  17 amends  the  section  regarding government,  military                                                               
service, or civil service.                                                                                                      
                                                                                                                                
2:02:37 PM                                                                                                                    
Section  18 is  a new  subsection that  gives specific  authority                                                               
with respect to gift transactions.                                                                                              
                                                                                                                                
Section  19 is  amended  to  relieve an  agent  of liability  for                                                               
breach of duty unless it was committed dishonestly.                                                                             
                                                                                                                                
Section  20 replaces  the term  "disability  or incompetence"  to                                                               
"incapacity."                                                                                                                   
                                                                                                                                
Section  23 addresses  judicial  relief and  allows  a number  of                                                               
people to petition the courts to review an agent's actions.                                                                     
                                                                                                                                
2:04:04 PM                                                                                                                    
Section  27  deals   with  substitute  decision-making  documents                                                               
between states.                                                                                                                 
                                                                                                                                
MS.  BLAISDELL  concluded  that   the  statute  was  updated  and                                                               
definitions were  brought current.  HB 8 provides  protection for                                                               
vulnerable adults and judicial relief.                                                                                          
                                                                                                                                
CHAIR STEDMAN requested an update  of the sectional analysis page                                                               
numbers to version N.A.                                                                                                         
                                                                                                                                
REPRESENTATIVE HUGHES noted that HIPAA  is related to payment for                                                               
health care services, not about making health care decisions.                                                                   
                                                                                                                                
2:06:14 PM                                                                                                                    
CHAIR STEDMAN opened public testimony.                                                                                          
                                                                                                                                
2:06:28 PM                                                                                                                    
THERESA  HOPE,  State  Long-term  Care  Ombudsman,  testified  in                                                               
support  of  HB 8.  She  related  that the  Ombudsman  frequently                                                               
investigates cases in  which family members or  others misuse the                                                               
POA document  to exploit  vulnerable adults,  especially seniors.                                                               
HB 8  clarifies and updates  definitions in the statute  and adds                                                               
important protections. She spoke in  favor of the changes made to                                                               
the POA  form. The  bill also provides  for judicial  review when                                                               
there is  suspicion that the  POA is being misused  and clarifies                                                               
when the document can be terminated.                                                                                            
                                                                                                                                
2:08:53 PM                                                                                                                    
DEBORAH BEHR, Chair, Alaska Uniform  Law Commission, testified in                                                               
support of HB 8. She noted that  page 37, to the end of the bill,                                                               
is  a  result  of  the  open public  process  and  is  a  uniform                                                               
recognition of Substitute  Decision-Making Documents across state                                                               
lines. She  provided an example.  She spoke of the  advantages of                                                               
the POA document.                                                                                                               
                                                                                                                                
2:10:45 PM                                                                                                                    
MARIE DARLIN, AARP  of Alaska, testified in support of  HB 8. She                                                               
provided  the  history of  the  development  of  the bill.  HB  8                                                               
continues  the work  that was  started  several years  ago -  the                                                               
Advanced Directive  bill. She said HB  8 is one more  step in the                                                               
right direction  to help protect  vulnerable adults. It is  a way                                                               
to  try and  correct some  of the  problems related  to Power  of                                                               
Attorney.                                                                                                                       
                                                                                                                                
2:13:03 PM                                                                                                                    
DENISE DANIELLO, Executive Director,  Alaska Commission on Aging,                                                               
testified in support  of HB 8. She said the  bill is important in                                                               
light of  the increasing senior population.  She especially liked                                                               
the fact that the bill conforms  to the Unified Power of Attorney                                                               
Act  and  makes  the  law interstate  compatible.  She  said  she                                                               
supports  increasing the  principal's control  regarding decision                                                               
making. She  suggested that there  be notification to  the public                                                               
to let them know of these changes.                                                                                              
                                                                                                                                
CHAIR STEDMAN closed public testimony.                                                                                          
                                                                                                                                
SENATOR GIESSEL thanked the sponsor.                                                                                            
                                                                                                                                
CHAIR STEDMAN held HB 8 in committee.                                                                                           
                                                                                                                                
