Legislature(2013 - 2014)BELTZ 105 (TSBldg)
03/13/2013 01:30 PM Senate JUDICIARY
| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing: Board of Governors of the Alaska Bar | |
| Confirmation Hearing: Commission on Judicial Conduct | |
| SB49 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | SJR 9 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| = | SB 49 | ||
SB 49-MEDICAID PAYMENT FOR ABORTIONS; TERMS
2:22:33 PM
CHAIR COGHILL announced the consideration of SB 49.
2:23:13 PM
WILLIAM STREUR, Commissioner, Department of Health and Social
Services (DHSS), provided answers to questions the committee
raised during previous discussions of SB 49.
1. How are adoptions playing out, what does it look like for
the future, and are the numbers going up, down, or
remaining flat?
COMMISSIONER STREUER said that according to the Office of
Children's Services (OCS), there were 329 adoptions in 2011 and
316 adoptions in 2012. Those numbers are indicative of year-to-
year swings. Adoption numbers fall as reunification numbers
rise, and OCS works toward reunification for all the children in
custody. He asked the committee's indulgence to continue to
research the total number of adoptions in the state, which would
involve contacting the five adoption agencies that operate in
Alaska.
SENATOR MCGUIRE clarified that she was looking for information
on children who were put up for adoption at birth as opposed to
those who were removed from their home because of neglect or
abuse. She said she looked forward to getting that data and the
information from the five adoption agencies in the state.
COMMISSIONER STREUR committed to provide the follow up.
2:26:26 PM
SENATOR WIELECHOWSKI requested follow up information on the
number of children adopted from within the state versus the
number that are adopted from out-of-state. He also asked how
Alaska is impacted by the bill that passed in Russia barring
adoptions to the U.S.
COMMISSIONER STREUR agreed to attempt to get that information.
2. What are the avenues for a woman who carries a baby to term
and after birth decides to place the child for adoption.
He explained that Catholic Social Services, Fairbanks Resource
Agency, Fairbanks Counseling and Adoption, LDS Family Services,
and the World Association for Parents and Children are the
agencies that work on adoptions in Alaska that are outside the
OCS system. In addition, many of the tribes assist with
adoptions for tribal members.
3. What is the status of the intermission nursery?
He relayed that the intermission crisis nursery was closed in
2003. The placements came almost exclusively from OCS with some
self-referrals. The facility was closed because of misuse. If it
was restarted it would have to be a different model.
SENATOR WIELECHOWSKI asked for information on the legislation
that passed several years ago allowing women to surrender their
babies.
COMMISSIONER STREUR said he would follow up with the numbers,
but in his tenure just three babies have been surrendered to an
emergency room.
CHAIR COGHILL noted that the safe haven was for 21 days.
SENATOR DYSON asked for an explanation of the Indian Child
Welfare Act (ICWA) in this context.
COMMISSIONER STREUR said that all cases determined to qualify,
which is most Alaska Native families, are treated specially. He
continued:
The state has a higher level of standard to meet and
must provide active versus reasonable services along
the entire continuum of child welfare. OCS is required
under ICWA to notify the child's tribe and tribes may
choose to intervene as a legal party to the case or
they may assert their jurisdiction over the
proceedings. ICWA requires that for Native children
eligible for enrollment as a tribal member, the tribe
must be notified of a pending adoption. This is true
for adoptions processed through the Office of
Children's Services or through private adoptions.
Tribal courts in Alaska may facilitate customary or
cultural adoptions. These do not require legal
relinquishment of parental rights under legalese
similar to a legal guardianship. This could be viewed
as special treatment for Native adoptions. The
cultural adoption in essence means the state provides
the consent to the tribal court who finalizes the
process and in these cases the termination of parental
legal rights is not terminated.
If a Native mother chooses to give up her infant for
adoption, [she] must wait 10 days after signing over
the power of attorney for the baby physically giving
the baby up before they can sign the legal
relinquishment paperwork. They must sign the paperwork
in front of a judge. This is different from non-Native
mothers who do not have to sign in front of a judge,
and can sign the relinquishment paperwork immediately
after the birth, and they don't have to wait 10 days
after giving the baby up.
