Legislature(2005 - 2006)CAPITOL 106
03/17/2005 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB193 | |
| HB185 | |
| HB156 | |
| HB151 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 151 | TELECONFERENCED | |
| *+ | HB 156 | TELECONFERENCED | |
| *+ | HB 185 | TELECONFERENCED | |
| = | HB 193 | ||
HB 193-LICENSING MEDICAL OR CARE FACILITIES CHAIR WILSON announced that the first order of business would be HOUSE BILL NO. 193 "An Act relating to the licensing, regulation, enforcement, and appeal rights of ambulatory surgical centers, assisted living homes, child care facilities, child placement agencies, foster homes, free-standing birth centers, home health agencies, hospices or agencies providing hospice services, hospitals, intermediate care facilities for the mentally retarded, maternity homes, nursing facilities, residential child care facilities, residential psychiatric treatment centers, and rural health clinics; relating to criminal history requirements, and a registry, regarding certain licenses, certifications, approvals, and authorizations by the Department of Health and Social Services; making conforming amendments; and providing for an effective date." 3:06:02 PM RICHARD MANDSAGER, M.D., Director, Division of Public Health, Department of Health and Social Services, (Department), introduced the slide entitled, "PUBLIC HEALTH: Protecting and Promoting the Health of All Alaskans, HB 193, a Bill to Consolidate DHSS Licensing, Certification, and Background Check Functions." He showed slide number 2 and explained: The existing statutory and regulatory environment ... that the Department deals with all kinds of programs and facilities that range in size from major hospitals, like Providence, to small family owned assisted living homes, to hospice, to ambulatory ... surgery centers, to foster families - there's this whole range of licensing and certification activities that the Department does. And, two years ago the Governor with "administrative order 108" ... began the centralization process of bringing the certification and licensing activities together into one place and separating them from the parts of the Department that pay for services ... there is some degree of separation of the licensing and certifying from the paying part of the organization. As we've started down that journey, it has become very apparent that these programs have all grown up independently ... with their own sets of statutes ... regulations ... appeal processes and they are sometimes similar ... many times with different steps. So, the first real purpose here is an administrative simplification and cohesion question about what makes sense ... for the Department across all of these entities to make them as similar as possible ... in terms of cost of certification and licensing ... even though there's a theory that we can bring together and centralize this licensing function ... the training of staff to be able to interact with more than one type of program is really markedly decreased ... We're aiming for a day ... when one person could go prepared to do two or three activities rather than three separate people going in on three separate plane trips into that [rural] community. To get there, requires us ... to try to get to much more standardized and simplified rules on the state side ... on the provider side, many providers have multiple types of programs and for them to keep track of separate program rules ... is an administrative cost ... DR. MANDSAGER described a past situation where a provider in a supported living home was misappropriating funds collected from a resident. He explained that the state does not demand a license or background check for [supported living homes] and there was little that the state could do in terms of recourse. He said that in Alaska there is a "nurse aid registry" and three nurse aids were found by investigative agencies to be mistreating residents in a nine month period and after the mandatory reporting period, two had not been entered into the registry; one case had involved physical violence. He pointed out that timeliness issues in the current process need to be improved. He added that many personal care attendants work for more than one agency and are required to have separate background checks with each agency. He offered that doing this once for all agencies could be more efficient. Dr. Mandsager reviewed which department divisions and service providers would be affected, and what would be standardized by HB 193. 3:18:20 PM REPRESENTATIVE GARDNER stated that Representative Kohring and she have constituents that are involved in the health care field and provide services to people at home, and they have inquired as to the development of a database that would allow for the detection of people who have been accused of fraud with Medicare billing. She explained that there is no legal way to inform other agencies that this has occurred with a past employee. She asked if the registry [mentioned by Dr. Mandsager] would include fraud allegations. STACIE KRALY, Senior Assistant to the Attorney General, Department of Law, said that she understood the theoretical concept behind the abuse registry to include a finding of fraud in that context if the individual had, in fact, been terminated for fraudulent billing activities. She explained that the idea [for the abuse registry] is to create a civil registry that would include all types of instances that a prospective employer would want to know about, before hiring. REPRESENTATIVE GARDNER said that there are gray areas that would include there being no record of offensive behavior. She opined that many employees [in assisted living homes, or acting as care providers] are minimally skilled and move from agency to agency for a variety of reasons; it seems that there is the possibility for "low-grade" violations to escape prosecution in many instances, which would provide little or no information on the registry. 3:21:31 PM MS. KRALY said that Representative Gardner brought up a good point and that ultimately, what is envisioned is a mechanism, to notify the state for the basis of the termination and provide them with some type of hearing. She highlighted that this is a process that benefits both parties so that one cannot be taken advantage of. 3:23:42 PM DR. MANDSAGER said that the [Division of Public Health] is looking for ideas of how to make this [registry] have the best value at a reasonable cost and accomplish all of the things mentioned. REPRESENTATIVE GARDNER inquired as to care providers participating in the process [of using the registry] and asked whom they should contact for more information. DR. MANDSAGER offered himself as a contact. 3:24:31 PM REPRESENTATIVE SEATON opined that there should be a hearing process that defines limitation on liability for the employer and provides information on past employees [that have committed offenses of some kind]. He said that there may be difficulty in the creation of a registry if employers could face lawsuits from past employees. 