Legislature(2021 - 2022)GRUENBERG 120
02/23/2022 01:30 PM House JUDICIARY
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 | |
| Confirmation Hearing(s): Violent Crimes Compensation Board | |
| HB172 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | HB 172 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 172-MENTAL HEALTH FACILITIES & MEDS
1:47:45 PM
CHAIR CLAMAN announced that the final order of business would be
HOUSE BILL NO. 172, "An Act relating to admission to and
detention at a subacute mental health facility; establishing a
definition for 'subacute mental health facility'; establishing a
definition for 'crisis residential center'; relating to the
definitions for 'crisis stabilization center'; relating to the
administration of psychotropic medication in a crisis situation;
relating to licensed facilities; and providing for an effective
date." [Before the committee, adopted as a working document on
2/16/22, was the proposed committee substitute (CS) for HB 172,
Version 32-GH1730\W, Foote, 2/16/22 ("Version W).]
CHAIR CLAMAN stated that Legislative Legal and Research Services
has permission to make technical or conforming changes to the
bill.
[CHAIR CLAMAN passed the gavel to Vice Chair Snyder.]
1:49:00 PM
CHAIR CLAMAN moved to adopt Amendment 1 to HB 172, Version W,
labeled, 32-GH1730\W.8 Foote 2/22/22, which read as follows:
Page 4, lines 23 - 24:
Delete "or crisis residential center;
psychotropic medication; rights; notification"
Page 6, line 3:
Delete "and"
Page 6, line 4:
Delete "or"
Insert "and"
Page 6, line 15, following the first occurrence of
"for":
Insert "seven.notdefday"
Page 6, line 16, following "for":
Insert "seven.notdefday"
Page 7, line 8, following "for":
Insert "seven.notdefday"
Page 7, line 9, following "for":
Insert "seven.notdefday"
REPRESENTATIVE EASTMAN objected.
REPRESENTATIVE CLAMAN explained that Amendment 1 would correct a
drafting error on page 4, lines 23-24, regarding a crisis
residential center, psychotropic medication rights, and
notification. He stated that AS 47.37.07 only relates to a hold
at a crisis stabilization center; therefore, the amendment would
delete the language in the subsequent sections of the bill. He
then referred to page 6, lines 3-4 and explained that a drafting
error had occurred pertaining to the way that notification is
given. The proposed amendment would clarify that the court
"shall" notify the respondent, the respondent's attorney, the
respondent's guardian, if any, the petitioner's attorney, if
any, and the attorney general. He noted that for the proposed
changes, the amendment would include a seven-day limit
associated with a stay at a crisis residential center, and it
would create consistency with language in the bill pertaining to
30-day limited treatment.
REPRESENTATIVE EASTMAN withdrew his objection.
1:51:42 PM
The committee took a brief at-ease at 1:51 p.m.
1:51:49 PM
CO-CHAIR SNYDER announced there being no further objection,
Amendment 1 was adopted.
1:51:57 PM
CHAIR CLAMAN moved to adopt Amendment 2 to HB 172, Version W, as
amended, labeled 32-GH1730\W.2 Foote 2/22/22, which read as
follows:
Page 3, line 6:
Delete "AS 47.30.915"
Insert "AS 47.32.900"
Page 3, line 9:
Delete "AS 47.30.915"
Insert "AS 47.32.900"
Page 11, lines 20 - 23:
Delete all material and insert:
"(21) "crisis residential center" has the
meaning given in AS 47.32.900;
(22) "crisis stabilization center" has the
meaning given in AS 47.32.900;"
Page 12, lines 27 - 30:
Delete all material and insert:
"(A) "crisis residential center" means a
subacute mental health facility that has a maximum
stay of seven days;
(B) "crisis stabilization center" means a
subacute mental health facility that has a maximum
stay of 23 hours and 59 minutes."
REPRESENTATIVE EASTMAN objected.
CHAIR CLAMAN explained that Amendment 2 is the result of
recommendations made by the Department of Health and Social
Services (DHSS) in reference to AS 47.30.915. The amendment
would define crisis stabilization centers and crisis residential
centers as being within the definition of a subacute treatment
center, as it appears in AS 47.32.900.
REPRESENTATIVE EASTMAN withdrew his objection. There being no
further objection, Amendment 2 was adopted.
[VICE CHAIR SNYDER passed the gavel back to Chair Claman.]
