Legislature(2021 - 2022)DAVIS 106
09/11/2021 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB3006 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB3006 | TELECONFERENCED | |
SB3006-HEALTH CARE REQS; COVID-19; TELEHEALTH
3:10:34 PM
CO-CHAIR ZULKOSKY announced that the only order of business
would be CS FOR SENATE BILL NO. 3006(L&C) am, "An Act relating
to COVID-19 immunization and proof of vaccination; relating to
personal objections to the administration of COVID-19 vaccines;
relating to COVID-19 immunization rights; relating to
utilization review requirements; making temporary changes to
state law in response to the novel coronavirus disease; relating
to telemedicine and telehealth; relating to background checks;
relating to certificates of need; and providing for an effective
date."
3:12:55 PM
ADAM CRUM, Commissioner, Department of Health and Social
Services (DHSS), testified that DHSS and the Department of
Commerce, Community, and Economic Development (DCCED) appreciate
the consideration of SB 3006 [sponsored by Senate Rules by
request of the governor]. He stated that "as introduced" the
proposed legislation would provide specific tools that have been
identified and requested by health care leadership as necessary
items needed to support Alaska's health care system and health
care workforce. This July, he said, the Delta variant created a
new landscape in the pandemic that [the administration] has been
responding to since early 2020. The Delta variant is highly
infectious with a transmission rate of one infected person to
five-eight people, and over 90 percent of Alaska's COVID-19
cases are the Delta variant. Successful mechanisms such as
robust testing programs statewide have continued to be deployed
and efforts are continuing to educate, distribute, and
administer vaccines for every Alaskan who wants one.
COMMISSIONER CRUM pointed out that the surge caused by the Delta
variant has negatively impacted Alaska's already fatigued and
stressed health care system and workforce that has been on the
frontline of response to COVID-19 for over 19 months. It has
created a different kind of public health emergency, one that
has more crisis of workforce and requires specific tools to
address it. For the past month, the governor, DHSS, and DCCED
have been in constant contact with Alaska's healthcare providers
and facilities to identify what is needed by Alaska's caregivers
and hospitals and the most appropriate mechanisms available to
provide them with the tools identified. The state's partners
have identified the need to reduce barriers to training,
licensing, and employing health care professionals, the need to
reduce barriers to the provision of telehealth and telemedicine
for Alaskans by providers outside of Alaska, the need for
insurers to waive utilization review requirements, and the need
to allow patients to be seen in a lower acuity setting rather
than emergency department, if appropriate, and with the
patient's consent.
3:15:06 PM
COMMISSIONER CRUM reminded members that several different tools
have already been identified and used through the authority
granted under the public health emergency passed by the
legislature with HB 76. Emergency regulations have implemented
other tools, such as the Alaska Board of Nursing's recent
adoption of an emergency regulation amending the certified
nursing assistant (CNA) program requirements and establishing a
CNA emergency courtesy license for these individuals. This
change allows for additional human resources to be deployed to
strengthen Alaska's health care system safety net.
COMMISSIONER CRUM specified that, as introduced, SB 3006
contains items of limited statutory changes to provide Alaska's
health care facilities and workforce the remaining tools they
need. He thanked the legislature for being a partner in the
state's response to COVID-19 and for being willing to consider
legislation that would provide the tools to support Alaska's
health care network.
3:16:13 PM
SARA CHAMBERS, Director, Division of Corporations, Business and
Professional Licensing, Department of Commerce, Community, and
Economic Development (DCCED), provided a sectional analysis of
CSSB 3006(L&C) am. She explained that Section 1 adds a new
section to the uncodified law to state that the purpose of this
act is to provide for mitigation measures that will enhance the
state's ongoing efforts to reduce the spread of COVID-19.
MS. CHAMBERS stated that Section 2, added on the Senate floor
[on 9/10/21], creates five new sections under AS 18.09 relating
to COVID-19 immunization rights. The first, AS 18.09.270, proof
of vaccination, provides that a person who requires an
individual to show proof of vaccination against COVID-19 shall
also accept evidence that the individual has antibodies against
COVID-19, as a means to satisfy the vaccination requirement.
The evidence shall include but is not limited to a documented
antibody test or a documented positive COVID-19 test. The
second, AS 18.09.280, personal objections to the administration
of COVID-19, provides that an individual may object to the
administration of a COVID-19 vaccine based on religious,
medical, or other grounds, and that a parent or guardian of a
minor child may object to the administration of COVID-19 vaccine
based on religious, medical, or other grounds. It further
stipulates that an individual may not be required to provide
justification or documentation to support the individual's
decision to decline the COVID-19 vaccine. The third, AS
18.09.290, access to areas and services, provides that a
business, state agency, or political subdivision of the state
may not require an individual to be vaccinated against COVID-19
for the individual to access an area or service that is open to
the public. The fourth, AS 18.09.300, exercise of rights and
access to benefits, provides that a state agency or political
subdivision of the state may not adopt or issue a regulation,
ordinance, order or similar policy that requires an individual
to be vaccinated against COVID-19 for the individual to exercise
a right or receive a benefit that is available to the public.
The fifth, AS 18.09.310, definition, defines "COVID-19" as the
novel coronavirus disease caused by the severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2).
MS. CHAMBERS conveyed that Section 3 amends AS 21.06.080 by
adding a new subsection (f) to allow the Division of Insurance
(DOI) director to order health care insurers to waive
utilization review requirements during a state or federal public
health disaster, thereby allowing for the safe discharge of
patients more efficiently to free up needed bed spaces.
3:19:45 PM
MS. CHAMBERS related that Section 4 adds a new section to the
uncodified law which temporarily waives licensure requirements
for physicians, physician assistants, nurses, and advance
practice registered nurses, if licensed, permitted, or certified
in good standing in another jurisdiction to provide telehealth
and telemedicine services to patients in Alaska without being
required to obtain an Alaska license or first conduct an in-
person physical exam. She said this does not allow a health
care professional not licensed in Alaska to provide in-person
treatment in Alaska or to prescribe a controlled substance.
Section 4 further provides that a provider practicing under this
section must charge a fee that is customary and reasonable. A
provider must only practice within their scope allowed in the
state in which they are licensed, and which is permitted in this
section. If unable to do so, they must recommend the patient
seek treatment from an Alaska licensed provider. This section's
language is the same language adopted by the legislature in
Senate Bill 241 in 2020 and HB 76 earlier this year, except that
subsection (c) was removed in the Senate Labor & Commerce
Committee; subsection (c) provided the commissioner of DHSS the
authority to waive state law or regulation that would prevent or
impede the provision of health care services under this
telemedicine section.
MS. CHAMBERS specified that Section 5 adds a new section to the
uncodified law which provides that a hospital or nursing
facility may employ a person without obtaining a background
check from DHSS if the hospital or nursing facility provides
sufficient information to the department attesting to the hiring
process for each person employed at this facility and confirms
that a background check has been conducted as part of the hiring
process. It also provides that the hospital or nursing facility
must receive a background check from DHSS for each person hired
between the effective date of this Act and July 1, 2022, no
later than July 1, 2022.
MS. CHAMBERS stated that Section 6, added on the Senate floor
[on 9/10/21], provides that a person is not required to obtain a
certificate of need under AS 18.07 for an expenditure that is
made between the effective date of this Act and June 30, 2022.
MS. CHAMBERS said Section 7 provides that Section 4, relating to
telehealth and telemedicine, and Section 5, relating to
background checks, are repealed on July 1, 2022.
MS. CHAMBERS concluded her sectional analysis by stating that
Section 8 provides for an immediate effective date.
3:22:55 PM
REPRESENTATIVE KURKA stated that the bill appears to be a sunset
bill with a short sunset period of not even one year. He asked
why the sunset and why not make some of these changes permanent
as they would greatly aid the health care market in Alaska.
COMMISSIONER CRUM replied that the short timeframe of the sunset
is because this is for the emergency response, it isn't trying
to set long-term policy. These are items that would require the
legislature's deliberation for long term policy.
REPRESENTATIVE KURKA remarked that the legislature has talked
about many of these things for years, such as removing the
waiver of the certificate of need. More than 12 months would be
needed to see if this works, he continued, and therefore he
advocates for a "more reasonable" sunset timeframe.
3:26:02 PM
REPRESENTATIVE FIELDS asked why eliminating the certificate of
need would drive up costs and potentially shut down hospitals,
making certain emergency rooms (ERs) uneconomical to operate.
3:26:23 PM
JARED KOSIN, President and CEO, Alaska State Hospital and
Nursing Home Association (ASHNA), concurred with Commissioner
Crum on the intent of the bill and said ASHNA [now the Alaska
Hospital and Healthcare Association (AHHA)] made many of those
requests. This is a pandemic response bill, he stressed, not a
health care reform bill. All those provisions would be
inappropriate to extend beyond a finite period such as what is
in the bill. In particular, the telemedicine portion is a band-
aid and to do long term reform, several other aspects would have
to be looked at for that to make sense. The certificate of need
amendment is unnecessary and ASHNHA does not support that. He
said his understanding of the intent of the certificate of need
amendment is so that alternate care sites could be erected
without certificate of need review. While that intent is well
thought, there are no alternate care sites that are being
erected for a million and a half dollars and ASHNHA isn't
expecting that to happen any time soon; it doesn't make sense to
even have that in there. Keeping the program in place and
reforming the program through regulations and tweaks makes more
sense, and ASHNHA testified to that effect when the bill was up
during regular session. Putting it in here to see what happens
is bad policy and ASHNHA thinks it would increase the cost of
care over time.
3:28:02 PM
REPRESENTATIVE SPOHNHOLZ asked if Commissioner Crum interprets
Section 2, Sec. 18.09.280, as meaning that private employers
could not require vaccination as a term of employment for any
reason, so hospitals would not be able to require vaccination of
their employees.
COMMISSIONER CRUM deferred to Stacy Kraly to provide an answer.
3:28:59 PM
STACIE KRALY, Chief Assistant Attorney General, Human Services
Section, Civil Division Juneau, Department of Law (DOL),
answered that that section, as she reads it, is very broad. She
said the limitation for personal objection is based not just on
religious or medical grounds, which are currently well
established in law, but also "any other grounds". The way that
is drafted would allow for an objection for any reason for
purposes of avoiding a vaccination. So, yes, as drafted,
[private employers could not require vaccination as a term of
employment for any reason].
REPRESENTATIVE SPOHNHOLZ concluded that this provision would
allow employees of private employers that potentially care for
folks who are immunocompromised or medically fragile to say, "I
don't want to follow your rules", and employers would have no
recourse.
MS. KRALY replied that given the bill was amended yesterday on
the Senate floor she hasn't looked at it very closely, but it
does appear that that is the intent.
3:30:25 PM
REPRESENTATIVE SPOHNHOLZ drew attention to Section 2, Sec.
18.09.270, and asked what the standard would be for proving that
a person has antibodies.
MS. KRALY deferred to the Division of Public Health to answer
the question.
3:31:20 PM
HEIDI HEDBERG, Director, Division of Public Health, Department
of Health and Social Services (DHSS), deferred to Dr. Anne Zink
to answer the question.
