Legislature(2005 - 2006)CAPITOL 120
05/05/2005 01:00 PM House JUDICIARY
| Audio | Topic |
|---|---|
| Start | |
| HB193 | |
| SB130 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 193 | TELECONFERENCED | |
| + | SB 137 | TELECONFERENCED | |
| + | SB 135 | TELECONFERENCED | |
| + | SB 20 | TELECONFERENCED | |
| + | SB 132 | TELECONFERENCED | |
| + | SB 130 | TELECONFERENCED | |
| *+ | HB 232 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 193 - LICENSING MEDICAL OR CARE FACILITIES 1:21:28 PM CHAIR McGUIRE 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." [Before the committee was CSHB 193(HES).] [Because of its length, what became known as Amendment 1 can be found at the end of the first set of minutes for HB 193 for this date.] 1:21:32 PM REPRESENTATIVE SHARON CISSNA, Alaska State Legislature, indicating that she would be providing testimony, first referred to Section 54, located on pages 42-43 of CSHB 193(HES). CHAIR McGUIRE noted that members' packets contain a proposed amendment that would remove Section 54 from CSHB 193(HES). REPRESENTATIVE CISSNA relayed her understanding that the purpose of Section 54 is to keep seniors in their own homes and save money through the use of home healthcare. The federal policy has been "least restrictive" and Alaska has been responding via Personal Care Attendants (PCAs). However, the costs for that have risen. She referenced a PowerPoint presentation and noted that it contains a chart illustrating that rise. She surmised that the Department of Health and Social Services (DHSS) met the challenge predominately by cutting and capping various services such as respite care and other items. The problem, she recounted, is that these cuts and caps have jeopardized the ability of seniors to stay in their homes. REPRESENTATIVE CISSNA referred to page 4 of the aforementioned presentation and recounted the situation of a woman who's working full time but whose mother has Alzheimer's. Although the mother qualifies for the "Medicaid Waiver" and could go to a nursing home, the daughter wants her mother to be able to stay at home, in a loving environment. However, currently the daughter can only get a PCA for her mother for 26 hours [during the workweek]. Representative Cissna then played a recording of an interview with the daughter for committee members wherein the daughter expresses concerns regarding her mother's safety. [This interview recording was not picked up well on the meeting recording.] REPRESENTATIVE CISSNA mentioned that the mother's previous plan would cover her for approximately 50 hours per week, and this allowed the daughter to maintain her fulltime job. 1:28:17 PM REPRESENTATIVE CISSNA summarized by saying that after new regulations became effective and after the previous plan expired, the mother's new plan now covers only 30 hours per week. This has resulted in the daughter having to cut back hours at work, which might, incidentally, jeopardize her health insurance benefits. Representative Cissna opined that such cuts will ultimately result in higher costs to the state. And so although the department now has the authority to make cuts to the aforementioned types of programs, she asked that the committee not remove Section 54 from the bill, reiterating that Section 54 proposes to keep people at home at a competitive price. CHAIR McGUIRE acknowledged the work Representative Cissna has put into senior care issues. REPRESENTATIVE CISSNA opined that the cuts and caps will ultimately have a detrimental impact on family caregivers. REPRESENTATIVE GARA said he supports Representative Cissna's attempt to get the program proposed in Section 54 started. He asked what "chore" services have been cut to. REPRESENTATIVE CISSNA offered her understanding that it is now 10 hours per week, and that respite services cannot be used while the primary caregiver is at work. 1:33:12 PM RICHARD MANDSAGER, M.D., Director, Division of Public Health, Department of Health and Social Services (DHSS), presented HB 193 on behalf of the administration. He relayed that the companion bill to HB 193 has just passed the Senate, and that HB 193 has three main purposes. He elaborated: The first purpose is to deal with an incredible statutory and regulatory variation around the multiplicity of types of organizations and entity that the Department of Health and Social Services licenses or certifies, and the intent is to simplify [and] streamline - [the process] ... - to make it more standard and more straightforward. The second goal is to also standardize, across all the various entities and individuals that work for those entities, the kinds of background checks that are done before employment - to work toward improving the health and safety of vulnerable Alaskans - and the intent is to deal both on the criminal side - with criminal background checks - and on the civil side - with fraud, abuse, neglect, and Medicaid fraud - both for entities, the organizations, the CEOs, and for the individuals that work with ... clients (indisc.). CHAIR McGUIRE raised the issue of predators of children, and offered her understanding that the system being proposed via HB 193 may well be affordable and accessible to nonprofit and volunteer organizations that should also be doing background checks but have found doing so to be too costly. DR. MANDSAGER referred to a handout, derived from a PowerPoint presentation, provided by the DHSS and dated 5/4/05, and relayed that it in part provides the committee with examples of problems occurring under existing regulations. For example, a supported- living home provider was misappropriating funds from residents; no background check had been conducted on that provider, since current law did not require that particular home to be licensed. There have also been instances of physical violence against and mistreatment of residents. He noted that currently PCAs, who are typically listed by multiple employment agencies, must submit separate fingerprint-based background checks for each agency, and [HB 193] proposes to allow one such background check to be made available to various employers. DR. MANDSAGER referred to page 4 of the DHSS's handout, and said it reflects that the DHSS administers 19 programs under as least 12 different statutory schemes for licensure. Furthermore, various agencies/entities are governed by different rules - some statutory, some regulatory. As a result of the passage of executive order (EO) 108, consolidation of licensing and certification activities in the Division of Public Health has begun, but there is internal tension with regard to different divisions' fiscal responsibilities. Page 6 of the aforementioned handout, he remarked, highlights some of the variations in rules for the different types of organizations licensed and/or certified by the DHSS. This page also lists the various types of organizations that will be subject to background checks should HB 193 pass. DR. MANDSAGER said that page 7 of the handout lists which statutes will be changed by passage of the bill, and page 8 lists some of the items included in the bill. For example, HB 193 is proposing a new article that will define who is required to have background checks, will provide for regulatory definition of barrier conditions, and will require the establishment and maintenance of a centralized registry available to all [prospective] employers. He characterized background checks as reflecting the criminal side of a person's history, and characterized what he termed as the misconduct registry as reflecting the "civil side" of a person's history, the latter registry being modeled on what currently exists for certified nurse attendants (CNAs) in nursing homes and assisted- living homes. DR. MANDSAGER relayed that the key provisions of HB 193 are listed on page 9 of the aforementioned handout and pertain to barrier conditions, background checks, barring of employment in instances where barrier crimes are committed, the misconduct registry, and waiver and appeals processes. He noted that page 10 of the handout outlines for the committee the regulations that [licensing and certifying] staff must keep track of. 1:42:32 PM CHAIR McGUIRE made a motion to adopt Amendment 1, labeled 05/04/05, 10:15 a.m. [Amendment 1 can be found at the end of the first set of minutes for HB 193 for this date.] REPRESENTATIVE DAHLSTROM objected for the purpose of discussion. DR. MANDSAGER explained that Amendment 1 would alter CSHB 193(HES) such that it would then be identical to the aforementioned Senate companion bill. He also noted that members' packets contain a side-by-side comparison between that companion bill and CSHB 193(HES). The first two changes proposed by Amendment 1 address concerns regarding firearms being possessed by individuals who are picking up their child at a licensed child care facility. REPRESENTATIVE GRUENBERG asked what the language, "encased in a container of a motor vehicle" means. 1:45:19 PM REPRESENTATIVE ANDERSON surmised that that would mean a gun case. REPRESENTATIVE GRUENBERG asked whether the gun case would have to be locked. DR. MANDSAGER relayed that the discussion that took place in Senate committee hearings implied that the gun case would be locked. CHAIR McGUIRE noted that Representative Dahlstrom has mentioned that the term could also refer to a glove compartment. REPRESENTATIVE GRUENBERG said his concern is that a firearm could still be easily obtained from an unlocked gun case. REPRESENTATIVE DAHLSTROM mentioned that the flip side of that is the attention that's being drawn by someone who transfers his/her firearm to and from the trunk of a car while at a licensed child care facility. She noted that people carry firearms for protection and various other reasons, none of which, she surmised, are furthered by having the firearm in the trunk of a vehicle. 1:46:49 PM REPRESENTATIVE GARA asked why this change is needed. DR. MANDSAGER indicated that current law prohibits a person from bringing a firearm to a [licensed child care] facility. REPRESENTATIVE GARA offered his understanding, though, that one cannot currently bring a firearm to a school. Therefore, why should on be permitted to bring a firearm to a child care facility? 