1:53:38 PM
REPRESENTATIVE KURKA moved to adopt Amendment 3 to HB 172,
Version W, as amended, labeled 32-GH1730\W.16 Dunmire/Foote
2/22/22, which read as follows:
Page 1, line 2, following "facilities;":
Insert "relating to the duties of the Department
of Health and Social Services;"
Page 3, following line 24:
Insert a new bill section to read:
"* Sec. 11. AS 47.30.350(a) is amended to read:
(a) The department shall
(1) develop and submit to the Surgeon
General of the United States Public Health Service a
comprehensive program for the constructing and
equipping of hospitals and other facilities for the
examination, observation, care, and treatment of the
mentally ill;
(2) develop and submit to the Surgeon
General plans and specifications for the constructing
and equipping of the hospitals and other facilities;
(3) construct and equip the hospitals and
other facilities in accordance with the program,
plans, and specifications approved by the Surgeon
General; construction and equipping under this
paragraph is governed by AS 36.30 (State Procurement
Code);
(4) cooperate, coordinate, and contract,
wherever indicated and desirable, with other state
boards, departments and agencies, and agencies of the
United States in the construction program, and hire
necessary personnel and enter into contracts with
private individuals and companies, to the end that the
hospitals and other facilities are constructed in the
most economical and expeditious manner; contracting
and construction under this section are governed by
AS 36.30 (State Procurement Code);
(5) twice each calendar year, conduct an
on-site inspection at each designated treatment
facility in the state."
Renumber the following bill sections accordingly.
Page 13, lines 3 - 4:
Delete "sec. 23"
Insert "sec. 24"
Page 13, line 5:
Delete "sec. 23"
Insert "sec. 24"
Page 13, line 14:
Delete "Section 27"
Insert "Section 28"
CHAIR CLAMAN objected.
REPRESENTATIVE KURKA explained that Amendment 3 would address
concerns which had arisen regarding due process, and the
existence of the potential for abuse by allowing for twice-
annual inspections of each treatment facility to be conducted by
DHSS.
1:54:38 PM
HEATHER CARPENTER, Senior Policy Advisor, Department of Health
and Social Services, offered that the department respectfully is
in opposition to the proposed amendment, as it would duplicate
work already being done by the health care facility licensing
team. She stated that, if immediate jeopardy exists in a case,
the team will respond to the facility to determine the veracity
of any claim and the potential for harm. She pointed out there
would be a fiscal need to accommodate additional positions held
by professional nurses with the required expertise.
REPRESENTATIVE KURKA asked whether each facility associated with
the proposed legislation is already subject to inspection by the
department.
MS. CARPENTER answered that the proposed amendment pertains to
designated treatment facilities, of which there are four in the
state: the Alaska Psychiatric Institute (API), Fairbanks
Memorial Hospital, Mat-Su Regional Medical Center, and Bartlett
Regional Hospital. She stated that DHSS conducts regular
inspections of these facilities. In response to a follow-up
question, she stated that current inspections are based on
existing requirements for compliance with the Center for
Medicare and Medicaid Services and the Joint Commission, and
this would be in addition to the state law which requires
periodic inspections. She expressed uncertainty concerning how
the proposed additional inspections would align with the current
required inspections, as twice-per-year inspections would differ
from the current inspection schedule. In response to a follow-
up question, concerning the current frequency of state
inspections, she answered that API is subject to the most
frequent surveys based on its accreditation as "deemed" or "not
deemed." She offered that the healthcare facility licensing
team is equipped to receive anonymous tips, resulting in
impromptu inspections. She continued that "deemed" and "not
deemed" facilities are inspected every two years. She offered
to follow up with examples of scheduled inspections among the
accreditation body and the facility licensing team.
1:59:55 PM
REPRESENTATIVE KURKA withdrew Amendment 3.
2:00:14 PM
REPRESENTATIVE KURKA moved to adopt Amendment 4 to HB 172,
Version W, as amended, labeled, 32-GH1730\W.7 Dunmire 2/22/22,
which read as follows:
Page 1, line 3, following "facilities;":
Insert "relating to patient grievance
procedures;"
Page 11, following line 2:
Insert a new bill section to read:
"* Sec. 19. AS 47.30.847(b) is amended to read:
(b) An evaluation facility and a designated
treatment facility shall have a uniform formal
grievance and appeal procedure for patient grievances
brought under (a) of this section. The facility shall
inform each patient of the existence and contents of
the grievance procedure and shall submit a copy of the
grievance procedure to the department. The department
shall keep a copy of the grievance procedure on file."
Renumber the following bill sections accordingly.
