Legislature(1997 - 1998)

04/16/1997 08:20 AM FIN

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
txt
  HOUSE BILL 152                                                               
                                                                               
       "An Act regulating hospice care."                                       
                                                                               
  REPRESENTATIVE JOE RYAN stated that HB 152 would provide for                 
  licensing of hospice care programs  in Alaska, ensuring that                 
  terminally ill  persons receive  comfort, support,  and care                 
  consistent  with hospice  philosophy and concepts  through a                 
  uniform level of services.  There are no federal regulations                 
  or licensing  requirements for either certified or volunteer                 
  hospice  programs.  As  of the  January, 1997,  forty states                 
  have  regulated   hospice  programs.    The   licensing  and                 
  appropriate regulation  of volunteer  and certified  hospice                 
  programs  in  Alaska  will assure  consumers  of  consistent                 
  standards in the delivery of hospice services.                               
                                                                               
  Representative Ryan noted that hospice is a unique component                 
  of a health care delivery system,  one that has evolved over                 
  the  past  twenty  years  in the  United  States.    Hospice                 
  provides care and support for  people with terminal illness.                 
  The  goal of hospice  care is to enable  patients to live an                 
  alert,  pain-free life  and to  manage symptoms so  that the                 
  last  weeks and months of  life may be  spent in dignity and                 
  peace.                                                                       
                                                                               
  The annual  growth in  the hospice  programs averaged  about                 
  eight percent in the early 1990's.  In the  last five years,                 
  growth has averaged seventeen percent.  Hospice services are                 
  provided through a  variety of  means.  Representative  Ryan                 
  continued, the rapid  growth of hospice  programs is due  to                 
  increased  demand  for  home care  services,  the  desire of                 
  terminally ill persons to keep control over the remainder of                 
  their lives, and a trend towards reimbursement for home-care                 
                                                                               
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  services.                                                                    
                                                                               
  Representative Ryan noted that passage of HB  152 would help                 
  to standardize hospice care and guarantee the Alaskan public                 
  the opportunity  to access  quality hospice  care from  both                 
  volunteer and certified hospice programs.                                    
                                                                               
  Representative  Ryan  stated  that  the  fiscal  note  would                 
  provide  for the travel  costs associated  with establishing                 
  licensure  of   six  new   hospice  facilities   outside  of                 
  Anchorage.                                                                   
                                                                               
  Representative Mulder  inquired  if  the  licensure  of  the                 
  volunteer program would make it difficult for the volunteers                 
  to achieve  the necessary requirements.  Representative Ryan                 
  replied that the volunteer programs in  Alaska adhere to the                 
  national hospice standard.  The  legislation would create an                 
  uniformity of those care standards.                                          
                                                                               
  Representative Martin expressed his hesitation of government                 
  becoming involved with  a system that currently  works well.                 
  He  asked  if  the  legislation  would  increase  the  costs                 
  associated  with the program.   Representative  Ryan replied                 
  that the legislation would provide  oversight that the dying                 
  person is not  taken advantage of.   A standard has  already                 
  been determined and the legislation  would not create micro-                 
  management.                                                                  
                                                                               
  Co-Chair  Therriault   referenced  language   in  the   bill                 
  referring to a  "temporary" license.   He asked why would  a                 
  temporary license  be given  before  an agency  had met  the                 
  requirements.     Representative  Ryan   replied  that   the                 
  temporary license  would be  provided if  a problem  existed                 
  which needed to be corrected during the time the program was                 
  being brought up to meet the standard.                                       
                                                                               
  Co-Chair Therriault  continued,  Page 3,  Lines 3-12,  makes                 
  reference  to the  Department "suspending"  or "reducing"  a                 
  license.  He asked if clients would be required to move from                 
  the  facility  when  the  agency's  license  was  suspended.                 
  Representative Ryan  stated that he would assume that if the                 
  agency's license was  revoked, the facility would  no longer                 
  be able to operate.  To  revoke a license, conditions listed                 
  on Page 2 would need to exist.  Representative Ryan stressed                 
  the vulnerability of people needing hospice services.                        
                                                                               