1:47:35 PM STACIE KRALY, Senior Assistant Attorney General, Human Services Section, Civil Division (Juneau), Department of Law (DOL), relayed that the discussion in the Senate committee hearings revolved around the issue of whether an individual would be allowed to have an unloaded firearm in his/her vehicle when he/she goes to pick up or drop off his/her child at a licensed child care facility. In other words, the qualifier used in the proposed change was that the firearm be unloaded, not that it was locked up in the trunk or encased in a container. She said that the DOL is neutral on that proposed change. REPRESENTATIVE GRUENBERG, in response to comments, noted that current law prohibits one from possessing a firearm at certain facilities. He opined that if the intent is to ensure that a firearm be encased in a gun case, then the language should actually state "gun case" rather than "container of a motor vehicle", particularly since a gun case is not actually a container of a motor vehicle and is instead a portable item. REPRESENTATIVE GRUENBERG made a motion to conceptually amend Amendment 1, to change the words, "encased in a container of a motor vehicle" to "encased in a gun case in a motor vehicle". REPRESENTATIVE DAHLSTROM said she has problems with the practicality of the language in that portion of Amendment 1 - both its current language and that which is being offered via the amendment to Amendment 1. She offered her belief that most people who carry firearms will not have them locked up in a gun case nor will the firearms be unloaded. What good is an unloaded gun, she queried. 1:52:30 PM REPRESENTATIVE GRUENBERG said his concern is that he doesn't know what is meant by the term "in a container of a motor vehicle". Would that be a glove box, for instance? REPRESENTATIVE DAHLSTROM said that that meaning would be fine with her. REPRESENTATIVE GRUENBERG concurred, but offered his understanding that the language makes it sound as though the container must be a part of the car - thus a gun case would not apply. CHAIR McGUIRE concurred with Representative Gruenberg's summation. She asked whether changing the language to "encased in a glove compartment or a locked gun case". REPRESENTATIVE GRUENBERG indicated that he would be amenable to such a change. CHAIR McGUIRE offered her belief that the current language in Amendment 1 would not allow for the use of a gun case. 1:53:34 PM REPRESENTATIVE GARA said he would be more comfortable changing the language in Amendment 1 such that it mirrors the language pertaining the possession of firearms on school grounds. REPRESENTATIVE GRUENBERG withdrew his motion to amend Amendment 1, but indicated that he may wish to revisit the issue later. DR. MANDSAGER explained that the next change proposed by Amendment 1 would delete Section 14 of CSHB 193(HES). Section 14, he relayed, has been found to be adding language in the wrong place, and so needs to be removed. The changes Amendment 1 proposes to pages 12 and 14, he opined, are important because they add the crime of medical assistance fraud to the criminal history and registry provision and applies both to individuals and to entities. 1:55:29 PM DR. MANDSAGER explained that the change proposed by Amendment 1 to page 16 will insert language, via a new Section 47.05.350, regarding immunity for using information obtained under a criminal history background check. MS. KRALY additionally explained that this proposed language is already included in the bill but in the wrong place, and so Amendment 1 also includes a corresponding change to delete this language from that wrong location. DR. MANDSAGER explained that the change proposed by Amendment 1 to page 21, line 9, is in response to concerns that the department could issue policies or procedures independent of regulation, and the change clarifies that any policies or procedures are not simply arbitrary rules but have gone through the regulatory process. 1:56:43 PM REPRESENTATIVE GRUENBERG asked whether the department must follow the Administrative Procedure Act (APA) regarding the adoption of regulations. MS. KRALY confirmed that the department must follow the APA in that regard. DR. MANDSAGER explained that the change proposed by Amendment 1 to page 23, lines 30-31 should clarify that licensing by the department does not obligate the department to place or maintain an individual. 