00 SENATE CS FOR HOUSE BILL NO. 36(JUD) 01 "An Act relating to treatment foster homes; relating to the examination and treatment 02 of minors; relating to consent for behavioral and mental health treatment for minors 16 03 years of age or older; relating to the placement of foster children in hospitals and 04 residential psychiatric treatment centers for psychiatric care; relating to the duties of 05 the Department of Family and Community Services; relating to the care of children in 06 state custody placed in psychiatric residential treatment facilities outside the state; 07 amending Rule 12.1(b), Alaska Child in Need of Aid Rules of Procedure; and providing 08 for an effective date." 09 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 10  * Section 1. AS 12.62.400(a)(25) is amended to read: 11 (25) licensure, license renewal, certification, or certification renewal 12 by the Department of Family and Community Services of an individual or entity, or 01 payment from the Department of Family and Community Services to an individual or 02 entity, subject to the requirements for a criminal history check under AS 47.05.310 for 03 an entity [A FOSTER HOME, CHILD PLACEMENT AGENCY, AND RUNAWAY 04 SHELTER] listed in AS 47.32.010(c), including an owner, officer, director, member, 05 partner, employee, volunteer, or contractor of an entity. 06  * Sec. 2. AS 25.20.025(a) is amended to read: 07 (a) Except as prohibited under AS 18.16.010(a)(3), 08 (1) a minor who provides documentation required under (d) of this  09 section demonstrating that the minor is an unaccompanied homeless minor or a 10 minor who is living apart from the minor's parents or legal guardian and who is 11 managing the minor's own financial affairs, regardless of the source or extent of 12 income, may give consent for medical, behavioral, mental health, and dental services 13 for the minor; 14 (2) a minor may give consent for medical and dental services if the 15 parent or legal guardian of the minor cannot be contacted or, if contacted, is unwilling 16 either to grant or withhold consent; however, where the parent or legal guardian 17 cannot be contacted or, if contacted, is unwilling either to grant or to withhold consent, 18 the provider of medical or dental services shall counsel the minor keeping in mind not 19 only the valid interests of the minor but also the valid interests of the parent or 20 guardian and the family unit as best the provider presumes them; 21 (3) a minor who is the parent of a child may give consent to medical,  22 behavioral, mental health, and dental services for the minor or the child; 23 (4) a minor may give consent for diagnosis, prevention or treatment of 24 pregnancy, and for diagnosis and treatment of venereal disease; 25 (5) the parent or guardian of the minor is relieved of all financial 26 obligation to the provider of the service under this section. 27  * Sec. 3. AS 25.20.025 is amended by adding a new subsection to read: 28 (d) To establish that a minor is a homeless unaccompanied minor for purposes 29 of giving consent under (a)(1) of this section, the minor must possess documentation 30 stating that the minor is 16 years of age or older, does not have a fixed, regular, 31 adequate nighttime residence, and is not in the care and physical custody of a parent or 01 guardian. The document must be signed by 02 (1) a director or the designee of a director of a governmental or 03 nonprofit entity that receives public or private funding to provide services to 04 individuals who are homeless; 05 (2) a local educational agency liaison for homeless children and youth 06 designated under 42 U.S.C. 11432(g)(1)(J)(ii), a local educational agency foster care 07 point of contact designated under 20 U.S.C. 6312(c)(5)(A), or a licensed clinical social 08 worker employed by a school in the state; 09 (3) an attorney who represents the minor in any legal matter; or 10 (4) the minor and two adults with actual knowledge of the minor's 11 circumstances. 12  * Sec. 4. AS 25.20 is amended by adding a new section to read: 13 Sec. 25.20.028. Behavioral and mental health treatment of minors. (a) A 14 minor who is 16 years of age or older may give consent to receive outpatient 15 behavioral or mental health services from a mental health provider for up to five 16 outpatient appointments of up to 90 minutes each. A mental health provider may not 17 prescribe medication to a minor receiving behavioral or mental health services without 18 obtaining the consent of the minor's parent or guardian. After the fifth appointment, a 19 mental health provider may continue to provide behavioral or mental health services to 20 the minor only as provided in (b) or (c) of this section. 