Legislature(2021 - 2022)BUTROVICH 205
03/31/2022 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB175 | |
| HB184 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 175 | TELECONFERENCED | |
| *+ | HB 184 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 31, 2022
1:35 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Shelley Hughes, Vice Chair (via teleconference)
Senator Mia Costello
Senator Lora Reinbold
Senator Tom Begich (via teleconference)
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 175
"An Act relating to telehealth; relating to the practice of
medicine; relating to medical assistance coverage for services
provided by telehealth; and providing for an effective date."
- HEARD & HELD
HOUSE BILL NO. 184
"An Act requiring state participation in a tribal child welfare
compact."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 175
SHORT TITLE: HEALTH CARE SERVICES BY TELEHEALTH
SPONSOR(s): SENATOR(s) WILSON
02/01/22 (S) READ THE FIRST TIME - REFERRALS
02/01/22 (S) HSS, L&C
02/24/22 (S) HSS AT 1:30 PM BUTROVICH 205
02/24/22 (S) -- Invited & Public Testimony --
03/03/22 (S) HSS AT 1:30 PM BUTROVICH 205
03/03/22 (S) Heard & Held
03/03/22 (S) MINUTE(HSS)
03/10/22 (S) HSS AT 1:30 PM BUTROVICH 205
03/10/22 (S) Heard & Held
03/10/22 (S) MINUTE(HSS)
03/17/22 (S) HSS AT 1:30 PM BUTROVICH 205
03/17/22 (S) <Bill Hearing Canceled>
03/31/22 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: HB 184
SHORT TITLE: REQUIRE TRIBAL CHILD WELFARE COMPACT
SPONSOR(s): REPRESENTATIVE(s) ZULKOSKY
04/21/21 (H) READ THE FIRST TIME - REFERRALS
04/21/21 (H) HSS, FIN
04/22/21 (H) HSS AT 3:00 PM DAVIS 106
04/22/21 (H) Heard & Held
04/22/21 (H) MINUTE(HSS)
04/27/21 (H) HSS AT 3:00 PM DAVIS 106
04/27/21 (H) Moved HB 184 Out of Committee
04/27/21 (H) MINUTE(HSS)
04/28/21 (H) HSS RPT 4DP 2NR 1AM
04/28/21 (H) DP: FIELDS, SPOHNHOLZ, SNYDER, ZULKOSKY
04/28/21 (H) NR: PRAX, KURKA
04/28/21 (H) AM: MCCARTY
04/28/21 (H) TRB REPLACES FIN REFERRAL
04/28/21 (H) BILL REPRINTED
05/04/21 (H) TRB RPT 4DP
05/04/21 (H) DP: TARR, ORTIZ, CRONK, ZULKOSKY
05/04/21 (H) TRB AT 8:00 AM DAVIS 106
05/04/21 (H) Moved HB 184 Out of Committee
05/04/21 (H) MINUTE(TRB)
05/13/21 (H) BEFORE HOUSE IN THIRD READING
05/13/21 (H) TRANSMITTED TO (S)
05/13/21 (H) VERSION: HB 184
05/14/21 (S) READ THE FIRST TIME - REFERRALS
05/14/21 (S) HSS
03/31/22 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
HEATHER CARPENTER, Healthcare Policy Advisor
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on SB
175.
SARA CHAMBERS, Director
Division of Corporations, Business, and Professional Licensing
Department of Commerce, Community and Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions during the discussion of
SB 175.
REPRESENTATIVE TIFFANY ZULKOSKY
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor HB 184.
TRACI MCGARRY, Director
Children & Family Services; Child Advocacy Center
Kawerak Inc.
Nome, Alaska
POSITION STATEMENT: Provided invited testimony in support of HB
184 and answered questions.
NICOLE BORROMEO, Executive Vice President; General Counsel,
Alaska Federation of Natives (AFN)
Anchorage, Alaska
POSITION STATEMENT: Provided invited testimony in support of HB
184 and answered questions.
VIVIAN KORTHUIS, Chief Executive Officer
Association of Village Council Presidents (AVCP)
Bethel, Alaska
POSITION STATEMENT: Provided invited testimony in support of HB
184 and answered questions.
TREVOR STORRS, President; Chief Executive Officer,
Alaska Children's Trust
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 184.
ACTION NARRATIVE
1:35:18 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 1:35 p.m. Present at the
call to order were Senators Reinbold, Costello, Hughes (via
teleconference), Begich (via teleconference), and Chair Wilson.
SB 175-HEALTH CARE SERVICES BY TELEHEALTH
1:36:03 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 175
"An Act relating to telehealth; relating to the practice of
medicine; relating to medical assistance coverage for services
provided by telehealth; and providing for an effective date."
1:36:33 PM
At ease
1:37:30 PM
CHAIR WILSON reconvened the meeting and solicited a motion.
1:37:34 PM
SENATOR COSTELLO moved to adopt the committee substitute (CS)
for SB 175, work order 32-LS1421\G, Version G, as the working
document.
1:37:47 PM
CHAIR WILSON objected for discussion purposes.
1:38:33 PM
CHAIR WILSON stated that, as sponsor, he would present the
summary of changes for SB 175 from Version I to Version G. It
read as follows:
[Original punctuation provided.]
Version 32-LS1421\G (Senate Health and Social Services
Committee Substitute)
6 distinct changes from first 32-LS1421\I to 32-
LS1421\G
1) The ability to prescribe, dispense, or administer
botulinum toxin (Botox) via telehealth is removed.
a. Page 2, Line 21: Removed "botulism toxins".