1:57:26 PM MS. KRALY, in response to questions, relayed that the term "entity" is defined in statute as referring to any of the 18 entities that the department licenses, and that use of that term in the proposed change is also meant to apply to any of those entities. In other words, the department is not obligated to find residents for any entity just because the department licensed the entity, nor is the department obligated to subsidize any entity it licenses. In response to further questions, acknowledged that this proposed change basically seeks to immunize the department from financial responsibility towards the entities it licenses. DR. MANDSAGER explained that the change proposed by Amendment 1 to page 32, line 4, will ensure that the provisions of the APA also apply. MS. KRALY, in response to questions, clarified that both the provisions of the APA and the procedures for administrative hearings would apply to the quasi-adjudicatory process established via proposed AS 47.32.150(a), and that for the most egregious type of sanctioning and licensing actions an administrative law judge will be used. 2:01:44 PM DR. MANDSAGER, in response to comments, offered his belief that the rest of the changes proposed by Amendment 1 are technical in nature - conforming language and renumbering. REPRESENTATIVE COGHILL, referring to the change proposed by Amendment 1 regarding firearms, offered his understanding that it merely mirrors language pertaining to the possession of firearms around school areas. REPRESENTATIVE DAHLSTROM removed her objection to the adoption of Amendment 1. CHAIR McGUIRE asked whether there were any further objections. REPRESENTATIVE GRUENBERG referred to the change proposed by Amendment 1 to delete proposed AS 47.32.900(1)(B), which defines "ambulatory surgical center" as including a facility that performs invasive diagnostic or therapeutic services. DR. MANDSAGER said that after discussion with industry personnel and physicians, it became clear to him that inclusion of such a definition was impractical and so he has decided to have that language removed. He offered his understanding that this language was removed via an amendment in the House Health, Education and Social Services Standing Committee, but Legislative Legal and Research Services neglected to include the change in CSHB 193(HES). 2:03:27 PM CHAIR McGUIRE, after ascertaining that there were no further objections, announced that Amendment 1 was adopted. REPRESENTATIVE ANDERSON made a motion to adopt Amendment 2, labeled 04/29/05, 2:30 PM., which read [original punctuation provided]: Page 1, lines 9 - 11: Delete "expanding reimbursable services under Medicaid waivers for older Alaskans and adults with disabilities to include adult companion services;" Page 42, line 24 through page 43, line 23: Delete all material. Renumber bill sections accordingly. Page 47, line 9: Delete "58" Insert "57" Page 47, line 10: Delete "59" Insert "58" Page 47, line 13: Delete "58(b)" Insert "57(b)" Page 47, line 15: Delete "60 - 62" Insert "59 - 61" DR. MANDSAGER relayed that Amendment 2 reflects the administration's desire to have Section 54, and its corresponding language in the title, deleted. It is the administration's position, he remarked, that HB 193 is not the appropriate bill with which to deal with Medicaid waiver issues, particularly given that a study regarding such issues is scheduled to be launched this summer. REPRESENTATIVE GARA objected to the motion. He said he is concerned that those with disabilities are being forced into nursing homes; opined that Representative Cissna's proposed language - Section 54 - attempts to address this issue now; and relayed that it is not acceptable to him for the legislature to delay addressing this issue until next year, until after the aforementioned study is completed. STEVEN P. ASHMAN, Director, Division of Senior and Disabilities Services, Department of Health and Social Services (DHSS), relayed that under the new regulations, the frequency of services was reduced. However, the division has not seen anyone that's been diverted from the waiver program and placed into an institution. Instead, the division has seen some of the cost efficiencies that were anticipated under the respite program being shifted over to the PCA budget, which has helped many families. He, too, noted that the division will be doing a long-term-care study, and said the division anticipates spending $260 million next year for long-term-care services and wants to ensure that any changes which will be made will be good changes, that they will be the best practices. 2:06:52 PM REPRESENTATIVE GARA pointed out, however, that next year is still next year. He surmised that the reason the division has not seen people going into nursing homes is because family members are making more sacrifices to keep their loved ones at home, and so that is not a good indication that there isn't a problem. He reiterated that he objects to the motion to adopt Amendment 2. CHAIR McGUIRE said she supports [Amendment 2] but agrees with Representative Gara. She added: It really was frustrating this interim to try to communicate a message ... from our constituents. And it is three branches of government, but we're supposed to be the lawmaking branch and we're supposed to be setting the policies and then we pay for whatever it is that we set. ... Not the other way around - that you set it and then cut the budget that you request from us - and I sort of feel a little bit like that went on. 2:09:02 PM A roll call vote was taken. Representatives McGuire, Anderson, Coghill, Kott, and Dahlstrom voted in favor of Amendment 2. Representatives Gruenberg and Gara voted against it. Therefore, Amendment 2 was adopted by a vote of 5-2. REPRESENTATIVE GRUENBERG referred to Amendment 1, specifically the change proposed to page 38, lines 7-15. He asked whether that is a substantive change. DR. MANDSAGER replied that this change will clarify that "assisted living homes" means the same thing throughout the bill. REPRESENTATIVE GRUENBERG asked whether the change will result in any diminution of service to the client. DR. MANDSAGER said no, adding that the language will merely match the current statutory definition. 