Once the relinquishment paperwork is signed, there is
another 10-day waiting period before the judge can
finalize the relinquishment. This is true for both
Native and non-Native mothers. Native mothers must
sign a tribal notification waiver if they do not want
their tribe to be notified of the adoption. If the
mother's tribe is noticed on the adoption, the tribe
may intervene and take over jurisdiction of the
adoption.
2:33:19 PM
SENATOR DYSON asked what happens when it isn't obvious that the
adoptive child falls under ICUA jurisdiction and the tribe
decides to intervene and claim the child.
COMMISSIONER STREUR said he would have to do follow up research
based on legal counsel.
SENATOR DYSON asked if a tribe can reach past a completed
adoption and lay claim to a child based on ICWA requirements.
2:34:37 PM
COMMISSIONER STREUR said he would have to investigate the
question legally.
SENATOR DYSON asked if ICUA says that the adoptive parent has to
be a member of the same tribe as the child or classified as
Indian.
COMMISSIONER STREUR said that the tribe has first priority for
adoptions followed by Native and finally non-Native.
SENATOR DYSON asked for follow up information on a case he
became involved in.
2:36:29 PM
SENATOR MCGUIRE asked for follow up information on the South
Dakota model which is designed to increase adoptions in the
state, including those under ICWA.
COMMISSIONER STREUR agreed to investigate the model.
4. What are the qualifications for Head Start?
COMMISSIONER STRUER clarified that the Department of Education
and Early Development (DEED), not DHSS, administers the Head
Start program. However, the basic requirements are that the
children are at least three years old and come from low income
families. Ten percent may be from families that exceed the
financial guidelines but meet other program criteria. Most of
the children in remote Alaska are eligible due to the poverty of
access amendment to the Economic Opportunity Act. Children
identified for Early Head Start range in age from birth to age
three.
5. What are the safety nets available for women that keep
their children?
COMMISSIONER STRUER identified the following programs:
· The Women, Infants, and Children (WIC) Program provides
nutrition services and other assistance to women who are
pregnant, nursing, or have children under age five. Other
family members and legal guardians can also qualify for
help for children under age five. He offered to provide
more informative literature.
· Child Care Assistance provides referrals and subsidies for
mothers receiving assistance, families transitioning off
welfare, and low-income working families to assist in
mainstreaming back into a productive work environment.
· The Alaska Temporary Assistance Program provides cash
assistance and work support for families with children
under age 18.
· The Commodity Supplemental Food Program is for pregnant,
breastfeeding, and postpartum women with infants and
children up to age six. This program cannot be accessed
concurrent with WIC.
SENATOR WIELECHOWSKI asked if he had looked at the programs
available through Medicaid for family planning where Medicaid
pays 90 percent and the state pays 10 percent.
COMMISSIONER STREUR replied that he tried to get that
information today, but was unsuccessful. He added that family
planning assistance was available through the [Division] of
Public Health, and a wide variety of programs were available
through Medicaid for both pregnant and postpartum women.
SENATOR WIELECHOWSKI asked if DHSS had or intended to look into
the Medicaid family planning program for birth control. It was
his understanding that the state has the option of taking this
program which is administered through Denali Kid Care.
CHAIR COGHILL recalled that the family planning Medicaid rules
fall under Social Security Title X, but can be administered
under Denali Kid Care.
SENATOR WIELECHOWSKI asked Commissioner Struer if he had or
planned to look into that program.
COMMISSIONER STREUR responded, "We've been looking at every
single option we can for young families in terms of family
planning." He reiterated that extensive services were available
through the Division of Public Health, and added that he would
be surprised if the department didn't already cover most of the
services offered through Medicaid and Denali Kid Care. However,
he would do further research.
CHAIR COGHILL described a mingling of monies flowing into Denali
Kid Care and Public Health based on programmatic approaches.
2:43:37 PM
SENATOR MCGUIRE asked Commissioner Struer to consider providing
a single, accessible access point for poor women to get a list
of the resources and services he described today.