21 (b) Not later than the fifth appointment and upon consultation with the minor, 22 the mental health provider, in conjunction with the provider's supervisor if the mental 23 health provider has a supervisor, shall determine whether attempting to obtain the 24 consent of the minor's parent or guardian to provide behavioral or mental health 25 services would be detrimental to the minor's well-being. Attempting to obtain the 26 consent of the minor's parent or guardian would be detrimental to the minor's well- 27 being if 28 (1) the behavioral or mental health services are related to allegations of 29 neglect, sexual abuse, or mental or physical abuse by the minor's parent or guardian; 30 or 31 (2) the mental health provider finds that 01 (A) requiring the consent of the minor's parent or guardian 02 would cause the minor to reject behavioral or mental health services; 03 (B) failing to provide behavioral or mental health services to 04 the minor would be detrimental to the minor's well-being; 05 (C) the minor sought behavioral or mental health services 06 knowingly and voluntarily; and 07 (D) the minor has the maturity to productively participate in 08 behavioral or mental health services. 09 (c) If the mental health provider determines that attempting to obtain the 10 consent of the minor's parent or guardian would not be detrimental to the minor's well- 11 being, the mental health provider shall inform the minor that the consent of the minor's 12 parent or guardian is required to continue providing behavioral or mental health 13 services to the minor. The mental health provider shall discontinue behavioral or 14 mental health services to a minor who does not permit the mental health provider to 15 obtain the consent of the minor's parent or guardian and notify the minor's parent or 16 guardian that the services were provided. If the minor permits the mental health 17 provider to obtain the consent of the minor's parent or guardian, the mental health 18 provider shall make reasonable attempts to obtain that consent. The mental health 19 provider shall document each attempt to obtain consent in the minor's clinical record. 20 The mental health provider may continue to provide behavioral or mental health 21 services to the minor without the consent of the minor's parent or guardian if 22 (1) the mental health provider has made at least two unsuccessful 23 attempts to contact the minor's parent or guardian to obtain consent by mail, electronic 24 mail, or telephone; and 25 (2) the mental health provider has the written consent of the minor. 26 (d) If the mental health provider determines that attempting to obtain the 27 consent of the minor's parent or guardian would be detrimental to the minor's well- 28 being, the mental health provider shall document the basis for the determination in the 29 minor's clinical record. The mental health provider may continue to provide behavioral 30 or mental health services to the minor upon the minor's written consent. The mental 31 health provider and the mental health provider's supervisor, if the mental health 01 provider has a supervisor, shall evaluate the determination made under (b) of this 02 section every 60 days until either the mental health provider discontinues providing 03 services to the minor or the minor turns 18 years of age. 04 (e) A mental health provider may not inform the parent or guardian of a minor 05 receiving behavioral or mental health services under (d) of this section of those 06 services without the written consent of the minor. A mental health provider shall 07 inform a minor before disclosing to the minor's parent or guardian information 08 regarding any behavioral or mental health services provided to the minor. The mental 09 health provider may not disclose the information to the parent or guardian if the minor 10 discontinues the behavioral or mental health services upon being informed of the 11 mental health provider's intent. A mental health provider may deny a minor's parent or 12 guardian access to any part of the minor's clinical record if the mental health provider 13 has compelling reasons for the denial. 14 (f) The parent or guardian of a minor is relieved of all financial obligation to 15 the provider of a service under this section. 16 (g) Nothing in this section may be construed to remove liability of the person 17 performing the examination or treatment for failure to meet the standards of care 18 common throughout the health professions in the state or for intentional misconduct. 19 (h) In this section, "mental health provider" means a behavioral health 20 professional as defined in AS 14.30.174(b) and a mental health professional as defined 21 in AS 47.30.915. 