2:11:39 PM REPRESENTATIVE GRUENBERG, noting that one of the changes proposed by Amendment 1 will repeal AS 25.27.244(s)(2), asked what that statute pertains to. MS. KRALY said that it pertains to child support, and the proposed change is in response to a concern raised by Legislative Legal and Research Services. She added: The premise is that we're licensing entities rather than individuals, and so what that was doing was allowing some garnishment issues, and there's another issue that deals with postsecondary education loans. And you can't garnish an entity for a loan default but you can garnish an individual, and since we're licensing entities, rather than individuals, that needed to be changed. 2:12:53 PM REPRESENTATIVE GARA made a motion to adopt Amendment 3, which, with handwritten additions, read [original punctuation provided]: Page 1, line 9, following "Services;": Insert "relating to public assistance for health facilities and assisted living homes, to rates charged by an assisted living home, and to the liability of recipients of home or community-based services to pay for those services; Page 18, following line 9 Insert new bill sections to read: Sec. 22 AS 47.07.070(a) is amended to read: (a) Except as provided under (d) - (f) of this section, the [THE] department shall, by regulation, set rates of payment for health facilities under this chapter and AS 47.25.120 - 47.25.300 in accordance with 42 U.S.C. 1396 (Title XIX, Social Security Act, Medical Assistance) and this section. A rate established under this section takes effect under AS 44.62 (Administrative Procedure Act) but not until approved in writing by the commissioner. The commissioner may delegate the performance of these functions. Sec. 23 AS 47.07.070 is amended by adding new subsections to read: (d) For residential support living services provided to an eligible recipient of medical assistance living in an assisted living home licensed under AS 47.33, the minimum daily reimbursement rate to the assisted living home for room and board expenses is $28. (e) The department may not establish a maximum daily rate for room and board expenses charged by an assisted living home. (f) A calculation of the rate for administrative and general costs for a provider, including an assisted living home, shall be determined in the same way as a calculation of the administrative and general cost rate for a Pioneers' Home. In this subsection, "administrative and general costs" means those expenses that are common to the overall operation of a provider providing home and community-based waiver services and that are not directly assignable to or borne by a specific program or recipient of a home and community-based service. Renumber the following bill sections accordingly. Page 41, following line 5 Insert a new bill section to read: Sec. 49 AS 47.07.070(c) is repealed." Renumber the following bill sections accordingly. Page 41, following line 14 Insert a new bill section to read: Sec 52. The uncodified law of the State of Alaska is amended by adding a new section to read: REGULATIONS ANNULLED. 7 AAC 43.1058(j) and 7 AAC 43.1058(k)(1)(B) are annulled." Renumber the following bill sections accordingly. Note to Leg. Legal: Conform all internal bill section references as necessary. REPRESENTATIVE GARA, indicating that the goal of Amendment 3 is to establish a minimum room and board rate for assisted living homes, made a motion to amend Amendment 3, to take out proposed subsection (e) of proposed AS 47.07.070. There being no objection, the amendment to Amendment 3 was adopted. REPRESENTATIVE GARA acknowledged that several legislators have had concerns about the reduction in the rates paid to help people stay at assisted living homes. That reduction was essentially a transfer, he noted, and went from $28 a day to $18 a day, and although some monetary compensation occurred via the Medicaid program, many assisted living homes feel that they can't legally use that program. Amendment 3, as amended, attempts to "roll back the new summer regulation to the former $28 [per] day compensation rate." He offered his understanding that corresponding amendments with regard to funding have been made to the [operating] budget. However, also according to his understanding, he remarked, until a new regulation is adopted, any forthcoming funds cannot be spent; thus the department may relay the need to adopt a new regulation. 