3:26:22 PM MS. KRALY referred to HB 193 and said: On page 13, section 47.32.170, there's an immunity section, subparagraph C, which addresses the liability and the criminal history check but we should probably look at that with respect to the abuse registries, as well ... We appreciate that comment, and we'll take a look at that. REPRESENTATIVE KOHRING inquired as to the description of this legislation as an "efficiency measure." DR. MANDSAGER said that he hopes that as the population grows and more providers come online, that the staff required to serve will remain the same and demonstrate efficiencies over time. 3:28:20 PM REPRESENTATIVE KOHRING inquired as to Dr. Mandsager's perception of the medical industry in terms of streamlining regulatory processes. DR. MANDSAGER said that he is also troubled by the aforementioned question which concerns regulatory simplifications in a heavily regulated industry. REPRESENTATIVE MCGUIRE asked, "are there any new categories that did not previously require licensure?" DR. MANDSAGER said that one of the amendments that is being worked on relates to the list on page 2, of HB 193. He explained: I have a concern ... as the medical industry ... evolves ... and develops more free standing services outside of hospitals, how do we have a list that includes some kind of a statement that there could be developed a checklist or criteria against which when the risks of a population is high enough, that they would then be brought into a licensed and regulated environment ... more and more services are leaving hospitals and going into stand alone types of service delivery. At the other end of the extreme ... there's ... "supported living homes" that aren't regulated ... "assisted living home" starts at [page] 25 and there's a set of criteria that are listed ... if a person is ... providing housing and food services or assisting with activities of daily living, this would ... say that you need to be licensed as an assisted living home. Right now, there are ... places out there that are choosing not to be licensed ... this will try and make it more clear what the break point is at which you need licensure or don't ... the staff would need the background check, as minimum, as this bill were to go into place ... 3:32:26 PM DR. MANDSAGER said that the Division of Public Health is working on a series of amendments [for HB 193]. REPRESENTATIVE GARDNER inquired as to the issue of employment and a record of termination [within the registry]. She then asked if [Alaskan Statute] "47.05.20" is part of HB 193. MS. KRALY explained that the first statutory cite in subparagraph C should be "47.05.310" and then it should be "47.05.320" and those are the statutes of reference on page 27, of HB 193. Under "Article 3" of the bill, the new sections under "47.05", which creates the "Criminal History; Registry" process and how the background check can occur. 3:36:17 PM REPRESENTATIVE SEATON mentioned the testimony from the Alaska State Hospital and Nursing Home Association, (ASHNHA), and its liability concerns. He inquired as to what has been done to prevent liability issues and if these concerns have been addressed, overall. DR. MANDSAGER said, " ... as we envision this in statute, we need to make sure that there are steps in place either in statute or ... in regulation to make it clear that the Department is ready to do such an action ... you can't expose frail elderly ... to risk, before they're moved out to another facility ... or another provider is brought in to manage the facility." MS. KRALY clarified that the bill was drafted in an effort to bring the 12 statutory provisions into one umbrella process, in an effort to serve a wide spectrum of entities. Currently, if there is a situation of immediate risk in a nursing home, a temporary manager must be contacted to go through a series of court processes, she related. When there is an assisted living home with an individual at risk, she said, the individual would be removed and the due-process hearing would occur later. She clarified that the instances that ASHNA had mentioned in their letter would be dealt with using the temporary manager, and court process, because from a legal and management standpoint, it would not be plausible to take over a large institution. 3:40:43 PM REPRESENTATIVE SEATON inquired as to the "taking over" of smaller assisted living homes if they are found to be "at risk" situations. MS. KRALY it would all be laid out through regulation, and more often than not, a resident would be removed before a "home" was "taken over." CHAIR WILSON mentioned the "Position Paper on House Bill 193 Offered by Rod Betit, President of ASHNHA," and inquired as to the Department addressing the concerns that were listed. DR. MANDSAGER said that the current regulations allow for gradation within the assisted living situations. The balance point between a nursing home and a "level 3" in a pioneer home, for example, is the discussion point. In light of the function pioneer homes have, he opined that in order to continue that level of home-based, social service, kind of care, rather than medical care, regulation opportunities will have to be created. CHAIR WILSON commented on the slow physical deterioration of individuals within care facilities and the adaptation of different forms of care that evolve. DR. MANDSAGER stated that one major issue concerns fire marshals. In a pioneer home, a fire marshal would require that people be able to readily get out and if someone had physically deteriorated to a certain level [where they could not readily get out], then that person would have to move to another facility. 3:45:19 PM REPRESENTATIVE CISSNA commented that she would like to stay informed as Dr. Mandsager and others make more decisions and modifications on HB 193. DR. MANDSAGER opined that in reality, HB 193 is unlikely to pass this legislative session. He advocated for moving through the process, making modifications, hearing concerns, and coming back next year with a clearer version of HB 193. REPRESENTATIVE MCGUIRE opined that, in many instances, language within HB 193 is unqualified. She referred to page 14, line 22, and said that this section was a very broad "access to information" clause. She encouraged Dr. Mandsager to spend time looking at HB 193 and qualifying sections that are lacking specific information. DR. MANDSAGER explained that the advantage of having introduced the bill is it is now public and can be inspected from many points of view. He said he hopes that there will be meeting over the summer and fall and then, HB 193 can be acted on next winter. MS. KRALY clarified: The genesis of this section 1, which is a centralized licensing and related administrative procedures, 99 percent of that is current law. It's just been cut and pasted and cleaned up ... to create one, centralized licensing statute. If you look at most of it, it's not pulled out of the pie in the sky type thoughts, we're currently using these statutes - it just pulls it into one ... we took the best of the best, we felt and we cleaned up the problems that we see we've envisioned in enforcing and advising the department and created this centralized panel, there are questions and issues and we knew there would be - but just so that's clear, we tried to take what was good and make it a little bit better. [HB 193 was held over.]
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