Legislature(2021 - 2022)BUTROVICH 205
05/05/2022 01:30 PM Senate HEALTH & SOCIAL SERVICES
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| SB191 | |
| HB392 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 242 | TELECONFERENCED | |
| += | HB 392 | TELECONFERENCED | |
| += | SB 191 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
May 5, 2022
1:35 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Shelley Hughes, Vice Chair
Senator Mia Costello
Senator Lora Reinbold
Senator Tom Begich
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 191
"An Act repealing emergency powers of the commissioner of health
and social services and certain provisions related to the
response to the novel coronavirus disease; and providing for an
effective date."
- MOVED CSSB 191(HSS) OUT OF COMMITTEE
COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 392(HSS) AM
"An Act relating to advanced practice registered nurses and
physician assistants; and relating to death certificates, do not
resuscitate orders, and life sustaining treatment."
- MOVED SCS CSHB 392(HSS) OUT OF COMMITTEE
SENATE BILL NO. 242
"An Act relating to exemptions for the purchase and sale of
certain food products for home consumption under the Alaska Food
Freedom Act."
- BILL HEARING CANCELED
PREVIOUS COMMITTEE ACTION
BILL: SB 191
SHORT TITLE: REPEAL COVID 19 DISASTER EMERGENCY
SPONSOR(s): SENATOR(s) REINBOLD
02/15/22 (S) READ THE FIRST TIME - REFERRALS
02/15/22 (S) HSS, FIN
05/03/22 (S) HSS AT 1:30 PM BUTROVICH 205
05/03/22 (S) Heard & Held
05/03/22 (S) MINUTE(HSS)
05/05/22 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: HB 392
SHORT TITLE: EXPAND ADV PRC REG NURSE, PHYS ASSIS AUTH
SPONSOR(s): REPRESENTATIVE(s) SNYDER
02/22/22 (H) READ THE FIRST TIME - REFERRALS
02/22/22 (H) HSS, L&C
03/24/22 (H) HSS AT 3:00 PM DAVIS 106
03/24/22 (H) -- MEETING CANCELED --
03/29/22 (H) HSS AT 3:00 PM DAVIS 106
03/29/22 (H) Heard & Held
03/29/22 (H) MINUTE(HSS)
03/31/22 (H) HSS AT 3:00 PM DAVIS 106
03/31/22 (H) -- MEETING CANCELED --
04/14/22 (H) HSS AT 3:00 PM DAVIS 106
04/14/22 (H) Moved CSHB 392(HSS) Out of Committee
04/14/22 (H) MINUTE(HSS)
04/20/22 (H) HSS RPT CS(HSS) NEW TITLE 4DP
04/20/22 (H) DP: FIELDS, SPOHNHOLZ, SNYDER, ZULKOSKY
04/20/22 (H) L&C AT 3:15 PM BARNES 124
04/20/22 (H) Heard & Held
04/20/22 (H) MINUTE(L&C)
04/22/22 (H) L&C AT 9:00 AM BARNES 124
04/22/22 (H) Moved CSHB 392(HSS) Out of Committee
04/22/22 (H) MINUTE(L&C)
04/25/22 (H) L&C RPT CS(HSS) NEW TITLE 3DP 1NR
04/25/22 (H) DP: SNYDER, FIELDS, SPOHNHOLZ
04/25/22 (H) NR: SCHRAGE
05/02/22 (H) TRANSMITTED TO (S)
05/02/22 (H) VERSION: CSHB 392(HSS) AM
05/03/22 (S) READ THE FIRST TIME - REFERRALS
05/03/22 (S) HSS
05/03/22 (S) HSS AT 1:30 PM BUTROVICH 205
05/03/22 (S) Heard & Held
05/03/22 (S) MINUTE(HSS)
05/05/22 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
MATT DAVIDSON, Special Assistant to the Commissioner
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions on SB 191.
REPRESENTATIVE LIZ SNYDER
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of HB 392.
ACTION NARRATIVE
1:35:24 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, Hughes, Costello, Begich
and Chair Wilson.
