Legislature(2013 - 2014)CAPITOL 106
02/14/2013 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB44 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 44 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 44-ADVANCE HEALTH CARE DIRECTIVES REGISTRY
3:07:23 PM
CHAIR HIGGINS announced that the only order of business would be
HOUSE BILL NO. 44, "An Act relating to a registry for advance
health care directives."
3:08:23 PM
REPRESENTATIVE LINDSEY HOLMES, Alaska State Legislature, relayed
that this was an act relating to a registry for advance health
care directives. She shared that a more common term for
"advance health care directive" was "living will." This
directive allowed for power of attorney, and described a
person's health care wishes in the event a person was
incapacitated and unable to make their own decisions. The
directive laid out what care the person wanted and did not want,
and who was authorized to make decisions for them. She relayed
that advance health care directives already existed in statute
and were not a new authority. She explained that the proposed
bill enabled Department of Health and Social Services (DHSS) to
create a voluntary registry which would allow people to submit
this living will to DHSS for inclusion in a confidential and
secure data base. The registry would be accessible by health
care facilities within Alaska. She shared that, although she
had a living will, it was locked away and it could be difficult
to access during an emergency. The proposed bill would allow
the advance health care directive to be accessed on-line.
3:10:59 PM
CHAIR HIGGINS asked if there was a fiscal note for the proposed
bill, as the registry would require software.
3:11:13 PM
REPRESENTATIVE HOLMES replied that DHSS would explain the fiscal
note. She shared that the submitted living wills would be
scanned and then put onto the registry. She reported that, as
this software was already available, it could be more economical
to buy. She agreed that there were some upfront costs, and that
the ongoing costs would be reduced over time.
3:12:09 PM
GRACE ABBOTT, Staff, Representative Lindsey Holmes, Alaska State
Legislature, reported that the fiscal note reflected the set up
costs and maintenance of the registry, and salary for a full
time employee to ensure that regulations were in place to
establish methods for identification and confidentiality. She
offered her belief that, in time, the full time position would
be reduced to a part time position.
3:13:11 PM
REPRESENTATIVE SEATON directed attention to the proposed bill,
page 2, line 12, and asked for the definition of an "agent."
3:13:48 PM
MS. ABBOTT, in response, explained that an agent, a guardian or
a surrogate were designated by the individual who filed the
directive and were listed in the directive. She compared this
to a durable power of attorney.
3:14:51 PM
MS. ABBOTT referred to the "House Bill 44 Sectional Analysis"
[Included in members' packets] and offered an analysis for
Section 1 of the proposed bill. She explained that Section 1
protected a health care facility from liability for access, or
non-access, to the registry.
3:15:21 PM
MS. ABBOTT moved on to Section 2, subsection (a) which directed
DHSS to create and maintain the registry. She stated that the
registry would only contain the name and scanned copy of an
advance health care directive for any registered individual.
3:15:48 PM
MS. ABBOTT explained that subsection (b) established that
participation in the registry was completely voluntary. She
reported that subsection (c) defined that the registry was
confidential and who had access to the directive. She noted
that this subsection also allowed DHSS to provide a copy of the
advance health care directive to a hospital outside the state,
if requested by the individual or guardian. She stated that
subsection (d) enabled the registry to be available on line, and
that subsection (e) clarified that DHSS was not responsible for
the legal validity of each directive.
3:17:24 PM
MS. ABBOTT noted that subsection (f) clarified that the
directive could be removed at any time and was completely
voluntary.
3:17:40 PM
CHAIR HIGGINS asked to clarify whether a living will on the
registry would supersede a family member.
MS. ABBOTT replied that the advance health care directive
supplied more information for medical issues, and that doctors
already had regulations for the acceptance of authority. She
stated that immediacy of care was the most important.
3:18:51 PM
REPRESENTATIVE KELLER referred to the proposed bill, page 2,
line 23, and asked who had the authority to access the registry
and the individual's directive.
MS. ABBOTT replied that although it was anticipated that the
doctor would most likely access the registry, the sponsor did
not want to limit access as the administrative practices at a
hospital could have a different protocol.