1:38:54 PM
CHAIR WILSON continued to review the changes in SB 175 from
Version I to Version G.
2) Language regarding Alaska Medicaid services in
Section 4 is cleaned up.
a. Page 5, Lines 24 and 25: Removed facsimile to
remove fax as a modality for Alaska Medicaid.
b. Page 5, Lines 5 and 6: Removed "and other federal
waivers or demonstrations" and added a separate line
for "services covered under federal waivers and
demonstrations other than home and community-based
services.
c. Page 5, line 17: Deleted "the Community Health Aide
Program Certification Board" and replaced it with "a
certifying entity for behavioral health professionals
in the state specified by the department in
regulations"
3) Language regarding prescribing via telehealth for
APRNs is tightened and clarified. Does not expand the
prescribing powers of APRNs.
a. Page 2, Lines 25: Added "if the advanced practice
registered nurse complies with AS 08.68.710."
1:40:18 PM
b. New section 3 (does not exist in version I):
Creates a new section under Title 8, Chapter 68
(Nursing) defining the telehealth prescriptive
authority of APRNs in statute. This section aligns the
regulatory authority of the Board of Nursing with the
State Medical Board regarding the prescription of
controlled substances via telehealth.
4) Language was added to require applicable licensing
boards and DHSS to adopt regulations necessary to
implement sections 3-6 of the Act (including the
Medicaid provisions) no later than June 30, 2023.
1:41:04 PM
CHAIR WILSON continued to review the changes in SB 175 from
Version I to Version G.
a. New section 11 (does not exist in version I): Adds
language to detail when each entity must adopt
regulations.
b. Adds a new effective date for section 11. New
section 11 takes effect immediately
5) Added 7-year sunset on Medicaid pay parity. a. New
Section 6 and 7 with effective date of June 30th,
2030: Sunset's language relating to Medicaid pay
parity for telehealth.
6) Changed language throughout to refer to Department
of Health.
1:42:17 PM
SENATOR BEGICH asked whether these changes were made in
collaboration with the department and the sponsor.
CHAIR WILSON noted that the department staff present was nodding
in agreement, and he sponsored SB 175 and agrees with the
changes.
1:42:48 PM
SENATOR HUGHES asked for clarification on Medicaid pay parity
and the sunset date.
CHAIR WILSON stated that pay parity would allow telehealth to
receive the same payment for services as in-person practitioners
for seven years and then sunset. This was based on best
practices for pay parity and would allow the stakeholders time
to work on this issue.
SENATOR HUGHES suggested a shorter time for non-Medicaid
telehealth patients. She wondered whether pay parity should be
three or four years rather than seven.
CHAIR WILSON answered that he envisioned it would take two years
for the department to develop regulations to set rates. He noted
that the department staff was nodding in agreement.
1:44:26 PM
SENATOR HUGHES related her understanding that Medicaid sets the
tone for other insurers. She expressed concern about high health
care costs, so the sooner savings were seen, the better for the
state. She asked whether private medical practice and insurance
could provide savings earlier than seven years.
1:46:00 PM
CHAIR WILSON directed attention to an article in members'
packets from the National Council of State Legislatures (NCSL)
on best practices regarding pay parity. He offered to resend the
information if need be. He noted that a floor amendment removed
pay parity from SB 56, the bill extending the COVID-19 disaster
emergency. He stated that research had shown that many entities
do not wish to engage in telehealth because it was more
profitable to continue to practice in person.
1:47:21 PM
HEATHER CARPENTER, Healthcare Policy Advisor, Office of the
Commissioner, Department of Health and Social Services (DHSS),
Juneau, Alaska, stated that the department held several
conversations with Chair Wilson and the sponsor of the companion
House bill. The department had expressed some concern but had
not focused on the number of years. She said the department
understood the desire to develop the infrastructure for
telehealth. She explained that Medicaid currently pays the same
for in-person and telehealth services. She indicated that it
would modernize the Medicaid program by moving away from fee-
for-service to value-based and bundled payments for managed
care. The department felt it would be helpful if the limitation
for paying the same for in-person versus telehealth does not
exist into perpetuity. She related her understanding that Chair
Wilson came up with a reasonable compromise for the department.
1:48:27 PM
SENATOR HUGHES maintained her concern about the length of time
because telehealth was initiated in many places at least ten
years ago. She expressed concern that seven years was too long
to allow for infrastructure and adjustments. She wondered if the
sponsor would consider shortening that timeframe but indicated
that she would not stop the bill because of it. She emphasized
that health care costs are one of the state's major problems.
CHAIR WILSON indicated that he was working with the sponsor of
the companion bill on that issue. He said he hoped to marry the
bills in the next committee of referral, the Senate Labor &
Commerce Committee.
1:49:54 PM
CHAIR WILSON [removed his objection]; he found no further
objection; and the committee substitute (CS) for SB 175, Version
G was adopted as the working document.
1:50:17 PM
SENATOR REINBOLD moved to adopt Amendment 1, work order 32-
LS1421\G.1.
32-LS1421\G.1
Foote
3/22/22
AMENDMENT 1
OFFERED IN THE SENATE BY SENATOR REINBOLD
TO: CSSB 175(HSS), Draft Version "G"
Page 1, line 9:
Delete "without"
Insert "only after"
1:50:19 PM
CHAIR WILSON objected for discussion purposes.