[Dr. Zink was not present.]
3:31:44 PM
The committee took an at-ease from 3:31 p.m. to 3:33 p.m.
3:33:20 PM
REPRESENTATIVE SPOHNHOLZ asked how long it currently takes DHSS
to process background checks.
COMMISSIONER CRUM deferred to DHSS Deputy Commissioner Albert
Wall to answer the question.
3:34:15 PM
ALBERT WALL, Deputy Commissioner, Medicaid & Health Care Policy,
Office of the Commissioner, Department of Health and Social
Services (DHSS), responded that regulation requires the
processing of background checks by fifteen days. Right now, he
said, the longest it is taking is fourteen days and most are
averaging between seven and fourteen days.
3:34:36 PM
REPRESENTATIVE FIELDS offered his understanding that given the
"anti-vaccination amendments" adopted in the Senate, the bill
could increase costs to providers. He requested Mr. Kosin to
talk about this.
MR. KOSIN answered that ASHNA does not support the amendments
for several reasons, but specifically because they undermine the
ability to promote mitigation measures. From a cost standpoint,
he continued, the federal administration recently put forward
notice of intent to make rules requiring all Medicare and
Medicaid certified healthcare facilities to be compliant with
all employees being vaccinated. So, the amendments in the bill
were to force Alaska employers and health care facilities to
somehow go against federal law, and ASHNA would argue federal
law would supersede it. But, even if it were to create that
question, it would force [ASHNA's members] not to comply with
federal law and [ASHNA's members] would lose their Medicare and
Medicaid funding, which would shut down every health care entity
in the state.
3:36:04 PM
REPRESENTATIVE FIELDS recalled that in previous debates on this
issue there were proposals that would have prohibited employers
from even asking about vaccination status. He asked whether not
knowing if employees are vaccinated would exacerbate workforce
shortages by forcing quarantines of people because employers
would have to assume that they were not vaccinated.
MR. KOSIN replied yes, if [an employer] doesn't have an ability
to know whether an employee/health care worker is vaccinated
then [the employer] would be forced to pull the employee out of
rotation if there is exposure or close contact, thereby
exacerbating the workforce shortages already being endured. It
would completely impede the ability to provide health care.
There are protocols in place to deal with appropriate situations
where a vaccine does not make sense for a particular employer.
"The way this is spelled out in the legislation undermines our
ability to do that," he added, "and thereby undermines our
ability to use our workforce to the fullest extent."
3:37:48 PM
REPRESENTATIVE FIELDS surmised that in calling this bill a band-
aid, Mr. Kosin was saying the bill modestly provides workforce
flexibility. He noted that a map of the Delta surge across the
US shows a strong correlation between areas of the US with low
vaccination rates also having overflowing hospitals. He asked
whether it is fair to say that unless low vaccination rates are
tackled, hospitals will continue to be at or beyond capacity.
MR. KOSIN responded that ASHNA believes in science. He said the
Centers for Disease Control and Prevention (CDC) guidelines and
mitigation measures are the single best way to get through the
latest surge with the Delta variant and any surges in the
future. This bill is helpful in the sense that it would provide
a few flexibilities but compared to the grand scheme of how
serious this situation is before us, it is more akin to a band-
aide. That is not meant to insult the bill because it is
useful. But to put it into context, while watching some of
yesterday's amendments that I just explained did not make sense
from a health care standpoint, I was talking to a critical
access hospital that is on the brink of running out of oxygen
for its high flow oxygen patients, as well as running against
capacity strain to even provide oxygen at the level needed to
sustain the lives of its patients. Running out of resources
like oxygen shows how big this is. This bill will help, but
mitigation measures and everybody doing their part will go a lot
longer and farther.
3:40:27 PM
REPRESENTATIVE SPOHNHOLZ, regarding Sec. 18.09.270 of Section 2,
inquired how a person would document or prove that he or she has
antibodies against COVID-19.
3:41:01 PM
ANNE ZINK, MD, Chief Medical Officer, Division of Public Health,
Department of Health and Social Services (DHSS), answered that
antibody tests are blood tests that look for proteins that were
developed in response either to vaccination or to a previous
infection. There are many different types of antibody tests.
Antibodies last for different periods in the body, they do not
last for a super long time for many of the different types of
antibody tests, and they wane over time. Unfortunately for
COVID-19, there is no perfect correlate for immunity, there is
no single blood test that can be done to say that a person has
protection from this disease moving forward. There is more and
more evidence that memory B cell and T cell may play a larger
role than antibodies given antibodies fade over time. She said
she doesn't know how that would be documented given that the
current language doesn't specify they type of antibodies, or
which antibodies, or which period of time, and therefore this
would be challenging to implement.
3:42:07 PM
REPRESENTATIVE SPOHNHOLZ, regarding antibodies waning over time,
inquired whether there is a difference in the length of time
that a person would have antibodies in response to the vaccine
versus in response to COVID-19 infection itself.
DR. ZINK replied that there is a variety of antibodies, such as
IgG, IgM, IgA, and more. She said IgM antibodies come up more
quickly and then fade more quickly and IgG tend to last longer,
but they are only one part of the immune system. They don't
represent the larger immune system, including B cells and T
cells. The antibodies that are produced from vaccine are
against the spike protein. For someone getting infected without
being vaccinated, a whole variety of different types of
antibodies may or may not be seen against the spike or
nucleotides, they can vary. The height of those antibodies as
well as the length of the antibodies appears to be variable for
both immunized and unimmunized individuals. Increasing data is
being seen that antibodies can decrease over time - both in
people being infected and acquiring the disease or from the
vaccine overall. What is known is that these vaccines were
intended to create long-term immunity and better lasting
immunity. It is not uncommon to have vaccines that require two
or three shots so that the body develops a long-term memory for
that infection. Vaccines don't work against the immune system,
they teach the immune system how to take down the virus in
general, so they work in combination. For example, if someone
was vaccinated and then got COVID-19, a variety of antibodies
may be seen against nucleotide and against spike that will fade
over time. So, there is not a single, simple answer to say that
somebody with previous infection is protected from this disease.
3:44:22 PM
REPRESENTATIVE SPOHNHOLZ asked whether antibodies from a
vaccination will tend to be present more robustly and for longer
than from infection itself.
DR. ZINK responded that there is still much to learn about this
vaccine and this virus, but that it is very common for longer
and more robust immunity from vaccination than from natural
infection itself. It also looks like natural infection may
provide a variety of responses some people may develop a very
robust immune response and some people may develop less of an
immune response. Early initial data is showing that people who
have had infection and been vaccinated have had even more robust
response than either one or the other.
3:45:34 PM
CO-CHAIR SNYDER drew attention to Sec. 18.09.270 of Section 2
and observed that no date is associated with the evidence. She
pointed out that if a documented COVID-19 test is allowed to be
a component of that evidence, in theory someone could show a
COVID-positive test from a day or two ago. She noted that the
bill's primary purpose is to address workforce needs and
inquired whether this section would alleviate or exacerbate the
pressures on the state's health care system.
DR. ZINK answered that in her work with companies, communities,
Alaskans, and businesses, it has been impressive to see the
requirements and the things they need to do to stay open and
running. It is very important, she said, to allow them the
flexibility to use whatever tools that they need to minimize the
impact of this virus on their workforce, including the health
care workforce. It is quite common within the health care
workforce to require immunization so that a worker is protected
and also does not accidentally infect patients and coworkers.
This has been a standard within health care for a long time and
increasingly used quite successfully within businesses so that
they can operate most efficiently.
3:47:26 PM
CO-CHAIR SNYDER clarified that her question was whether Dr. Zink
would interpret the utilization of an antibody test, or a
documented COVID-19 test, as an avenue for reducing the
pressures on Alaska's workforce in the same way that proof of
vaccination would be anticipated to reduce the pressure.
DR. ZINK replied that that would be challenging for numerous
reasons. It is currently in place that if someone tests
positive within 90 days there is no need for a repeat test, but
antibody testing has not been seen as a useful marker for
protection to be able to see that that person is protected in a
way that would allow safe interaction within a workforce and
that would minimize the risk of COVID-19 within that workforce.
So, while a recent test within the 90 days can be useful, there
is no good way to use antibody testing in the same way for the
workforce at this time.
3:48:38 PM
CO-CHAIR SNYDER stated she is asking the question more in the
setting of health care and the crush of patients that is being
experienced. She asked whether this would be an avenue for
reducing the pressure on Alaska's health care system assisting
those who have contracted COVID-19.
DR. ZINK responded she would have to defer to Mr. Kosin. She
said there are ways that people who have been previously exposed
to COVID-19 can continue to work within the workforce. Someone
who is vaccinated can continue to work, particularly within the
health care setting, on a regular basis. But when someone is
not vaccinated it makes that much more challenging. There is no
good way to use antibody testing to keep people in the workforce
versus vaccination. For example, if a health care worker's
child contracted COVID-19 at school and comes home and exposes
the worker, that vaccinated worker does not need to quarantine
and can continue to work. It is currently being seen that
vaccinated workers can keep working, but there is no great way
to use antibody testing on top of that. A previous infection
within 90 days can be useful but after those 90 days it starts
to wane and as a result the usefulness of a previous infection
is significantly reduced compared to vaccination.
3:50:04 PM
REPRESENTATIVE KURKA, regarding Sec. 18.09.270 of Section 2,
offered his understanding that late last year Fred Meyer
Pharmacy was offering antibody tests. He said he is perplexed
by this commentary because his understanding is that the
strongest immunity is the natural immunity a person gets from
having a sickness. He asked whether Dr. Zink can point to any
COVID-19 studies that compare the effectiveness of antibodies
versus natural immunity from having had COVID-19.
DR. ZINK answered that she would be happy to provide in writing
additional information from immunologists specific to natural
infection versus vaccination in general. The immune system is
complex in the way that it works, she said, and it is not always
the same for every person. For example, young children develop
a very robust immune response to viruses, older people develop a
much lower response, immunosuppressed individuals develop less
of a response, and those who don't get as sick develop less of a
response. She concurred that many stores do sell antibody
testing and that they can be used, but she cautioned that their
usefulness as far as whether a person has protection from the
virus has not been determined in the literature. Many studies
have been done on antibody tests from vaccine versus natural
infection, Dr. Zink continued, and she can provide that
information. Many of the initial studies for vaccination as
well as for natural infection look at antibody tests and levels.
It is a marker but is not a correlate for full protection, so it
is important to realize the limitations of those studies. Data
from real-world studies in the US and Israel shows that people
who had previous COVID-19 and then were vaccinated are more
likely to be protected than if they just had previous infection.
People with just previous infection were 2.5 times more likely
to get reinfected from COVID-19 than those who had previous
infection and got vaccinated. Also, the Delta variant is
different in many ways higher rates of infection are being
seen as well as some decreased effectiveness of the vaccination
in general.
3:54:45 PM
REPRESENTATIVE PRAX requested Dr. Zink to point committee
members to the most authoritative studies that she is following
to arrive at her conclusions.