22  * Sec. 5. AS 47.07.020(b) is amended to read: 23 (b) In addition to the persons specified in (a) of this section, the following 24 optional groups of persons for whom the state may claim federal financial 25 participation are eligible for medical assistance: 26 (1) persons eligible for but not receiving assistance under any plan of 27 the state approved under 42 U.S.C. 1381 - 1383c (Title XVI, Social Security Act, 28 Supplemental Security Income) or a federal program designated as the successor to the 29 aid to families with dependent children program; 30 (2) persons in a general hospital, skilled nursing facility, or 31 intermediate care facility, who, if they left the facility, would be eligible for assistance 01 under one of the federal programs specified in (1) of this subsection; 02 (3) persons under 21 years of age who are under supervision of the 03 department, for whom maintenance is being paid in whole or in part from public 04 funds, and who are in foster homes, treatment foster homes, or private child-care 05 institutions; in this paragraph, "treatment foster home" has the meaning given in  06 AS 47.32.900;  07 (4) aged, blind, or disabled persons, who, because they do not meet 08 income and resources requirements, do not receive supplemental security income 09 under 42 U.S.C. 1381 - 1383c (Title XVI, Social Security Act), and who do not 10 receive a mandatory state supplement, but who are eligible, or would be eligible if 11 they were not in a skilled nursing facility or intermediate care facility to receive an 12 optional state supplementary payment; 13 (5) persons under 21 years of age who are in an institution designated 14 as an intermediate care facility for persons with intellectual and developmental 15 disabilities and who are financially eligible as determined by the standards of the 16 federal program designated as the successor to the aid to families with dependent 17 children program; 18 (6) persons in a medical or intermediate care facility whose income 19 while in the facility does not exceed 300 percent of the supplemental security income 20 benefit rate under 42 U.S.C. 1381 - 1383c (Title XVI, Social Security Act) but who 21 would not be eligible for an optional state supplementary payment if they left the 22 hospital or other facility; 23 (7) persons under 21 years of age who are receiving active treatment in 24 a psychiatric hospital and who are financially eligible as determined by the standards 25 of the federal program designated as the successor to the aid to families with 26 dependent children program; 27 (8) persons under 21 years of age and not covered under (a) of this 28 section, who would be eligible for benefits under the federal program designated as 29 the successor to the aid to families with dependent children program, except that they 30 have the care and support of both their natural and adoptive parents; 31 (9) pregnant women not covered under (a) of this section and who 01 meet the income and resource requirements of the federal program designated as the 02 successor to the aid to families with dependent children program; 03 (10) persons under 21 years of age not covered under (a) of this section 04 who the department has determined cannot be placed for adoption without medical 05 assistance because of a special need for medical or rehabilitative care and who the 06 department has determined are hard-to-place children eligible for subsidy under 07 AS 25.23.190 - 25.23.210; 08 (11) persons who can be considered under 42 U.S.C. 1396a(e)(3) (Title 09 XIX, Social Security Act, Medical Assistance) to be individuals with respect to whom 10 a supplemental security income is being paid under 42 U.S.C. 1381 - 1383c (Title 11 XVI, Social Security Act) because they meet all of the following criteria: 12 (A) they are 18 years of age or younger and qualify as disabled 13 individuals under 42 U.S.C. 1382c(a) (Title XVI, Social Security Act); 14 (B) the department has determined that 15 (i) they require a level of care provided in a hospital, 16 nursing facility, or intermediate care facility for persons with 17 intellectual and developmental disabilities; 18 (ii) it is appropriate to provide their care outside of an 19 institution; and 20 (iii) the estimated amount that would be spent for 21 medical assistance for their individual care outside an institution is not 22 greater than the estimated amount that would otherwise be expended 23 individually for medical assistance within an appropriate institution; 24 (C) if they were in a medical institution, they would be eligible 25 for medical assistance under other provisions of this chapter; and 26 (D) home and community-based services under a waiver 27 approved by the