Legislature(1997 - 1998)
04/08/1998 09:08 AM Senate HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
April 8, 1998
9:08 a.m.
MEMBERS PRESENT
Senator Gary Wilken, Chairman
Senator Loren Leman, Vice-Chairman
Senator Lyda Green
Senator Jerry Ward
Senator Johnny Ellis
MEMBERS ABSENT
None
COMMITTEE CALENDAR
SPONSOR SUBSTITUTE FOR SENATE BILL NO. 203
"An Act relating to phonemic awareness, letter-sound
correspondence, word-attack skills, spelling, vocabulary, use of
decodable text, reading comprehension strategies, and testing for
basic reading and reading comprehension skills in the public school
system."
PASSED CSSB 203(HES) OUT OF COMMITTEE
SENATE BILL NO. 160
"An Act relating to registration, inspection, and testing relating
to radiological equipment in dentists' offices."
PASSED CSSB 160(HES) OUT OF COMMITTEE
SENATE BILL NO. 272
"An Act relating to children in need of aid matters and
proceedings; relating to murder of children, criminally negligent
homicide, kidnaping, criminal nonsupport, the crime of indecent
exposure, and the crime of endangering the welfare of a child;
relating to registration of certain sex offenders; relating to
sentencing for certain crimes involving child victims; relating to
the state medical examiner and reviews of child fatalities;
relating to teacher certification and convictions of crimes
involving child victims; relating to access, confidentiality, and
release of certain information concerning the care of children,
child abuse and neglect, and child fatalities; authorizing the
Department of Health and Social Services to enter into an
interstate compact concerning adoption and medical assistance for
certain children with special needs; authorizing the establishment
of a multidisciplinary child protection team to review reports of
child abuse or neglect; relating to immunity from liability for
certain state actions concerning matters involving child protection
and fatality reviews and children in need of aid; relating to
persons required to report suspected child abuse or neglect;
relating to foster care placement and to payment for children in
foster and other care and the waiver of certain foster care
requirements; relating to the access to certain criminal justice
information and licensure of certain child care facilities;
amending Rule 218, Alaska Rules of Appellate Procedure; amending
Rules 1, 3, 15, 18, and 19, Alaska Child in Need of Aid Rules; and
providing for an effective date."
HEARD AND HELD
SENATE BILL NO. 266
"An Act relating to Medicaid coverage for certain eligible children
and pregnant women; relating to primary care case management and
managed care services as optional services and to premiums and
cost-sharing contributions under the Medicaid program; establishing
the Healthy Families Alaska program; and providing for an effective
date."
HEARD AND HELD
PREVIOUS SENATE COMMITTEE ACTION
SB 203 - See HESS minutes dated 2/20/98, 2/23/98, 3/23/98,
4/1/98.
SB 266 - No previous Senate Committee action.
SB 160 - See Labor and Commerce Committee minutes dated 3/5/98 and
4/2/98.
SB 272- No previous Senate Committee action.
WITNESS REGISTER
Ms. Mel Krogseng
Staff to Senator Taylor
Alaska State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Testified for sponsor of SSSB 203 and SB 266
Dr. Shirley Holloway, Commissioner
Department of Education (DOE)
801 West 10th Street, Suite 200
Juneau, Alaska 99801-1894
POSITION STATEMENT: Commented on CSSB 203
Barbara Thompson, Director
Teaching and Learning Support
Department of Education
801 W 10th St., Suite 200
Juneau, Alaska 99801
POSITION STATEMENT: Addressed fiscal note for CSSB 203
Dan Anderson
POSITION STATEMENT: Supports SB 160
Kate Coleman
Radiological Health Specialist
Department of Health and Social Services (DHSS)
P.O. Box 110601
Juneau, Alaska 99811-0601
POSITION STATEMENT: Opposed to SB 160
Catherine Reardon, Director
Division of Occupational Licensing
Department of Commerce and Economic Development
P.O. Box 110806
Juneau, Alaska 99811-0806
POSITION STATEMENT: Commented on SB 160
Representative Fred Dyson
Alaska State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Presented SB 272
Brant McGee
Office of Public Adocacy
Department of Administration
900 W 5th Ave., Suite 525
Anchorage, Alaska 99501-2090
POSITION STATEMENT: Supports and presented SB 272
Del Smith