2:15:18 PM MR. ASHMAN said that Amendment 3, as amended, will deal with individuals who have incomes in excess of Supplemental Security Income (SSI) and Adult Public Assistance (APA), and will allow clients to retain their SSI and APA and use it for whatever purpose they wish. Furthermore, if the department becomes authorized to promulgate emergency regulations on this issue, it will then do so, providing for an effective date of July 1, 2006. REPRESENTATIVE GARA said he wants to be assured that if the funding is made available this year, that assisted living homes will be compensated at $28 per day immediately, not 2006. MR. ASHMAN offered his understanding that an option might be to institute reimbursement retroactively. MS. KRALY also offered her understanding that if the funding is made available via the budget, monies would be paid to assisted- living home operators starting July 1, and that in lieu of regulatory authorization, the [DHSS] will work as quickly as possible to amend the regulations back to what they were a year ago. REPRESENTATIVE GARA indicated that for the time being his intention is try to get Amendment 3, as amended, adopted and then, when he gets something in writing assuring him of the department's intent on this issue, he will withdraw Amendment 3 as the bill continues through the legislative process. 2:18:04 PM CHAIR McGUIRE said she would agree to oppose Amendment 3, as amended, but pointed out that it would be nice to have something in writing anyway so as to understand the timing on the regulation process. She remarked that Representative Gara makes a good point, that assisted living homes are under the assumption that they will be fine if the budgetary change is forthcoming and so are acting a certain way in order to stay afloat; therefore if the monies aren't actually going to be made available until 2006, it won't help assisted living homes now. She reiterated that it would be nice to have something in writing, something stating that the department will pursue the promulgation of emergency regulations. 2:20:05 PM MR. ASHMAN said he would discuss the issue with the commissioner of DHSS, adding his assurance that the department does have a commitment to follow through if the funding is made available. 2:20:19 PM CHAIR McGUIRE objected to the motion to adopt Amendment 3, as amended. 2:20:40 PM A roll call vote was taken. Representatives Dahlstrom, Gruenberg, and Gara voted in favor of Amendment 3, as amended. Representatives McGuire and Anderson voted against it. Therefore, Amendment 3, as amended, was adopted by a vote of 3- 2. The committee took an at-ease from 2:21 p.m. to 2:23 p.m. 2:23:03 PM CHAIR McGUIRE relayed that the House Judiciary Standing Committee would continue discussion - perhaps even moving on to the next bill - and be awaiting a letter from the DHSS addressing members' concerns regarding the assisted living provider regulations. REPRESENTATIVE GRUENBERG referred to Amendment 1 and offered his understanding that it would repeal a provision that would allow the department to pull a person's license if he/she has not paid child support. REPRESENTATIVE GRUENBERG made a motion to adopt Amendment 4, to delete the language added to the bill via adoption of Amendment 1 that read: Page 41, following line 2: Insert a new bill section to read: "* Sec. 46. AS 25.27.244(s)(2) is repealed." REPRESENTATIVE ANDERSON objected for the purpose of discussion. 2:25:13 PM MS. KRALY said that the DOL has no objection Amendment 4. CHAIR McGUIRE announced that Amendment 4 was adopted. CHAIR McGUIRE announced that CSHB 193(HES), as amended, would be set aside until later in the meeting. AMENDMENT(S) Amendment 1 [Labeled 05/04/05, 10:15 a.m.] (adopted): Page 1, line 7, following "clinics;": Insert "relating to possession of a firearm at licensed entities and facilities;" Page 4, line 3, following "children": Insert ", except that a person 21 years of age or older may possess an unloaded firearm in the trunk of a motor vehicle or encased in a container of a motor vehicle" Page 6, line 31 through page 8, line 15: Delete all material. Renumber the following bill sections accordingly. Page 12, line 16, following "jurisdiction": Insert "or to have committed medical assistance fraud under AS 47.05.210 or a substantially similar provision in another jurisdiction" Page 14, line 8, following "jurisdiction": Insert "or to have committed medical assistance fraud under AS 47.05.210 or a substantially similar provision in another jurisdiction" Page 16, following line 11: Insert "Sec. 47.05.350. Immunity. An entity or individual service provider that obtains information about an employee under a criminal history check under AS 47.05.310 may use that information only as provided in regulations adopted by the department under AS 47.05.320. However, if that entity or individual service provider reasonably