1:50:22 PM
SENATOR REINBOLD explained that Amendment 1 would require an in-
person visit before providing telehealth services. She offered
her view that this protects physicians in Alaska.
1:50:47 PM
CHAIR WILSON stated that the purpose of previous versions of the
bill was to allow those physicians who have established network
care to practice, allowing the expansion of telehealth for
Alaskans. He said the language in Version G requires the
physician to be an Alaskan provider who practices in Alaska.
1:51:39 PM
SARA CHAMBERS, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community and
Economic Development, Juneau, Alaska, stated that Version G made
many changes that are not in the House version of the bill. She
explained that Amendment 1 would remove "without." However, the
language "without" reinforces the statutes regarding health care
providers in AS 08. The boards have adopted regulations allowing
telehealth care without requiring an in-person visit. She noted
that Chair Wilson indicated this also allows Teladoc physicians
who are licensed in Alaska but may not physically be in Alaska
to provide health care to Alaskans, which is currently allowed.
She related that Teladoc is a large health care provider part of
the state employee health network that uses Alaska-licensed
physicians. She explained that removing "without" and inserting
"after" would mean they could no longer practice in Alaska.
Instead, these physicians would need to be physically present in
Alaska to provide health care for Alaskans.
1:53:51 PM
CHAIR WILSON noted that these physicians must be licensed in the
State of Alaska to practice medicine using telehealth.
1:54:04 PM
MS. CHAMBERS answered yes; these physicians must be licensed in
the state unless they practice medicine through the Indian
Health Service (IHS) or the military.
1:54:20 PM
SENATOR HUGHES raised the issue of health care costs. She asked
the record to reflect her support for Alaskan physicians and
providers. However, she said it is a concern that Alaska
physicians charge from 100 to 300 percent more for services than
out-of-state providers. She highlighted her desire to create
competition. She said she would oppose Amendment 1 because a
telehealth provider might be helpful to Alaskans. She noted that
a telehealth provider might provide a specialty not provided in
Alaska. She highlighted that the state should not stop Alaskans
from seeking more affordable care.
1:55:41 PM
SENATOR REINBOLD stated that she would never undercut Alaska
physicians. She read Section 1 (a):
A health care provider other than a physician licensed
in another state may provide health care services
within the health care provider's authorized scope of
practice to a patient in this state through telehealth
without first conducting an in-person visit.
SENATOR REINBOLD offered her view that it was easy to miss many
things in telehealth and that medical personnel learn much more
with in-person patient care.
1:57:13 PM
SENATOR COSTELLO referred to page 3, lines 2-5, subsection (i),
which does not force health care providers or patients to use
telehealth but leaves it up to the patient to decide.
1:57:43 PM
SENATOR REINBOLD stated that it is expensive to move to Alaska
and set up a practice only to have people make phone calls to
the Lower 48. She maintained her support for Amendment 1.
1:58:06 PM
A roll call vote was taken. Senators Reinbold voted in favor of
the motion to adopt Amendment 1, and Senators Hughes, Begich,
Costello and Wilson voted against it. Therefore, Amendment 1
failed on a 1:4 vote.
CHAIR WILSON announced that Amendment 1 failed on a vote of 1
yea and 4 nays.
1:58:46 PM
SENATOR COSTELLO emphasized that an out-of-state medical doctor
who provides telehealth to a patient in the state must have an
established relationship and have previously conducted a
physical examination. She related her understanding that a
physician must have a connection to the patient or an Alaskan
physician. She asked if that was correct.
CHAIR WILSON answered no. He indicated that it was similar to
the Alaska Care plan, Teladoc, so all the members under Alaska
Care could call Teladoc and reach health care providers licensed
in Alaska.
2:00:00 PM
SENATOR COSTELLO clarified that she was referring to medical
professionals who are licensed outside the state. She
interpreted the bill to mean that the physician must have an
established physician-patient relationship and have previously
conducted a physical examination in person.
MS. CHAMBERS explained that subsection (b) creates a carve-out
that does not currently exist that would allow physicians not
licensed in Alaska to deliver telehealth services. Currently,
out-of-state physicians can be physically in another state, but
the physician must be licensed in Alaska.
2:01:02 PM
SENATOR REINBOLD read subsection (a) "A health care provider
other than a physician licensed in another state may provide
health care services within the health care provider's
authorized scope of practice to a patient located in the state
through telehealth without first conducting an in-person visit."
She asked whether this could apply to international health care
providers.
2:01:57 PM
MS. CHAMBERS referred to page 3, line 7, to the definition of
health care provider, which applies to those licensed in the
state. She stated that the health care provider referenced in
Section 1, on page 1, line 6, related to a person practicing any
listed profession who holds a license in Alaska. A person
traveling internationally could provide telehealth so long as
they are in good standing in Alaska.
2:02:54 PM
At ease
2:03:32 PM
CHAIR WILSON reconvened the meeting.
2:03:38 PM
SENATOR REINBOLD moved to adopt Amendment 2, work order 32-
LS1421\G.3.
32-LS1421\G.3
Foote
3/30/22
AMENDMENT 2
OFFERED IN THE SENATE BY SENATOR REINBOLD
TO: CSSB 175(HSS), Draft Version "G"
Page 10, following line 17:
Insert a new subsection to read:
"(f) Nothing in this section authorizes an
individual employed by an entity permitted to provide
telehealth under this section to prescribe, dispense,
or administer through telehealth a controlled
substance listed in AS 11.71.140 - 11.71.190."