COMMISSIONER STREUR responded that the Division of Public
Assistance is already a one-stop-shop where an individual can
access the continuum of services. He discussed the work DHSS had
done to break down the silos within the department to connect
the services and acknowledged there was more work to do to
better serve the whole person.
2:46:54 PM
SENATOR WIELECHOWSKI asked Commissioner Struer to describe the
process DHSS went through to develop the new regulations and
what they were.
COMMISSIONER STREUR explained that a new section was added to
DHSS's regulations governing abortion payment conditions. This
was prompted by "losing a half a million dollars every year out
of my budget because of what I pay for abortions," he said. More
importantly, it was to make sure that the abortions that the
state pays for meet the intent of the Supreme Court decision of
2002. For a physician or provider in Alaska to be paid for
performing an abortion under Medicaid, they are required to
certify either that it meets the conditions of the Hyde
Amendment or that it doesn't meet the conditions of the Hyde
Amendment but that the abortion procedure is medically
necessary. Only the physician can signify that the abortion was
medically necessary. There is no definition of medical
necessity, but DHSS is allowed to track the required Hyde
procedures, which are reimbursable under federal guidelines or
non-Hyde, which are reimbursable under the 2002 decision. He
offered to provide a copy of the form.
SENATOR WIELECHOWSKI asked him to discuss the public comment on
the new regulations.
COMMISSIONER STREUR confirmed that DHSS did receive a lot of
public comment. Many of the comments were not particularly
constructive, but they were regarding access, denial of access,
or increasing access. Planned Parenthood contributed in multiple
lively discussions and ultimately accepted that the form met the
letter of the law in the Supreme Court decision.
SENATOR WIELECHOWSKI asked if the new regulation permits doctors
to perform elective abortions.
COMMISSIONER STREUR responded that the certificate does not
address physician limits of practice. It speaks to reimbursement
for an elective abortion versus a medically necessary abortion
through Medicaid.
SENATOR WIELECHOWSKI inquired if a doctor would have to verify
medical necessity in order to receive payment.
COMMISSIONER STREUR answered yes. The attending physician has to
certify to one of the two conditions listed below to obtain
reimbursement. The first option addresses the Hyde Amendment and
the second option addresses the Supreme Court decision.
· I certify based upon all the information available to me
that before performing the abortion procedure on the
above patient her pregnancy was the result of an act of
rape or incest, or the abortion procedure on the above
patient was performed due to physical disorder, physical
injury, or physical illness, including a life-endangering
physical condition caused by or arising from the
pregnancy itself, that would place the woman in danger of
death unless an abortion was performed.
· I certify based upon all the information available to me
that the above does not apply, but the abortion procedure
was medically necessary.
SENATOR WIELECHOWSKI asked if physicians have been submitting
the certificate and if DHSS has been accepting them and making
reimbursement.
COMMISSIONER STREUR explained that the requirement is effective
April 1, 2013, but some certifications have already come in
2:52:35 PM
SENATOR WIELECHOWSKI noted the exception in the bill for
abortion services in cases of rape or incest, and asked if he
had given any thought to how that determination would be made.
COMMISSIONER STREUR said he had given it thought but hadn't come
to a conclusion. He added that he didn't intend to form a
conclusion until he had to deal with it in some form or manner.
SENATOR WIELECHOWSKI said he thought it was important to have
some discussion about who would make the determination before
the bill comes to a vote. He asked Commissioner Struer if he
would be able to come to some conclusion about how the provision
would be enacted either before the bill moved from committee or
before it came to a vote on the floor. "As a Senator who is
going to be voting on this, I would want to know what the policy
is," he said.
COMMISSIONER STREUR responded that he couldn't provide an
answer, but he thought that a lot would depend on Legislative
Legal Services, the legal counsel for DHSS, and probably the
courts should it go forward.
CHAIR COGHILL offered his perspective that the allegation of
rape would be indicated on the doctor's certification, nothing
more.
2:55:32 PM
SENATOR MCGUIRE stated that she would hope that state resources
would not be expended to investigate women in what would amount
to a witch hunt. If a woman tells her doctor she has been raped
or a victim of incest, she should be believed.
COMMISSIONER STREUR related that the only investigation that
DHSS is doing is requiring the certification.