3:19:52 PM
MS. ABBOTT resumed her explanation for subsection (h) and shared
that DHSS was permitted to charge a fee equivalent to the
administrative cost, or not charge a fee. She pointed out that
DHSS was not permitted to charge a fee for removal of a
directive. She reported that subsection (i) empowered DHSS to
make regulations for cyber access to a directive, while
subsection (j) empowered DHSS to make regulations for human
access. She noted that the sponsor wanted DHSS to create
regulations which worked best for them.
3:21:43 PM
MS. ABBOTT moved on to subsection (k), which protected DHSS and
its employees from any legal liability for operation of the
registry. She concluded with subsection (l), which provided
definitions of registry and directive.
3:22:15 PM
REPRESENTATIVE SEATON asked to clarify whether the definition of
directory as written in the proposed bill would only include a
written directive, and that any advancement for directives would
require a change to the law.
3:22:50 PM
MS. ABBOTT explained that the definition for a written directive
included scanned copies, as these were the only current means
for acceptance into the registry.
3:23:55 PM
REPRESENTATIVE REINBOLD asked if the concept for the proposed
bill had been initiated by lawyers or physicians.
MS. ABBOTT replied that Representative Holmes had initiated the
proposed bill as a response to the difficulty for having the
actual copy of a directive in hand.
3:24:56 PM
REPRESENTATIVE REINBOLD reported that approximately 12 states
offered this service for no charge. Directing attention to the
proposed bill, page 3, line 3, she asked if this referred to a
registration fee.
MS. ABBOTT replied that the referenced fee would pay for DHSS to
file the advanced health care directive on the registry. She
declared that the assumption was to not charge a fee, but that
the proposed bill allowed DHSS to charge a fee, not exceeding
the actual cost, for filing the directive.
3:26:08 PM
REPRESENTATIVE REINBOLD, referring to the fiscal note [Included
in members' packets] asked for an explanation to the continued
fees being so high in Alaska.
MS. ABBOTT deferred to DHSS, as they had researched the cost
differential for various contracted vendors.
3:26:52 PM
REPRESENTATIVE REINBOLD asked if there had been any polling
regarding the proposed bill among the medical community.
MS. ABBOTT replied that there had not been any negative comments
from the medical community. Noting that advanced health care
directives already existed, she offered her belief that the
proposed bill would provide the medical community with more
information for better treatment.
3:28:13 PM
REPRESENTATIVE SEATON directed attention to page 2, line 3 of
the proposed bill, and asked for clarification as to which
individual this referred.
MS. ABBOTT replied that this was a legal way for stating that a
person could write and file the directive for themselves.
3:29:04 PM
REPRESENTATIVE SEATON asked if the agent would also be able to
submit the directive.
MS. ABBOTT replied that although an individual could receive
assistance for completing the directive, the individual had to
file with the registry, either by mail, fax, or electronic.
3:30:23 PM
CHAIR HIGGINS asked about the open ended fee referenced in the
proposed bill.
JILL LEWIS, Deputy Director-Juneau, Central Office, Division of
Public Health, Department of Health and Social Services, said
that the proposed bill limited the fee to only cover the
administrative cost. She reported that DHSS was considering to
not charge, similar to other states, which was reflected in the
fiscal note. She offered her belief that a fee would reduce
participation.
MS. LEWIS, in response to Chair Higgins, said that a fee was not
included in the fiscal note.
CHAIR HIGGINS pointed out that, although a fee was not included
in the fiscal note, it was not prohibited in the proposed bill.
He reported that document fees could be as high as $300 for an
individual's records. He stated that technically the Department
of Health and Social Services could charge up to $300 per
individual.
3:32:22 PM
MS. LEWIS read from the narrative on page 2 of the fiscal note,
"a fee might offset administrative costs but would likely reduce
participation." She affirmed that the fiscal note assumed there
would not be a fee.
CHAIR HIGGINS replied that he was not comfortable with this
assumption, and he declared that if there was no intent to
charge, then this should be written in the proposed bill.
Pointing out that information technology (IT) was expensive, he
asked about the recourse if the $137,000 allocated in the fiscal
note was not sufficient.