Reletter the following subsection accordingly.
Page 11, following line 12:
Insert a new subsection to read:
"(f) Nothing in this section authorizes an
individual employed by a facility permitted to provide
telehealth under this section to prescribe, dispense,
or administer through telehealth a controlled
substance listed in AS 11.71.140 - 11.71.190."
Reletter the following subsection accordingly.
2:03:41 PM
CHAIR WILSON objected for discussion purposes.
2:03:44 PM
SENATOR REINBOLD explained that Amendment 1 would insert a new
subsection (f), which she read.
2:04:19 PM
SENATOR HUGHES emphasized the importance of being careful with
controlled substances. She said her daughter, a physician, just
prescribed a controlled substance via telehealth. She said it
would have been unethical for her not to provide the needed
treatment for her patient in a rural setting. She stated that
she would oppose Amendment 2.
2:05:10 PM
SENATOR BEGICH agreed with Senator Hughes that allowing a
telehealth provider to prescribe means the patient only needs to
meet with one in-person provider, but that the second provider
could be via telehealth. He offered his view that Amendment 2
would place an undue burden on people who might not be able to
access an in-person provider. He highlighted the importance of
being cautious about opioids but would oppose Amendment 2 based
on the provider's ethical duty.
2:06:02 PM
SENATOR REINBOLD maintained that given the opioid crisis, it was
important to get a handle on controlled substances. She said
allowing someone to prescribe controlled substances from out-of-
state via telehealth was alarming. She offered her view that it
should require an in-person visit.
2:06:55 PM
A roll call vote was taken. Senator Reinbold voted in favor of
the motion to adopt Amendment 2, and Senators Hughes, Begich,
Costello, and Wilson voted against it. Therefore, Amendment 2
failed on a 1:4 vote.
CHAIR WILSON announced that Amendment 2 failed on a vote of 1
yea and 4 nays.
2:07:19 PM
CHAIR WILSON asked Ms. Chambers to provide the committee with
information on how the Prescription Drug Monitoring Program
(PDMP) would work with telehealth prescriptions for controlled
substances.
CHAIR WILSON held SB 175 in committee.
2:07:46 PM
At ease
HB 184-REQUIRE TRIBAL CHILD WELFARE COMPACT
2:12:07 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of HOUSE BILL NO. 184 "An Act requiring state
participation in a tribal child welfare compact."
2:12:41 PM
REPRESENTATIVE TIFFANY ZULKOSKY, Alaska State Legislature,
Juneau, Alaska, sponsor of HB 184 stated that this legislation
seeks to protect the implementation of the Alaska Tribal Child
Welfare Compact by codifying it in Alaska statute.
REPRESENTATIVE ZULKOSKY explained that the State of Alaska
entered the landmark Tribal Child Welfare Compact (Compact) with
18 Tribal cosigners, representing 161 federally-recognized
Alaska Native Tribes. The Alaska Tribal Child Welfare Compact
would offer the state systemic innovation to provide services
and care that every child deserves. She offered her view that
there were elements in this policy that all legislators could
embrace. If fully implemented, it could save the state millions
of dollars over time and transform a struggling child welfare
system with its policies.
REPRESENTATIVE ZULKOSKY turned to slide 2, Why the Work Began.
REPRESENTATIVE ZULKOSKY highlighted that the Office of
Children's Services (OCS) has high staff turnover rates and
frontline workers carry caseloads more than three times the
national average despite the legislature's efforts to address
the issue.
REPRESENTATIVE ZULKOSKY stated that Alaska Native children make
up 15 percent of Alaska's children but roughly 60 percent of the
children in state custody. She said disparities of this nature
generally indicate a failure in the child welfare system.
2:14:20 PM
REPRESENTATIVE ZULKOSKY turned to slide 3, How the Work Began.
She stated that tribes, the state, and invited stakeholders had
worked collaboratively on child welfare issues for over 25 years
through tribal and state efforts. The goals are to strengthen
Alaska's compliance with the Indian Child Welfare Act (ICWA) of
1978, reduce the disproportionality of Alaska Native children in
state custody, and build and strengthen the relationships
between stakeholder groups.
REPRESENTATIVE ZULKOSKY stated that Tribal Title IV-E agreements
provide tribes with a higher federal reimbursement rate than
states for services including foster care, guardianship, and
adoption assistance. This means that tribal and state
partnerships can leverage increased federal funding and save
state dollars.
2:15:08 PM
REPRESENTATIVE ZULKOSKY reviewed slide 4, What is Alaska's
Tribal Child Welfare Compact, which read:
[Original punctuation provided.]
The Alaska Tribal Welfare Compact (Compact) is a
government-to-government agreement to improve the life
outcomes for Alaska's children and families by
transferring specific, negotiated child welfare
services and supports (including revenue streams) from
the Office of Children's Services (OCS) to the Tribal
CoSigners
The Compact was signed in 2017 by Governor Walker and
18 Tribal Co-Signers; representing 161 Federally-
recognized Tribes and Tribal Organizations and
continued under Governor Dunleavy in 2019
REPRESENTATIVE ZULKOSKY asked members to keep in mind that the
Alaska Tribal Child Welfare Compact does not transfer the
jurisdiction of the child to the tribe. It remains solely with
the state. She said that tribes are better positioned than OCS
to focus on prevention and early intervention strategies for
vulnerable families using the compact.
2:15:46 PM
REPRESENTATIVE ZULKOSKY reviewed slide 5, Implementation
Timeline.
