03/30/2017 03:00 PM House HEALTH & SOCIAL SERVICES

        HB 164-PROTECT: VULNERABLE ADULTS/LONG TERM CARE                                                                    
                                                                                                                                
3:08:08 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced  that the first order  of business would                                                              
be  HOUSE BILL  NO. 164,  "An Act  relating to  the protection  of                                                              
vulnerable adults and residents of long term care facilities."                                                                  
                                                                                                                                
3:08:28 PM                                                                                                                    
                                                                                                                                
TERESA HOLT,  Long Term  Care Ombudsman, Office  of the  Long Term                                                              
Care Ombudsman,  Alaska Mental Health Trust  Authority, Department                                                              
of  Revenue,  introduced HB  164  on  behalf  of the  House  Rules                                                              
Committee  on request  of the Governor.   She  explained that  the                                                              
proposed bill  would amend provisions  of AS 47.62, Office  of the                                                              
Long Term Care  Ombudsman, and AS 47.24, protection  of vulnerable                                                              
adults, to ensure  alignment with the Older Americans  Act of 1965                                                              
and its  implementing regulations.   She  reported that  the Older                                                              
Americans Act  was reauthorized  in 2016  and new regulations  for                                                              
Long  Term  Care  Ombudsman  were  created.    As  a  result,  the                                                              
Administration  for  Community   Living  reviewed  all  states  to                                                              
ensure compliance  with these changes, and this  review identified                                                              
two  Alaska   statutes  as  being   out  of  alignment   with  the                                                              
reauthorization  and the  Long  Term Care  Ombudsman  regulations.                                                              
She lauded  these as good  changes which  would be helpful  to her                                                              
office.  She stated  that the proposed bill would  align state and                                                              
federal  statutes and  regulations to  ensure that  the Office  of                                                              
the  Long Term  Care Ombudsman  only  shared resident  information                                                              
with informed  consent, and to ensure  that the office  can obtain                                                              
records  to investigate  and make  referrals when  a resident  was                                                              
unable to provide  informed consent.  The proposed  bill added new                                                              
terms for  residents and  resident representatives  and, due  to a                                                              
conflict  of  interest,  it  removed   the  option  for  mandatory                                                              
reporters  to meet  reporting requirements  by submitting  reports                                                              
to the  office.   The proposed  bill clarified  the separation  of                                                              
the role  of the  Long Term Care  Ombudsman from  the role  of the                                                              
Department of Health  and Social Services, and  clarified that the                                                              
Office  of the Long  Term Care  Ombudsman may  serve residents  in                                                              
long term care facilities under the age of 60.                                                                                  
                                                                                                                                
3:10:30 PM                                                                                                                    
                                                                                                                                
MS.  HOLT   paraphrased  the   Sectional  Analysis   [Included  in                                                              
members' packets], which read:                                                                                                  
                                                                                                                                
     Section 1  is a technical  amendment to AS  47.24.010(a)                                                                 
     to  update  the  name  of  the  entity  responsible  for                                                                   
     receiving  reports to the  department "vulnerable  adult                                                                   
     centralized intake office".                                                                                                
                                                                                                                                
     Section 2  is a technical  amendment to AS  47.24.010(e)                                                                 
     to  update  the  name  of  the  entity  responsible  for                                                                   
     receiving  reports to the  department "vulnerable  adult                                                                   
     centralized intake office".                                                                                                
                                                                                                                                
     Section   3  amends  AS   47.24.013(a)  to  remove   the                                                                 
     requirement  to forward reports  of maltreatment  to the                                                                   
     Long   Term  Care  Ombudsman's   office.  Adds   passive                                                                   
     language  to  allow the  DHSS  to transfer  reports  for                                                                   
     Long  Term  Care Ombudsman's  investigation  as  defined                                                                   
     under AS.62.015.                                                                                                           
                                                                                                                                
     Section  4 amends  AS 47.24.013(b)  to delete  reference                                                                 
     to  DHSS's   obligation  to   investigate  reports   for                                                                   
     vulnerable  adult's age  60 or less.  The Department  of                                                                   
     Health and  Social Services  is responsible for  reports                                                                   
     involving vulnerable adults ages 18 and older.                                                                             
                                                                                                                                
     Section  5 amends  AS 47.24.013(d)  to  remove the  Long                                                                 
     Term   Care  Ombudsman's   obligation   to   mandatorily                                                                   
     provide  a report  to the  DHSS  Central Intake.  Aligns                                                                   
     state  law with  federal  law  requiring the  Long  Term                                                                   
     Care Ombudsman's  office to only forward  information of                                                                   
     a complainant  or resident  with appropriate consent  or                                                                   
     court   order.  (45  CFR   1327.11(e)(3)).  Amended   to                                                                   
     reflect   current  Department   of   Human  and   Social                                                                   
     Services    responsibility    for    vulnerable    adult                                                                   
     centralized intake.                                                                                                        
                                                                                                                                