            SB 72-DESIGNATED CAREGIVERS FOR PATIENTS                                                                        
                                                                                                                                
2:15:58 PM                                                                                                                    
CHAIR STEDMAN announced the consideration of SB 72.                                                                             
                                                                                                                                
SENATOR CATHY  GIESSEL, Alaska State  Legislature, sponsor  of SB                                                               
72. She read from the sponsor statement:                                                                                        
                                                                                                                                
     SB 72  seeks to improve post-discharge  health outcomes                                                                    
     by improving  coordination with  designated caregivers,                                                                    
     providing   training  to   them  on   discharge  tasks,                                                                    
     reducing preventable  and costly  hospital readmissions                                                                    
     and enabling older Alaskans to  stay in their own homes                                                                    
     longer.                                                                                                                    
                                                                                                                                
     At  any   given  time,   around  88,000   Alaskans  are                                                                    
     providing   some  type   of  caregiving   services  and                                                                    
     supports   to  a   loved  one,   friend  or   neighbor.                                                                    
     Caregivers  are  increasingly  being asked  to  perform                                                                    
     complex nursing and medical tasks  - such as dispensing                                                                    
     numerous  medications,   administering  injections  and                                                                    
     providing  wound care  -  often  with inadequate  skill                                                                    
     training.                                                                                                                  
                                                                                                                                
     Caregivers  are a  critical  link  in the  transitional                                                                    
     care  for frail  adults  and  those with  disabilities;                                                                    
     with  few exceptions,  caregivers  are responsible  for                                                                    
     providing and  coordinating much  of the  care received                                                                    
     at home following  discharge. Untrained and unsupported                                                                    
     caregiving jeopardizes the  patient's recovery, as well                                                                    
     as  often puts  the  caregiver at  risk  for their  own                                                                    
     injury and  burnout, frequent symptoms of  those caring                                                                    
     for others.                                                                                                                
                                                                                                                                
     SB 72 contains three important provisions:                                                                                 
     The name  of a caregiver  is recorded when a  loved one                                                                    
     is admitted  into a hospital  facility, if  the patient                                                                    
     so desires to name a caregiver.                                                                                            
                                                                                                                                
     The designated  caregiver is notified of  the patient's                                                                    
     discharge home or transfer to  another facility as soon                                                                    
     as practicable                                                                                                             
                                                                                                                                
     The  hospital   must  attempt   to  consult   with  the                                                                    
     designated   caregiver   about   the   discharge   plan                                                                    
     describing  the  patient's  aftercare needs  and  offer                                                                    
     training to the caregiver for aftercare tasks.                                                                             
                                                                                                                                
     The value of  family caregiving in Alaska  is valued at                                                                    
     over  a  billion  dollars   a  year….money  that  would                                                                    
     otherwise likely  have to come  from the  state coffers                                                                    
     for paid caregiving in the home or in a facility.                                                                          
     Unsupported  caregivers are  more likely  to experience                                                                    
     burnout,  develop their  own  health  problems, or  see                                                                    
     their  loved  one  moved  into   a  facility  for  more                                                                    
     expensive care.  Most of  all, SB  72 will  help people                                                                    
     continue  to  live  independently  at  home,  and  will                                                                    
     support the family caregivers who make this possible.                                                                      
                                                                                                                                
2:18:48 PM                                                                                                                    
JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State                                                                         
Legislature, explained the sectional analysis of SB 72 on behalf                                                                
of the sponsor. She read from the sectional:                                                                                    
                                                                                                                                
     Sec. 1: Amends 18.20 by adding a new section:                                                                              
     Article  5:  Caregivers   of  Hospital  Patients  after                                                                    
     Discharge                                                                                                                  
                                                                                                                                
     Sec. 18.20.500 Naming a caregiver.  Gives a patient the                                                                    
     opportunity to  name a  caregiver to  provide aftercare                                                                    
     following discharge  and outlines  the details  of that                                                                    
     process.                                                                                                                   
                                                                                                                                