[Original punctuation provided.]
2018
square4 Tribal Co-Signers developed their programs, built
capacity and infrastructure
square4 OCS began sharing Protective Services Reports
(PSRs or 'screen ins' or 'screen outs'), and provided
training and technical support
2019
square4 Tribal Co-Signers began performing Initial Diligent
Relative Searches
square4 The Parties negotiated four new Scopes of Work for
Ongoing Relatives Searches, Family Contact,
Licensing Assists, and Safety Evaluations
square4 State-Tribal partnership was stalled due to a change
in Administration
REPRESENTATIVE ZULKOSKY noted that the tribes and OCS were
grateful for the support of Governors Walker and Dunleavy.
Still, because it is not in statute but is an executive
initiative, this adds significant ambiguity to the vital work
done under the Compact.
2:16:19 PM
REPRESENTATIVE ZULKOSKY reviewed slide 6, Implementation
Timeline.
[Original punctuation provided.]
2020
square4 Parties worked out differences and signed all five
previously -negotiated Scopes:
square4 Initial Diligent Relative Searches (IDRS)
square4 Ongoing Relative Searches (ORS)
square4 Family Contact
square4 Licensing Assists
square4 Safety Evaluations
2021
square4 Compact negotiations included all previously -
negotiated scopes of work and added funding for
preventative services
2022
square4 Negotiations will occur in April 2022
2:16:53 PM
REPRESENTATIVE ZULKOSKY reviewed slide 7, Advantages.
[Original punctuation provided.]
square4 Provides higher quality services, closer to home,
at a lower cost through leveraging Tribal
resources
square4 Strengthens state services by engaging Tribes,
often the most local government, on an issue of
shared interest
square4 Increased public trust through existing family
relationships with Tribes
square4 Preventative services lower ACE scores
square4 ACEs are potentially traumatic events that
occur in childhood (0-17 years) and can lead to
chronic health problems, mental illness,
substance abuse disorders and increased
incarceration in adulthood.
2:17:54 PM
REPRESENTATIVE ZULKOSKY reviewed slide 8, Sectional Analysis.
Section 1: Amends AS 47.05 to add a new section to
article 1 requiring the State to participate in a
Tribal Child Welfare Compact.
2:18:11 PM
REPRESENTATIVE ZULKOSKY explained the timing for HB 184.
Currently, the Tribal Child Welfare Compact is accomplished by
executive initiative. She said HB 184 seeks to provide a firm
anchor in state law for the ongoing implementation of the
Compact with zero fiscal impact. This bill would give the co-
signers stability and predictability to administer quality
programs to vulnerable youth and families in the most remote
parts of the state without worrying about whether the Compact
will continue.
REPRESENTATIVE ZULKOSKY acknowledged that legislators often hear
statistics that generally lead to good policy. Still, they also
provide distance between the legislature's decisions and their
consequential effects on families. She said that is why this
bill and the Compact are fascinating. The Tribal Child Welfare
Compact is not just a positive step in the state's relationship
with its tribal partners, it is also an innovative and forward-
thinking policy that reaches children and families in a
meaningful way.
2:19:58 PM
SENATOR REINBOLD commented that she had heard numerous
complaints about OCS and was seeking solutions. She wondered
about the discrepancy between the 161 tribes mentioned today and
the 229 tribes mentioned during a hearing on another bill.
REPRESENTATIVE ZULKOSKY answered that there are 229 federally-
recognized tribes in Alaska. This initiative is a state and
tribal compact, which means that the state and tribal co-signers
are signing on in an agreement to provide specifically
negotiated scopes of work. She referred to slide 4, which shows
that 18 tribal co-signers represent 161 of the 229 federally-
recognized tribes in Alaska.
2:21:35 PM
SENATOR REINBOLD wondered how tribes were identified.
REPRESENTATIVE ZULKOSKY deferred the question to Nicole
Borromeo, General Counsel, Alaska Federation of Natives.
CHAIR WILSON reiterated that the question for Ms. Borromeo was
how tribal membership is established.
2:22:51 PM
SENATOR REINBOLD asked whether the Alaska Tribal Child Welfare
Compact would only impact children in Alaska or if it would
affect tribes in other states.
REPRESENTATIVE ZULKOSKY answered that Alaska Tribal Child
Welfare Compact is a negotiated agreement between Alaska's
federally-recognized tribes and the state concerning specific
work being done through the Office of Children's Services (OCS).
She explained that the jurisdiction of the child remains with
the state. The tribes are leveraging their resources and
relationships to offer support to OCS in diligent and ongoing
relative searches, family contacts, licensing assistance, and
safety evaluations.
2:24:20 PM
SENATOR REINBOLD related a scenario involving a woman from
another state whose divorce led to a jurisdictional dispute. She
stated that she was trying to understand the impacts of HB 184.
2:25:12 PM
SENATOR COSTELLO stated that she had questions similar to the
ones Senator Reinbold had asked regarding the number of tribes
and how tribal membership is defined. She wondered about the
number of children helped by the Alaska Tribal Child Welfare
Compact and in which communities they reside.
REPRESENTATIVE ZULKOSKY deferred to invited testifiers to
discuss the type of support that tribes have provided to
families and clarify the scope of the compact. She stated that
the compact seeks to leverage support and provide diligent
relative searches, but the custody of the child remains with the
state.