Page 13, lines 3 - 4:
Delete "sec. 23"
Insert "sec. 24"
Page 13, line 5:
Delete "sec. 23"
Insert "sec. 24"
Page 13, line 14:
Delete "Section 27"
Insert "Section 28"
CHAIR CLAMAN objected.
REPRESENTATIVE KURKA explained that Amendment 4 would address
concerns regarding the lack of additional safeguards. He stated
that the amendment would provide for a consistent grievance
procedure, with each facility reporting directly to DHSS.
MS. CARPENTER offered that the department considers grievances
to be very serious. She suggested that changes to grievance
procedures should be made with consideration of stakeholders, as
the grievance procedures should be well thought out. She
expressed the concern that the amendment could cause
administrative burden and disruption to providers. She added
that the existence of grievance procedures is a federal
requirement for accreditation. She stated that the proposed
legislation relates to different types of facilities, and a
uniform grievance procedure could cause conflict with or
duplicate those required by specific accreditation bodies. She
advised that the accreditation requirements are stringent.
REPRESENTATIVE KURKA suggested that the proposed amendment would
not be prescriptive and asked whether an adequate process
exists.
MS. CARPENTER answered that inspection processes by
accreditation bodies and the state do exist, as well as
requirements that facilities maintain a grievance process. She
stated that the department's concern is that the proposed
amendment would prescribe a uniform grievance process for all
facilities.
2:04:16 PM
ALBERT WALL, Deputy Commissioner, Office of the Commissioner,
Department of Health and Social Services, answered that all
detention, evaluation, and treatment centers (DETs) in Alaska
are hospitals and accredited nationally. He explained that
national regulations stipulate each have a grievance policy, and
further stipulate quality assurance checks in response to
questions or problems which may arise at a hospital. He stated
that it would be difficult to specify a specific number of
visits to a hospital because it depends on the survey team's
inspections, which are the results of complaints. He noted that
the state is one of several inspection bodies. Others include
the Centers for Medicare and Medicaid Services, the Division of
Healthcare Services, the Joint Commission, and the Occupational
Safety and Health Administration (OSHA). He stated that each
share overlapping checks on quality and safety. He expressed
the concern that because grievance policies are established by
accreditation bodies, they are subject to periodic changes. He
stated that statutory mandate of uniform grievance policies
would result in the need for changes to statute, should changes
to the accreditation criteria change. He added that API is an
accredited agency, and a survey may result in a plan of
correction which, if left uncorrected, would jeopardize its
accreditation.
2:08:24 PM
REPRESENTATIVE KURKA expressed the understanding that the
concern is about the word "uniform." He asked whether there are
multiple grievance forms.
MS. CARPENTER answered that "uniform" grievance procedures are
tantamount to micromanaging providers to a level which does not
exist for other healthcare facilities. She explained that
regional and cultural differences exist among various
communities.
CHAIR CLAMAN noted that adding the word "uniform" would be
consequential.
MR. WALL offered that the Joint Commission requirements for
grievance policies are that uniform and individual policies may
exceed the standard. He offered to provide copies to the
committee.
REPRESENTATIVE KURKA asked Chair Claman to further explain his
previous comment which related that uniform requirements could
be consequential.
CHAIR CLAMAN offered that the Commission on Uniform Laws
proposes hundreds of Acts, such as the Uniform Notary Act. He
suggested that using the word "uniform" in statute results in
identical conformity among grievance procedures for different
facilities.
2:13:40 PM
REPRESENTATIVE EASTMAN expressed concern that grievance
procedures within one facility could vary, based on the services
or the nature of the complaint. He questioned whether the
department would support the concept of each facility having a
policy consistent throughout that facility.
MS. CARPENTER stated that it is assumed that grievance policies
are uniform within a particular facility and would not vary from
patient to patient.
REPRESENTATIVE EASTMAN suggested that the drafter be contacted
to assuage any concerns with the word "uniform." He referred to
lines 10-11 of the amendment and asked whether the department
requests a copy of grievance procedures from each facility.
MS. CARPENTER explained that grievance procedures for evaluation
facilities are reviewed by an accreditation body, but a copy may
not necessarily be kept on file.
2:17:27 PM
GENNIFER MOREAU-JOHNSON, Director, Division of Behavioral
Health, Department of Health and Social Services, offered to
provide a detailed answer in writing. She stressed the
administrative burden on facilities in responding to
accreditation requirements.
REPRESENTATIVE VANCE referred to line 8, regarding the appeal
procedure. She requested an explanation of this process.
MS. CARPENTER stated that all grievance policies require the
existence of an appeal process.