DR. ZINK replied that her specialty is emergency medicine where
she pulls together different specialists to serve the patient
she is seeing, and she sees her role as chief medical officer as
being similar. There are many studies, she said, and every
Thursday the entire week's literature, 20-50 articles, is
discussed with other health care providers. Everyone in the
team has a different area of the literature that they closely
follow and there is also reliance upon the partners across the
state. Therefore, a broad look is taken at the literature
rather than relying on one study or series of studies. Every
study has limitations and looking at the overall evidence rather
than just one or two studies helps to better understand where
the science is moving in general. She said she would be happy
to include committee members on the list of people who receive
the list of studies for each week. In further response to
Representative Prax, Dr. Zink said she will sign him up for the
weekly newsletter and that he can direct the public to the
department's weekly [Extension for the Community Healthcare
Outcomes (ECHO)] every Wednesday from 12:00-1:00 p.m. at which
the whole team is present to take questions from the public.
3:58:18 PM
REPRESENTATIVE MCCARTY noted that telemedicine and background
checks are a premise of the bill to expedite workers into the
field. He inquired whether there is a certain standard of
background check that is expected so that providers or
organizations can go to that source and fulfill the guidelines
of that standard and expedite providers into their agencies.
DEPUTY COMMISSIONER WALL responded that there are several types
of facilities and several types of providers. Each of those
different types of providers or facilities have their own
requirements for how they become licensed professionally in
Alaska if they have a professional license, and how the facility
becomes certified or licensed to be that type of health care
facility in the state.
3:59:45 PM
REPRESENTATIVE MCCARTY asked whether Deputy Commissioner Wall is
stating that any agency or organization that is doing background
checks in Alaska is recognized to be able to do those checks in
compliance with DHSS.
DEPUTY COMMISSIONER WALL answered no. He said a provider must
take several different steps to practice medicine in Alaska. A
medical doctor or nurse would get their professional license
through the license office and a background check is part of
that process. Enrolling as a provider in Medicaid is a separate
process done through DHSS and includes a separate background
check, and it is for this process of enrollment as a Medicaid
provider that the proposed legislation would offer the waiver.
4:00:58 PM
REPRESENTATIVE MCCARTY related that he is hearing from health
care facilities that the DHSS background check for providers who
are waiting to be hired is not happening fast enough, so
patients are not being seen. The purpose of this bill, he
noted, is so that providers are available to help once a
background check is done within just days. He asked whether
organizations could send providers to organizations that do
background checks so the providers could qualify to start
providing services.
DEPUTY COMMISSIONER WALL deferred to the Department of Law to
provide an answer.
MS. KRALY answered that the background check process is set
forth in state law under AS 47.05.300. It requires that every
individual who is paid for in whole or in part by the Department
of Health and Social Services have a background check, which
includes a criminal history check and a civil registry check.
Under this DHSS process, a fingerprint-based check must be
submitted for every individual who is going to be employed by
one of these provider types a hospital, nursing home, assisted
living home, and so forth. The requirements within the
statutory framework are robust. A third-party background check
or running some sort of analysis of someone's criminal history
through a web-based system is not sufficient. For purposes of
this bill, it has been identified that nursing homes and
hospitals provide a very robust pre-employment vetting screen
system through policies and procedures and third-party
fingerprint-based background checks that are sufficient to meet,
or are equivalent to, the standards that the state engages in as
required by state law. So, if that were to be expanded further,
that same level of vetting and review would need to be
established and identified by the state in order to feel
comfortable that individuals were getting to be hired because
ultimately the background check is to ensure the health, safety,
and welfare of the individuals being cared for by the providers.
4:05:06 PM
REPRESENTATIVE MCCARTY said he has talked to organizations that
still don't have results from background checks pursued over a
month ago, so they cannot hire the people. He interpreted Ms.
Kraly to be saying that policymakers set the background check
that is expected and therefore policymakers could say that a
third-party entity recognized for doing business in Alaska can
be used to solve this problem in the immediate.
MS. KRALY replied that it is more complex than that; a third-
party provider licensed to do business in Alaska would not be
sufficient or meet the same standard that is set forth in state
statute. A background check requires a complete application, so
individuals experiencing a delay may have not submitted a
complete background check, which requires several different
pieces of paper. State law requires a background check to be
completed within fifteen days, and DHSS is meeting or exceeding
that fifteen-day period; most background checks are being turned
around in seven to ten days. If this were to be expanded to
allow [for third-party background checks], it would need to be
very clear about what type of background checks are being
authorized and that the health, safety and welfare minimum
requirements are being met that are necessary to make sure
individuals are safe in Alaska who are providing care.
4:07:32 PM
REPRESENTATIVE FIELDS recounted that there was discussion in the
Senate about robustness of vaccines versus natural immunity,
which stemmed from a blog called the "Alaska Watchman". He
charged that the blog blatantly misrepresented the statements of
the state epidemiologist.
4:07:59 PM
The committee took an at-ease from 4:08 p.m. to 4:22 p.m.
4:22:20 PM
CO-CHAIR ZULKOSKY opened public testimony on SB 3006.
4:23:03 PM
MICHELE GIRAULT, Executive Director, Hope Community Resources;
Board President, Key Coalition of Alaska, urged the committee to
consider an amendment to SB 3006 to include employers providing
supports to seniors and those with disabilities living in Alaska
to utilize a third-party vendor to do initial background
screening. She pointed out that the May 2021 malware attack [on
DHSS] took offline many critical systems, including the
background check unit (BCU), which created significant delays in
background check clearance and an additional barrier and burden
for employers that provide critical health and safety support in
the community. Organizations like hers employ direct support
professionals who work alongside those with disabilities and
have kept them out of hospitals during the pandemic crisis.
MS. GIRAULT noted that currently the competition for employees
is enormous. She related that Hope recently lost an employee
because her background check had not cleared after 25 days, so
she may seek employment elsewhere. [Service organizations]
currently cannot compete with the quick onboarding of the retail
or hospitality industries. The stakeholders [using service
organizations] deserve the protection of a background check
process, but during this technology crisis, now four-and-a-half
months, community providers must be given an option to seek
third party verification to onboard employees while continuing
the elongated process to the state background check unit.
MS. GIRAULT shared that she is one of many executive directors
around the state who are currently working shifts to relieve
frontline workers. She allowed that this proposed amendment
would not magically fix the current dynamic but said it would
remove one barrier to providing adequate support for
stakeholders and current employees.
4:25:36 PM
NICOLE BASS, Co-owner, Tides LLC, noted that Tides LLC is a home
and community-based service (HCBS) Medicaid provider agency with
55 employees that provides direct support to 30 children and
adults who experience intellectual and developmental
disabilities and complex medical conditions. She said Tides is
experiencing a workforce shortage like nothing before. She
urged that the bill be amended to include home and community-
based Medicaid providers to expedite the background check
process by allowing a third-party vendor. While Tides does not
operate any assisted living facilities, it does provide
essential daily support in the private homes of Medicaid
recipients. The current delay in processing background checks
is severely impacting the ability of Tides to meet recipient
needs. It is currently taking three to four weeks to get
provisional clearance even for employees who are already cleared
in the same system. This during a time of experiencing a severe
staffing shortage, high turnover, and employees having to
isolate due to increased COVID-19 exposure with the Delta
variant. Caregivers are being lost who have been navigating
this pandemic successfully over the past 19 months but are just
unable to continue without help.
MS. BASS related that for most of the pandemic Tides was able to
obtain provisional clearance within 24-72 hours due to the
emergency order, but now because of the cyber-attack Tides is
having to tell recipients and families who are potentially in
crisis that they may have to wait up to four weeks before Tides
can meet their needs. Typically, when hiring an employee who is
already cleared in the BCU, Tides can obtain immediate clearance
by connecting to their application in the system. However,
after over four months the state has been unable to find a way
to expedite this process and providers are having to wait a
month for this to happen. This doesn't include the time it
takes to onboard employees which can extend that time to six to
eight weeks. In the past month Tides hired six experienced
employees but lost three of them because they could not wait for
a month to get paid. She urged that the bill be amended to
include home and community-based Medicaid providers and expedite
the background check process for direct service professionals.
4:28:14 PM
ALBERTA UNOK, President and CEO, Alaska Native Health Board
(ANHB), stated that ANHB is the statewide voice for the Alaska
tribal health system, and has advocated for the health and
wellbeing of Alaska Native people for 50 years. She said ANHB
supports the two provisions that will allow for the expanded
telehealth and background check flexibilities for health care
providers to have tools to respond to the current public health
emergency. These provisions will support placing health care
providers quickly into the workforce to meet the surge in COVID-
19 numbers and the crisis happening in the hospitals. She added
that her testimony today mirrors ANHB's written support for
expanded telehealth and background check flexibilities.
4:29:27 PM
The committee took an at-ease from 4:29 p.m. to 4:30 p.m.
4:30:58 PM
CO-CHAIR ZULKOSKY urged witnesses to provide their testimony in
writing given the short amount of time for oral testimony.
REPRESENTATIVE PRAX said he would like to know from providers
and employers whether their background checks and other
screening methods meet the state's standards.
4:32:23 PM
RIC NELSON, Advocacy & Outreach Manager, Consumer of Services,
The Arc of Anchorage, provided testimony via an interpreter,
Dean Paul. He stated that because of his disability he receives
services through the system. He hires people through a provider
agency and sometimes it takes up to three months to get somebody
hired because of the background check. He has had to wait up to
eight weeks to get somebody trained and hired. People are
waiting and unable to get adequate services because of these
delays. He asked the committee to amend the bill to include
home and community-based service provider agencies to have a way
to get the background checks much faster - in three-seven days.
4:35:11 PM
AMANDA FAULKNER, President, Alaska Association on Developmental
Disabilities (AADD), explained that AADD supports providers
across Alaska. She noted she is also the executive director of
[Frontier Community Services] in the Soldotna area that provides
community services to individuals with disabilities. Finding
employees has been a struggle, she said, and the past 18 months
have proven to be the perfect storm. While COVID-19 had
unprecedented challenges, providers stood strong and kept a very
vulnerable population safe as they juggled unintended and
unfunded mandates. The [May 2021] cyber-attack compounded
employers' recruitment efforts and in particular the background
checks have made it very challenging. From May 17-24, providers
were allowed to use a third party to expedite background checks
but then it was removed. She requested that home and community-
based services be added to the bill to allow providers to
utilize third-party background checks when the committee votes
to authorize this option for hospitals and nursing homes. The
people her organizations support meet a level of institutional
care, she added, and it has been very challenging. As the
executive director she has been working shifts and is proud to
do so. A manager she lost this last week said she was leaving
because she just couldn't do it anymore. Her organizations are
struggling beyond struggling and as stated by Commissioner Crum,
it is a workforce crisis and allowing use of this tool will help
in the short term.
REPRESENTATIVE PRAX asked whether AADD's background checks and
other screening standards compare to or equal the standards set
by the state.
MS. FAULKNER answered, "We would be able to meet those
standards."
