Legislature(1997 - 1998)
04/07/1997 09:09 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 530 CHAIRMAN WILKEN announced that SB 96 would be the next order of business before the committee. Chairman Wilken noted that the K version of the bill was before the committee. BEN BROWN , Staff to Senator Kelly, discussed the changes that version K includes. On page 8, line 21 after "which" the word "including" was deleted and "may include" was inserted. That language was inserted because sometimes a volunteer hospice would not include all the items listed for bereavement services. Page 9, line 14 the reference to 24 hour, seven days a week was deleted because in a volunteer context that would not occur. That language is on page 5 under the definition of nursing services as provided by nonvolunteer hospice programs. CHAIRMAN WILKEN asked Ms. Sonner to provide her testimony and noted that the packet included her letter. RITCHIE SONNER , Hospice & Home Care of Juneau, supported SB 96 as written. With the changes to SB 96, Ms. Sonner did not believe it to be burdensome administratively or financially. Hospice & Home Care of Juneau is a small volunteer hospice with few funds. SB 96 is written to protect the consumer. Ms. Sonner noted that she was not a supporter of regulation, but in this situation she recommended the passage of SB 96. SENATOR LEMAN asked Ms. Sonner if her notion that SB 96 was not burdensome was the general consensus among volunteer hospices. RITCHIE SONNER believed so, but noted there were folks on line who could speak to that. SENATOR LEMAN did not want to burden such organizations unnecessarily. CHARLES QUARRE , President of the Central Peninsula Hospice, stated that he maintained his previous testimony regarding concerns of the administrative and financial burdens of SB 96. Mr. Quarre noted that many industries are regulated by market forces. The volunteer hospices adhere to the guidelines of the National Hospice Organization which are almost identical to those specified in the bill. Mr. Quarre suggested reviewing the advisability of incurring additional expense and regulations in this area. Mr. Quarre questioned if there are current statutes that address abuses in this system. In response to Chairman Wilken, Mr. Quarre agreed that he was speaking in opposition to SB 96. Mr. Quarre requested that the volunteer hospice may be noted in the bill, but be excluded from the provisions if not entirely. CHAIRMAN WILKEN asked Mr. Quarre if he had any suggestions regarding how to accomplish that within SB 96. CHARLES QUARRE suggested that if the bill is to pass, the volunteer hospice could be recognized but excluded from the provisions of the bill. Number 427 BEN BROWN explained that if hospices are to be regulated, there must be a standard that applies to any organization using the term hospice. In the Commonwealth of Virginia, a bill excluding the volunteer hospices was passed which resulted in volunteer hospices being unable to use the term hospice in their name. Mr. Brown acknowledged that language could be used to avoid that problem. However, that would result in regulating only a portion of the industry providing hospice services. Mr. Brown recognized that the volunteer hospices in Alaska are exceeding the standards specified in the bill, but that may not continue as time passes. Eliminating the reference to the volunteer programs in SB 96 would not accomplish the primary goal and the remainder of the hospice community may not want that to go forward. RITCHIE SONNER noted that there are shams, although not in Alaska currently. Thirty-eight states have had to regulate hospices in even a more restrictive manner. SB 96 is a proactive bill to protect consumers who are in a vulnerable state. Ms. Sonner feared the possibility of an opportunist. Ms. Sonner pointed out that eliminating the reference to volunteer hospices would allow anyone to refer to themselves as a hospice. SB 96 should be passed as is or not at all. SENATOR WARD inquired as to the number of cases of abuse in Alaska this year. BEN BROWN did not believe there was a situation of abuse in Alaska currently. SENATOR WARD suggested that regulation could harm the process that is currently working. BEN BROWN referred to Article 2 when saying that the Administrator of Health Facilities Licensing & Certification will be reviewing mainly nonvolunteer hospices a couple days a year. The volunteer programs have a lower standard to adhere and the department has no intention of charging volunteer hospices. Mr. Brown reiterated that the volunteer hospices are already exceeding the standards in SB 96. Mr. Brown noted that nurses and doctors have associations that regulate them, only attorneys regulate themselves. Mr. Brown did not know what more could be done to lighten the burden without making the legislation meaningless. Number 366 SENATOR WARD agreed that there was no middle ground. Senator Ward inquired as to the public safety reasons for SB 96 within Alaska. BEN BROWN could not give an example within the hospice community. There was a problem in an assisted living home which lead to changes in law. Mr. Brown noted that an assisted