     Section  18.20.510  Release   of  medical  information.                                                                    
     This  section  provides  hospital to  ask  for  patient                                                                    
     consent to  release the patient's  medical info  to the                                                                    
     caregiver. (b)  allows for the patient  to prohibit the                                                                    
     release of  the medical records, thereby  releasing the                                                                    
     hospital  from its  obligation to  notify  or inform  a                                                                    
     caregiver.                                                                                                                 
                                                                                                                                
     Section 18.20.520  Notice to named  caregiver. Requires                                                                    
     the  hospital  to notify  the  named  caregiver of  the                                                                    
     planned discharge  date and  time or  of a  transfer to                                                                    
     another facility as soon as it can.                                                                                        
                                                                                                                                
     Section   18.20.530  Caregiver   not  obligated.   This                                                                    
     section says that  if a person is named  by the patient                                                                    
     as the caregiver,  that person has the  right to refuse                                                                    
     the designation.                                                                                                           
                                                                                                                                
     Section  18.20.540   Discharge  plan.     Requires  the                                                                    
     hospital to  prepare a discharge  plan for  the patient                                                                    
     and assesses  the named  caregiver's skills  to provide                                                                    
     the prescribed  aftercare to  the patient.  It outlines                                                                    
     what needs  to be  included in  the discharge  plan and                                                                    
     provides  a  hospital  contact or  hospital  contractor                                                                    
     contact who  can answer  questions the  caregiver might                                                                    
     have.                                                                                                                      
                                                                                                                                
     Section  18.20.550  Caregiver instruction.  Requires  a                                                                    
     hospital  or hospital  contractor to  instruct a  named                                                                    
     caregiver on  the tasks outlined in  discharge plan for                                                                    
     aftercare. The  section outlines  the various  means by                                                                    
     which this  can be done  and that the  instruction must                                                                    
     be culturally  sensitive and  comply with  federal law.                                                                    
     It  requires  that  the training  be  done  before  the                                                                    
     discharge  if possible,  unless  that  would delay  the                                                                    
     discharge; in  that event the  training can  take place                                                                    
     as soon as possible after the patient's discharge.                                                                         
                                                                                                                                
     Section 18.20.560  Recording obligations.  This section                                                                    
     outlines  what  must  be   recorded  in  the  patient's                                                                    
     medical record.                                                                                                            
                                                                                                                                
     Section 18.20.565  No delay  of discharge  or transfer.                                                                    
     This  section   states  that  the   required  caregiver                                                                    
     instruction  cannot  delay  a  patient's  discharge  or                                                                    
     transfer to another facility.                                                                                              
                                                                                                                                
     Section  18.20.570 Construction  of provisions.  States                                                                    
     that  the  provisions of  this  bill  do not  create  a                                                                    
     liability for  the hospital,  a hospital  contractor or                                                                    
     employee  for their  performance or  non-performance of                                                                    
     tasks.                                                                                                                     
                                                                                                                                
     Section  18.20.580 Coordination  with other  authority.                                                                    
     The provisions in this bill  do not override the duties                                                                    
     of an agent  under an advance health  care directive or                                                                    
     the powers or duties of a legal guardian.                                                                                  
                                                                                                                                
     Section 18.20.585 Regulations.  Gives the Department of                                                                    
     Health  and  Social  Services the  authority  to  write                                                                    
     regulations to carry out the provisions of this bill.                                                                      
                                                                                                                                
     Section 18.20.590 Definitions.  Provides 10 definitions                                                                    
     of terms used in the bill.                                                                                                 
                                                                                                                                
     Sec. 2 Adds a new  section that gives the Department of                                                                    
     Health  and  Social  Services the  authority  to  adopt                                                                    
     regulations  necessary to  implement the  provisions of                                                                    
     the bill and  that the regulations will  take effect on                                                                    
     January 1, 2016.                                                                                                           
                                                                                                                                
     Sec. 3  Allows the  Department to begin  the regulation                                                                    
     process immediately                                                                                                        
                                                                                                                                
     Sec. 4 Provisions of the  bill are effective on January                                                                    
     1, 2016.                                                                                                                   
                                                                                                                                
2:23:16 PM                                                                                                                    
CHAIR STEDMAN opened public testimony.                                                                                          
                                                                                                                                