relies on that information provided under the regulations adopted by the department to deny employment to an individual who was selected for hire as an employee, including during a period of provisional employment, the entity or individual service provider is not liable in an action brought by the individual based on the employment determination resulting from the information." Page 21, line 29, following "AS 47.32.010(b)": Insert ", as defined by regulation" Page 23, line 30, following "(c)", through line 31: Delete all material and insert "The issuance of a license by the department does not obligate the department to place or maintain an individual in an entity or through an entity, or to provide financial support to an entity." Page 32, line 4: Delete "applies" Insert "and AS 44.62.330 - 44.62.630 apply" Page 32, lines 24 - 30: Delete all material. Page 34, line 21, following "ambulatory surgical center": Insert "means a facility that" Page 34, line 22: Delete all material. Page 34, line 23: Delete "(i)" Insert "(A)" Page 34, line 25: Delete "(ii)" Insert "(B)" Delete "and" Page 34, lines 27 - 28: Delete all material. Page 35, line 5: Delete "or" Page 35, following line 5: Insert "(iii) offers personal assistance as defined in AS 47.33.990; or" Page 35, line 6: Delete "(iii)" Insert "(iv)" Page 37, line 13, following "care": Insert "or rehabilitative services" Page 37, line 31: Delete "35" Insert "34" Page 38, line 7, following "to", through line 15: Delete all material and insert "assisted living homes as defined in AS 47.32.900." Page 41, following line 2: Insert a new bill section to read: "* Sec. 46. AS 25.27.244(s)(2) is repealed." Page 41, line 6: Delete "47.33.420," Page 41, line 18: Delete "1 - 15, 17 - 19, 21 - 35, 37 - 42, and 44 - 51" Insert "1 - 14, 16 - 18, 20 - 34, and 36 - 51" Page 41, line 21: Delete "35" Insert "34" Page 41, line 22: Delete "35" Insert "34" Page 41, line 24: Delete "1 - 15, 17 - 19, 21 - 35, 37 - 42, and 44 - 51" Insert "1 - 14, 16 - 18, 20 - 34, and 36 - 51" Page 41, line 25: Delete "1 - 15, 17 - 19, 21 - 35, 37 - 42, and 44 -" Insert "1 - 14, 16 - 18, 20 - 34, and 36 -" Page 41, line 27: Delete "35" Insert "34" Page 41, line 30: Delete "1 - 15, 17 - 19, 21 - 35, 37 - 42, and 44 - 51" Insert "1 - 14, 16 - 18, 20 - 34, and 36 - 51" Page 42, line 2: Delete "SEC. 20" Insert "SECS. 19 AND 35" Page 42, line 3: Delete "sec. 20" Insert "secs. 19 and 35" Page 42, line 5: Delete "sec. 20" Insert "secs. 19 and 35" Page 42, line 8: Delete "20" Insert "19" Page 42, line 9: Delete "35" Insert "34" Page 42, line 12: Delete "sec. 20" Insert "secs. 19 and 35" Page 42, line 14: Delete "20" Insert "19" Page 42, line 17: Delete "sec. 20" Insert "secs. 19 and 35" Page 42, line 20: Delete "20" Insert "19" Delete "35" Insert "34" Page 42, line 21: Delete "20" Insert "19" Page 42, line 23: Delete "20" Insert "19" Page 43, line 27: Delete "35" Insert "34" Page 43, line 28: Delete "35" Insert "34" Page 43, line 29: Delete "1 - 15, 17 - 19, 21 - 35, 37 - 42, and 44 - 51" Insert "1 - 14, 16 - 18, 20 - 34, and 36 - 51" Page 44, line 5: Delete all material. Page 44, line 6: Delete "(4)" Insert "(3)" Delete "18" Insert "17" Page 44, line 7: Delete "(5)" Insert "(4)" Delete "19" Insert "18" Page 44, line 8: Delete "(6)" Insert "(5)" Delete "21" Insert "20" Page 44, line 9: Delete "(7)" Insert "(6)" Delete "22" Insert "21" Page 44, line 10: Delete "(8)" Insert "(7)" Delete "23" Insert "22" Page 44, line 11: Delete "(9)" Insert "(8)" Delete "24 and 25" Insert "23 and 24" Page 44, line 12: Delete "(10)" Insert "(9)" Delete "27" Insert "26" Page 44, line 13: Delete "(11)" Insert "(10)" Delete "28" Insert "27" Page 44, line 14: Delete "(12)" Insert "(11)" Delete "29" Insert "28" Page 44, line 15: Delete "(13)" Insert "(12)" Delete "30" Insert "29" Page 44, line 16: Delete "(14)" Insert "(13)" Delete "31" Insert "30" Page 44, line 17: Delete "(15)" Insert "(14)" Delete "32" Insert "31" Page 44, line 18: Delete "(16)" Insert "(15)" Delete "33" Insert "32" Page 44, line 19: Delete "(17)" Insert "(16)" Delete "34" Insert "33" Page 44, line 20: Delete "(18)" Insert "(17)" Delete "38" Insert "37" Page 44, line 21: Delete "(19)" Insert "(18)" Delete "41" Insert "40" Page 44, line 26: Delete "1 - 15, 17 - 19, 21 - 35, 37 - 42, and 44 - 51" Insert "1 - 14, 16 - 18, 20 - 34, and 36 - 51" Page 45, line 1: Delete "35" Insert "34" Page 45, line 4: Delete "35" Insert "34" Page 45, line 14: Delete "35" Insert "34" Page 45, line 15: Delete "1 - 15, 17 - 19, 21 - 35, 37 - 42, and 44 - 51" Insert "1 - 14, 16 - 18, 20 - 34, and 36 - 51" Page 45, line 17: Delete "1 - 15, 17 - 19, 21 - 35, 37 - 42, and 44 - 51" Insert "1 - 14, 16 - 18, 20 - 34, and 36 - 51" Page 45, lines 19 - 20: Delete "1 - 15, 17 - 19, 21 - 35, 37 - 42, and 44 - 51" Insert "1 - 14, 16 - 18, 20 - 34, and 36 - 51" Page 45, line 25: Delete "1 - 15, 17 - 19, 21 - 35, 37 - 42, and 44 - 51" Insert "1 - 14, 16 - 18, 20 - 34, and 36 - 51" Page 45, line 28: Delete "1 - 15, 17 - 19, 21 - 35, 37 - 42, and 