MS. LEWIS replied that research by DHSS was "pretty certain"
that the allocation would be sufficient. She said that DHSS had
looked into building the program software, but had found that
national registries already existed at a much more reasonable
cost. She clarified that the fiscal note was based on
conversations and cost structure estimates with an existing
registry.
3:34:10 PM
CHAIR HIGGINS asked how a living will would be written and
implemented.
MS. ABBOTT, in response, said that the advance health care
directive would be submitted by an individual to DHSS, but it
would not be confirmed as valid simply by its listing on the
registry.
3:34:54 PM
REPRESENTATIVE KELLER asked what percentages of the population
of other states were participating, and what percentage of
participation was anticipated in Alaska.
MS. LEWIS replied that Alaska could expect 1,000 registry users,
although there was anecdotal information suggesting that
Providence Alaska Medical Center in Anchorage already had 1,000
directives on file. She opined that a comparable statewide
ratio could increase the registry use to 4,000. She reported
that the flat rate fee structure for the proposed registry would
include a minimum of 5,000 registrants.
3:36:38 PM
MS. ABBOTT said that the fiscal note also included an outreach
program to the communities to encourage and, hopefully, increase
participation.
3:37:11 PM
REPRESENTATIVE KELLER asked to clarify that the fiscal note
included an outreach program. He asked about private sector
data bases in other states. He questioned whether he could
register in advance to the Providence Alaska Medical Center
registry.
3:38:03 PM
REPRESENTATIVE KELLER announced that he had heard rumors about
an iPad application to store personal health records, and he
asked if there were any options other than a public registry.
MS. ABBOTT said that individual hospitals had created their own
registry however, unless a person was a current patient at the
hospital, the advanced health care directive would not be
accessible. She opined that many users of advance health care
directives were not a target demographic for iPad.
3:39:44 PM
MS. LEWIS said that a trend for some states was alignment of the
advance care directives with the state health information
exchange. She offered her belief that electronic records were
an optional qualifying condition for incentive payments to
providers.
3:40:38 PM
REPRESENTATIVE KELLER asked to clarify that the health
information exchange was a data base for sharing medical records
among providers, and was not the same as a health exchange. He
noted that the State of Alaska had financially encouraged a
health information exchange in the state.
3:41:11 PM
REPRESENTATIVE TARR, referring to the attached fiscal note,
asked to clarify the cost if there were only 1,000 participants.
She also asked about the significant change to cost of services
in FY 2015.
3:42:03 PM
MS. LEWIS, in response to Representative Tarr, said that the
potential maximum fee would be much lower as there were more
participants. She pointed out that the fee charged by other
states was very nominal, and that DHSS, if they chose to
implement a fee, would follow that direction. She opined that
DHSS would not try to recoup the entire cost for the registry
unless directed by the legislature.
REPRESENTATIVE TARR suggested that the proposed bill should be
more explicit for a limit to the fee, in order to guarantee
success for the program.
3:43:52 PM
REPRESENTATIVE REINBOLD noted that there was no fee for the
registry in other states. She directed attention to the
$112,000 for personal services and the $11,000 for travel listed
in the attached fiscal note, and reported that the cost per
registrant would be more than $1,000 if there were only 1,000
participants, as projected. She declared that there were tough
budget decisions currently being discussed, and she offered her
belief that it was necessary to "shrink our budget, if we want
it sustainable." Noting that the concept of the proposed bill
was worthy of discussion, she asked why Alaska would not model
after Virginia, as that state had been offering the program at
no operational cost since 2008.
MS. ABBOTT explained that participation in Virginia had occurred
when hospitals had aligned with a healthcare information
exchange and, as that was not occurring in Alaska, there was
anticipation for creation with this registry.
3:45:47 PM
REPRESENTATIVE SEATON directed attention to page 2, line 7 of
the proposed bill, and noted that there was language for the
release of directives, but no mention for a means of submission.
He asked for an explanation as to why an agent for the
participant could access a copy of the directive, but could not
file a certified copy for the participant.
MS. ABBOTT, in response, opined that Alaska statute declared
that only an individual could fill out the advance health care
directive, therefore the proposed bill extended this intent by
stating that only the individual could submit the directive to
the registry. She pointed out that an individual could receive
assistance with this task.