2:23:48 PM                                                                                                                    
ANN  LOVEJOY, Mountain  Pacific Improvement  (MPI), testified  in                                                               
support of SB  72. She related that MPI is  a quality improvement                                                               
organization for  Alaska and is  under contract with  the Centers                                                               
for Medicare  and Medicaid. She  listed the reasons  MPI supports                                                               
the  bill -  it  is  beneficial for  people  and  for the  health                                                               
industry.  It  benefits  people   who  are  discharged  from  the                                                               
hospital without  clear roles and  responsibilities for  who will                                                               
deliver their  aftercare. She  said one of  the drivers  for high                                                               
readmission  rates and  for  very poor  health  outcomes is  that                                                               
individuals  do not  receive the  necessary aftercare.  Secondly,                                                               
readmission is  a very  important issue  because the  industry is                                                               
receiving  negative   payment  adjustments,  or   penalties,  for                                                               
excessively high  rates of readmissions.  If a hospital  took the                                                               
extra  time  to educate  the  caregiver,  the readmissions  rates                                                               
would  go down.  Another benefit  to the  industry is  that their                                                               
accreditation would  be assured. The  bill does not  mandate what                                                               
the caregiver education says, it  just says the education must be                                                               
done.                                                                                                                           
                                                                                                                                
2:27:10 PM                                                                                                                    
DEBBY RETHERFORD,  representing herself, testified in  support of                                                               
SB  72.  She  said  she  has personal  experience  with  being  a                                                               
caregiver of a  senior relative. She stressed  how important this                                                               
bill  is  because  it  requires   the  hospital  to  provide  the                                                               
caregiver with instructions.                                                                                                    
                                                                                                                                
2:30:29 PM                                                                                                                    
VICTORIA MARTIN,  representing herself,  testified in  support of                                                               
SB 72.  She shared a personal  experience as a caregiver  who was                                                               
given no  instructions after a  patient was discharged.  She said                                                               
it was important for the  hospital to provide the information for                                                               
a  discharge plan.  She said  she does  not want  to see  another                                                               
person go through what she had to.                                                                                              
                                                                                                                                
2:33:38 PM                                                                                                                    
TERRY SNYDER, State  President, AARP, testified in  support of SB                                                               
72. She suggested that everyone will  be a caregiver at some time                                                               
during their lives.  She shared that 65 percent  of older persons                                                               
with long-term  care needs will  need to  be cared for  by family                                                               
and  friends, the  majority of  whom are  women. She  said it  is                                                               
essential  that   the  caregiver   and  the  patient   are  given                                                               
instructions for  a discharge plan with  successful outcomes. The                                                               
state must develop methods for  Alaskans to be caregivers at home                                                               
and avoid costly readmissions. The  bill will benefit Alaskans of                                                               
all ages and will save money.                                                                                                   
                                                                                                                                
2:36:48 PM                                                                                                                    
ED ZASTROW, representing himself, testified  in support of SB 72.                                                               
He  shared a  personal story  of his  experience with  a hospital                                                               
discharge  in  Ketchikan.  He  said   the  discharge  program  in                                                               
Ketchikan is similar to the plan in  SB 72. He said his wife, his                                                               
caregiver, was  schooled in  how to  care for  him and  they were                                                               
assisted in  how to prepare home  accommodations. However, others                                                               
did  not  receive  the  same  discharge  information  and  became                                                               
confused. He opined the bill would address that situation.                                                                      
                                                                                                                                
2:39:17 PM                                                                                                                    
KEN  HELANDER,  Advocacy  Director,  AARP  Alaska,  testified  in                                                               
support of  SB 72. He stated  that the bill is  about caregivers.                                                               
He  said  at any  given  moment  there  are about  88,000  family                                                               
caregivers  in Alaska.  Over a  course of  a year,  about 128,000                                                               
people serve in that role to  some degree. This represents over a                                                               
billion dollars  in care  that otherwise  would have  likely been                                                               
borne by the state.                                                                                                             
                                                                                                                                