4:37:53 PM
ANDREA CONTER, Human Resources Director, The Arc of Anchorage,
stated that before coming to The Arc in December 2020 she was a
retail store manager for 30 years and therefore understands the
finances of the for-profit world. She said The Arc's tenuous
hiring situation was further devastated by the malware attack
that affected the BCU. Before the attack The Arc could get a
State of Alaska sanctioned provisional clearance within 1-3 days
and she could therefore have a new hire orientation within a
week. Once the BCU went down, getting a provisional clearance
increased to 15-21 days and actual orientation would not happen
until a month after the first interview. It is challenging for
people to wait a month for a job that only pays $16 an hour when
they can receive essentially the same pay as a cashier or
dishwasher. Since the attack The Arc has lost 17 potential
hires due to the delay in starting.
MS. CONTER stated that The Arc currently has over 40 positions
that need filling. All these issues are a financial burden, she
explained. The Arc's overtime costs have grown to be an average
of $15,000 a week and worker burnout has become another concern.
She noted that food prices nationwide have risen close to 10
percent due to businesses having to pay their employees more.
However, she continued, The Arc differentiates from for-profit
businesses in that The Arc doesn't have the luxury of raising
its prices because the State of Alaska determines how much this
industry gets paid through Medicaid. The extra cost that The
Arc is now incurring will lead to tough decisions that could
dramatically affect the population that The Arc loves and
serves. These challenges are further affected by the pandemic.
MS. CONTER shared the human cost element. She said she gets
calls weekly from individuals whom The Arc services, adults who
experience intellectual and physical disabilities, who call
begging her to find someone to work with them and help them.
She requested that the background check process be expedited,
and that the committee also look at additional funding to help
organizations through this process, especially those that cannot
raise prices in any manner.
4:40:14 PM
MELISSA O'BRYAN, Ketchikan Program Director, Southeast Alaska
Independent Living (SAIL), stated that SAIL is the front door to
those needing home and community-based services. She requested
that the committee amend the bill to include all home and
community-based service providers so that the health and safety
of [Alaska's] senior and disabled populations remain a priority.
She noted that a direct support professional (DSP) shortage was
being experienced in Alaska before the pandemic. Service
provider agencies need to be able to fill these positions
quickly, and this is reliant on the timeliness of background
checks for employment. Since the May 2021 malware attack,
delays in background checks have impacted the ability to receive
services that are needed for activities of daily living.
Amending this bill to include HCBS providers allows these
positions to be filled at a rate that is responsive to the
needs. This segment of the workforce provides essential
services, and the support is critical for keeping people safe in
their communities and out of hospitals and nursing homes when
not necessary, especially to not overcrowd health care
facilities during this pandemic. [This proposed amendment]
would help citizens get the critical care they are entitled to.
4:41:55 PM
BARBARA RODRIGUEZ-RATH, Chief Executive Officer, The Arc of
Anchorage, stated that during its nearly 65 years of providing
home and community-based services to individuals who experience
intellectual and developmental disabilities, The Arc has never
faced the immensity of the issues that it does today. A drastic
workforce shortage has been made much worse by the COVID-19
pandemic and the malware attack on the state BCU. The Arc has
had far fewer applications for its entry level direct support
professional positions. Staff have left because of the delays
caused by the BCU - 14-15 days to get clearance. Between the
pandemic, the worker shortage, and the BCU delay, The Arc is
stretched thin and is having to pull employees from other
programs to cover the shifts at its residential homes that must
be staffed 24 hours a day, 7 days a week (24/7). This means
that other individuals may go without services. Frontline case
managers all the way up to senior leadership, including herself,
are on call taking shifts to cover gaps - it is not sustainable.
As currently written, SB 3006 does not provide the same access
to third-party background checks to home and community-based
providers. She asked that the bill be amended to allow the same
options to agencies like The Arc as the options to hospitals and
nursing homes.
4:44:16 PM
DEAN PAUL testified that he has worked for a few years as a
direct service provider caring for other people, including his
aging parents. He related that his daughter-in-law recently
moved to Alaska but is unable to work in the nursing industry
because her registered nurse (RN) license from another state has
not been accepted by the State of Alaska. He further noted that
during his 15 years of providing care, there have been
challenges with the BCU taking way too long to hire DSPs, which
put a further burden on him. He ended up selling his company in
September 2014 because he couldn't run a successful company and
care for his parents and help Mr. Ric Nelson.
MR. PAUL stated that getting provisional background checks has
taken much longer than what the BCU says, and perhaps an inquiry
is needed to check the data on how long it really has taken. He
said he is nearly 64 and has health issues so will not be able
to continue doing these types of services. He is concerned
about what will happen to Mr. Nelson if the system is not fixed
so that qualified direct service providers can be hired. He
said he is in favor of this bill but doesn't understand why HCBS
provider agencies have been excluded. He urged that this be
included so it is a little easier to get the background checks.
4:47:14 PM
HEIDI YOUNG, Care Coordinator, Island Care Services, stated she
has been a care coordinator serving clients all over Alaska for
the past 12 years and she has never seen it this difficult to
get providers through the background check unit. She said she
has checked with all the providers she does business with and
the two-week threshold that was quoted is not being met. She
urged the committee to adopt an amendment to add home and
community-based waiver services, which were designed to provide
services in the community that a person would receive in an
institution. These services allow people to go home from the
hospitals, and without workers to do so Alaska's already
overburdened hospital system is not going to see any relief
soon. Alaska's long-term care unit beds are full, hospital
capacity is being maxed out. If there is an emergency there is
nowhere for people to go. Alaska is in a crisis, and these
services are desperately needed to get Alaskans back into their
homes and home communities. Agencies have waiting lists for
people who are approved for these services, but the agencies
cannot provide them.
4:49:18 PM
LIZETTE STIEHR, Executive Director, Alaska Association on
Developmental Disabilities (AADD), explained that AADD is an
association of 60 large and small providers across Alaska that
service individuals with intellectual and developmental
disabilities. She said she has been in this field for decades
in several different positions and she can attest things have
never been this difficult. [The pandemic] has steered people
out of jobs where they are face-to-face with COVID-19. One
program reported that its typical 35 percent annual turnover
rate was 68 percent last year. There are not enough staff in
the field right now to offer the services that are needed. An
AADD poll found that up to 80 percent of managers are filling
shifts because there are not sufficient DSPs to cover. This is
not sustainable. Several providers noted that up to 50 percent
of their shifts are being covered by supervisors or managers of
their organization.
MS. STIEHR stated that compounding this difficulty is the
extensive delay in hiring if providers are lucky enough to have
applicants that they interview and want to hire. The background
check from Alaska's unit has been significantly impacted by the
malware attack. The background check unit working manually
claims to process complete applications within 15 working days,
but she has numerous stories of where that timeline has not been
met. One provider turned in five complete background check
applications with a credit card for payment: three were paid
with the credit card and two were not processed due to miss on
payment. In addition, it is excruciatingly difficult to track
whether the background check is being processed. This situation
is untenable. She urged that the bill be amended to include
home and community-based service providers to allow them to
utilize third-party background checks.
4:52:52 PM
TABITHA ALONE, Executive Director, Hearts and Hands of Care,
urged that the bill be amended to include direct care workers.
She said her organization provides home and community-based
waiver services and personal care services to more than 300
individuals and provides employment to about the same number of
employees. Some of the challenges faced with the background
check unit is loss of complete application items to include
receipts that was provided by the background check unit after
payment over the phone with a credit card. Yesterday an email
was received about needing an additional two-day wait period
beyond the fourteen days for the BCU to even acknowledge receipt
of a complete application. Her organization has had instances
of background check applications taking up to three months to
gain a provisional determination. Even within three to four
weeks of waiting for a provisional, her organization has had
numerous employees or potential employees find other places of
employment. The BCU has also impacted the amount of overtime
that is currently being done. At the Medicaid reimbursement
rate, this is contributing to provider burnout, shortage of
shifts, and ensuring everyone has the services necessary for
staying out of the hospitals. She said her organization
supports amending the bill to add direct care workers to the
background check.
4:55:23 PM
RONALD LITTLE, Co-owner, One Source Homecare Services, testified
that everything the committee has heard from previous witnesses
is exactly what is happening to his business. He said he
respects the people at the BCU, but [direct care service
providers] are not getting the results that they must have to
provide the services that they agreed to provide. He said
[direct care providers] must be given the ability to hire staff
in a timely manner because without that ability he doesn't know
how much longer his small company can stay in business.
4:56:44 PM
TYLER MCNEIL, Disability Services Program Manager, Community
Connections, said he echoes many of the sentiments spoken to
today regarding the home and community-based service programs
and the hardships they have been facing. He explained that to
be eligible for many of the services that Community Connections
provides, the individuals served must meet nursing facility
level of care. So, instead of receiving care in a nursing home
these individuals are receiving care in their private homes and
communities where they live. It is important to be able to meet
the needs of these individuals, but with the delays in
background checks for hiring new staff and getting them trained,
organizations are functioning understaffed, resulting in burnout
of existing staff, and Community Connections is seeing an
increase in turnover that is really concerning. Excessive
challenges in meeting the level of needs already existed in
Alaska prior to COVID-19, and these have been exacerbated by the
pandemic and the technological issues and attacks. He said he
echoes the importance of flexibility for the background checks
to add the home and community-based services.
4:58:44 PM
VICKI HERMAN urged the committee to vote for the bill with the
vaccine amendments. She stated that this crisis with workers
will only be made worse come mid-October when one of Alaska's
major hospitals requires its nurses and health care providers to
be vaccinated. She predicted there will be numerous nurses and
health care workers who will be quitting their job because they
are being forced to take the vaccine, making the personnel
shortage worse. She urged committee members to vote for the
bill with the vaccine amendments to save the constitutional
right to choose for oneself on the vaccine.
5:00:00 PM
JACKI CHURCHILL, a registered nurse, shared her personal
experience as a caregiver to her husband with cancer. She said
cancer not only attacks healthy tissue, but attacks every aspect
of life, including relationships and finances. The burden is
real, the exhaustion is real, and any reduction in stress from
this overwhelming situation is beneficial. If something
positive could be said about COVID-19, it would be the
suspension of the state law requiring an Alaska license to
practice medicine by telehealth. The suspension had an
astounding impact in that it instantly removed many of the
burdens that come with having to travel out of state for medical
care. Over the past 20 years she and her husband have made
three trips to Seattle for the purposes of having a lymphoma
specialist recommend treatment options for what has turned out
to be an unpredictable span of events. Treating cancer is hard
work. For example, there are more than 70 types of lymphoma and
each person's response to treatment is variable. Alaskans have
great access to medical care locally, but quality care comes
from collaboration and she and her husband have personally
benefitted with each trip to Seattle.
MS. CHURCHILL related that in October, through a telehealth
visit with her husband's specialist in Seattle, she and her
husband were able to talk about how he was feeling, his lab
results, and most importantly they were able to hear the
doctor's opinion regarding the abnormalities on her husband's
scan and discuss treatment options moving forward. Unlike the
three prior visits when they had to fly Seattle, her husband was
able to just slip on his shoes and not have to worry about the
cost or time boarding their dog and two cats or parking at the
airport or airfare for three people or a roundtrip
transportation between the hotel and the airport or hotel fees
or eating out or the loss of time from work and school or
worrying about our home while away, especially with winter
temperatures. Best of all she and her husband didn't have to
worry about COVID-19 since her husband is considered
immunocompromised. She and her husband are able-bodied so she
cannot imagine what it would be like for a person in a
wheelchair and using oxygen or a single parent or someone who
lives remotely.