44 - 51" Insert "1 - 14, 16 - 18, 20 - 34, and 36 - 51" Page 45, line 30: Delete "35" Insert "34" Page 46, line 3: Delete "35" Insert "34" Page 46, line 12: Delete "20" Insert "19" Page 46, line 14: Delete "20" Insert "19" Page 46, line15: Delete "20" Insert "19" Page 46, line 16: Delete "20" Insert "19" Page 46, line 18: Delete "20" Insert "19" Page 46, line 21: Delete "20" Insert "19" Page 46, line 23: Delete "20" Insert "19" Page 46, lines 30 - 31: Delete "1 - 15, 17 - 19, 21 - 35, 37 - 42, and 44 - 51" Insert "1 - 14, 16 - 18, 20 - 34, and 36 - 51" Page 47, line 3: Delete: "16, 20, and 36" Insert "15, 19, and 35" Page 47, line 11: Delete all material. Renumber the following bill sections accordingly. Page 47, line 12: Delete "16, 20, and 36" Insert "15, 19, and 35" Page 47, line 15: Delete "62" Insert "61" [End of amendment(s); CSHB 193(HES), as amended, was set aside until later in the meeting.] HB 193 - LICENSING MEDICAL OR CARE FACILITIES 2:59:04 PM CHAIR McGUIRE announced that the committee would next return to the hearing on 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." [Before the committee was CSHB 193(HES), which was amended earlier in the meeting.] REPRESENTATIVE GRUENBERG made a motion to rescind the committee's action in adopting Amendment 4, adopted earlier in the meeting, that deleted the language added to the bill via adoption of Amendment 1 that read: Page 41, following line 2: Insert a new bill section to read: "* Sec. 46. AS 25.27.244(s)(2) is repealed." CHAIR McGUIRE, after ascertaining that there were no objections to the motion to rescind the committee's action in adopting Amendment 4, announced that the committee has rescinded its action in adopting Amendment 4; therefore the language that proposes to repeal AS 25.27.244(s)(2) is now still part of the bill. REPRESENTATIVE GRUENBERG made a motion to adopt Amendment 5, to alter the language added via Amendment 1 that proposes to repeal AS 25.27.244(s)(2) such that it would instead repeal AS 25.27.244(s)(2)(B)(ii). There being no objection, Amendment 5 was adopted. 3:01:48 PM CHAIR McGUIRE - after recapping some of the actions taken and intentions expressed earlier in the meeting with regard to Amendment 3, as amended - made a motion to rescind the committee's action in adopting Amendment 3, as amended [text provided during the first portion of the minutes on HB 193 for this date]. REPRESENTATIVE GARA objected to the motion. STEVEN P. ASHMAN, Director, Division of Senior and Disabilities Services, Department of Health and Social Services (DHSS), said that Amendment 3, as amended, essentially restores [the former regulatory language] with regard to clients being able to retain their Supplemental Security Income (SSI) and Adult Public Assistance (APA) and spend it any way they desired. He said he has gone on record as saying, and written letters to the effect that it is the intent of the department to allow the clients to spend the aforementioned income any way they want. 3:04:41 PM REPRESENTATIVE GARA said he wants to ensure that the former process under which clients got $362 per month in APA payments and could use it for room and board would still apply. He offered his understanding that should the funding go through, then the APA payments would go back up to $362 for those that used to qualify for those payments. MR. ASHMAN clarified, however, that it is the department's intent to retain the Medicaid refinancing and the "cost shift" that occurred last year. He offered his understanding that [Amendment 3, as amended] will free up, for the aforementioned clients, all excess funds, funds which can then be spent in any fashion, just as was the case prior to the adoption of the [latest] regulations. REPRESENTATIVE GARA said he still has a concern. CHAIR McGUIRE said she hopes that the committee will rescind its action in adopting amendment 3, as amended, and that afterwards she and other members can work together with the department to ensure that their concerns are addressed. REPRESENTATIVE GARA expressed a preference for retaining Amendment 3, as amended, as a means of encouraging the department to address members' concerns. 3:07:32 PM A roll call vote was taken. Representatives McGuire, Anderson, Coghill, Kott, and Dahlstrom voted in favor of the committee rescinding its action in adopting Amendment 3, as amended. Representatives Gruenberg and Gara voted against it. Therefore, the committee rescinded its action in adopting Amendment 3, as amended, by a vote of 5-2. REPRESENTATIVE DAHLSTROM moved to report CSHB 193(HES), as amended, out of committee with individual recommendations and the accompanying fiscal notes. REPRESENTATIVE GARA objected to note that the motion should include the forwarding of the attached letter from Mr. Ashman. CHAIR McGUIRE acknowledged that point and asked whether there were any further objections. There being none, CSHB 193(JUD) was reported from the House Judiciary Standing Committee.
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