  Representative  Kelly asked  if the  requirements listed  on                 
  Page 4, were  different from the procedures  currently used.                 
  Representative Ryan stated they were not.                                    
                                                                               
  RITCHIE SONNER, EXECUTIVE DIRECTOR, HOSPICE AND HOME CARE OF                 
  JUNEAU, noted that the proposed legislation was supported by                 
                                                                               
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  hospices throughout the  State of Alaska.   She stated  that                 
  the  bill adequately  differentiates  between the  certified                 
  hospice and the  volunteer hospice.  The  volunteer hospices                 
  are required to  fulfill a  minimum set of  standards.   The                 
  criteria listed on Pages 4, 5  & 6 of the bill would  not be                 
  required for  a voluntary hospice.   Page 7  establishes the                 
  criteria  that  a  voluntary  hospice  must  fulfill.    She                 
  stressed that  criteria recommended would not be financially                 
  or administratively burdensome for a hospice to meet.                        
                                                                               
  Ms.  Sonner   continued,  the  proposed   legislation  would                 
  prohibit any agency from calling itself a  hospice.  Hospice                 
  infers a  set of  a comprehensive  services as  well as  the                 
  ability to address the entire family's needs.                                
                                                                               
  She added, in Alaska there is  no specific hospice facility.                 
  Most  of the hospice care is done  in the home or in a home-                 
  like setting.   To  fit into the  certified criteria,  there                 
  needs to  be a facility available.   All the hospices in the                 
  State use only one or two beds designated in a hospital.  At                 
  this  time,  care  is provided  in  the  home  and must  fit                 
  established criteria.                                                        
                                                                               
  In  response to  Co-Chair Therriault's  query regarding  the                 
  confidentiality  statement,  Ms.  Sonner  replied  that  the                 
  confidentiality aspect  would guarantee that a  staff member                 
  or  volunteer  that   is  involved  in  a   patient's  home,                 
  understand the requirements of confidentiality regarding the                 
  client and family's personal issues.                                         
                                                                               
  Representative  Martin asked  if current  facilities in  the                 
  State would be grand-fathered  in.  Ms. Sonner replied  that                 
  every facility  would be  required to  fulfill the  criteria                 
  when  the  regulations  become  effective.    That  criteria                 
  guarantees anyone coming into the hospice fulfills the needs                 
  of what the consumer expects and deserves in the business.                   
                                                                               
  (Tape Change HFC 97-99, Side 2).                                             
                                                                               
  Ms.  Sonner explained  that most hospices  in the  State are                 
  small and depend on community funding.  She added, that with                 
  the exception  of one hospice,  the rest are  confident that                 
  the regulations imposed through the legislation would not be                 
  difficult to  incorporate.   This observation  was based  on                 
  hospice testimony from previous committee hearings.                          
                                                                               
  Representative  G.  Davis asked  if  there exists  a hospice                 
  international organization.  Ms. Sonner explained that there                 
  is   a   National   Hospice   Organization  with   voluntary                 
  membership.   They establish standards of excellence.  It is                 
  up to each individual hospice to  choose whether or not they                 
  fulfill  those  standards.    All  the hospices  which  have                 
                                                                               
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  testified in the past  few weeks have stated that  they meet                 
  and exceed the criteria established by that organization.                    
                                                                               
  Representative Martin warned that eventually  a fee would be                 
  charged by the  Department for  licensure; he stressed  that                 
  someone  will  be   responsible  to   pay  to  inspect   the                 
  facilities.  Ms.  Sonner could  not speak  to that  concern.                 
  Representative  G.   Davis  commented   that  the   proposed                 
  legislation would provide  an immediate return to  the State                 
  by taking care of our sick and dying population.                             
                                                                               
  Representative Foster MOVED to report CS HB 152 (HES) out of                 
  Committee  with  individual  recommendations  and  with  the                 
  accompanying fiscal  note.  There being NO OBJECTION, it was                 
  so ordered.                                                                  
                                                                               
  CS  HB  152 (HES)  was reported  out  of Committee  with "no                 
  recommendation"  and with a fiscal note by the Department of                 
  Health and Social Services dated 4/2/97.                                     

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