REPRESENTATIVE VANCE asked to confirm that there exist four
evaluation facilities and asked whether the intention was to
create more, should HB 172 pass.
MS. CARPENTER confirmed that this as correct.
REPRESENTATIVE VANCE asked whether her recollection was correct
that a law had been passed which would require hospitals to make
basic service fee schedules available to the public.
CHAIR CLAMAN answered that the law passed required a limited
listing of fees.
REPRESENTATIVE VANCE stated that the intent of that law was to
assure the public that fee schedules would be consistently
available and suggested that the proposed amendment would
provide a similar assurance. She expressed her opinion that a
consistent grievance and appeal process is needed to build
public trust. She suggested that there has been a breakdown of
[public] trust with the API and federal standards may not be the
"gold standard." She argued that Alaska should provide for a
standard which exceeds national standards. She questioned which
word could be used to convey the consistency being sought. She
expressed concern that the department may be focused on reducing
the administrative burden on facilities rather than on the
patients.
2:24:21 PM
CHAIR CLAMAN drew a distinction between a healthcare facility
offering fee schedules and grievance procedures related to acute
psychiatric care where individuals may have difficulty
functioning. He stated that the process of involuntary holds
and appointed counsel exists to ensure patients are made aware
of their rights in a complex legal circumstance. He allowed
that every grievance procedure could benefit from improvement;
however, he questioned whether the [current] procedures are so
lacking patients are unable to advocate for their rights. He
suggested that, if the latter were true, the matter would be
beyond the scope of HB 172.
MS. CARPENTER lauded Chair Claman's observation, adding that the
department takes seriously the balance between individual
rights, grievances, and the burdens for facilities to remain
compliant. She stated that the API is the only state-run
facility, and DHSS relies on community partners to ensure that
[public mental] health care needs are met. She cautioned that
addressing grievance procedures in legislation would require
thoughtful engagement among stakeholders rather than via the
amendment process. She stated that grievance procedures for
involuntary commitment are protected in existing statute by
requiring that patients be informed of their rights. She stated
that a patient's understanding of rights may not occur until
after the patient leaves the facility following treatment. She
suggested that the Alaska State Ombudsman retains oversight, as
this is an important stakeholder in the discussion surrounding
grievance procedures.
2:29:55 PM
REPRESENTATIVE SNYDER pointed out that the issues with API have
been serious. She questioned whether the issues could be
attributed to its grievance procedures. She further allowed
that the intent of the amendment is sincere and encouraged
cautious consideration of how things are working and stakeholder
engagement. She stated that the proposed legislation appears to
maintain a focus on ensuring that adequate facilities exist to
meet urgent public mental health care needs.
REPRESENTATIVE KURKA stated that expanding the number of
facilities should include appropriate safeguards. He stated
that the intent of the amendment would require each facility to
have its own uniform grievance procedure rather than one
prescribed by the department.
MS. CARPENTER offered that the department respectfully disagrees
with the definition of "uniform" as described in the amendment,
as it would require uniformity between all facilities, but would
not apply to uniformity for procedures for all patients in any
one facility.
REPRESENTATIVE KURKA requested confirmation that the
department's interpretation of the proposed amendment is that
all facilities would have a uniform grievance procedure rather
than uniformity for procedures for all patients in any one
facility.
MS. CARPENTER confirmed this as correct and added this would
result in the creation of a highly litigious area of law,
requiring oversight by other agencies.
2:35:27 PM
REPRESENTATIVE EASTMAN moved Conceptual Amendment 1 to Amendment
4, such that the word "uniform" be replaced with "internally
uniform." There being no objection, Conceptual Amendment 1 to
Amendment 4 was adopted.
MS. CARPENTER allowed that the conceptual amendment improved the
underlying amendment. To avoid rash changes resulting in
unintended consequences, she expressed that the department would
prefer a cautious and in-depth review with all stakeholders.
MR. WALL offered the previously requested information on the
federal standards and cited the Code of Federal Regulations
(CFR), Section 482.13, pertaining to patients' rights. He
stated that the CFR is a set of regulations and, should the
state establish requirements above and beyond regulations, then
any changes to the federal regulation would result in the need
to pass legislation to update the associated laws. He explained
that most on-site surveys are conducted by a federal team or a
Joint Commission team. The team would measure the facility
against the standard, which could result in a "gold standard
award" for the facility if it meets or exceeds the federal
grievance procedure requirements. He added that federal teams
would not measure a facility against a state standard;
therefore, the state would be required to assemble its own team
to conduct the surveys to ensure compliance with state
standards. He concluded that this would result in additional
costs.