2:26:45 PM
SENATOR COSTELLO wondered about the number of children and where
they were located. She related her understanding that HB 184
requires the state to participate in a compact, which typically
is government-to-government. She stated that in the past, the
compact was something the executive branch initiated with the
tribes. She asked whether the Alaska Tribal Child Welfare
Compact would violate any balance of power between the
legislative and executive branches. She noted that the executive
branch and federally-recognized tribes have already been doing
this successfully. If this is allowed, she wondered what would
keep the legislature from forcing the executive branch to enter
into compacts in other areas such that that it would dilute the
power of the executive branch.
REPRESENTATIVE ZULKOSKY responded that the intent of HB 184 was
to protect, provide clarity, and allow the state to continue to
explore the state and tribal relations as it relates to the
compact. She stated that nothing in HB 184 would compel the
state to specific negotiations, agreements, or funding levels.
She noted that those negotiated scopes of work and funding
agreements that accompany them were at the discretion of the
state and the tribes. She indicated that she intended to protect
this systematic innovation by codifying it in statute. She
indicated she was open to suggestions to provide clarity and
ensure protection for the excellent work of the compact without
running into constitutional issues.
2:29:53 PM
SENATOR HUGHES asked whether this approach has resulted in
improvements.
REPRESENTATIVE ZULKOSKY deferred to Nicole Borromeo to respond.
2:30:58 PM
SENATOR BEGICH stated that the bill uses the directive language
"shall enter into agreements." He asked why that language was
necessary.
REPRESENTATIVE ZULKOSKY responded that the intent was to codify
the expectation and intent that the tribal compacts would
continue to accomplish the work that needs to be done.
2:31:53 PM
SENATOR BEGICH related his understanding that "shall" means that
if a compact is negotiated between the department and state, the
state must adhere to it. He offered his view that would be good
intent, but he was unsure whether he had fairly described it.
REPRESENTATIVE ZULKOSKY responded that the state and the tribes
would negotiate yearly in any compact. She characterized it as
essentially doing an annual program evaluation to determine what
is successful, what needs additional work, and any funding
agreements to align with that work. She indicated that "shall"
was used because the state and tribes have agreed on the scope
of work and funding. She acknowledged that there might be
concerns. Ultimately, the goal is to codify the innovation being
accomplished between the state and the tribes by protecting that
work in statute.
2:33:32 PM
SENATOR BEGICH stated that she had affirmed the certainty of the
bill.
2:33:40 PM
CHAIR WILSON turned to invited testimony.
2:34:40 PM
At ease
2:35:26 PM
CHAIR WILSON reconvened the meeting.
2:36:00 PM
TRACI MCGARRY, Director, Children & Family Services; Child
Advocacy Center, Kawerak Inc., Nome, Alaska, provided invited
testimony supporting HB 184. She said she speaks on behalf of
the three Alaska Tribal Child Welfare Compact co-leaders and 15
co-signers representing 161 of the 229 Alaska Native Tribes
throughout the state. She said she had been the director for 10
years. She noted that Alaska Native tribes know what is best for
their children and Alaska Native families and communities are
the best places for their children to thrive. Alaska Native
children steeped in the love, values, and cultures of their
tribe have the best chance of being healthy, engaged members of
society.
MS. MCGARRY reminded members that this compact is the first
agreement in the nation between the state and tribal
organizations to transfer certain negotiated child welfare
services and associated funding streams to tribes and tribal
organizations to administer on behalf of the state. She said the
goal of the compact is to improve child welfare by including and
investing in tribes. She noted that codifying the compact into
state law ensures that tribes can invest in infrastructure and
longevity of staff and not worry about future funding. This
allows co-signers to focus on the most important work, the
children and families of Alaska. She stated that tribes and
tribal organizations have worked alongside the Office of
Children's Services (OCS) for many years. This compact would
solidify the commitment of both parties to improve outcomes for
all children, Native and non-Native, in state custody. She
suggested that co-signers can provide efficient, effective child
welfare work in children's home communities. She urged members
to move HB 184 from committee.
2:38:29 PM
SENATOR HUGHES asked for data showing improvements in outcomes
over the last 10 years.
MS. MCGARRY responded that the implementation process is
ongoing. She related that Casey Family Programs, a clinical case
management organization, recently provided training to the state
and tribes on implementation science. She has been working on
ensuring that the scopes are appropriately implemented. She
stated that, parents, foster parents and grandparents don't want
their children in state custody, so being able to care for their
children was important. She explained that the infrastructure
support that the state provides through the Alaska Tribal Child
Welfare Compact would allow the tribes and tribal entities to do
preventative work instead of handling crises. She stated that
Kawerak's staff has been able to conduct relative searches.
Although she did not have specific figures, she indicated that
Kawerak had been able to hire someone via the compact. This has
resulted in moving children into relative placements earlier
than in the past. She noted that Kawerak could not have hired
that person without the funding that the Alaska Tribal Child
Welfare Compact provided.
2:40:10 PM
SENATOR HUGHES said it is a challenging world right now, and
these children need help. She expressed an interest in learning
more about the successes.
2:40:26 PM
SENATOR BEGICH reinforced Ms. McGarry's comments regarding
certainty because it allows tribes and tribal entities to
recruit and retain child welfare staff with the highest
turnover. He surmised that it goes to Senator Hughes' concern
about outcomes because experienced caseworkers are often the
most effective ones. He emphasized that it makes sense to
support HB 184 because of the level of certainty it would
provide.
2:41:32 PM
NICOLE BORROMEO, Executive Vice President; General Counsel,
Alaska Federation of Natives (AFN), Anchorage, Alaska, stated
that she had held this position since 2014. She said she has
served as the facilitator for the Alaska Tribal Child Welfare
Compact.
