Legislature(1997 - 1998)

03/21/1997 09:05 AM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
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               SB  96 REGULATION OF HOSPICE CARE                              
                                                                              
                                                                               
  CHAIRMAN WILKEN  introduced  SB 96  as the next order of business and        
 noted that there was a CS for consideration.  Chairman Wilken said            
 that he would entertain a motion.                                             
                                                                               
  SENATOR LEMAN  moved to adopt CSSB 96(HES), Lauterbach version dated         
 3/10/97, for discussion purposes.  Without objection, it was so               
 ordered.                                                                      
                                                                               
  BEN BROWN , Staff to Senator Kelly, recalled that there had been             
 some questions regarding why volunteer hospice programs were being            
 regulated.  After conferring with Hospice of Anchorage, the                   
 requestor of the bill, Mr. Brown said that the legislation attempts           
 to provide some consumer protection and provide a standard.  SB 96            
 would allow people to know what to expect when entering into a                
 hospice situation.  In order to avoid a loophole in the original              
 bill, the CS specifies under Article 2 which standards are applied            
 to the volunteer hospice programs.  Mr. Brown emphasized that SB 96           
 intends to establish minimal standards.  Mr. Brown acknowledged the           
 concern that the regulations adopted to enforce the standards could           
 be complicated.                                                               
                                                                               
 Some of the definitions were also changed in Article 3.  On page 8,           
 the Administrative Procedure Act is referenced in order to protect            
 those whose license is revoked.  The definition of "hospice                   
 program" was changed by deleting the reference to "discrete entity"           
 because some of the Hospitals and Nursing Homes feared that would             
 not allow them to offer a hospice program within the institution.             
 The definition of "interdisciplinary team" was changed to include             
 a primary health care provider in order to cover a physician or an            
 advanced nurse practitioner allowing flexibility.  The definition             
 on line 14, page 9 was changed to "primary health care provider" to           
 conform with the aforementioned change.                                       
                                                                               
  SENATOR LEMAN  asked for clarification regarding the change from             
 primary physician to health care provider with regard to page 9,              
 line 9.   BEN BROWN  clarified that the definition of "medical                
 director" would still require a licensed physician and that                   
 definition only applies to the certified programs.  The definition            
 of "interdisciplinary team", those who coordinate the care plan of            
 a dying person, was changed to a health care provider.  The other             
 change to a health care provider is located on line 14, page 9.               
                                                                               
 Number 250                                                                    
                                                                               
  CHAIRMAN WILKEN  inquired as to the burden this would create for a           
 volunteer hospice, a noncertified hospice, with regard to the cost            
 and administrative requirements.  Chairman Wilken requested that              
 Mr. Brown submit an answer to the committee in writing.                       
                                                                               
  PAULA MCCARRON  informed the committee that she had been employed            
 with Hospice of Anchorage since 1982.  She noted the changes to               
 accommodate the volunteer hospices.  Ms. McCarron informed the                
 committe of legislation in Virginia which did not include the                 
 volunteer hospice category, now those volunteer hospices are                  
 battling to preserve the volunteer programs since there is no                 
 definition allowing for the volunteer hospice to exist.  Ms.                  
 McCarron believed that SB 96 would preserve the tradition of                  
 volunteer hospices as well as legitimizing the volunteer programs             
 by increasing funding opportunities in the future.  Hospice of                
 Anchorage has grown from volunteer efforts of concerned community             
 members and health care workers who desired an alternative to                 
 terminally ill persons to stay at home.  There have been many                 
 changes since that time.  Ms. McCarron noted that the average                 
 length of a hospital stay for hospitalized patients is down to                
 three or four days.  Hospitals once had social admissions which               
 would alleviate the stress of family members caring for a dying               
 loved one; this is rarely an option.  Coverage for nursing and                
 assisted living homes is limited and out of the reach for most                
 Alaskans.  All of these factors with the increasing aging                     
 population and people living alone translates into a growing need             
 for quality hospice services.  SB 96 is primarily a consumer                  
 protection act.                                                               
                                                                               