CHAIR CLAMAN maintained his objection to Amendment 4, as
conceptually amended.
REPRESENTATIVE EASTMAN expressed opposition to the view that the
proposed amendment would result in an undue burden on facilities
and the department.
REPRESENTATIVE KURKA stated his belief that the proposed
requirements were basic in nature and disagreed with the
suggestion that they would result in an undue burden.
2:42:44 PM
A roll call vote was taken. Representatives Eastman, Kurka, and
Vance voted in favor of Amendment 4, as conceptually amended, to
HB 172, as amended. Representatives Drummond, Snyder, Kreiss-
Tomkins, and Claman voted against it. Therefore, Amendment 4
failed by a vote of 3-4.
2:43:27 PM
The committee took a brief at-ease.
2:44:23 PM
CHAIR CLAMAN announced that HB 172 was held over.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Violent Crimes Compensation Board Appointment - Greg Bringhurst Resume 2.23.2022.pdf |
HJUD 2/23/2022 1:30:00 PM |
|
| Violent Crimes Compensation Board Appointment - Greg Bringhurst Cover Letter 2.23.2022.pdf |
HJUD 2/23/2022 1:30:00 PM |
|
| HB 172 Work Draft Committee Substitute v. W 2.16.2022.pdf |
HJUD 2/16/2022 1:30:00 PM HJUD 2/21/2022 1:00:00 PM HJUD 2/23/2022 1:30:00 PM HJUD 2/25/2022 1:30:00 PM |
HB 172 |
| HB 172 Transmittal Letter 4.9.2021.pdf |
HJUD 5/14/2021 1:00:00 PM HJUD 2/16/2022 1:30:00 PM HJUD 2/21/2022 1:00:00 PM HJUD 2/23/2022 1:30:00 PM |
HB 172 |
| HB 172 Sectional Analysis v. W 2.16.2022.pdf |
HJUD 2/16/2022 1:30:00 PM HJUD 2/21/2022 1:00:00 PM HJUD 2/23/2022 1:30:00 PM |
HB 172 |
| HB 172 Additional Document - Introduction Presentation to HJUD Committee 5.14.2021.pdf |
HJUD 5/14/2021 1:00:00 PM HJUD 2/16/2022 1:30:00 PM HJUD 2/21/2022 1:00:00 PM HJUD 2/23/2022 1:30:00 PM |
HB 172 |
| HB 172 Additional Document - Definitions for Alaska Involuntary Commitment Statutes (AS 47.30.915) 2.21.2022.pdf |
HJUD 2/21/2022 1:00:00 PM HJUD 2/23/2022 1:30:00 PM |
HB 172 |
| HB 172 Supporting Document - Letters Received by 5.14.2021.pdf |
HJUD 5/14/2021 1:00:00 PM HJUD 2/16/2022 1:30:00 PM HJUD 2/21/2022 1:00:00 PM HJUD 2/23/2022 1:30:00 PM |
HB 172 |
| HB 172 Supporting Document - Disability Law Center Letter 2.21.2022.pdf |
HJUD 2/21/2022 1:00:00 PM HJUD 2/23/2022 1:30:00 PM |
HB 172 |
| HB 172 Opposing and Amend Letters and Testimony Received by 2.23.2022.pdf |
HJUD 2/23/2022 1:30:00 PM |
HB 172 |
| HB 172 Fiscal Note DPS-AST 4.7.2021.pdf |
HJUD 5/14/2021 1:00:00 PM HJUD 2/21/2022 1:00:00 PM HJUD 2/23/2022 1:30:00 PM |
HB 172 |
| HB 172 Fiscal Note DFCS-IMH 2.11.2022.pdf |
HJUD 2/16/2022 1:30:00 PM HJUD 2/21/2022 1:00:00 PM HJUD 2/23/2022 1:30:00 PM |
HB 172 |
| HB 172 Fiscal Note DOH-MS 2.11.2022.pdf |
HJUD 2/16/2022 1:30:00 PM HJUD 2/21/2022 1:00:00 PM HJUD 2/23/2022 1:30:00 PM |
HB 172 |
| HB 172 Fiscal Note JUD-ACS 2.17.2022.pdf |
HJUD 2/21/2022 1:00:00 PM HJUD 2/23/2022 1:30:00 PM |
HB 172 |
| HB 172 v. W Amendments #1-4 HJUD 2.23.2022.pdf |
HJUD 2/23/2022 1:30:00 PM |
HB 172 |