Legislature(1997 - 1998)
03/21/1997 09:05 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 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.