Legislature(1997 - 1998)

02/24/1997 09:00 AM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= 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               
  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            
 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               
  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          

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