Legislature(1997 - 1998)
02/24/1997 09:00 AM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
SB 96 REGULATION OF HOSPICE CARE Number 424 CHAIRMAN WILKEN announced SB 96 as the next order of business. CHARLES QUARRE' , President of the Hospice of the Central Peninsula, informed the committee that the Hospice of the Central Peninsula had been in operation for 10 years with 90 members and 50 volunteers. The Hospice of the Central Peninsula operates under the guidelines of the National Hospice Organization. Mr. Quarre' did not believe it is necessary to include volunteer hospice programs for licensing. A fee would cause the hospice to pay for the fee out of the funds used to provide services to its clients. Mr. Quarre' said that the Central Peninsula Hospice adheres to all the licensing provisions of volunteer hospice programs. Mr. Quarre' recommended that volunteer hospice programs be excluded from SB 96. The Central Peninsula Hospice has not received any complaints during its 10 years of operation. If there is a problem with hospices, that could be handled under the current laws and regulations. SENATOR WARD asked how long the Central Peninsula Hospice had been in existence and how much of a clientele does it serve. CHARLES QUARRE' reiterated that the Central Peninsula Hospice is in its tenth year and it normally serves approximately 20-22 clients per year. Most of these clients cannot afford any paid hospice. SENATOR GREEN inquired as to who requested SB 96. Number 462 BENJAMIN BROWN , Staff to Senator Kelly, said that this bill was in response to a request from Hospice of Anchorage. Mr. Brown noted that the concerns of the small volunteer hospices should be addressed. Hospice of Anchorage does not intend to make it difficult to operate a hospice program, particularly volunteer hospice programs. Mr. Brown informed the committee that 38 states have state licensing laws for hospice programs, of the 12 that do not six of those have pending licensing laws. Mr. Brown cited the growth in hospice as the main reason for SB 96. About one of every three persons in the U.S. dying from cancer and AIDS use a hospice program. Mr. Brown preferred to let those speaking from Hospice of Anchorage discuss the specifics. The committee packet does include a sectional analysis. There is only one section in SB 96 which creates Chapter 18 in Title 18 of Alaska Statutes. The three articles in Chapter 18 regulate hospices under DHSS. Article 1 establishes parameters for licensing hospice programs that are formal businesses. Article 2 establishes standards for volunteer hospice programs. Mr. Brown noted that during drafting, Legislative Legal Services pointed out that much would hinge on the use of "relevance" in Article 2. It will be left to DHSS to determine in regulation what the relevant provisions of the code for larger, formally organized hospices would be applied to volunteer hospices. This is the concern mentioned by Mr. Quarre' which would need to be addressed in order to define "relevant" so as not to place onerous regulations on the volunteer hospices. Article 3 merely defines terms in the bill and provides penalties for violations of the statutes. SENATOR LEMAN asked if of the 38 states with such legislation, do any have exclusions for volunteer hospices? BENJAMIN BROWN specified that SB 96 was drafted from Maine's law which does not specify what is relevant, the Department of Health is left to determine the regulations. Mr. Brown stressed that SB 96 does not intend to create difficulties for small, volunteer organizations. The intent is to standardize without regulating with too much burden as well as having the regulation pay for itself. Number 522 MIKE SHIFFER , Board Member with Hospice of Anchorage, indicated the need to ensure the quality of hospice care that was being diluted by the definition of what a hospice program is. Mr. Shiffer supported SB 96 and did not want to restrict any of the volunteer hospices efforts. Mr. Shiffer offered to work with the committee and the volunteer hospices on this issue. PAULA MCCARRON , Executive Director of Hospice of Anchorage, informed the committee that she had been working with the program since 1982. Hospice of Anchorage began as a volunteer program in 1980 and is a member of the National Hospice Organization who establishes what a hospice program should entail. Ms. McCarron echoed comments regarding the increased profile and use of hospice programs. The current change in health care increases the need for licensing of hospice programs. Originally, hospice began as an alternative for persons who wished to die at home. Currently, people are not afforded the opportunity to remain in a hospital. Furthermore, increased reimbursement for home care services, and a need for people to remain near their home has sometimes made hospice the program of choice by patients, family and other health care providers. Mr. McCarron expressed concern with the use of the term hospice without regard for the philosophy of the National Hospice Organization. SB 96 would preserve and protect the components of the National Hospice Organization while ensuring that those seeking such services would receive at least a minimum level of standards and quality. Number 563 SHELBERT LARSEN , Administrator of Health Facilities Licensing & Certification for DHSS, stated that he had heard about SB 96 last week and therefore, has not had much time to review. Mr. Larsen did not oppose the idea of licensing hospice programs, but there are some concerns with SB 96. If the bill moves forward, the powers of DHSS should be very clear with regard to licensing, the denial of a license, the suspension of a license, and the revocation of a license. Mr. Larsen recommended the deletion of Section 18.18.030. Medicare only requires on site visits for those facilities at 10-15 percent frequency, therefore many years could pass before any oversight would take place. Currently, there are no licensed facilities or provider types that are Medicare certified that have deemed status for licensure. Mr. Larsen echoed the concerns regarding the need to define "relevant" in Section 18.18.040. TAPE 97-18, SIDE B Mr. Larsen was unsure as to the results of lines 16-18 on page 2. Currently, licensed facilities have the right to throw out the department although such action can effect the licensure status. The meaning of "discrete entity" in subsection (c) under Section 18.18.100 is not clear. Mr. Larsen recommended the deletion of a "discrete entity." In conclusion, Mr. Larsen noted that he could recommend many other changes and would forward his suggestions to the committee. CHAIRMAN WILKEN noted that SB 96 would be held in order to receive that information from Mr. Larsen. He asked if the committee had any questions. SENATOR WARD requested a copy of the national standards to which have been referred. SENATOR GREEN asked if this created a need for occupational licensing. BENJAMIN BROWN replied no. The end of Article 1 says that licensure of a facility or a program does not obviate the need for the individuals part of that program's interdisciplinary team to have the appropriate occupational licenses. This only creates program licensure of the hospice. SENATOR WARD asked if SB 96 would create a situation in which someone who does not currently have to be licensed would have to become licensed. BENJAMIN BROWN explained that would depend upon what provisions in Article 1 were deemed relevant to volunteers. No one would have to obtain additional licenses if DHSS determines that a volunteer program can exist without a doctor, a certified nurse practitioner, or other people with various licenses. There is nothing explicit in the statute that would require additional licenses for individuals. Mr. Brown said that the relevant provisions for volunteer programs and service providers should be determined. In response to Senator Ward, Mr. Brown said that SB 96 does not require additional licenses, but the resulting regulations may if the definition of "relevant" is not clarified. CHAIRMAN WILKEN did not see the need for this legislation and indicated that discussion regarding the need would be discussed at the next hearing of SB 96. This legislation would also require a fiscal note which should be completed before the next hearing of this bill. BENJAMIN BROWN noted that during testimony he reviewed Georgia and California's statutes and found no reference to volunteer programs. He did not know how other states deal with volunteer programs, but the intent here is to allow them to function without unnecessary regulation. Mr. Brown said that would be reviewed. CHAIRMAN WILKEN announced that SB 96 would be held pending further information.