MS. CHURCHILL said telehealth should not be looked at as a
replacement of the medical care but in conjunction with local
medical care. As a nurse she knows that telehealth has been
around for more than 24 years. She urged that this tried-and-
true technology of telehealth be made more accessible and not be
dependent upon where someone lives but what they have access to,
and so she is asking for further access to that type of
technology.
5:04:52 PM
DEBORAH BROLLINI testified in support of the bill. She related
that she was an employee of "Cross Country Staffing" which had a
management service contract with Providence Hospital that
covered the traveling nurses and allied staff working
temporarily throughout the state. During her tenure, she said,
it could take up to six months to onboard travelers at
Providence. The licensing and background check issue is a long-
term problem. Keep in mind that there are 49 other states and
past employers who must verify employment. As an Alaskan she is
not comfortable waiving background checks for hospitals because
Alaska's hospitals are serving her family, friends, and
neighbors. She said she can appreciate the governor wanting to
backfill nursing and allied staff positions within hospitals,
and she hopes "the legislature seeks reimbursement for their new
HR duties."
5:05:54 PM
CO-CHAIR ZULKOSKY closed public testimony after ascertaining no
one else wished to testify.
5:06:04 PM
CO-CHAIR ZULKOSKY invited Mr. Kosin to offer ASHNHA's comments
on the bill.
MR. KOSIN stated that ASHNHA, which represents all of Alaska's
hospitals and nursing homes, does not support the bill in its
current form because of the amendments that were added. He said
ASHNHA categorizes them as anti-vaccine efforts and things that
would impede ASHNHA's effort on mitigation measures. Without
those provisions added, ASHNHA does support the bill.
MR. KOSIN said it is important to acknowledge the origin of the
bill. He related that ASHNHA has been meeting with the
administration and the legislature and the bill has always been
designed to be a pandemic response bill; it's about aiding a
rapid response. While he appreciates his colleagues that are
home and community-based service providers, the bill is not
meant to address systematic problems within some of the
processes in the department and the state. It is not a bill
that is meant to be a health care reform bill, something to test
different programs. It is truly meant to be a targeted effort
to help hospitals and nursing homes in the field try and respond
to what has turned into an increasingly daunting task.
MR. KOSIN pointed out that talk about the pandemic has evolved
from case counts and coordination efforts to talking about
crisis standards of care and whether there is a plan to ration
care as Alaska continues down the road it is headed. This is as
serious as it gets. The background check process is a means to
get staff on the floor immediately where first responders are
needed to respond to this crisis. He specified that the
utilization review piece is one potential tool that will improve
throughput to get people out of the hospital into nursing homes
and sub-acute care at a faster clip so that each of those
hospitals as they were previously occupied can become available.
Every bed counts. He stated that telemedicine helps reduce
transmission risk and potentially sets a way to stand up more
aggressive in-home patient monitoring efforts and things of that
nature to keep people out of the acute settings. Members of
ASHNHA, he said in conclusion, respectfully request that this
bill be adopted as it was originally introduced, or close there-
to, and that the committee move on it as quickly as possible.
5:09:46 PM
REPRESENTATIVE KURKA posited that the crisis seems to be more
about lack of available health care workers, not the number of
beds, although the focus earlier in the pandemic was about beds
and equipment. He asked whether Mr. Kosin has tracked the
number of health care professionals. He said his understanding
is that there have been thousands if not tens of thousands of
health care professionals who are leaving the industry and/or
leaving their job for a different one in a different location
because they are being forced to take the COVID-19 vaccine that
they do not want to take.
MR. KOSIN responded that the statement that tens of thousands of
health care workers are leaving the market due to mandated
vaccines is not correct based on the information he has been
shown, especially in Alaska. He said ASHNHA is not collecting
that as a datapoint, but ASHNHA is talking to hospital leaders
as well as nursing home leaders as these vaccine programs and
protocols are being implemented to ask about the effect on the
workforce and to date ASHNHA has not received any meaningful
concern about a significant exodus of staff. But, he allowed,
ASHNHA has not tracked that from a statistical point of view.
REPRESENTATIVE KURKA clarified he was speaking on a national
level with that number.
MR. KOSIN replied he was speaking on a national level as well.
5:12:33 PM
REPRESENTATIVE MCCARTY recalled a testifier having stated that
third-party entities were allowed to do the background check.
He surmised there is a standard that third-party entities must
comply with and requested clarification in this regard.
DEPUTY COMMISSIONER WALL deferred to Ms. Kraly to provide an
answer.
MS. KRALY responded that she would need to talk with the BCU to
learn what was decided in the immediate days following the
cyber-attack.
5:14:21 PM
REPRESENTATIVE PRAX offered his understanding that ASHNHA is
opposed to the vaccine provision [in the current bill version].
He requested clarification on whether ASHNHA would object to
including the home and community-based providers in this bill.
MR. KOSIN answered that it is a hard thing to do working for
hospitals and nursing homes and understanding the continuum of
care. He said ASHNHA believes, being on the frontlines on the
ground right now, that it is important to prioritize very
targeted response efforts and those efforts should be limited to
the content in the bill as it was introduced or something very
similar to that.
REPRESENTATIVE PRAX stated he isn't seeing a reason why the home
and community-based care providers who seem to be having the
same challenge shouldn't be offered the same opportunity to
expedite their hiring process. He requested Mr. Kosin to
explain the objection.
MR. KOSIN replied that the bill, as it was contemplated from the
beginning, is about rapid response in responding to the
pandemic; it is not a health care reform bill. There could be
the same question and answer about ways to approach reforming
Medicaid. Right now, the legislature is in special session and
the biggest crisis point is about the pandemic and responding on
the frontlines, not about the cyber-attack on the department or
other things that have affected Alaska's economy or way of life.
So, while he supports his colleagues in the home and community-
based sector, he must urge the committee, if it is prioritizing
a rapid response, that that rapid response occur almost
exclusively in hospitals and nursing homes.
5:17:03 PM
CO-CHAIR ZULKOSKY inquired about the tools, issues, or solutions
that DHSS has put forward to address the background check delays
beyond SB 3006.
DEPUTY COMMISSIONER WALL responded that this hearing has been
about two different provider types the hospitals and the home
and community-based service (HCBS) waivers. The hospitals, he
said, have a background check that is built into what they do as
an organization and as an institution. They are accredited by
an outside third party that also tracks their background checks
and the validity of their personnel. There are many checks and
balances that ensure providers have had the right types of
background checks for their credentials, for their licensure,
and for enrollment as a Medicaid provider. Hospitals have the
emergency rooms, so from his perspective it is somewhat of
life/limb/or eyesight issue specifically for their emergency
rooms and their personnel. Hospitals also have a number of
applications that come through sometimes in groups. On the
other side of that coin, he continued, are the home and
community-based service providers that are very much needed, and
it isn't being said that DHSS isn't going to do the background
checks in an expedited fashion. Home and community-based waiver
service providers, he pointed out, do not have the overarching
one-size-fits-all-this-is-how-things-are-done in this facility
for background checks and for personnel. For that, many HCBS
providers rely upon DHSS to process their background checks
because they don't have an overarching body like a credentialing
unit within a hospital.
DEPUTY COMMISSIONER WALL continued and presented a scenario to
explain why the proposed legislation, in its original form, will
also speed up the background check process for HCBS providers.
He posed a scenario of having a stack of applications on a desk,
50 from a hospital and 50 from health and community-based
services providers. Under the proposed legislation, the 50
applications from the hospitals would be taken out of the stack
for a short period of time, allowing the department to focus
entirely on the other service providers for the exact purpose of
processing their applications more quickly. The legislation
will speed up the process of processing home and community-based
waivers background checks, and other providers, by taking a
known block of providers, the hospital facilities, out of that
mix for a short period of time until the situation can be
addressed for COVID-19.
5:21:06 PM
CO-CHAIR ZULKOSKY asked whether legislation is the only avenue
for hospitals to achieve the flexibilities needed on background
checks.
MR. KOSIN answered yes and no. He said ASHNHA is working with
DHSS directly to see what unilateral authorities exist to try to
secure different processes for its members, which has been a
successful process. No, it's not the exclusive route for
achieving some of the flexibilities needed, but it is the gold
standard for ASHNHA because it sets it in statute and takes away
any ambiguity. He stressed that ASHNHA is asking for anything
and everything right now and added that the department has been
extremely helpful particularly on the background check piece.
5:22:06 PM
REPRESENTATIVE FIELDS, for the benefit of the witness whose
[daughter-in-law] is licensed in another state as a registered
nurse, noted that 12 AAC 44.318, Emergency Courtesy Licenses for
Nurses, allows the department emergency licensing for nurses.
He said his understanding is that DHSS uses this already and the
daughter-in-law could work with her prospective employer on
getting her license through that existing authority.
5:22:37 PM
CO-CHAIR SNYDER said it is clear from testimony and e-mails
received from stakeholders and constituents that the committee
is getting mixed messages on the speed of background checks.
She said it would be helpful to get some clarity on that issue
from the department. Regarding speeding up the background check
or loosening up the requirements temporarily for hospitals and
nursing homes, she said she anticipates that that would then
free up resources to address the other background checks. She
inquired about the real-world percentage distribution of
applications between hospitals and HCBS so the committee could
get a sense of how much would be freed up in terms of resources.
DEPUTY COMMISSIONER WALL replied he doesn't know the percentage
off-hand and will get that information back to the committee.
CO-CHAIR SNYDER stated she would like to receive that
information along with the previously requested documentation.
She asked whether the deputy commissioner could provide a
ballpark percentage.
DEPUTY COMMISSIONER WALL responded that he does not know, and it
would be better for him to get back with a correct answer.
5:24:53 PM
REPRESENTATIVE KURKA drew attention to Section 4(3)(b), on page
3, lines 20-24, which addresses the amount charged by the
telehealth provider. He presumed that for telehealth, providers
could be used nationwide, and a provider could be a specialist
that is very rare in that field. He opined that price controls
in this provision muddy the waters and do not seem appropriate.
DEPUTY COMMISSIONER WALL deferred to Ms. Chambers to answer.
MS. CHAMBERS responded that this section has been in the
legislation that the legislature has approved in the last two
COVID-19 mitigation bills and [DCCED] requested that this be
repeated here because more than anything it suggests that
telehealth providers should not take advantage of an unusual
situation and price gouge or otherwise work outside of what may
be customary in their markets. This is a measure that hopes to
set a tone more than a particular type of control. For this
reason, during the last year or so that this has been in place,
there has been no disciplinary type of outcome for a provider.
5:28:34 PM
REPRESENTATIVE KURKA stated he is thinking of telehealth as
being potentially nationwide service and the opportunity for
price shopping and comparing providers and their qualifications
and their pricing is a good thing. He said he therefore doesn't
see the need for this, and it is counterproductive for the
purposes of telehealth.