  PATRICIA SENNER , Registered Nurse and Executive Director of the             
 Alaska Nurses Association (ANA), supported CSSB 96(HES) which will            
 help develop the type of quality services needed for this time in             
 life.  The Nursing Association likes the two-tier approach in the             
 legislation.  A minimal standard for volunteer hospices prevents              
 them being regulated out of business while providing the public an            
 avenue in which to take action against unscrupulous providers.  Ms.           
 Senner noted that those hospices receiving reimbursement receive it           
 from national insurance companies who may require licensure for               
 reimbursement.  Ms. Senner said that the ANA is pleased with the              
 bill's emphasis on the role of the registered nurse and advanced              
 nurse practitioners.  Advanced nurse practitioners were requested             
 for inclusion in the definition of primary care provider.  In                 
 Alaska, advanced nurse practitioners are allowed to have                      
 independent practice and are increasingly caring for dying seniors.           
 Ms. Senner emphasized that the ANA completely agrees with the                 
 hospice philosophy as outlined in the bill.                                   
                                                                               
 Number 140                                                                    
                                                                               
  MIKE SHIFFER , Board of Hospice in Anchorage, informed the committee         
 that Hospice of Anchorage is a private nonprofit organization that            
 does not receive any state funds.  Alaska needs licensed hospice              
 programs.  The environment of health care is changing.  Hospice               
 programs make it possible for the terminally ill to die in a home             
 environment by focusing on comfort care.  Hospice involves the                
 coordinated use of and interdisciplinary team including physicians,           
 nurses, social workers, therapists, pastoral and bereavement                  
 counselors, and volunteers.  The unique component of hospice's                
 interdisciplinary team is its volunteers.  Hospice of Anchorage               
 provides hospice services without regard for ability to pay.                  
 Hospice works with the patient and family to accept death as a                
 natural part of life; the family and the patient are considered the           
 unit of care.  Mr. Shiffer noted that hospice addresses the                   
 spiritual, emotional, social, physical care and comfort of the                
 patient.  Licensure will ensure that hospice services are provided            
 according to an established standard.  Mr. Shiffer strongly                   
 supported this legislation.  Mr. Shiffer referred Chairman Wilken             
 to page 6, subsection (j) which clarifies his previous question.              
                                                                               
  TINA KOCSIS , Director of Hospice of Tanana Valley, said that she            
 would speak to the issue of the two different hospices in Alaska,             
 volunteer hospices and certified or for profit hospices.  With                
 regards to the notion that certified hospices are more organized              
 than volunteer hospices, Ms. Kocsis said that was not correct.                
 According to the National Hospice Organization and Medicare                   
 standards, volunteer hospices have medical directors.  The position           
 is merely voluntary.  As a volunteer hospice in Fairbanks, it does            
 not employee nurses, physical therapists, or other related medical            
 personnel but work closely with home health nursing providers.                
 Patients are not charged for any services and no payments are                 
 received from any third-party payers.  The Hospice of Tanana Valley           
 is supported by donations, memorials, fundraisers, and small grants           
 from the community.  Hospice of Tanana Valley is the largest, most            
 comprehensive bereavement program in Alaska.  Ms. Kocsis noted that           
 Hospice of Tanana Valley exceeds the regulations specified in the             
 bill and the National Hospice Organization and Medicare Certified             
 Standards.                                                                    
                                                                               
  TAPE 97-32, SIDE A                                                           
                                                                               
 Ms. Kocsis urged the committee to take steps to eliminate any                 
 hardships that may be created for volunteer hospices because of               
 this licensing process.                                                       
                                                                               
  BARBARA RICH  said that most of the issues regarding the volunteer           
 hospices had been addressed in the CS before the committee.  Ms.              
 Rich was concerned with the cost this would pose for hospices with            
 limited funds.  If this bill is passed, Ms. Rich hoped that the               
 Department of Health would develop regulations that would be easy             
 to adhere.  The regulations in the bill are lower than required of            
 the hospice in Fairbanks.                                                     
                                                                               