MS. BORROMEO, in response to Senator Reinbold's question about
how tribes determine membership, explained that membership is
based on a case-by-case determination by the 229 federally-
recognized tribes, but there are 574 federally-recognized tribes
throughout the nation. She said each tribe is an independent
sovereign with its policies and procedures for determining
tribal membership. In the 1970s, the US Supreme Court in Morton
v. Mancari [417 U.S. 535 (1974] held that how a tribe defines
its membership was up to each tribe. The federal government will
not second-guess tribal involvement. Most tribes have an
eligibility process, such that children are eligible in most
instances if their parents are enrolled members of the tribe or
if they are eligible for membership in the tribe.
2:44:20 PM
SENATOR REINBOLD asked for an example of tribal eligibility for
one of the tribes.
2:44:44 PM
MS. BORROMEO responded that several criteria applied. For
example, a number of tribes have blood quantum criteria;
however, that was more popular in the early 70s and 80s, and
many tribes are moving away from blood quantum. Some tribes had
geographic requirements, such as living on a reservation or in a
village. She noted that except for Metlakatla, an Indian
Reserve, Alaska does not have reservations. She said those were
traditional criteria; whether the tribes adhere to the
requirements is up to the individual tribes.
2:45:50 PM
SENATOR COSTELLO related her understanding that HB 184 would
require the executive branch to have a compact. She asked
whether this was something new and if it meant the legislative
branch had a new avenue within the executive branch. For
instance, she asked if the legislature could create compacts to
require the executive branch to enter into agreements or
compacts. She asked whether the Alaska Tribal Child Welfare
Compact would continue without this bill under a subsequent
administration.
2:46:47 PM
MS. BORROMEO related her understanding that the questions all
relate to whether HB 184 would upset the balance of power
between the executive and legislative branches of government.
She responded that the short answer was no. She suggested that
if members think of the Alaska Tribal Child Welfare Compact
(Compact) as a regulation, the legislature would be codifying
the regulation. It would cement the Alaska Tribal Child Welfare
Compact more permanently in state law. It would make it easier
for future administrations to move forward with the compact and
for tribal co-signers to plan on its existence each year. She
explained that compacts could be authorized by statute or by
executive branch action. She noted that it frequently occurs in
the federal government, such as the Indian Self-Determination
Act and the compacts between Alaska tribal organizations and
tribes for health care services and the delivery of self-
governance-related services. She offered her belief that HB 184
makes it easier for the state and tribes to administer child
welfare services cost-effectively and provide higher quality
services at a lower cost to the state.
2:48:31 PM
MS. BORROMEO, in response to the question on service population,
said it would depend on how the tribal co-signer defined its
service population and service delivery area. For instance, it
would be possible for a co-signer to service a child outside the
State of Alaska if the child was enrolled in the tribe or
eligible for membership in the tribe. She stated that it would
fall under the service-delivery population, not necessarily the
service-delivery area, but generally tied to the village or
region where the tribe or tribal organization operates.
MS. BORROMEO indicated that Representative Zulkosky covered much
of her planned testimony. She reiterated that compacts of this
nature are entirely legal under federal and state law. The
Alaska State Legislature was not being asked to do anything that
would take away from the State of Alaska's jurisdiction over
tribal welfare matters. HB 184 was meant to improve the
administration of children in need of care, Alaska Native or
non-Native children, depending on whether the tribe would like
to provide services to those children. However, only Alaska
Native children were currently being served by the Alaska Tribal
Child Welfare Compact.
2:50:41 PM
VIVIAN KORTHUIS, Chief Executive Officer, Association of Village
Council Presidents (AVCP), Bethel, Alaska, provided invited
testimony in support of HB 184. She stated that AVCP was the
largest tribal consortium in the nation, with 56 federally-
recognized tribes as members, serving tribes on the Yukon River,
Kuskokwim River, and the Bering Sea coast on the Yukon-Kuskokwim
Delta (YKD). She said approximately 30,000 residents live in the
region.
MS. KORTHUIS stated that the Alaska Tribal Child Welfare Compact
is a government-to-government agreement between the State of
Alaska and tribes. She explained that tribes agree to perform
negotiated child welfare services for tribal children on behalf
of the state. Tribes can perform these services efficiently,
effectively, and culturally appropriately. AVCP's executive
board decided to be one of the founding members of the compact
in 2017 because tribes place a high value on their children. She
provided an example of what this means to the YKD region. She
said approximately 500 tribal children from the AVCP region are
in the Office of Children's Service (OCS) custody. She noted
that a medium-sized village in the region would be 500 people.
She said half of the children placed live in homes or facilities
outside the YKD. That figure represents a smaller village in the
region.
2:53:22 PM
MS. KORTHUIS stated that removing a child from their home and
parents is a traumatic experience for any child, even if the
removal was to keep them safe. She asked members to imagine a
child leaving their home, their house, their parents, and
everything familiar to move to Anchorage or another part of
Alaska, which multiplies the trauma. She emphasized that each of
the 500 children are people.
MS. KORTHUIS related that OCS removed an AVCP tribal member's
child from their parent's home in Anchorage. In that case, OCS
contacted AVCP to identify a relative. AVCP found a relative and
completed a safety walk-through of the home. She reported that
the child was able to move to the relative's home in the
village. She highlighted that this was possible because the
Alaska Tribal Child Welfare Compact provided the process for OCS
to make the referral. She said AVCP received the funding to
identify a home and obtain approval. She indicated this was one
way the tribal organization was helping its children through the
compact and why it is so important.