SB 191-REPEAL COVID 19 DISASTER EMERGENCY
1:36:11 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 191
"An Act repealing emergency powers of the commissioner of health
and social services and certain provisions related to the
response to the novel coronavirus disease; and providing for an
effective date."
1:36:25 PM
SENATOR BEGICH asked what the impact would be to the state with
regard to SNAP benefits if SB 191 were to pass.
1:36:59 PM
MATT DAVIDSON, Special Assistant to the Commissioner, Office of
the Commissioner, Department of Health and Social Services
(DHSS), Juneau, Alaska, offered his understanding that due to
the states public health emergency (PHE) declaration, the SNAP
program receives an additional $7.6 million dollars a month in
supplemental benefits to Alaskans.
SENATOR BEGICH asked what triggers the extra benefits and
whether a concomitant declaration is required to receive those
federal funds.
MR. DAVIDSON confirmed that was his understanding; the state
must be under a public health emergency for the supplemental
benefits to be implemented.
1:38:15 PM
SENATOR REINBOLD questioned why the state should have to be in a
public health emergency to receive the enhanced benefits. She
asked how many people this affects.
MR. DAVIDSON said he would have to follow up with the number,
but his understanding is that a PHE is necessary to qualify
because these are supplemental benefits.
1:38:59 PM
SENATOR HUGHES asked him to repeat the amount the state receives
each month in supplemental SNAP benefits.
MR. DAVIDSON replied it's approximately $7.6 million per month.
SENATOR HUGHES asked if there have been any adjustments recently
based on rising inflation.
MR. DAVIDSON said he was not aware of any adjustments to SNAP
due to inflation. The supplement benefits were an enhancement
due to the federal disaster.
SENATOR REINBOLD asked if he could say with certainty that the
state has to be in a state of emergency to receive the
supplemental SNAP benefits.
MR. DAVIDSON stated that he would provide a written response to
the committee.
1:40:56 PM
CHAIR WILSON solicited a motion.
1:40:59 PM
SENATOR BEGICH moved to adopt Amendment 1, work order 32-
LS1497\I.1.
32-LS1497\I.1
Ambrose/Foote
5/4/22
AMENDMENT 1
OFFERED IN THE SENATE BY SENATOR BEGICH
TO: SB 191
Page 1, line 5:
Delete "9, 10,"
Delete "21(b)-(e)"
Insert "21(c) and (e)"
1:41:01 PM
CHAIR WILSON objected for purposes of discussion.
1:41:03 PM
SENATOR BEGICH explain that the amendment removes the references
in the bill to Sections 9 and 10 [ch. 2, SLA 2021] that deal
with charitable gaming and school operating funds respectively.
Legislation on these issues has yet to pass so they could
unnecessarily be affected if they are included in SB 191. The
reference to "21(b) - (e), ch. 2, SLA 2021," is also changed to
"21(c) and (e)" to reflect the removal of Sections 9 and 10.
1:42:43 PM
SENATOR REINBOLD stated that she would support Amendment 1 out
of comradery and to ensure that minority voices are heard.
1:43:22 PM
CHAIR WILSON removed his objection; he found no further
objection and Amendment 1 was adopted.
SENATOR REINBOLD stated her belief that the local, state, and
federal mandates have created a larger disaster than COVID-19
itself. SB 191 responds by stripping what she sees as
illegitimate, illegal constitutional powers from public health
Commissioner Adam Crum. She emphasized that there was no
justification for the continued emergency and the department had
failed to provide data in response to her questions for the past
two years. She thanked the chair for scheduling the hearings on
the bill and asked the members for their support.
CHAIR WILSON solicited the will of the committee.
1:45:10 PM
SENATOR HUGHES moved to report SB 191, work order 32-LS1497\I,
as amended, from committee with individual recommendations and
attached fiscal note(s).
1:45:21 PM
CHAIR WILSON found no objection and CSSB 191(HSS) was reported
from the Senate Health and Social Services Standing Committee.
1:45:30 PM
At ease.