  CHAIRMAN WILKEN  asked Ms. Kocsis to review page 6, lines 9-27 of            
 the CS; would that level of paper work be acceptable.   TINA KOCSIS           
 said that the level specified in the bill is already being exceeded           
 in the Tanana Valley Hospice.  The specifications in the bill are             
 fine.                                                                         
                                                                               
  BEN BROWN  clarified that regarding the presence of a medical                
 director at volunteer hospices, Mr. Brown only meant that the bill            
 does not require that of volunteer hospices.  Mr. Brown pointed out           
 that only lines 9-20 on page 6 apply to volunteer hospices.                   
                                                                               
 Number 071                                                                    
                                                                               
  CHARLES QUARRE , President of Hospice of the Central Peninsula,              
 noted that Hospice of the Central Peninsula was a volunteer hospice           
 that serves approximately 20 clients annually.  Hospice of the                
 Central Peninsula is a member and adheres to all the guidelines of            
 the National Hospice Organization.  Hospice of the Central                    
 Peninsula has one part-time director and about 50 volunteers.  Mr.            
 Quarre expressed concern that this legislation would create an                
 additional burden.  Mr. Quarre requested that the volunteer                   
 hospices be deleted from the legislation because all the                      
 requirements under Article 2 are being adhered to.                            
                                                                               
  BEN BROWN  clarified that Article 2 could be deleted or steps can be         
 taken to ensure that the department does not adopt regulations more           
 stringent than specified in the language of the statute.                      
 Furthermore, the department can be prohibited from adopting                   
 regulations and only adopt guidelines or procedures.  Mr. Brown               
 noted that Mr. Larsen who will do the inspections and regulation              
 can speak to this issue.                                                      
                                                                               
  SHELBY LARSEN , Administrator of Health Facilities Licensing &               
 Certification, supported SB 96.  The licensing process is not                 
 burdensome.  There is a two to three page application that must be            
 completed annually.  The licensing process also includes an on site           
 inspection which would be followed by a report.  If the volunteer             
 agencies are already adhering to the standards specified in the               
 bill, the report would be brief.  The purpose of the bill and                 
 subsequent regulations would be to ensure that quality is                     
 maintained in the future.  Oversight is also important; only                  
 minimal oversight occurs with certified hospice organizations.  Mr.           
 Larsen believed that more oversight was necessary.  Mr. Larsen                
 informed everyone that the department has a policy that any                   
 organizations effected by the regulations are involved in order to            
 have input.  It is not the intent of the department to develop                
 regulations that would put hospice organizations out of business.             
 The regulations are developed for minimum standards, quality care,            
 and protection of the clients.  Mr. Larsen stressed that there will           
 not be an annual fee, there has never been an annual fee charged              
 for licensure although that is an option of the department.                   
                                                                               
  CHAIRMAN WILKEN  referred to page 7, line 8 when asking if proof of          
 auto insurance and a valid driver's license were required of other            
 volunteer organizations.   SHELBY LARSEN  did not know.   CHAIRMAN            
 WILKEN  asked Mr. Brown to follow up on that matter.                          
                                                                               
  CHAIRMAN WILKEN  asked Mr. Larsen to provide the committee examples          
 of why this licensure is necessary.   SHELBY LARSEN  said that Alaska         
 has not had any problems.  As resources are shrinking, the health             
 industry is attempting to find resources.  There are organizations            
 that, in an attempt to capture resources, say that hospice care is            
 provided when it is not.  In some areas, as managed care has                  
 developed, hospice-like services may be provided but in a                     
 fragmented manner through the HMOs.  Those are not true hospices.             
 SB 96 would ensure that when an organization says that it provides            
 hospice services that it truly does, not just pieces.  Mr. Larsen             
 said that managed care is creeping into Alaska and this is a                  
 concern for the future.                                                       
                                                                               
  CHAIRMAN WILKEN  held SB 96.  There being no further business before         
 the committee, the meeting was adjourned at 10:53 a.m.                        

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