MS. KORTHUIS emphasized that YKD wants their children to remain
in the community whenever possible.
2:55:11 PM
MS. KORTHUIS highlighted another benefit of working with tribes
under the Alaska Tribal Child Welfare Compact: the ability to
leverage resources. She stated that it allows AVCP to leverage
other programs, such as providing potential foster care families
with the equipment they need to become licensed, making
necessary repairs to foster homes, and providing childcare
resources. She emphasized that the children are important,
needed, and represent one of the most valuable resources for all
of the tribes in the region. She said AVCP fully supports the
Alaska Tribal Child Welfare Compact and reaffirms the state's
goal for better outcomes for all of Alaska's children. She
further stated that AVCP supports HB 184 and all of its intent.
2:56:19 PM
CHAIR WILSON opened public testimony on HB 184.
2:56:31 PM
TREVOR STORRS, President; Chief Executive Officer, Alaska
Children's Trust, Anchorage, Alaska, stated that he was speaking
to the committee from the land of the Dena'ina people. As the
statewide lead organization working to prevent child abuse and
neglect, the Alaska Children's Trust strongly supports the
Alaska Tribal Child Welfare Compact.
MR. STORRS stated that Alaska has one of the country's highest
child abuse and neglect rates. Each year the Office of
Children's Services (OCS) receives approximately 20,000 calls,
of which 45 percent result in investigations. As the Department
of Health and Social Services shared this year, OCS continually
struggles with high turnover rates, most recently reported at 60
percent. OCS cannot engage in prevention work with every case it
receives. The Alaska Tribal Child Welfare Compact represents an
innovative approach to strengthening OCS's capacity. Still, it
would allow for culturally appropriate services and support for
Alaska's families in their communities.
2:57:40 PM
MR. STORRS stated that Alaska Native children make up 15 percent
of the state's general population but represent approximately 65
percent of the kids in state custody. The disproportionate
number of Alaska Native children in the OCS system must be
addressed, but it will take long-term sustainable, systemic
change. He emphasized that was exactly what the Alaska Tribal
Child Welfare Compact seeks to accomplish. He reported that over
the last four years, the compact had allowed tribes and tribal
organizations to assist in finding relatives to care for
children, visit homes in advance to ensure safe placement, help
at-risk families before they need OCS intervention, and work
alongside OCS to ensure families have the additional support
they need.
MR. STORRS indicated that this historic, unique compact was
working and needed to be made permanent to address the child
welfare needs. He urged members to support HB 184 to help
prevent child abuse and neglect.
2:58:44 PM
CHAIR WILSON closed public testimony on HB 184.
2:59:00 PM
SENATOR HUGHES remarked that Ms. Korthuis's testimony about
children being removed from the world they know was compelling.
She expressed interest in knowing that the Alaska Tribal Child
Welfare Compact was working well.
2:59:43 PM
CHAIR WILSON suggested that OCS could provide the committee with
data on the effectiveness of the Alaska Tribal Child Welfare
Compact.
REPRESENTATIVE ZULKOSKY thanked the committee. She said this
bill would provide an opportunity to help protect the work being
done collaboratively by the state and tribes.
2:59:57 PM
CHAIR WILSON held HB 184 in committee.
3:02:00 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee meeting at 3:02 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 184 Sectional Analysis version A.pdf |
HHSS 4/22/2021 3:00:00 PM HTRB 5/4/2021 8:00:00 AM SHSS 3/31/2022 1:30:00 PM |
HB 184 |
| HB 184 Sponsor Statement version A.pdf |
HHSS 4/22/2021 3:00:00 PM HTRB 5/4/2021 8:00:00 AM SHSS 3/31/2022 1:30:00 PM |
HB 184 |
| HB 184 LOS_Maniilaq.pdf |
SHSS 3/31/2022 1:30:00 PM |
HB 184 |
| HB 184 LOS_Alaska Childrens Trust.pdf |
HHSS 4/27/2021 3:00:00 PM HTRB 5/4/2021 8:00:00 AM SHSS 3/31/2022 1:30:00 PM |
HB 184 |
| HB 184 LOS_Alaska Regional Coalition.pdf |
HHSS 4/27/2021 3:00:00 PM SHSS 3/31/2022 1:30:00 PM |
HB 184 |
| SB 175 Work Draft v.G.pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |
| SB 175 Testimony 3.21.22.pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |
| SB 175 Letters 3.30.22.pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |
| SB 175 Exp of Changes V.I to V.G.pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |
| HB 184 Letter 3.16.22.pdf |
SHSS 3/31/2022 1:30:00 PM |
HB 184 |
| SB 175 A 1.pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |
| HB 184 Powerpoint 3-31-2022.pdf |
SHSS 3/31/2022 1:30:00 PM |
HB 184 |
| SB 175 A 2.pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |
| HB 184 Powerpoint #2 3.31.22.pdf |
SHSS 3/31/2022 1:30:00 PM |
HB 184 |
| SB 175 Supporting Doc Pay Parity 4.4.22.pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |
| SB 175 Ammendments Considered.pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |
| SB 175 FN BH UPDATED 2.18.22.pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |
| SHSS SB175 Follow-Up Information from CBPL (4.4.22).pdf |
SHSS 3/31/2022 1:30:00 PM |
SB 175 |