MS. CHAMBERS replied that she understands but reiterated that
this is language the legislature has already approved twice, and
the hope is to fast-track the legislation to get solutions in
place. She said it would be a policy call for the legislature
to depart from what it previously approved and remove it in an
amendment. That was the intent behind the legislation
previously, she added, and this bill is simply to avoid some
sort of a price gouging scenario.
5:30:07 PM
REPRESENTATIVE PRAX asked whether the background check is a
search of publicly available databases, and the source would be
government databases.
MS. KRALY answered that some civil registry databases are public
and available but some of the information is tied to
confidential information, in particular information related to
the Office of Children's Services, so not everybody can access
that information, nor does everybody have permission to receive
that information. The sex offender database and some of the
information on the Office of Inspector General database with
respect to Medicaid fraud and those sorts of things would be
publicly available but some of the information being looked at
in terms of substantiated findings of abuse/neglect are not
publicly available.
REPRESENTATIVE PRAX said it sounds like the state is providing a
service to these home and community-based providers. He asked
whether there would be any reason why they could not obtain the
same information through a third party.
MS. KRALY answered that some of the information could be
provided or identified but some of the information is not
publicly available, so it is not an apples-to-apples comparison
of the databases that are required to be reviewed. Some of the
information with respect to juvenile delinquency findings and
Office of Children's Services is confidential as a matter of
state law. That information could not be gathered [without]
having the proper clearances, so a third-party vendor or even an
individual couldn't do those checks on their own.
5:32:58 PM
The committee took an at-ease from 5:32 p.m. to 5:47 p.m.
5:47:57 PM
CO-CHAIR ZULKOSKY entertained amendments to the bill.
5:48:20 PM
CO-CHAIR SNYDER moved to adopt Amendment 1, labeled 32-
GS3384\B.A.2, Fisher, 9/11/21, which read:
Page 1, lines 1 - 3:
Delete "relating to COVID-19 immunization and
proof of vaccination; relating to personal objections
to the administration of COVID-19 vaccines; relating
to COVID-19 immunization rights;"
Page 1, line 12, through page 2, line 23:
Delete all material.
Renumber the following bill sections accordingly.
Page 4, line 12:
Delete "Sections 4 and 5"
Insert "Sections 3 and 4"
CO-CHAIR ZULKOSKY objected for the purpose of discussion.
CO-CHAIR SNYDER explained Amendment 1 would remove Section 2 in
its entirety, which pertains to proof of vaccination, personal
objections to the administration of vaccine, access to areas and
services, and exercise of rights and access. She recounted that
the committee heard from the hospitals today that a clean bill,
or a bill as close to its original form as possible, would be
the most helpful and best meet their workforce needs. The
inclusion of Section 2 introduced new problems that could undo
the good that would otherwise be done. Sec. 18.09.270 presents
challenges about using a positive antibody test or documented
COVID-19 test in lieu of proof of vaccination. As heard from
Dr. Zink that there isn't enough information to safely and
reliably utilize that method. Sec. 18.09.280 is already covered
federally, and the phrase "other grounds" adds uncertainty and
vagueness that could cause problems. Sec. 18.09.290 clearly
limits what businesses can decide for what they want to do with
their employees to meet the needs of their own business and keep
their workforce safe so they can keep operating. Sec. 18.09.300
is not good public health policy; it is not for the benefit of
the public good.
5:51:12 PM
CO-CHAIR ZULKOSKY asked whether antibody testing or proof of
previous infection is a public health protective measure that
protects other individuals from potentially being exposed to
COVID-19 in an outbreak scenario.
DR. ZINK replied no, antibody testing is not a useful tool in
the setting of an outbreak; it has limited usefulness overall as
a public health measure. The CDC has lots of information on
this and the use of antibody testing. It can be occasionally
useful in clinical decision making, for example when trying to
determine the cause of a blood clot, but as a public health tool
it is not useful at this time.
DR. HODGES agreed that there is no utility of antibody testing
and added that it may harm any efforts.
5:52:35 PM
REPRESENTATIVE KURKA objected to Amendment 1. He argued that it
is always in the best interests of businesses, especially larger
businesses, to give them more authority over their workforce and
removing these provisions would be an affront to workers' rights
to make their own health care decisions. Regarding natural
immunity versus vaccine-based or acquired immunity, he said he
has yet to hear any solid evidence to contradict thousands of
years of medical science, and he awaits to see that from Dr.
Zink. The COVID-19 vaccine is so new that there hasn't been
time to study it, and the studies he is aware of say that viral
shedding is far greater from individuals who have been
vaccinated than individuals who have natural immunity.
5:55:10 PM
REPRESENTATIVE FIELDS stated his support for Amendment 1. He
argued that he has clearly heard from providers that if the
anti-vaccine language is not removed, this bill would do more
harm than good. A low vaccination rate is driving Alaska's
overfull emergency rooms. Some people, such as kids under the
age of 12, cannot be vaccinated, so anti-vaccine language
directly imperils kids like his own.
5:55:42 PM
CO-CHAIR ZULKOSKY asked whether COVID-19 vaccines are still
considered experimental.
DR. HODGES responded no; the Pfizer vaccine has received full
U.S. Food and Drug Administration (FDA) approval. The emergency
use authorization in the US of Moderna, as well as Johnson &
Johnson, does not mean the drug or the vaccine is experimental;
it has undergone rigorous simultaneous FDA approval. It just
means that the phase IV trials have not been completed.
CO-CHAIR ZULKOSKY said there has been some confusion around how
quickly the vaccine came to being and often people say steps
were skipped in the process of developing these vaccines. She
requested the doctors to speak to why a COVID-19 vaccine was
made available so quickly.
DR. ZINK was unavailable.
DR. HODGES was trying to call back online after losing contact.
5:57:22 PM
REPRESENTATIVE SPOHNHOLZ offered her support for Amendment 1.
She argued that the science on this is clear as heard from the
medical professionals today. As reported by Dr. Zink, the
latest research is presented during the ECHOs with the public,
and it has been clear that the vaccine is not experimental and
is built on over 150 years of vaccine science. The quick
vaccine development was built on over 150 years of vaccine
knowledge and science. Scientists across the world set aside
everything else to work on developing these vaccines, which have
helped to make people much safer. The hospitals clearly stated
today that it is critical to have widespread vaccination use for
hospitals to be safe and to ensure that those who are cared for
in hospitals are safe. The first responsibility of health care
providers is to do no harm and that means not bringing a virus
into a hospital where medically fragile people are being cared
for. Hospitals, as private employers, need to have the tools
necessary to ensure that Alaskans are safe.
5:59:42 PM
CO-CHAIR ZULKOSKY reiterated her question regarding the speed
and efficiency with which a COVID-19 vaccine occurred. She
requested Dr. Hodges to speak to whether steps were skipped in
the vaccine safety process.
DR. HODGES answered that it is important to understand that many
steps must be taken to bring a medication like a vaccine to
market. The federal government, through Operation Warp Speed,
guaranteed a profit to the drug companies that agreed to develop
a vaccine so they wouldn't have to take a risk on a medication
or vaccine that might not make it or might not be safe or for
other reasons would have to be taken off the market. In
Operation Warp Speed, all the normal steps to assure that a
vaccine is safe were taken, they were just allowed to be taken
simultaneously because of the support of the federal government.
No steps were skipped. It is a credit to all the scientists who
did this round-the-clock work on the research and development of
these vaccines, and they have used successfully, safely, and
effectively on billions of people worldwide.
6:01:10 PM
REPRESENTATIVE MCCARTY stated that the premise of the bill is to
get health care workers to meet the need that is greatly there.
He argued that requiring vaccination means health care workers
who don't want to get vaccinated cannot help with this need,
creating an even greater problem with lack of workers. He said
he is not against vaccines. As a mental health care person, he
has physicians working for him, and when he hears of [problems]
or death due to a vaccine or drug it raises a great question.
He has heard of people just recently who have been vaccinated
and have died from COVID-19 or died from the vaccination. He
asked what the doctors are hearing and whether it raises concern
when people say they want to wait a little longer to see what is
going on because they don't want to be one of those statistics.
DR. HODGES replied she is aware of people who have died after
being vaccinated with COVID-19 vaccine. However, she continued,
the risk of dying in Alaska is about 7.5 - 8 times higher for an
unvaccinated person and an unvaccinated person's risk of getting
COVID is much, much higher, although she doesn't have those
numbers at hand. The risk of getting and dying of COVID-19 is
much, much higher with an unvaccinated population. Everyone in
the health care field shares the concern about people dying from
the vaccination as none would want to recommend a medication or
vaccine that might cause harm to their patients. However, it is
important to take to mind that the risks of getting COVID-19 and
dying of COVID are much, much higher than the risk of a vaccine.
There are some well-done papers comparing some of the various
risks of the complications of COVID-19 to the risk of the
complications of the vaccination. On a balance, the risk of
catching COVID-19 is much higher than the risk of having the
vaccination done.
6:05:53 PM
REPRESENTATIVE MCCARTY asked whether the risk of losing health
care workers at this time is acceptable or not acceptable by
requiring the standard that they must be vaccinated.
MR. KOSIN responded that he must base his answer on the hospital
operators whom he talks to across the state, many of which have
mandated or are going to mandate vaccine requirements. On top
of that the federal government is doing it as well. He has not
heard from any hospital operator a significant concern that
there is going to be some meaningful exodus in Alaska's health
care workforce from that policy. So, no, ASHNHA is not
concerned of it, and, no, ASHNHA does not think the risk is
significant enough to not move forward with that policy.
6:07:15 PM
CO-CHAIR ZULKOSKY inquired about the economic impacts that
hospitals might encounter should Section 2 remain unamended and
move forward in the bill.
MR. KOSIN answered that if this were to become law and if it
were to interfere in any health care facilities that receive
Medicare or Medicaid funding or reimbursement, it would
interfere in a facility's ability to comply with federal law and
then they would lose Medicare and Medicaid funding. There is no
hospital or nursing home in the country or Alaska that could
remain open and provide health care without Medicare and
Medicaid services. So, the economic impact would be a shutdown
of hospitals, nursing homes, and beyond, across the state.
6:08:26 PM
REPRESENTATIVE KURKA referred to the CDC's website that tracks
adverse reactions to vaccines. He maintained that it is well
known this system is underutilized and underreported, and that
more than half of the adverse events on the website are from
COVID-19 vaccines in the last year or two. He also maintained
that up to 80 percent of pregnant women taking the vaccine lose
their child in-utero.
DR. HODGES replied she is aware of the vaccine adverse event
reporting system (VAERS). She said she is not sure about the
statistics cited by Representative Kurka, but that VAERS is used
in the US to track adverse events to vaccinations and is used
robustly. For example, she was handed a way of interacting with
that system when she got vaccinated. Because of VAERS, a brief
pause was placed on the Johnson & Johnson vaccine for the
concern of myocarditis, so the system is robust enough to detect
adverse events and problems that are associated with vaccines.
Regarding up to 80 percent of women having a death in-utero
after a vaccination, she said that is not her understanding of
the current facts of vaccination. Several observational studies
have shown that vaccines are safe and effective in pregnancy and
that pregnancy is a risk for severity of COVID-19. Pregnant
women have about a 2-3 times higher rate of intensive care unit
admission and a 2-3 times higher rate of death when they get
infected with COVID-19 than a non-pregnant person would have.