     Section  6 amends  AS 47.24.015(a)  to remove  reference                                                                 
     to reports transferred  to the Office of Long  Term Care                                                                   
     Ombudsman    under   47.24.013.   Updates    legislative                                                                   
     language   to   appropriately  reference   subjects   of                                                                   
     reports are  vulnerable adults. Removes  requirement for                                                                   
     face to face interview.                                                                                                    
                                                                                                                                
     Section  7 amends  AS 47.62.015(a)  to  add language  to                                                                 
     align state  law with federal law by providing  the Long                                                                   
     Term  Care Ombudsman  the authority  to investigate  and                                                                   
     resolve  a complaint  for a  person residing  in a  long                                                                   
     term  care  facility who  is  not  defined as  an  older                                                                   
     Alaska.                                                                                                                    
                                                                                                                                
     Section  8   amends  AS  47.62.015(c)  to   include  all                                                                 
     residents of a long term care facility.                                                                                    
                                                                                                                                
     Section 9  repeals and reenacts  AS 47.62.025  to define                                                                 
     access  to long  term  care facilities,  older  Alaskan,                                                                   
     and  records.  Title  amended  to include  all  ages  of                                                                   
     residents  of long  term  care facilities.  Section  (a)                                                                   
     amended to  include all ages  of residents of  long term                                                                   
     care  facilities. Section  (b)  amended  to include  all                                                                   
     ages  of residents  of  long  term care  facilities  and                                                                   
     amended  to allow  for  consent to  be  provided by  the                                                                   
     resident   or  the  resident's   representative   or  by                                                                   
     subpoena.                                                                                                                  
                                                                                                                                
     Section  10  repeals  and reenacts  AS  47.62.030(b)  to                                                                 
     include  all ages  of residents.  Amended  to allow  for                                                                   
     disclosures  with consent.  Adds authority for  resident                                                                   
     representative to  give consent. Amended to  align state                                                                   
     law with  federal law  to clarify limited  circumstances                                                                   
     when  the  Office  of  Long   Term  Care  Ombudsman  has                                                                   
     authority  to  report  resident-identifying  information                                                                   
     without  obtaining resident  or resident  representative                                                                   
     consent.                                                                                                                   
                                                                                                                                
     Section 11  amends AS 47.62.060  to include all  ages of                                                                 
     residents of long term care facilities.                                                                                    
                                                                                                                                
     Section   12  amends   AS   47.62.090   to  revise   the                                                                 
     definition  of  "older  Alaskan" as  an  individual  who                                                                   
     lives  in  Alaska  since definition  of  "resident"  was                                                                   
     added  to mean  individual living  in a  long term  care                                                                   
     facility.  Adds new  sections to define  resident as  an                                                                   
     individual  who resides  in  a long  term care  facility                                                                   
     and  to  align state  law  with  federal law  to  define                                                                   
     resident  representative  and   authority  the  resident                                                                   
     representative has to act on behalf of the resident.                                                                       
                                                                                                                                
     Section     13    repeals     AS    47.24.010(f),     AS                                                                 
     47.24.013(c)(3),  and AS  47.24.013(e). AS  47.24.010(f)                                                                   
     is   repealed  as   Federal   statute  and   regulations                                                                   
     prohibit  representatives of the  Office Long Term  Care                                                                   
     Ombudsman  from abuse reporting  requirements when  such                                                                   
     reporting  would disclose identifying  information  of a                                                                   
     complainant or  resident without appropriate  consent or                                                                   
     court   order.   (45   CFR    1327.11(e)(3)).   Therefor                                                                   
     mandatory  reporting to  the  Office of  Long Term  Care                                                                   
     Ombudsman  does  not  fulfill   a  mandatory  reporter's                                                                   
     obligation  under  law  to  make  mandatory  reports  of                                                                   
     maltreatment.    AS    47.24.013(c)(3)    repeals    the                                                                   
     requirement  for  the  Office  of  the  Long  Term  Care                                                                   
     Ombudsman  to provide  results of  investigation to  the                                                                   
     DHSS.  OAA   Section  712(d)(2)(B)  establishes   strict                                                                   
     disclosure  limitations. The  Long  Term Care  Ombudsman                                                                   
     program  is  intended  to  be  a  safe,  person-centered                                                                   
     place for  residents to bring their concerns.  Residents                                                                   
     can  be  assured  that their  information  will  not  be                                                                   
     disclosed  without  their consent,  the  consent of  the                                                                   
     resident    representative,   or    court   order.    AS                                                                   
     47.24.013(e)  is  repealed as  the  Office of  the  Long                                                                   
     Term  Care Ombudsman  is not the  appropriate agency  to                                                                   
     officially substantiate  abuse or neglect  complaints on                                                                   
     behalf  of  DHSS.  The  Office of  the  Long  Term  Care                                                                   
     Ombudsman   represents  the   interests  of   residents,                                                                   
     rather  than  the  interests   of  the  DHSS.  (See  OAA                                                                   
     Section    712(a)(3)(E),     (a)(5)(B)(iv);    45    CFR                                                                   
     1327.13(a)(5), 1327.19(a)(4)).                                                                                             
                                                                                                                                