He referred to an article in  the Fairbanks Daily News Minor that                                                             
covered the annual  cost of care report  from Genworth Financial,                                                               
which tracks the  costs of long-term care across  the country. In                                                               
the U.S,  one year  in a  nursing home is  equal to  three years'                                                               
tuition  at a  private college.  Alaska has  the highest  average                                                               
cost of  nursing home care in  the nation - $281,415  a year. The                                                               
degree to which we can  support family caregivers, saves families                                                               
and the state money.                                                                                                            
                                                                                                                                
He described  a survey by  AARP of 800  Alaskans from age  45 and                                                               
over to  hear about  their experiences  in caregiving.  Among the                                                               
findings, 56 percent identified themselves  as being a current or                                                               
former  caregiver;  50 percent  said  it  was likely  they  would                                                               
provide care  for a friend  or family member. The  average Alaska                                                               
caregiver is over 55 and female,  who works full or part time, in                                                               
addition to caregiving  for someone over the age of  73. They all                                                               
face challenges;  emotional and financial stress,  balancing jobs                                                               
and   caregiving,  finding   enough  rest,   difficulty  managing                                                               
medications and  medical tasks. There  is a need for  support for                                                               
patients  living  at  home,  for   respite  for  caregivers,  and                                                               
resources and training for caregivers.  Most indicated that there                                                               
was no instruction  after a hospital discharge.  They agreed that                                                               
hospitals should  keep families  informed of major  decisions and                                                               
the discharge and keep records.                                                                                                 
                                                                                                                                
He  pointed  out that  discharged  plans  are required,  but  are                                                               
complex  and  not clear.  Hospitals  are  aware  of the  need  to                                                               
improve  the  transition  from  hospital to  home  and  some  are                                                               
working hard  to do so. He  concluded that the bill  provides the                                                               
incentive for all hospitals to do so.                                                                                           
                                                                                                                                
2:45:25 PM                                                                                                                    
DENISE DANIELLO, Executive Director,  Alaska Commission on Aging,                                                               
testified  in support  of SB  72. She  stated that  it is  a very                                                               
important bill  and it contains  many important  provisions, such                                                               
as  instruction and  training. The  senior population  is growing                                                               
and  will  need  to  rely   increasingly  more  on  their  family                                                               
caregivers.                                                                                                                     
                                                                                                                                
2:47:25 PM                                                                                                                    
BECKY  HULTBERG,  CEO, Alaska  State  Hospital  and Nursing  Home                                                               
Association, testified  in opposition to  SB 72. She said  she is                                                               
willing to  work with the  sponsor on the  bill. She said  she is                                                               
very  concerned about  successful  transitions  from hospital  to                                                               
home. This work  is happening well in some places.  The bill does                                                               
not address  a lack of  caregivers, nor  many of the  problems of                                                               
those with chronic  diseases. She listed problems  with the bill.                                                               
Setting this in statute does  not provide for changes in process,                                                               
medicine, and  technology. There  is a great  deal of  variety in                                                               
hospitals  across Alaska.  Imposing  the same  standards on  all-                                                               
sized  hospitals will  not work.  This bill  is setting  a fourth                                                               
level  of administrative  regulation  on a  nursing process.  The                                                               
focus should  be on  patient care and  quality, not  on resources                                                               
for keeping records.                                                                                                            
                                                                                                                                
2:51:36 PM                                                                                                                    
She  voiced  specific  concerns.  The  hospital  is  expected  to                                                               
contact  and  follow  up  with  a  caregiver,  which  is  a  huge                                                               
requirement  of  nurses.  It requires  hospitals  to  assess  the                                                               
caregiver's  ability to  provide aftercare,  which could  be very                                                               
challenging  for hospitals.  There is  no explanation  of what  a                                                               
hospital's obligation  is when the caregiver  is incapable. There                                                               
are  concerns about  how hospitals  will provide  instruction "as                                                               
soon as possible"  and a problem with aftercare follow  up. It is                                                               
a problem  that hospitals are  required to document  and instruct                                                               
caregivers, but caregivers have  no accountability to accept that                                                               
instruction.  Language   is  unclear   about  who   provides  the                                                               
instruction  and records  information. She  pointed out  that the                                                               
electronic health  network said it  could cost about  $100,000 to                                                               
capture this information.                                                                                                       
                                                                                                                                