2:56:11 PM
SENATOR DYSON expressed hope for universal honesty and
acknowledged reality.
CHAIR COGHILL said the discussion about not getting between a
woman and her doctor has been legitimate. It's also a legitimate
discussion that some abortions are elective and, to date, those
haven't been defined.
SENATOR WIELECHOWSKI asked if the intention is to require a
doctor or DHSS to report a rape or incest to the authorities for
investigation.
COMMISSIONER STREUR said he couldn't speak to the requirements
for a physician, but he didn't believe it was the department's
responsibility to report what is on the certification form.
CHAIR COGHILL asked if there weren't already mandatory reporting
statutes.
COMMISSIONER STREUR answered yes.
CHAIR COGHILL said he believes that mandatory reporting is
important, particularly when it protects the young and innocent.
COMMISSIONER STREUR said he didn't disagree but by the time
Medicaid is informed, it's beyond third hand. He deferred to
legal counsel to further articulate DHSS responsibility.
CHAIR COGHILL opined that policy makers would look at that
within the mandatory reporting requirements.
2:59:52 PM
SENATOR WIELECHOWSKI asked Commissioner Struer if he envisioned
creating a new form to address rape and incest.
COMMISSIONER STREUR responded that DHSS bases payment for
abortion on the Hyde Amendment and the Supreme Court decision.
If SB 49 is signed into law, the form will be amended to
accommodate what's in the bill.
SENATOR WIELECHOWSKI asked if DHSS received legal advice not to
define medical necessity in the regulation.
COMMISSIONER STREUR said the department had legal counsel
through the entire process, but he didn't recall getting that
advice. The Supreme Court didn't provide a definition and the
regulation followed that decision for basing payment.
CHAIR COGHILL said he believes the bill refines what the court
said.
3:02:41 PM
SENATOR WIELECHOWSKI asked Commissioner Struer to follow up with
what the Planned Parenthood litigation cost the state.
CHAIR COGHILL suggested he get the information from the
Department of Law (DOL).
CHAIR COGHILL stated that he would hold SB 49 in committee and
bring it up again on Friday along with any amendments that might
be offered.
| Document Name | Date/Time | Subjects |
|---|---|---|
| 1 - SJR 9 Sponsor Statement.pdf |
SJUD 3/13/2013 1:30:00 PM SJUD 3/15/2013 1:30:00 PM SJUD 3/18/2013 1:30:00 PM |
SJR 9 |
| 2 - SJR 9 Quick Reference.pdf |
SJUD 3/13/2013 1:30:00 PM SJUD 3/15/2013 1:30:00 PM SJUD 3/18/2013 1:30:00 PM |
SJR 9 |
| 3 - Leg Legal March 8 Memo.pdf |
SJUD 3/13/2013 1:30:00 PM SJUD 3/15/2013 1:30:00 PM SJUD 3/18/2013 1:30:00 PM |
SJR 9 |
| 4 - Leg Legal March 4 Memo.pdf |
SJUD 3/13/2013 1:30:00 PM SJUD 3/15/2013 1:30:00 PM SJUD 3/18/2013 1:30:00 PM |
SJR 9 |
| 5 - Amendments to the Constitution.pdf |
SJUD 3/13/2013 1:30:00 PM SJUD 3/15/2013 1:30:00 PM SJUD 3/18/2013 1:30:00 PM |
SJR 9 |
| 6 - Alaska Performance Scholarship Data.pdf |
SJUD 3/13/2013 1:30:00 PM SJUD 3/15/2013 1:30:00 PM SJUD 3/18/2013 1:30:00 PM |
SJR 9 |
| 7 - AlaskaAdvantage Education Grant.pdf |
SJUD 3/13/2013 1:30:00 PM SJUD 3/15/2013 1:30:00 PM SJUD 3/18/2013 1:30:00 PM |
SJR 9 |
| 8 - Select Grants to Ed Programs Facilities Training.pdf |
SJUD 3/13/2013 1:30:00 PM SJUD 3/15/2013 1:30:00 PM SJUD 3/18/2013 1:30:00 PM |
SJR 9 |