3:13:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  asked  about the  rationale  for                                                              
the amendment in Section 3.                                                                                                     
                                                                                                                                
MS. HOLT  explained that often there  were residents of  long term                                                              
care  facilities  who were  55  years  of  age, and  the  previous                                                              
legislation  only allowed that  her office  work with  people over                                                              
60 years  of age.  This  would allow the  Office of the  Long Term                                                              
Care Ombudsman to serve people under the age of 60.                                                                             
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD   asked  about  removal   of  the                                                              
requirement to  forward reports of  maltreatment to the  Office of                                                              
the Long Term Care Ombudsman.                                                                                                   
                                                                                                                                
CHAIR  SPOHNHOLZ clarified  that Ms.  Holt had  been referring  to                                                              
Section   4,   and  that   Representative   Sullivan-Leonard   had                                                              
questions regarding Section 3.                                                                                                  
                                                                                                                                
MS.  HOLT  directed  attention  to  the  original  statute,  which                                                              
stated  that  Department  of Health  and  Social  Services  (DHSS)                                                              
would forward  all reports  on people  over the age  of 60  to the                                                              
Office of  the Long  Term Care Ombudsman  for investigation.   She                                                              
explained  that the  Office of the  Long Term  Care Ombudsman  had                                                              
different investigation  priorities, and would  investigate issues                                                              
for residents  of long term care  facilities.  She  explained that                                                              
Adult   Protective   Services  and   Licensing   investigated   to                                                              
substantiate  a report  of harm.    This would  clarify that  DHSS                                                              
would  conduct  the  verifications,  and those  reports  would  be                                                              
forwarded to the Office of the Long Term Care Ombudsman.                                                                        
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  suggested that the  Office of the                                                              
Long Term Care  Ombudsman would want that information  in order to                                                              
assist in the process for helping.                                                                                              
                                                                                                                                
MS. HOLT  replied that two years  prior, there had been  a meeting                                                              
of  people  who worked  with  seniors  living  in long  term  care                                                              
facilities,  which resulted in  a system  of initial response  for                                                              
investigation.   She  relayed that  this  memorandum of  agreement                                                              
dictated   that  "if   adult  protective   services,   residential                                                              
licensing,  and quality assurance  feels like  it's a  report that                                                              
we should  have a  copy of, that  they will  forward that  to us."                                                              
She stated  that the majority  of the reports  of harm  were about                                                              
residents  who had  fallen  to the  floor,  but  were checked  and                                                              
found  to be  fine.   She pointed  out that  a review  of each  of                                                              
these  was very  time consuming,  and  was not  necessary for  her                                                              
office to review.                                                                                                               
                                                                                                                                
3:17:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  asked if the Office of the  Long Term Care                                                              
Ombudsman wanted to  know about an incident for  maltreatment of a                                                              
person in long term care.                                                                                                       
                                                                                                                                
MS. HOLT  replied that her  office did  want to know,  adding that                                                              
the office  received between  15-20 reports  daily.  She  reported                                                              
that  central intake  received  about 50  reports  daily, and,  as                                                              
many of these had  already been resolved, her office  did not need                                                              
to receive those  reports.  She added that people  could also call                                                              
her office  directly.  She offered  her belief that  this proposed                                                              
process would work.                                                                                                             
                                                                                                                                
3:18:35 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ  summarized  that   the  proposed  process  would                                                              
narrow the  requirement for data  reporting or reports of  harm to                                                              
only   be  those   which  were   substantiated   or  needed   more                                                              
investigation.                                                                                                                  
                                                                                                                                
MS. HOLT expressed  her agreement, and stated that  the mandate of                                                              
the Office of the  Long Term Care Ombudsman was  to resolve issues                                                              
of residents that required assistance.                                                                                          
                                                                                                                                
CHAIR  SPOHNHOLZ  suggested that  there  could be  language  which                                                              
would more specifically address the concern.                                                                                    
                                                                                                                                
3:20:39 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that HB 164 would be held over.