HB 392-EXPAND ADV PRC REG NURSE, PHYS ASSIS AUTH
1:49:24 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of CS FOR HOUSE BILL NO. 392(HSS) am "An Act
relating to advanced practice registered nurses and physician
assistants; and relating to death certificates, do not
resuscitate orders, and life sustaining treatment."
CHAIR WILSON asked the sponsor if she had any comments before
the committee considered amendments.
1:50:03 PM
REPRESENTATIVE LIZ SNYDER, Alaska State Legislature, Juneau,
Alaska, sponsor of HB 392, stated that during the initial
hearing the committee focused on the DNR order in Section 5 that
requires written consent of the patient or the parent or
guardian of a minor patient. Section 10 did not receive much
attention but it explicitly states that a patient that is
capable has the right to make their own health decisions,
including revoking a DNR order that may be made by a physician.
If the bill were to pass, this would also include an advanced
practice registered nurse (APRN) or physician's assistant (PA).
She noted that the health care professional who testified during
the first hearing was referencing this protection that is
already in statute.
REPRESENTATIVE SNYDER explained that AS 13.52.065(b) directs the
department to adopt a protocol for DNR orders, which is subject
to approval by the State Medical Board. That protocol is laid
out in 7 AAC 16.010. When an individual comes in to a health
care facility, the first step is for the health care provider to
determine the patient's identity by one of the following means:
the patient could communicate their identity; the patient's
hospital or institutional arm band; the patient is known to the
health care provider; the patient's driver's license; another
person identified the patient; or with a medical necklace,
bracelet, or information card the patient is wearing. Once the
identity has been determined, the provider must examine the
patient, review patient records, and look to see if there is a
medical bracelet, necklace, or card that identifies the
individual's DNR status. The patient can provide their DNR
status if they're awake, and the provider could look to see if a
Physician Orders for Life Sustaining Treatment (POLST) form is
on file. This is a form that is filled out in consultation
between the patient and health care provider documenting what
the individual wants to do if a DNR is in question. She
confirmed that the patient's signature on the POLST form is
voluntary and that there was good reason. Some people are
physically unable to sign, but the form is filled out in
consultation with their physician. She acknowledged that absent
a POLST or any clear direction from the patient about their DNR
wishes, an attending physician can assess the patient and make a
determination about whether a DNR order is appropriate.
REPRESENTATIVE SNYDER highlighted that that according to the DNR
protocol that is in regulation, CPR must be administered until
items 1 and 2 have been worked through and confirmed. That is
the current issue. As currently written, Section 5, requires the
written consent no matter what. This ensures the patient, their
surrogate, or guardian is making an informed decision on a DNR
order, but it's made it impossible for medical professionals to
respond in other acute instances where the consent process is
not possible. Medical professionals have voiced concern that
physicians in an emergency department would have to perform CPR
in situations where it was not in the best interest of the
patient.
REPRESENTATIVE SNYDER urged the committee to find a way to
ensure that consent when possible is obtained and documented,
and when it's not possible to rely on the DNR protocol that's in
regulation.
1:57:38 PM
SENATOR HUGHES asked what items 1 and 2 are in the protocol for
an attending physician to assess the patient and make a
determination about whether issuing a DNR order is appropriate.
REPRESENTATIVE SNYDER answered that those are the steps to first
identify the patient and second to determine whether there is or
is not a documented DNR order or completed POLST form. In the
absence of these things, regulation authorizes a physician to
make the determination about whether issuing a DNR order is
appropriate in the particular situation.
1:58:45 PM
SENATOR HUGHES expressed concern that just one physician could
make this decision after going through steps 1 and 2 and
assessing the immediate situation. Her preference would be to
have several physicians in consultation come to agreement on
whether it was appropriate to issue a DNR order. She
acknowledged that this was beyond the scope of the bill, but
suggested that the issue probably needed to be revisited because
it was too much power and responsibility to be vested in just
one physician.
2:00:18 PM
SENATOR REINBOLD said it's an important point, particularly in
light of the COVID-19 mandates that blocked patient advocacy.
CHAIR WILSON noted that Senator Costello had an amendment for
the committee to consider.
2:01:27 PM
At ease.