3:47:32 PM
MS. LEWIS detailed that the proposed full time dedicated
position for the registry during the first few years was to work
with people in outreach programs, to offer a toll free line for
technical assistance, and to scan the paper directives when
submitted. She noted that it was also necessary to determine a
system for the security of the paper documents which would
ensure compliance with the Health Insurance Portability and
Accountability Act (HIPAA).
3:48:39 PM
REPRESENTATIVE SEATON asked to clarify that it was acceptable
for an agent to submit the health care directive for an
individual upon admission to a health care facility, yet there
was a barrier for filing with the registry.
MS. ABBOTT, in response to Representative Seaton, explained that
the intent for requiring an individual to register would be to
ensure "it is not falsified."
3:49:34 PM
CHAIR HIGGINS, directing attention to page 2 of the attached
fiscal note for the proposed bill, asked about the projection
for 4,000 directives. He questioned if this was a realistic
projection, and if not, how this program could become revenue
neutral. He expressed that, although the concept of the program
was good, he was concerned with the potential cost.
3:51:13 PM
CHAIR HIGGINS opened public testimony.
3:51:37 PM
MARIE DARLIN, Coordinator, AARP Capital City Task Force, stated
that AARP had submitted a letter of support [Included in
members' packets]. She reminded the committee that it had taken
four years to get the advance health care directives approved by
the legislature, and AARP viewed this proposed bill as the next
step toward usefulness for the directives. She encouraged use
of the directives, and she declared that many of the committee's
questions were answered on the directive itself. She offered
that AARP would be "helping to spread the word" for
participation in the registry, and she endorsed that any fee for
registration be nominal. She shared that AARP had almost 95,000
members in Alaska. She declared that the most important aspect
of the advance health care directive was to initiate discussion
for what the individual wanted in advance of any emergency. She
declared that AARP supported the proposed bill.
3:55:22 PM
REPRESENTATIVE TARR asked if the AARP membership was aware of
the opportunity to file a directive.
MS. DARLIN, in response, said that AARP had focused on the need
for advance health care directives, and she emphasized the need
for a family discussion with regard to the directives.
REPRESENTATIVE TARR, referencing the number of advance directive
registrants through Providence Alaska Medical Center in
Anchorage, asked if AARP was surprised that so few people had
currently registered.
MS. DARLIN questioned the number of individuals with advance
health care directives, and noted that a registry would be a
means to ascertain this. She declared that the directives were
an important ongoing project.
REPRESENTATIVE TARR asked if many people kept their own
directive.
MS. DARLIN offered an anecdotal story of advance directives with
her family.
4:00:17 PM
JEFFREY MITTMAN, Executive Director, American Civil Liberties
Union of Alaska (ACLU), stated that the proposed bill "was an
excellent balance of the state providing a mechanism for
individuals in the State of Alaska to voluntarily be part of a
scheme that improves the provision of health care, while
recognizing the need for medical decisions to be made between
the patient and his or her healthcare provider." He declared
that ACLU supported proposed HB 44.
4:00:59 PM
CHAIR HIGGINS stated that he would leave public testimony open.
CHAIR HIGGINS held over HB 44.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB044 Ver A.PDF |
HHSS 2/14/2013 3:00:00 PM |
HB 44 |
| HB044 Sectional.pdf |
HHSS 2/14/2013 3:00:00 PM |
HB 44 |
| HB044 Sponsor Statement.pdf |
HHSS 2/14/2013 3:00:00 PM |
HB 44 |
| HB044 Fiscal Notes-DHSS-EP-2-9-13.pdf |
HHSS 2/14/2013 3:00:00 PM |
HB 44 |
| HB044 Background - Memo Re AHD Registry.pdf |
HHSS 2/14/2013 3:00:00 PM |
HB 44 |
| HB044 Supporting Documents - AK Commission on Aging.pdf |
HHSS 2/14/2013 3:00:00 PM |
HB 44 |
| HB044 Supporting Documents - AARP.pdf |
HHSS 2/14/2013 3:00:00 PM |
HB 44 |