Legislature(2017 - 2018)BUTROVICH 205

03/17/2017 01:30 PM HEALTH & SOCIAL SERVICES

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01:30:39 PM Start
01:31:17 PM SB83
01:47:43 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ SB 83 PROTECT: VULNERABLE ADULTS/LONG TERM CARE TELECONFERENCED
Heard & Held
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         March 17, 2017                                                                                         
                           1:30 p.m.                                                                                            
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator Cathy Giessel                                                                                                           
Senator Tom Begich                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Senator Natasha von Imhof, Vice Chair                                                                                           
Senator Peter Micciche                                                                                                          
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE BILL NO. 83                                                                                                              
"An Act relating to the protection of vulnerable adults and                                                                     
residents of long term care facilities."                                                                                        
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 83                                                                                                                   
SHORT TITLE: PROTECT: VULNERABLE ADULTS/LONG TERM CARE                                                                          
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
                                                                                                                                
03/08/17       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/08/17       (S)       HSS, FIN                                                                                               
03/17/17       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
TERESA HOLT, Long Term Care Ombudsman                                                                                           
Alaska Mental Health Trust Authority                                                                                            
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Presented information on SB 83.                                                                           
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:30:39 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:30 p.m.  Present at the                                                               
call to  order were Senators  Begich, Giessel, and  Chair Wilson.                                                               
Senators Von Imhof and Micciche were excused.                                                                                   
                                                                                                                                
        SB 83-PROTECT: VULNERABLE ADULTS/LONG TERM CARE                                                                     
                                                                                                                                
1:31:17 PM                                                                                                                    
CHAIR WILSON announced the consideration of SB 83.                                                                              
                                                                                                                                
TERESA HOLT, Long Term Care Ombudsman, Alaska Mental Health                                                                     
Trust Authority, presented information on SB 83. She provided an                                                                
overview of SB 83:                                                                                                              
                                                                                                                                
     SB 83 will  amend provisions of AS 47.62  Office of the                                                                    
     Long  Term Care  Ombudsman and  AS 47.24  protection of                                                                    
     vulnerable adults  to ensure  alignment with  the Older                                                                    
     Americans  Act  and  its implementing  regulations.  In                                                                    
     2016, the Older Americans  Act was reauthorized and new                                                                    
     regulations for Long Term  Care Ombudsman were created.                                                                    
     As a  result, the  Administration for  Community Living                                                                    
     reviewed  all states  to ensure  compliance with  these                                                                    
     changes.  Through  this  review, these  Alaska  statues                                                                    
     were  identified as  being out  of  alignment with  the                                                                    
     reauthorized  Older Americans  Act and  Long Term  Care                                                                    
     Ombudsman  regulations.   But  regardless   of  federal                                                                    
     requirements these changes are  good policy changes for                                                                    
     our office and we would recommend them anyway.                                                                             
                                                                                                                                
     Briefly, this bill would:                                                                                                  
                                                                                                                                
     Align   state  statutes   with  federal   statutes  and                                                                    
     regulations  to ensure  Office of  the  Long Term  Care                                                                    
     Ombudsman   only  shares   resident  information   with                                                                    
     informed consent.                                                                                                          
                                                                                                                                
     Ensure  Office  of the  Long  Term  Care Ombudsman  can                                                                    
     obtain records  to investigate and make  referrals when                                                                    
     resident is unable to provide informed consent.                                                                            
                                                                                                                                
     Add new term for resident and resident representative                                                                      
     Due to a  conflict of interest, removes  the option for                                                                    
     mandatory reporters  to meet reporting  requirements by                                                                    
     submitting report to  the Office of the  Long Term Care                                                                    
     Ombudsman.                                                                                                                 
                                                                                                                                
     Clarify the  separation of  the role  of the  Long Term                                                                    
     Care Ombudsman from the role of DHSS.                                                                                      
                                                                                                                                
     Clarify  that Office  of the  Long Term  Care Ombudsman                                                                    
     may serve residents in long  term care facilities under                                                                    
     the age of 60.                                                                                                             
                                                                                                                                
1:33:42 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
1:36:56 PM                                                                                                                    
MS. HOLT presented the sectional analysis:                                                                                      
                                                                                                                                
     Section 1  is a technical amendment  to AS 47.24.010(a)                                                                  
     update  the   name  of   the  entity   responsible  for                                                                    
     receiving reports  to the department  "vulnerable adult                                                                    
     centralized intake office". This  section also adds the                                                                    
     statutory  reference  for   the  definition  of  mental                                                                    
     health professional.                                                                                                       
                                                                                                                                
     Section 2  is a technical amendment  to AS 47.24.010(e)                                                                  
     to  update  the  name  of the  entity  responsible  for                                                                    
     receiving reports  to the department  "vulnerable adult                                                                    
     centralized intake office".                                                                                                
                                                                                                                                