2:02:35 PM
CHAIR WILSON reconvened the meeting and solicited a motion.
2:02:38 PM
SENATOR COSTELLO moved to adopt Amendment 1.
AMENDMENT 1
Page 3, line 5:
Delete "written"
2:02:40 PM
CHAIR WILSON objected for purposes of discussion.
2:02:41 PM
SENATOR COSTELLO stated that Amendment 1 removes the word
"written" because the physician's order for life sustaining
treatment (POLST) form, which is filled out in consultation with
the patient and placed in a national database, does not require
the patient's signature. The patient's signature is voluntary
and it can be witnessed. As currently written, the bill negates
all existing POLST forms that do not have a patient signature.
The amendment does not remove the requirement in Section 5 for
consent from the patient [or the parent or guardian of a minor
patient]. The amendment only removes the requirement for the
consent to be in writing.
2:05:24 PM
SENATOR HUGHES summarized her understanding that a POLST form
would be filled out in consultation between an individual and
their physician, it may or may not be signed, the form would be
filed in a national database, and it would remain valid until
the individual opted to change it. She asked if that was an
accurate characterization.
2:06:16 PM
At ease.
2:10:00 PM
CHAIR WILSON reconvened the meeting.
2:10:03 PM
SENATOR BEGICH read the following about POLST forms, noting that
46 states have these forms:
Health care providers should complete this form only
after a conversation with the patient or the patient's
representative. A POLST decision-making process is for
patients who are at risk for a life-threatening
clinical event because they have a serious life-
limiting medical condition, which may include advanced
frailty.
The POLST form is a medical order, which means that
the POLST form is always signed by a medical
professional and, depending upon the state, the person
stated on the form can sign as well.
SENATOR BEGICH highlighted that in Alaska the patient's
signature on the POLST form is optional. He continued to read:
A pragmatic rule for initiating a POLST can be if the
clinician would not be surprised if the individual
were to die within one year.
One difference between the POLST form and an advanced
directive is that the POLST form is designated to be
actionable throughout an entire community. It is
immediately recognizable and can be used by doctors
and first responders, including paramedics, fire
departments, police, emergency rooms, hospitals and
nursing homes.
2:11:37 PM
SENATOR COSTELLO summarized that a POLST is a medical order that
allows the individual to convey their wishes about receiving
CPR, including mechanical ventilation, defibrillation and
cardioversion should they be incapacitated.
SENATOR HUGHES also pointed out that a POLST form allows for a
patient to designate a representative if they so desire.
2:12:39 PM
CHAIR WILSON removed his objection; he found no further
objection, and Amendment 1 was adopted.
SENATOR HUGHES commented that she was very impressed that both
PAs and APRNs have assumed greater responsibility and helped to
improve access to more affordable health care in the state. The
training they receive has become more comparable to the training
physicians receive so it makes sense to give them this added
authority.
2:13:58 PM
SENATOR HUGHES moved to report HB 392, work order 32-LS1561\B.A,
as amended, from committee with individual recommendations and
attached fiscal note(s).
2:14:14 PM
CHAIR WILSON found no objection and SCS CSHB 392(HSS) was
reported from the Senate Health and Social Services Standing
Committee.
CHAIR WILSON thanked the committee and support staff for their
work.
SENATOR REINBOLD thanked the chair for hiring good staff.
SENATOR BEGICH thanked Chair Wilson for running the committee
for the last six years.
SENATOR HUGHES commented that she avoided sitting on this
committee initially, but she enjoyed it.
2:16:29 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee meeting at 2:16 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 191 Ammendment 5.5.22.pdf |
SHSS 5/5/2022 1:30:00 PM |
SB 191 |
| HB 392 Testimony 5.5.22.pdf |
SHSS 5/5/2022 1:30:00 PM |
HB 392 |
| HB 392 Ammendment 1 5.5.22.pdf |
SHSS 5/5/2022 1:30:00 PM |
HB 392 |
| HB 392 AK POLST Form.pdf |
SHSS 5/5/2022 1:30:00 PM |
HB 392 |