federal government are either not available to them under this 28 chapter or would be inappropriate for them; 29 (12) disabled persons, as described in 42 U.S.C. 30 1396a(a)(10)(A)(ii)(XIII), who are in families whose income, as determined under 31 applicable federal regulations or guidelines, is less than 250 percent of the official 01 poverty line applicable to a family of that size according to the United States 02 Department of Health and Human Services, and who, but for earnings in excess of the 03 limit established under 42 U.S.C. 1396d(q)(2)(B), would be considered to be 04 individuals with respect to whom a supplemental security income is being paid under 05 42 U.S.C. 1381 - 1383c; a person eligible for assistance under this paragraph who is 06 not eligible under another provision of this section shall pay a premium or other cost- 07 sharing charges according to a sliding fee scale that is based on income as established 08 by the department in regulations; 09 (13) persons under 19 years of age who are not covered under (a) of 10 this section and whose household income does not exceed 175 percent of the federal 11 poverty line as defined by the United States Department of Health and Human 12 Services and revised under 42 U.S.C. 9902(2); 13 (14) pregnant women who are not covered under (a) of this section and 14 whose household income does not exceed 225 percent of the federal poverty line as 15 defined by the United States Department of Health and Human Services and revised 16 under 42 U.S.C. 9902(2); 17 (15) persons who have been diagnosed with breast or cervical cancer 18 and who are eligible for coverage under 42 U.S.C. 1396a(a)(10)(A)(ii)(XVIII). 19  * Sec. 6. AS 47.10.084(c) is amended to read: 20 (c) When there has been transfer of legal custody or appointment of a guardian 21 and parental rights have not been terminated by court decree, the parents shall have 22 residual rights and responsibilities. These residual rights and responsibilities of the 23 parent include, but are not limited to, the right and responsibility of reasonable 24 visitation, consent to adoption, consent to marriage, consent to military enlistment, 25 consent to major medical treatment except in cases of emergency or cases falling 26 under AS 25.20.025 or 25.20.028, and the responsibility for support, except if by court 27 order any residual right and responsibility has been delegated to a guardian under (b) 28 of this section. In this subsection, "major medical treatment" includes the 29 administration of medication used to treat a mental health disorder. 30  * Sec. 7. AS 47.10.087 is amended to read: 31 Sec. 47.10.087. Placement in [SECURE] residential psychiatric treatment  01 center. (a) The court may authorize the department to place a child who is in the 02 custody of the department under AS 47.10.080(c)(1) or (3) or 47.10.142 in a 03 [SECURE] residential psychiatric treatment center if the court finds, based on the 04 testimony of a mental health professional, that 05 (1) the child is gravely disabled or is suffering from mental illness and, 06 as a result, is likely to cause serious harm to the child or to another person; 07 (2) there is no reasonably available, appropriate, and less restrictive 08 alternative for the child's treatment or that less restrictive alternatives have been tried 09 and have failed; and 10 (3) there is reason to believe that the child's mental condition could be 11 improved by the course of treatment or would deteriorate if untreated. 12 (b) A court shall review a placement made under this section at least once 13 every 90 days. The court may authorize the department to continue the placement of 14 the child in a [SECURE] residential psychiatric treatment center if the court finds, 15 based on the testimony of a mental health professional, that the conditions or 16 symptoms that resulted in the initial order have not ameliorated to such an extent that 17 the child's needs can be met in a less restrictive setting and that the child's mental 18 condition could be improved by the course of treatment or would deteriorate if 19 untreated. 20 (c) The department shall transfer a child from a [SECURE] residential 21 psychiatric treatment center to another appropriate placement if the mental health 22 professional responsible for the child's treatment determines that the child would no 23 longer benefit from the course of treatment or that the child's treatment needs could be 24 met in a less restrictive setting. The department shall notify the child, the child's 25 parents or guardian, [AND] the child's guardian ad litem, and any other parties of a 26 determination and transfer made under this subsection. 