6:12:03 PM
The committee took an at-ease from 6:12 p.m. to 6:20 p.m.
6:20:38 PM
CO-CHAIR ZULKOSKY removed her objection to Amendment 1.
6:20:49 PM
REPRESENTATIVE KURKA maintained his objection to Amendment 1.
He asked Dr. Hodges to name the study she was referring to.
Regarding the statement that the COVID-19 vaccines were built on
150 years of research, he said his understanding is that these
new vaccines are using new technology with mRNA technology that
alters human DNA. He asked Dr. Hodges or Dr. Zink to address
whether that has been used in other FDA-approved or CDC-approved
vaccine for treating other diseases.
CO-CHAIR ZULKOSKY stated that the committee is talking about the
merits of Amendment 1 and that contact information for Dr.
Hodges could be provided to Representative Kurka.
REPRESENTATIVE KURKA said it is important for the record as
Amendment 1 addresses these specific vaccines.
6:22:06 PM
REPRESENTATIVE PRAX related that there is a video on the
National Institute of Health's website that confirms what Co-
Chair Zulkosky said about the process involved. However, he
continued, he represents the dozens of people who have sent him
emails as opposed to the few who have basically said a vaccine
is needed. Because he has not found enough documentation to say
that vaccines are so proven that his constituents should be
"economically coerced" into accepting a vaccination and because
someone else in the other body thought it was a good idea, he is
hesitant to take this out of the bill.
6:24:39 PM
CO-CHAIR ZULKOSKY said she finds it problematic for the State of
Alaska to tell private employers how they should conduct their
businesses and the policies that they should be setting. Under
the language of Section 2, the State of Alaska is dictating to
private employers, whether Alaska Native corporations or
hospitals or private venues, how they should conduct their
business. She said she is not in a position of supporting big
government in that way and therefore supports Amendment 1.
6:25:36 PM
A roll call vote was taken. Representatives Spohnholz, Fields,
Snyder, and Zulkosky voted in favor of the motion to adopt
Amendment 1. Representatives Kurka, McCarty, and Prax voted
against it. Therefore, Amendment 1 was adopted by a vote of
4-3.
6:26:26 PM
REPRESENTATIVE FIELDS moved to adopt Amendment 2, labeled 32-
GS3384\B.A.4, Fisher, 9/11/21, which read:
Page 1, lines 5 - 6:
Delete "relating to certificates of need;"
Page 4, lines 7 - 11:
Delete all material.
Renumber the following bill sections accordingly.
CO-CHAIR ZULKOSKY objected for the purpose of discussion.
REPRESENTATIVE FIELDS explained that Amendment 2 would clean up
language added in the Senate that suspended certificate of need.
As heard in testimony, it is unrelated to addressing the
workforce issues related to COVID-19. Also, as heard in
testimony, suspending certificate of need would ultimately drive
up costs for Alaskans and would destabilize facilities that
could ultimately lead to emergency rooms shutting down where
they are critically needed. He said Amendment 2 is imperative
before moving the bill forward.
6:27:19 PM
REPRESENTATIVE KURKA objected to Amendment 2. He argued that
the certificate of need has been a substantial problem for years
and is a version of "protection racket" that creates a monopoly
and gives a single bureaucrat control over whether someone can
set up shop and provide health care in a community, and to the
same level, a hospital. What is needed is more providers, more
competition, not less. If existing hospitals cannot compete and
cannot provide the same level of care for the same price as
competitors, then maybe that is a statement about their motives
or the way they run their business.
6:28:48 PM
CO-CHAIR SNYDER cautioned that there is an alternative vantage
point when talking about certificate of need and economic
drivers. Health care is quite different than going out and
shopping for a person's next new car, she argued. Alaskans and
Americans cannot shop for health care, usually, in the same way,
particularly when talking about emergency services. Someone
with a compound fracture is not going to scroll through the Web
to find the cheapest price for care. It has been shown that
without these certificates of need Alaska stands to see the
proliferation of health care facilities that provide unnecessary
capacity and then the market is flooded with beds that cannot be
filled because there is not the demand. This will then result
in a situation where providers must figure out how else they are
going to pay for the services and the overhead and that results
in increased prices. This would be a very large policy change
that can be debated at length another time. She urged members
to not go down that road as they try to address these very
immediate needs this evening.
6:30:28 PM
REPRESENTATIVE PRAX said he supports repealing certificate of
need requirements but finds Co-Chair Snyder's argument
compelling in this case. This is not directly associated with
what this bill is trying to accomplish, he argued, and he has
not had a lot of calls asking for the certificate of need to be
repealed. So, while he thinks it is a good idea and a debate
that the legislature needs to have, this probably isn't the
right way to make that policy change, and therefore he supports
Amendment 2.
6:31:24 PM
CO-CHAIR ZULKOSKY argued that [the provision in the bill] is not
germane with respect to the underlying bill which is looking at
addressing capacity and staffing issues for an immediate crisis.
She removed her objection to Amendment 2.
[REPRESENTATIVE KURKA maintained his objection to Amendment 2.]
6:31:50 PM
A roll call vote was taken. Representatives Prax, Spohnholz,
Fields, McCarty, Snyder, and Zulkosky voted in favor of the
motion to adopt Amendment 2. Representative Kurka voted against
it. Therefore, Amendment 2 was adopted by a vote of 6-1.
6:32:47 PM
REPRESENTATIVE SPOHNHOLZ moved to adopt Amendment 3, labeled 32-
GS3384\B.A.5, Fisher, 9/11/21, which read:
Page 3, line 29, following "APPLICABILITY.":
Insert "(a)"
Page 4, following line 6:
Insert a new subsection to read:
"(b) Notwithstanding any other provision of law,
a public home care provider described in AS 47.05.017
or a provider of home and community-based waiver
services financed under AS 47.07.030(c) may employ a
person without obtaining a background check from the
Department of Health and Social Services if the
provider
(1) has 200 or more employees;
(2) obtains approval from the Department of
Health and Social Services of the provider's pre-
employment vetting system, which must include proof
that a valid fingerprint-based background check that
is substantially similar to a background check
required under 7 AAC 10.910(a) is conducted as part of
the hiring process; and
(3) not later than July 1, 2022, obtains a
background check from the Department of Health and
Social Services for each person hired by the provider
between the effective date of this Act and July 1,
2022."
Page 4, following line 11:
Insert a new bill section to read:
"* Sec. 7. The uncodified law of the State of
Alaska is amended by adding a new section to read:
NOTIFICATION TO REVISOR OF STATUTES. The
commissioner of health and social services shall
notify the revisor of statutes in writing when the New
Alaska Background Check System (NABCS) is online and
functional."
Renumber the following bill sections accordingly.
Page 4, line 12:
Delete "5"
Insert "5(a)"
Page 4, following line 12:
Insert a new bill section to read:
"* Sec. 9. Section 5(b) of this Act is repealed on
the earlier of
(1) the date the commissioner of health and
social services notifies the revisor of statutes in
writing under sec. 7 of this Act that the New Alaska
Background Check System (NABCS) is online and
functional; or
(2) July 1, 2022."
Renumber the following bill section accordingly.
6:32:49 PM
CO-CHAIR ZULKOSKY objected for the purpose of discussion.
6:32:53 PM
REPRESENTATIVE SPOHNHOLZ spoke to Amendment 3. She noted that
the dozens of home and community-based providers who testified
today expressed exasperation at the length of time it is
currently taking for background checks to be processed by DHSS.
An intersection of two things happened COVID-19 produced
challenging worker shortages in many industries, including
health care, and then a cyber-attack on DHSS that forced the
department's system to shut down. This perfect storm of events
has meant that home and community-based service providers
throughout Alaska are struggling to get new employees onboarded
in a timely manner. This [amendment] was drafted in partnership
with DHSS to come up with a modest solution that would allow
employers providing home and community-based waiver services
that have 200 or more employees to temporarily implement
background checks themselves. The committee heard this evening
from a CEO who runs an organization with 600 employees, and this
CEO was working a group home last night because her staffing
shortage was so bad. She offered her appreciation for the
department's willingness to come up with a compromise solution.
6:35:10 PM
CO-CHAIR SNYDER offered her support for Amendment 3. She
recalled the statement of one witness that adopting this
amendment would make it possible for individuals who are in the
hospital receiving care to go home and thereby opening
facilities and resources to meet the crush of demand on Alaska's
hospitals. She said she was also moved in hearing that the
solution to background checks for hospitals and nursing homes
would alleviate the pressure on DHSS and allow the department to
refocus its efforts on the requests from home health care.
6:36:24 PM
The committee took an at-ease from 6:36 p.m. to 6:38 p.m.
6:38:26 PM
REPRESENTATIVE MCCARTY moved to adopt Amendment 1 to Amendment
3, [which would, on page 1, line 10, delete "200" and insert
"25"].
6:38:44 PM
REPRESENTATIVE SPOHNHOLZ objected.
REPRESENTATIVE MCCARTY explained that Amendment 1 to Amendment 3
would delete the number "200" and change it to "25" because
there are quite a few home-based programs that are smaller in
employee number than 200 and they are trying to survive as well.
He noted that Amendment 3 and the language in the bill state
that all agencies or organizations must be DHSS background
checked by July 1, 2022, if the system is working by then.
Small business operations of 25 or more employees should receive
the same privilege of getting background checks rapidly to
sustain their existence and provide services to people who are
no longer in the hospital but have come to that business.
6:40:23 PM
REPRESENTATIVE PRAX said he supports Amendment 1 to Amendment 3
but would go further by just deleting the number of "200". He
noted that the committee heard from quite a number of home and
community-based [service] providers that are struggling. The
providers are not going to just hire anyone off the street. All
the providers should be given the same opportunity. Even 25
seems unnecessarily high and the number could just be deleted,
he suggested. He requested the department's view.
DEPUTY COMMISSIONER WALL stated that Amendment 3 is asking a
threshold of number of employees that an organization would have
that would be waived in the same way that hospitals would be
waived. A small percentage of the approximately 750 assisted
living homes in Alaska have a large number of employees, but as
well these homes have a more robust human resources (HR) process
and they have background checks that they do within those,
although it is not 100 percent of them. Of the applications
coming through from hospitals and nursing homes, about 25
percent are from hospitals, so about 25 percent of the workload
would be removed from the background check unit, allowing the
unit to focus on the remaining applicants. He said the
threshold of the larger organizations makes sense when he looks
at the processes their HRs use for clearing their own personnel
and for the department's relationship with them as a provider.
6:44:54 PM
REPRESENTATIVE PRAX stated he is trying to get an idea of the
scope of the problem that is trying to be addressed.
DEPUTY COMMISSIONER WALL replied that there are about 750
assisted living homes in Alaska, with the majority being smaller
organizations. He clarified that the 25 percent of the workload
that he was talking about in the background check unit is the
volume of applications that come in across the board, it doesn't
have anything to do with how many assisted living homes there
are or how many hospitals there are it has to do with the
volume of applications and about 25 percent of those are
hospital applications. Being looked at in this discussion, he
pointed out, is the fine balance between safety and efficiency.