     Section  3   amends  AS  47.24.013(a)  to   remove  the                                                                  
     requirement to  forward reports of maltreatment  to the                                                                    
     Long  Term   Care  Ombudsman's  office.   Adds  passive                                                                    
     language  to allow  the DHSS  to  transfer reports  for                                                                    
     Long  Term Care  Ombudsman's  investigation as  defined                                                                    
     under AS.62.015.                                                                                                           
                                                                                                                                
     Section 4  amends AS  47.24.013(b) to  delete reference                                                                  
     to  DHSS's   obligation  to  investigate   reports  for                                                                    
     vulnerable adult's  age 60 or  less. The  Department of                                                                    
     Health and  Social Services is responsible  for reports                                                                    
     involving vulnerable adults ages 18 and older.                                                                             
                                                                                                                                
     Section  5 amends  AS 47.24.013(d)  to remove  the Long                                                                  
     Term   Care  Ombudsman's   obligation  to   mandatorily                                                                    
     provide  a report  to the  DHSS Central  Intake. Aligns                                                                    
     state  law with  federal  law requiring  the Long  Term                                                                    
     Care Ombudsman's office to  only forward information of                                                                    
     a complainant  or resident with appropriate  consent or                                                                    
     court  order.   (45  CFR  1327.11(e)(3)).   Amended  to                                                                    
     reflect   current  Department   of  Human   and  Social                                                                    
     Services    responsibility    for   vulnerable    adult                                                                    
     centralized intake.                                                                                                        
                                                                                                                                
     Section 6  amends AS  47.24.015(a) to  remove reference                                                                  
     to reports transferred to the  Office of Long Term Care                                                                    
     Ombudsman   under    47.24.013.   Updates   legislative                                                                    
     language   to  appropriately   reference  subjects   of                                                                    
     reports are vulnerable  adults. Removes requirement for                                                                    
     face to face interview.                                                                                                    
                                                                                                                                
     Section  7 amends  AS 47.62.015(a)  to add  language to                                                                  
     align state law with federal  law by providing the Long                                                                    
     Term Care  Ombudsman the  authority to  investigate and                                                                    
     resolve a  complaint for  a person  residing in  a long                                                                    
     term  care facility  who  is not  defined  as an  older                                                                    
     Alaska.                                                                                                                    
                                                                                                                                
     Section  8  amends  AS   47.62.015(c)  to  include  all                                                                  
     residents of a long term care facility.                                                                                    
                                                                                                                                
     Section 9  repeals and reenacts AS  47.62.025 to define                                                                  
     access  to long  term care  facilities, older  Alaskan,                                                                    
     and records.                                                                                                               
     Title amended to include all  ages of residents of long                                                                    
     term care  facilities. Section  (a) amended  to include                                                                    
     all  ages of  residents of  long term  care facilities.                                                                    
     Section (b)  amended to include  all ages  of residents                                                                    
     of long term  care facilities and amended  to allow for                                                                    
     consent  to   be  provided  by  the   resident  or  the                                                                    
     resident's representative or by subpoena.                                                                                  
                                                                                                                                
     Section  10 repeals  and  reenacts  AS 47.62.030(b)  to                                                                  
     include  all ages  of residents.  Amended to  allow for                                                                    
     disclosures with  consent. Adds authority  for resident                                                                    
     representative to give consent.  Amended to align state                                                                    
     law with  federal law to clarify  limited circumstances                                                                    
     when  the  Office  of  Long  Term  Care  Ombudsman  has                                                                    
     authority  to  report resident-identifying  information                                                                    
     without obtaining  resident or  resident representative                                                                    
     consent.                                                                                                                   
                                                                                                                                
     Section 11 amends  AS 47.62.060 to include  all ages of                                                                  
     residents of long term care facilities.                                                                                    
                                                                                                                                
     Section   12  amends   AS  47.62.090   to  revise   the                                                                  
     definition  of "older  Alaskan"  as  an individual  who                                                                    
     lives  in Alaska  since  definition  of "resident"  was                                                                    
     added to  mean individual  living in  a long  term care                                                                    
     facility. Adds  new sections to  define resident  as an                                                                    
     individual  who resides  in a  long term  care facility                                                                    
     and  to align  state  law with  federal  law to  define                                                                    
     resident  representative  and  authority  the  resident                                                                    
     representative has to act on behalf of the resident.                                                                       
                                                                                                                                