27 (d) In this section, 28 (1) "likely to cause serious harm" has the meaning given in 29 AS 47.30.915;  30 (2) "residential psychiatric treatment center" has the meaning  31 given in AS 47.32.900.  01  * Sec. 8. AS 47.10 is amended by adding a new section to read:  02 Sec. 47.10.105. Short-term psychiatric care. (a) The department may seek 03 services for a child who is in the custody of the department under AS 47.10.080(c)(1) 04 or (3) or 47.10.142 at a hospital that is not a residential psychiatric treatment center to 05 receive psychiatric care if the person in charge of admittance to the hospital finds that 06 (1) the child is suffering from a mental illness and, as a result, may 07 cause serious harm to the child or another person; and 08 (2) there is no reasonably available, appropriate, and less restrictive 09 alternative for the child to receive treatment. 10 (b) Within 24 hours after seeking services for a child at a hospital as 11 authorized under (a) of this section, the department shall notify the court, the child, the 12 child's parents or guardians, the child's guardian ad litem, and any other parties to an 13 ongoing child-in-need-of-aid case involving the child of the placement. Providing 14 notification under this subsection does not relieve the department of the duty to 15 promptly look to place the child in a less restrictive setting. The department is not 16 required to provide notice to the court under this subsection if the child is released 17 from the hospital to a less restrictive placement within 23 hours after arriving at the 18 hospital to seek services. 19 (c) A court shall review a placement made under (a) of this section within 20 seven calendar days after the child's placement in a hospital. The court may grant one 21 request to continue the hearing for up to seven calendar days if necessary to secure the 22 attendance of the child, a party, or a material witness. The court may authorize the 23 department to continue the placement of the child in a hospital if the court finds by 24 clear and convincing evidence, based on the testimony of a mental health professional, 25 and taking into account the length of time the child has been in the hospital, that the 26 conditions or symptoms that resulted in the initial placement made under (a) of this 27 section have not ameliorated to the extent that the child's needs can be met in a less 28 restrictive setting, and that the child's mental condition could be improved by the 29 course of treatment or would deteriorate if untreated. If a court does not make the 30 findings required under this subsection, the child shall be released from the hospital 31 for placement in a less restrictive setting. The court may vacate a hearing scheduled as 01 required under this subsection if either 02 (1) the child is released to a less restrictive setting before the scheduled 03 hearing; or 04 (2) all parties agree that the initial placement under (a) of this section 05 was reasonable and necessary, the parties submit to the court a written stipulation that 06 includes a treatment plan and timeline that will result in releasing the child to a less 07 restrictive setting, and the court finds in writing that the treatment plan and timeline 08 are reasonable and will result in releasing the child to a less restrictive setting. 09 (d) The court shall review a placement approved under (c) of this section 10 (1) at least once every 30 days; and 11 (2) when requested by the child, the child's parent or guardian, the 12 child's guardian ad litem, or any other party, upon a showing of good cause. 13  * Sec. 9. AS 47.10.990(12) is amended to read: 14 (12) "foster care" means care provided by a person or household under 15 a foster home license or treatment foster home license required under AS 47.32; 16  * Sec. 10. AS 47.12.150(c) is amended to read: 17 (c) When there has been transfer of legal custody or appointment of a guardian 18 and parental rights have not been terminated by court decree, the parents shall have 19 residual rights and responsibilities. These residual rights and responsibilities of the 20 parent include the right and responsibility of reasonable visitation, consent to 21 adoption, consent to marriage, consent to military enlistment, consent to major 22 medical treatment except in cases of emergency or cases falling under AS 25.20.025 23 or 25.20.028, and the responsibility for support, except if by court order any residual 24 right and responsibility has been delegated to a guardian under (b) of this section. 