2:54:29 PM                                                                                                                    
She said  the concepts in the  bill have been identified  by AARP                                                               
as a priority. She suggested  looking at other states to identify                                                               
how to support the intent of the bill.                                                                                          
                                                                                                                                
2:55:16 PM                                                                                                                    
SENATOR STOLTZE asked what the nurses' organizations think.                                                                     
                                                                                                                                
MS.  HULTBERG explained  they have  only  received feedback  from                                                               
their  own  association's  administrative nurses,  but  not  from                                                               
nurses' associations.                                                                                                           
                                                                                                                                
2:56:20 PM                                                                                                                    
CHAIR STEDMAN held SB 72 in committee.                                                                                          
                                                                                                                                
2:56:29 PM                                                                                                                    
There being nothing further to come before the committee,                                                                       
Chair Stedman adjourned the Senate Health and Social Services                                                                   
Standing Committee at 2:56 p.m.                                                                                                 

Document Name Date/Time Subjects
CSHB8(JUD)am Power of Attorney hearing request 13Mar15.pdf SHSS 4/10/2015 1:30:00 PM
HB 8
CSHB0008(JUD) 27Feb15.pdf SHSS 4/10/2015 1:30:00 PM
HB 8
HB0008-1-2-022515-DHS-N.pdf SHSS 4/10/2015 1:30:00 PM
HB 8
HB0008-2-2-022515-LAW-N.pdf SHSS 4/10/2015 1:30:00 PM
HB 8
HB0008A 27Feb15.pdf SHSS 4/10/2015 1:30:00 PM
HB 8
HB8 Description of Changes to ver E.pdf SHSS 4/10/2015 1:30:00 PM
HB 8
HB8 Section Analysis-Power of Attorney.pdf SHSS 4/10/2015 1:30:00 PM
HB 8
HB8 Sponsor Statement - Power of Attorney.pdf SHSS 4/10/2015 1:30:00 PM
HB 8
HB8 Supporting Documents - AARP letter.pdf SHSS 4/10/2015 1:30:00 PM
HB 8
HB8 Supporting Documents - LTCO.pdf SHSS 4/10/2015 1:30:00 PM
HB 8
HB8 Supporting Documents-Article AARP summary report.pdf SHSS 4/10/2015 1:30:00 PM
HB 8
HB8 Supporting Documents-Article Remedying Financial Abuse by Agents Under a POA for Finances.pdf SHSS 4/10/2015 1:30:00 PM
HB 8
HB8 Supporting Documents-Article Uniform Law Commission.pdf SHSS 4/10/2015 1:30:00 PM
HB 8
HB8 Supporting Documents-Articles multiple articles.pdf SHSS 4/10/2015 1:30:00 PM
HB 8
SB72 Backup Article Helping the Helpers.pdf SHSS 4/10/2015 1:30:00 PM
SB 72
SB72 Backup AARP Survey AKs over 45.pdf SHSS 4/10/2015 1:30:00 PM
SB 72
SB72 Backup AARP Survey Caregivers.pdf SHSS 4/10/2015 1:30:00 PM
SB 72
SB72 Backup AARP Survey Independents.pdf SHSS 4/10/2015 1:30:00 PM
SB 72
SB72 Backup CARE ACT states.pdf SHSS 4/10/2015 1:30:00 PM
SB 72
SB72 Backup Home Alone Study.pdf SHSS 4/10/2015 1:30:00 PM
SB 72
SB72 Designated Caregivers vsn P.pdf SHSS 4/10/2015 1:30:00 PM
SB 72
SB72 Hrg Rqst SHSS.pdf SHSS 4/10/2015 1:30:00 PM
SB 72
SB72 Sponsor Statement.pdf SHSS 4/10/2015 1:30:00 PM
SB 72
SB72 Support AARP.pdf SHSS 4/10/2015 1:30:00 PM
SB 72
SB72 Support Am. Lung Assn..pdf SHSS 4/10/2015 1:30:00 PM
SB 72
HB8 Section Analysis-ver N-A Power of Attorney.pdf SHSS 4/10/2015 1:30:00 PM
HB 8