The rules around background checks and having a thorough
application process are there to protect patients who are in a
vulnerable state. So, there must be some checks and balances on
the process, some rationale behind how it is done, to provide
the best chance of always keeping patients safe and not exposing
them to undue harm or personnel that wouldn't be wanted if their
background was known. This legislation has attempted to put
together the best window possible with what DHSS has to work
with, not only the manpower within the background check unit but
also the procedures that the various providers go through to get
their applicants through this process. He stated he strongly
believes that if hospitals are allowed this wiggle room and DHSS
can process the applications for the assisted living homes
faster because of it during this period of time of waiver, DHSS
will be able to meet both needs at the same time.
6:47:50 PM
REPRESENTATIVE PRAX inquired about the percentage of applicants
weeded out because of the background check process.
DEPUTY COMMISSIONER WALL replied that he doesn't know the
percentage offhand, but that there is a percentage. He said
there is also a variance process that people go through if
they've had something in their background that would normally
make them ineligible to enroll, but because they fulfilled the
terms of their court order they can be reinstated. He said he
will provide the percentage in writing. In further response,
Deputy Commissioner Wall said he doesn't have a rough estimate
of the percentage offhand, but he can get that number quickly.
6:49:22 PM
REPRESENTATIVE KURKA inquired about the origin of the number.
He said he agrees with Representative Prax because he dislikes
giving bigger businesses a competitive advantage, from a
regulatory standpoint, over smaller ones.
REPRESENTATIVE SPOHNHOLZ responded that the reason for picking
employers of 200 or more was a workload issue for the folks at
the DHSS background check unit. Many of the [750] assisted
living homes are mom-and-pop shops with essentially 20 employees
and no professional HR department and very little capacity to
create the rigorous policies that would be necessary. The idea
with the threshold of 200 employees or larger was that it would
be a small number of employers that would have a large number of
employees who would need background checks. Those organizations
that meet that threshold will have very professional HR
departments that will be able to manage the very serious process
of doing background checks. She said she feels strongly about
having a rigorous background check process for people who are
caring for folks who are physically or intellectually vulnerable
and cannot provide care for their own selves and must have
people come into their homes to help them with the most intimate
of daily functions. In talking with DHSS and DOL, it was
thought that this compromise zone would allow for increased
efficiency, accelerating the number of background checks that
are processed by diverting a portion of those background checks
that need to go through the BCU and thereby speeding up the
processing time for mom-and-pop shops over the next few months
while the department works to get the online system back online.
Once the online system is back up, everything can return to when
background checks were processed in three to five days, which is
good for everybody.
6:52:55 PM
REPRESENTATIVE KURKA asked why background checks need to be run
through DHSS.
REPRESENTATIVE SPOHNHOLZ answered that when running a background
check, DHSS is checking about seven databases, including the
FBI's criminal history, the Department of Public Safety's
criminal justice information, sex offender lists, and other
databases. Checking these databases is to ensure these folks
don't have any background that would indicate they might not be
able to keep the people they are charged with safe.
6:54:24 PM
REPRESENTATIVE KURKA stated his question again for Deputy
Commissioner Wall to answer.
DEPUTY COMMISSIONER WALL replied that Representative Spohnholz
answered the question spot on. He said there are several
different and rigorous checks that the department must make, and
that there is a difference between running a third-party
background check and running it through DHSS. He deferred to
Ms. Kraly to answer further.
MS. KRALY explained that background checks are required by
federal law for many of the programs administered through DHSS.
All these providers are recipients of federal and state funds
and as a matter of federal law they are required to have
background checks. A background check is broader than just a
criminal history check, it also includes a robust check into
other civil matters that may provide an indication that an
individual is not appropriate for providing direct service care.
Many of those registries are confidential registries that are
housed within DHSS, so managing these programs through DHSS
makes sense because these are programs that [DHSS] pays for and
administers. Also, it is important that DHSS maintain the
control over that because of the confidential nature of the
databases that are required to be searched both as a matter of
state and federal law.
6:56:58 PM
REPRESENTATIVE PRAX surmised that, given the background check is
required by federal law, someone wanting to have their own
background check would have to be approved by the state. He
further surmised that a mom-and-pop provider would still have to
go through a background check of some sort if they were
participating in a federally funded program.
MS. KRALY replied correct, the federal requirements are there.
She said the state's system mirrors and buttresses the federal
requirements and allows the state to provide those services on
behalf of the providers that it licenses and pays through the
department's programs.
REPRESENTATIVE PRAX commented that from today's testimony he
thinks the greater concern, which he hasn't been able to verify,
is that having any assistance is more urgent than having a fully
background checked [employee]. He offered his presumption that
the department is being overly cautious and therefore people who
need the care aren't getting it because the people simply aren't
available there to provide it and something is better than
nothing. He said he therefore supports [Amendment 1 to
Amendment 3] to lower the number to 25.
6:58:59 PM
CO-CHAIR ZULKOSKY stated that the intention of the bill and the
underlying bill overall is in very narrow response to hospital
capacity for COVID-19. She said she appreciates and understands
the perspective shared overwhelmingly in public testimony today.
However, she continued, she is struggling with the concern that
the [underlying] amendment drops what should be a solution by
the department for a separate but somewhat related issue into a
bill that seeks to narrowly focus on COVID-19 response.
7:00:11 PM
REPRESENTATIVE SPOHNHOLZ maintained her objection to Amendment 1
to Amendment 3.
REPRESENTATIVE MCCARTY stated that the amendment to Amendment 3
is not countering the need for background check and verifying
that we have vetted people to serve and that is not at all what
it's about. This is about is the demand of people in the field
and being able to serve the demand that is there, yet people
wanting to work cannot be hired fast enough because of the
dynamics that are there, no fault of DHSS. As things get fixed,
as well as people having to get department authorization by July
1, some businesses may decide to go through DHSS, but others
could elect to go elsewhere if given this temporary privilege.
CO-CHAIR SNYDER noted that all seven committee members are
concerned about the background check delay and what that means
for Alaska's health care system and the Alaskans it serves. She
said she is trying to thread the needle in finding a balance
between what she heard in public testimony and the department.
She said she therefore may not support Amendment 1 to Amendment
3, but that Amendment 3 feels reasonable, and she will "hang her
hat" on the increased capacity that would be opened up by
passing the bill.
7:03:17 PM
A roll call vote was taken. Representatives McCarty, Prax, and
Kurka voted in favor of the motion to adopt Amendment 1 to
Amendment 3. Representatives Fields, Spohnholz, Snyder, and
Zulkosky voted against it. Therefore, Amendment 1 to Amendment
3 failed to be adopted by a vote of 3-4.
7:04:08 PM
CO-CHAIR ZULKOSKY announced that Amendment 3 is back before the
committee. She requested Commissioner Crum to provide DHSS's
view on Amendment 3.
COMMISSIONER CRUM replied that Amendment 3 is a good compromise
for the overall system and DHSS supports it. He explained that
the BCU is not just for health care providers, it also does
foster care parents, childcare providers, even taxis for the
Medicaid program. So, per the original bill, taking away the
facility-based providers would be a 25 percent [reduction in the
BCU's] workload and, the 200-plus employee facilities in
Amendment 3 would be another large removal from the [BCU]
system, thereby increasing the overall bandwidth to address the
needs of the other assisted living facilities as well as the
home and community-based providers. He further stated that DHSS
is considering making a change towards allowing transference of
people who pass the background check moving between providers.
CO-CHAIR ZULKOSKY stated that the committee may want to consider
a hearing with an update from DHSS regarding ongoing needs of
the department after the cyber-attack.
7:07:07 PM
REPRESENTATIVE MCCARTY drew attention to page 1 of Amendment 3,
beginning on line 23, which states, "The commissioner of health
and social services shall notify the revisor of statutes in
writing when the New Alaska Background Check System (NABCS) is
online and functional." He said this leads him to believe that
whatever is existing now is not functional. He asked whether
Commissioner Crum is saying that things for the background check
are now functional.
COMMISSIONER CRUM responded that the internal background check
system is still down from the cyber-attack, so background checks
are being done by hand. Once the system is back online, he
continued, people will be run through the normal process and
hopefully no one will have to be removed.
7:09:02 PM
CO-CHAIR ZULKOSKY removed her objection to the motion to adopt
Amendment 3. There being no further objection, Amendment 3 was
adopted.
7:09:32 PM
CO-CHAIR SNYDER moved to report CSSB 3006(L&C) am, as amended,
out of committee with individual recommendations and the
accompanying zero fiscal notes. There being no objection, HCS
CSSB 3006(HSS) was reported out of the House Health and Social
Services Standing Committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 3006 Letter of Support - ATA.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/7/2021 1:30:00 PM |
SB3006 |
| SB 3006 Governor Letter to Presiding Officers 9.3.21.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/7/2021 1:30:00 PM |
SB3006 |
| SB 3006 Transmittal Letter.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/7/2021 1:30:00 PM |
SB3006 |
| SB 3006 Sectional Analysis (Version A).pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/7/2021 1:30:00 PM |
SB3006 |
| SB 3006 Fiscal Note 1 DCCED - CBPL.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/7/2021 1:30:00 PM |
SB3006 |
| SB 3006 Fiscal Note 2 DHSS.pdf |
HHSS 9/11/2021 3:00:00 PM |
SB3006 |
| SB 3006 Fiscal Note 3 DCCED - Insurance.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/7/2021 1:30:00 PM |
SB3006 |
| SB 3006 Letter of Support - ASHNHA.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/8/2021 1:30:00 PM |
SB3006 |
| SB 3006 Fiscal Notes DHSS.pdf |
HHSS 9/11/2021 3:00:00 PM |
SB3006 |
| SB 3006 Fiscal Note DPS.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/8/2021 1:30:00 PM |
SB3006 |
| SB 3006 Letter of Support - Providence.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/8/2021 1:30:00 PM |
SB3006 |
| SB 3006 Letter of Support - Teledoc Health.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/8/2021 1:30:00 PM |
SB3006 |
| SB 3006 Amendment A.2.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/8/2021 1:30:00 PM |
SB3006 |
| SB 3006 Amendment A.4.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/8/2021 1:30:00 PM |
SB3006 |
| SB 3006 Amendment A.3.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/8/2021 1:30:00 PM |
SB3006 |
| SB 3006 Amendment A.5.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/8/2021 1:30:00 PM |
SB3006 |
| SB 3006 Letter of Support - ASMA.pdf |
HHSS 9/11/2021 3:00:00 PM SL&C 9/8/2021 1:30:00 PM |
SB3006 |
| SB 3006 Sectional Analysis (Version B.A).pdf |
HHSS 9/11/2021 3:00:00 PM |
SB3006 |
| SB 3006 Summary of Changes (Version A to B.A).pdf |
HHSS 9/11/2021 3:00:00 PM |
SB3006 |
| SB 3006, 9.13 Amendment #1-4.pdf |
HHSS 9/11/2021 3:00:00 PM |
SB3006 |
| SB 3006, Amendment #1 to Amendment #3.pdf |
HHSS 9/11/2021 3:00:00 PM |
SB3006 |