25  * Sec. 11. AS 47.14.010 is amended to read: 26 Sec. 47.14.010. General powers of department over juvenile facilities and  27 institutions. The department may 28 (1) purchase, lease, or construct buildings or other facilities for the 29 care, detention, rehabilitation, and education of children in need of aid or delinquent 30 minors; 31 (2) adopt plans for construction of juvenile detention facilities, juvenile 01 treatment facilities, and other juvenile institutions; 02 (3) adopt standards and regulations for the design, construction, repair, 03 maintenance, and operation of all juvenile detention facilities, juvenile treatment 04 facilities, and institutions; 05 (4) inspect periodically each juvenile detention facility, juvenile 06 treatment facility, or other institution to ensure that the standards and regulations 07 adopted are being maintained; 08 (5) reimburse municipalities maintaining and operating juvenile 09 detention facilities; 10 (6) enter into contracts and arrangements with cities and state and 11 federal agencies to carry out the purposes of AS 47.10, AS 47.12, and this chapter; 12 (7) do all acts necessary to carry out the purposes of AS 47.10, 13 AS 47.12, and this chapter; 14 (8) adopt the regulations necessary to carry out AS 47.10, AS 47.12, 15 and this chapter; 16 (9) accept donations, gifts, or bequests of money or other property for 17 use in construction of juvenile institutions, detention facilities, or juvenile treatment 18 facilities; 19 (10) operate juvenile detention facilities when municipalities are 20 unable to do so; 21 (11) receive, care for, and place in a juvenile detention facility, the 22 minor's own home, a foster home, a treatment foster home, a juvenile treatment 23 facility, or treatment institution all minors committed to its custody under AS 47.10, 24 AS 47.12, and this chapter. 25  * Sec. 12. AS 47.14.110(a) is amended to read: 26 (a) A representative of the department shall visit, as often as is considered 27 necessary, every foster home, treatment foster home, or institution in which a child 28 is placed, and, if not satisfied as to the care given, may remove the child from the 29 foster home or institution and place the child elsewhere. 30  * Sec. 13. AS 47.14.112(d) is amended to read: 31 (d) The division of the department with responsibility over the custody of 01 children shall prepare and make available to the legislature an annual report on 02 employee recruitment and retention, including a five-year plan, for the division. Not 03 later than November 15 of each year, the department shall deliver the report to the 04 senate secretary and the chief clerk of the house of representatives and notify the 05 legislature that the report is available. The report prepared under this subsection is 06 separate from the annual report to the legislature required under AS 18.05.020 and 07 must include, for the previous 12 months, 08 (1) the number of frontline case [SOCIAL] workers employed by the 09 division, the annual average turnover rate of the workers, and the average caseload of 10 the workers on January 1 and July 1 of that year; 11 (2) the number of children removed from their homes; 12 (3) the achievement of success measured by the following: 13 (A) rate of family reunification with a biological parent; 14 (B) average length of time children spent in custody of the 15 department; 16 (C) rate of placement with an adult family member or family 17 friend; 18 (D) number of children placed in a permanent living 19 arrangement with a guardian or [BIOLOGICAL OR] adoptive parent; 20 (E) number of children released from the custody of the 21 department; 22 (4) if the department has met or exceeded the caseload standards under 23 this chapter and, if the standards were exceeded, the number of caseworker positions 24 in the division that could be eliminated and the amount of funding that could be 25 reduced while continuing to meet but not routinely exceed the caseload standards; 26 (5) the performance of the department on federal benchmarks focused 27 on the safety, well-being, and permanent placements of foster children compared with 28 the previous five years;  29 (6) the number of children placed in psychiatric residential  30 treatment facilities providing care for children outside the state. 31  * Sec. 14. AS 47.14.115 is amended by adding a new subsection to read: 01 (c) The department shall require a foster parent who has a treatment foster 02 home license under AS 47.32 to participate in ongoing training in providing trauma- 03 informed care. 04  * Sec. 15. AS 47.14.900 is amended by adding a new paragraph to read: 05 (13) "treatment foster home" has the meaning given in AS 47.32.900. 06  * Sec. 16. AS 47.32.010(c) is amended to read: 07 (c) The following entities are subject to this chapter and regulations adopted 08 under this chapter by the Department of Family and Community Services: 09 (1) child placement agencies; 10 (2) foster homes; 11 (3) runaway shelters;  12 (4) treatment foster homes. 