living home was a comparable field. BARBARA RICH , Hospice of the Tanana Valley, said that she was speaking for the Board of Directors. Ms. Rich noted that all of the concerns regarding the bill initially speaking only to volunteer hospices when relevant were addressed. Ms. Rich noted that she was concerned with the administrative and financial costs of SB 96. Mr. Shelby of the Department of Health & Social Services assured Ms. Rich that it would be very minimal: a yearly on-site inspection would occur with a report following. The standards in the bill are minimal. SB 96 would protect vulnerable patients and families. Ms. Rich said that there has never been a problem in this area and the impetus is to continue that record. In response to Senator Ward, Ms. Rich said that the Hospice of the Tanana Valley has not experienced any problems. Ms. Rich was concerned that others may not do so. With regard to the expansion of the regulations, Ms. Rich did not believe there could be expansion. Ms. Rich said that she had heard of others who have lower standards as well as problems with this in other states. SENATOR WARD was not sure that regulation was necessary for a problem that does not exist. BARBARA RICH believed that the certified hospices would be regulated due to the presence of nursing staff and such. JOY JANSSEN , representing the forming Petersburg Hospice, informed the committee that Petersburg was in the process of forming a hospice beginning with neighbor to neighbor care. Ms. Janssen asked if neighbor to neighbor care was given without using the name hospice, would the organization still be regulated under this bill. BEN BROWN replied no. SB 96 applies only to groups representing themselves as hospices. Mr. Brown said that it would be a judgement call for the Department of Law upon the request of the Department of Health & Social Services. Mr. Brown pointed out the definition of "hospice services" when noting that providing only one service at home or not meeting all the needs listed could possibly eliminate Ms. Janssen's concerns. Identifying an organization as a hospice is the triggering mechanism and the secondary definition is providing hospice services. Number 251 MAXINE WORHATCH , testifying from Petersburg, asked if insurance, personal or group, would be necessary if a group fell under this bill as a volunteer. BEN BROWN said that was not covered by SB 96. Mr. Brown believed that most volunteer hospices carried insurance. SB 96 does not mandate liability insurance. Mr. Brown referred Ms. Worhatch to Ms. Sonner or Ms. Rich. MAXINE WORHATCH commented that it does not seem necessary to regulate volunteer hospices. Why would someone volunteer and then take advantage of a patient? ERICA WORHATCH asked if a hospice became licensed would the hospice be liable if a neighbor who was not a hospice volunteer wanted to help. BEN BROWN said that if a person wanted to help a dying neighbor, of course that can be done. As long as that neighbor did not say he/she was affiliated with a particular hospice, that hospice would not be liable for his/her actions. CHAIRMAN WILKEN suggested that those in Petersburg could consult the many successful volunteer hospices such as those represented by Ms. Sonner and Ms. Rich. SHELBERT LARSEN , Administrator of Health Facilities Licensing & Certification for DHSS, said that his agency would probably develop and enforce the regulations if this statute were to pass. Mr. Larsen believed that SB 96 was a good bill, providing minimum standards for hospice programs. Mr. Larsen did not believe SB 96 would be burdensome for either the for profit or volunteer hospices. CHAIRMAN WILKEN referred to Article 2, page 7, line 18 when asking if other volunteer organizations were required to show proof of auto insurance and valid drivers license. BEN BROWN said that he had asked Terri Lauterbach about that matter. Ms. Lauterbach was unaware of other volunteer organizations requiring such. That requirement was included because it was in the main statute and seemed appropriate to put in SB 96. This has not been a concern for anyone. Mr. Brown said that it would not be appropriate for an individual to be driving around a terminally ill patient without auto insurance and a valid drivers license. This is one reason for a hospice to have liability insurance. Liability would be increased if the two requirements were not met. SENATOR GREEN informed everyone that her husband was employed by the Auto Insurance Provider. Senator Green recalled that when she drove for Scouts or her church, she was required to have proof of insurance. Senator Green did not believe that those requirements were unique to hospices. SENATOR WARD requested that SB 96 be held until Kenai could provide an amendment to eliminate the volunteers from the bill. Senator Ward did not know when the amendment would be ready. Senator Ward said that he did not want to move SB 96 out of committee; people should not be regulated for a problem that does not exist. CHAIRMAN WILKEN said that he would prefer not to hold SB 96 beyond Wednesday. There being no further business before the committee, the meeting was adjourned at 10:35 a.m.