     Section    13     repeals    AS     47.24.010(f),    AS                                                                  
     47.24.013(c)(3), and  AS 47.24.013(e).  AS 47.24.010(f)                                                                    
     is   repealed  as   Federal  statute   and  regulations                                                                    
     prohibit representatives  of the Office Long  Term Care                                                                    
     Ombudsman from  abuse reporting requirements  when such                                                                    
     reporting would  disclose identifying information  of a                                                                    
     complainant or resident  without appropriate consent or                                                                    
     court   order.   (45   CFR   1327.11(e)(3)).   Therefor                                                                    
     mandatory  reporting to  the Office  of Long  Term Care                                                                    
     Ombudsman  does  not  fulfill  a  mandatory  reporter's                                                                    
     obligation  under  law  to make  mandatory  reports  of                                                                    
     maltreatment.    AS    47.24.013(c)(3)   repeals    the                                                                    
     requirement  for  the  Office  of the  Long  Term  Care                                                                    
     Ombudsman to  provide results  of investigation  to the                                                                    
     DHSS.  OAA  Section   712(d)(2)(B)  establishes  strict                                                                    
     disclosure  limitations. The  Long Term  Care Ombudsman                                                                    
     program  is  intended  to be  a  safe,  person-centered                                                                    
     place for residents to  bring their concerns. Residents                                                                    
     can  be  assured that  their  information  will not  be                                                                    
     disclosed  without their  consent, the  consent of  the                                                                    
     resident   representative,    or   court    order.   AS                                                                    
     47.24.013(e)  is repealed  as  the Office  of the  Long                                                                    
     Term Care  Ombudsman is not  the appropriate  agency to                                                                    
     officially substantiate abuse  or neglect complaints on                                                                    
     behalf  of  DHSS. The  Office  of  the Long  Term  Care                                                                    
     Ombudsman  represents   the  interests   of  residents,                                                                    
     rather  than  the  interests  of  the  DHSS.  (See  OAA                                                                    
     Section    712(a)(3)(E),    (a)(5)(B)(iv);    45    CFR                                                                    
     1327.13(a)(5), 1327.19(a)(4)).                                                                                             
                                                                                                                                
1:40:15 PM                                                                                                                    
CHAIR  WILSON asked  for clarification  of  Section 10  regarding                                                               
elders that do not have someone to advocate for them.                                                                           
                                                                                                                                
MS.  HOLT explained  that  they  often deal  with  those who  are                                                               
unable to give  informed consent and do not have  someone to make                                                               
decisions on  their behalf. There  are four conditions  that must                                                               
be met: the  referral must affect their  health, welfare, safety,                                                               
or rights;  there must be  reasonable cause  that it is  in their                                                               
best  interests;   that  all  situations  are   approved  by  the                                                               
Ombudsman;  and there  is no  evidence that  the person  would be                                                               
opposed to  the referral.  She listed  the referral  options they                                                               
might  have   -  to  the   police,  adult   protective  services,                                                               
licensing, or elder fraud.                                                                                                      
                                                                                                                                
1:41:48 PM                                                                                                                    
SENATOR BEGICH noted that in District  J, 168 out of 300 beds had                                                               
seniors and the rest were vacant.  Under Sections 4, 8, 9, and 11                                                               
the Long  Term Care Ombudsman  will now have to  consider clients                                                               
below the  age of 60,  and yet there  are zero fiscal  notes. The                                                               
bill appears to  be a burden to what is  being done currently. He                                                               
asked if there is additional cost for the potential new clients.                                                                
                                                                                                                                
MS.  HOLT   explained  that  the  changes   come  from  Ombudsman                                                               
regulations and  the reauthorization of the  Older Americans Act.                                                               
The reauthorization changed the  wording from "older residents in                                                               
long  term  care facilities"  to  "residents  in long  term  care                                                               
facilities." She said she asked  if they must expand services and                                                               
was told that  it allows for expansion, but it  is not required -                                                               
it  is optional.  She provided  an  example of  their ability  to                                                               
prioritize needs  and services for their  clients. Top priorities                                                               
are  seniors  who  live in  senior  licensed  facilities,  mental                                                               
health and development disabilities, abuse and neglect.                                                                         
                                                                                                                                
1:44:52 PM                                                                                                                    
SENATOR BEGICH summarized that they  don't anticipate a financial                                                               
burden because they are not required to take on new patients.                                                                   
                                                                                                                                
MS. HOLT agreed.                                                                                                                
                                                                                                                                
1:45:46 PM                                                                                                                    
CHAIR WILSON opened public testimony on SB 83.                                                                                  
                                                                                                                                
He noted the people who were available to answer questions.                                                                     
                                                                                                                                
1:46:27 PM                                                                                                                    
CHAIR  WILSON  closed   public  testimony  and  held   SB  83  in                                                               
committee.                                                                                                                      
                                                                                                                                
1:47:43 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair  Wilson adjourned  the Senate  Health  and Social  Services                                                               
Standing Committee at 1:47 p.m.                                                                                                 

Document Name Date/Time Subjects
SB83 ver A.PDF SHSS 3/17/2017 1:30:00 PM
SB 83
SB83 Sponsor Statement - Governor's Transmittal Letter.pdf SHSS 3/17/2017 1:30:00 PM
SB 83
SB83 Fiscal Note-DHSS-SDSA-1-20-17.pdf SHSS 3/17/2017 1:30:00 PM
SB 83
SB83 Fiscal Note-DOR-OLTCO-1-20-17.pdf SHSS 3/17/2017 1:30:00 PM
SB 83
ACoA Support SB 83, Protection of Vulnerable Adults in LTC Settings.pdf SHSS 3/17/2017 1:30:00 PM
SB 83
SB 83 Sectional v A.pdf SHSS 3/17/2017 1:30:00 PM
SB 83