13  * Sec. 17. AS 47.32.032(b) is amended to read: 14 (b) The department shall approve a variance of the applicable building code 15 requirements for licensure of a foster care home or treatment foster home to the 16 extent permitted by federal law if an applicant does not meet the requirements at the 17 time of inspection and 18 (1) the home design and construction is consistent with homes located 19 in the community; and 20 (2) the home is otherwise a safe environment for a child. 21  * Sec. 18. AS 47.32.032 is amended by adding a new subsection to read: 22 (d) A treatment foster home shall ensure that the treatment foster home meets 23 the training requirements provided under AS 47.14.115(c). 24  * Sec. 19. AS 47.32.900(3) is amended to read: 25 (3) "child placement agency" means an agency that arranges for 26 placement of a child 27 (A) in a foster home, treatment foster home, residential child 28 care facility, or adoptive home; or 29 (B) for guardianship purposes; 30  * Sec. 20. AS 47.32.900 is amended by adding new paragraphs to read: 31 (22) "specialized services" includes medical care, trauma-informed 01 care, and interventions for post-traumatic stress disorder, abuse-related trauma, 02 depression, anxiety, suicidal ideation, and substance abuse; 03 (23) "treatment foster home" means a place where specialized services 04 are provided on a 24-hour continuing basis to not more than four children who have a 05 special behavioral, developmental, emotional, or medical need resulting from a 06 condition determined by a person who is licensed, certified, or otherwise authorized 07 by the law of this state to administer health care in the ordinary course of business or 08 practice of a profession. 09  * Sec. 21. AS 47.10.990(31) is repealed.  10  * Sec. 22. The uncodified law of the State of Alaska is amended by adding a new section to 11 read: 12 DIRECT COURT RULE AMENDMENT. Rule 12.1(b), Alaska Child in Need 13 of Aid Rules of Procedure, is amended to read: 14 (b) Appointment Types. 15 (1) Mandatory Appointments. 16 (A) The court shall appoint an attorney for a child who is 10 17 years of age or older in any of the following circumstances: 18 (i) [(A)] The child does not consent to placement in a 19 [PSYCHIATRIC HOSPITAL OR] residential treatment center; 20 (ii) [(B)] The child does not consent to administration 21 of psychotropic medication; 22 (iii) [(C)] The child objects to disclosure of 23 psychotherapy information or records under CINA Rule 9(b); 24 (iv) [(D)] A request for a court order authorizing 25 emergency protective custody has been made under AS 47.10.141(c); 26 or 27 (v) [(E)] The child is pregnant or has custody of a minor 28 child; and 29 (B) The court shall appoint an attorney for a child who has  30 been placed in a hospital as authorized under AS 47.10.105. 31 (2) Discretionary Appointments. The court may appoint an attorney 01 in other circumstances including, but not limited to: 02 (A) The child's and guardian ad litem's positions are not 03 aligned on placement, family or sibling contact, permanency goal, case plan, or 04 another important issue in the case; 05 (B) The child would benefit from a confidential relationship 06 with an attorney; or 07 (C) The child is not residing in the designated placement. 08  * Sec. 23. The uncodified law of the State of Alaska is amended by adding a new section to 09 read: 10 MEDICAID STATE PLAN; WAIVERS. The Department of Health shall, as 11 necessary for federal approval by the United States Department of Health and Human 12 Services, submit amendments to the state plan for medical assistance coverage or apply for 13 any waivers necessary to implement sec. 5 of this Act. 14  * Sec. 24. The uncodified law of the State of Alaska is amended by adding a new section to 15 read: 16 CONDITIONAL EFFECT; NOTIFICATION. (a) Section 5 of this Act takes effect 17 only if, and to the extent that, the United States Department of Health and Human Services 18 approves, on or before July 1, 2031, waivers or amendments to the state plan submitted under 19 sec. 23 of this Act. 20 (b) The commissioner of health shall notify the revisor of statutes in writing within 30 21 days after the United States Department of Health and Human Services approves the waivers 22 or amendments to the state plan. 23  * Sec. 25. If sec. 5 takes effect, it takes effect the day after the date the United States 24 Department of Health and Human Services approves the waivers or amendments to the state 25 plan submitted under sec. 23 of this Act. 26  * Sec. 26. Sections 2 - 4, 6, and 10 of this Act take effect January 1, 2026.