Deputy Commissioner
Department of Public Safety
P.O. Box 111200
Juneau, Alaska 99811-1200
POSITION STATEMENT: Supports and presented SB 272
Susan G. Wibker
Assistant Attorney General
Department of Law
1031 W 4th Ave., Suite 200
Anchorage, Alaska 99501-1994
POSITION STATEMENT: Supports and presented SB 272
Dean Guaneli
Chief Assistant Attorney General
Department of Law
P.O. Box 110300
Juneau, Alaska 99811-0300
POSITION STATEMENT: Supports and presented SB 272
Russ Webb
Deputy Commissioner
Department of Health and Social Services
P.O. Box 110601
Juneau, Alaska 99811-0601
POSITION STATEMENT: Supports and presented SB 272
Jay Livey
Deputy Commissioner
Department of Health and Social Services
P.O. Box 110601
Juneau, Alaska 99811-0601
POSITION STATEMENT: Supports and presented SB 266
Bob Labbe
Division of Medical Assistance
Department of Health and Social Services
P.O. Box 110660
Juneau, Alaska 99811-0660
POSITION STATEMENT: Supports and presented SB 266
ACTION NARRATIVE
TAPE 98-32, SIDE A
Number 001
CHAIRMAN WILKEN called the Senate Health, Education and Social
Services (HESS) Committee to order at 9:08 a.m. Present were
Senators Leman, Ward, Green, Ellis, and Chairman Wilken. The first
order of business before the committee was SB 203.
SB 203 - PHONICS CURRICULUM
SENATOR GREEN moved to adopt CSSB 203(HES), version C, as the
working document of the committee. SENATOR ELLIS objected.
CHAIRMAN WILKEN described the changes made to the committee
substitute, which was the result of incorporating input from
interested parties, as follows. First, the purpose was expanded in
Section 1. Second, the bill now requires, rather than encourages,
school districts to adopt a balanced approach to language arts
instruction that includes intensive systematic phonics. Third,
language was included to clarify that CSSB 203 is part of the
effort to begin preparing students for the high school exit exam.
Fourth, mandatory tests for first graders was eliminated in Section
2, however, students in second and third grades will be tested.
Fifth, language on page 2, line 6, requires testing to occur in the
fall. On line 17, the provision that required schools to use
phonics instruction if 25 percent or more of their students tested
at or below the 25th percentile has been changed and now requires
school districts to establish an alternative program that includes
specific instructional methods for any student who scores below the
25th percentile on the nationally normed test. Language on line 24
requires DOE to compile a list of nationally normed tests.
Finally, language on line 4 requires that a nationally normed test
be used instead of an assessment developed by DOE.
Number 086
SENATOR LEMAN stated language on page 2, line 11, references first
graders, which may no longer be consistent with line 4.
CHAIRMAN WILKEN noted lines 5 and 6 allow a first grader to be
tested if a teacher believes that student may need additional help.
Number 099
SENATOR ELLIS asked if a new fiscal note was submitted for the
committee substitute.
CHAIRMAN WILKEN said no.
SENATOR ELLIS asked that the committee request a new fiscal note
from DOE.
CHAIRMAN WILKEN agreed.
SENATOR ELLIS maintained that if a revised fiscal note is not
requested, he would have to consider this bill an unfunded mandate
because of the new requirements.
SENATOR ELLIS withdrew his objection to adopt CSSB 203(HES),
version C.
Number 123
MEL KROGSENG, staff to Senator Taylor, sponsor of SSSB 203,
reported that Senator Taylor reviewed the proposed committee
substitute and he concurs with the changes. Also, Senator Taylor
wanted the committee to know he appreciates the time it has spent
on this piece of legislation.
SENATOR LEMAN moved to report CSSB 203(HES) out of committee and
then withdrew his attempt to move the legislation in order to hear
testimony by teleconference.
Number 140
CHAIRMAN WILKEN took teleconference testimony.
COMMISSIONER SHIRLEY HOLLOWAY, Department of Education, stated she
applauds the goal of CSSB 203, to ensure that all students leave
the third grade as independent readers, but she again asked
legislators to look at a comprehensive assessment plan. DOE
believes such a plan is critical to provide the right building
blocks for student success throughout the K-12 program. An entry
and exit exam will not be adequate, especially if those exams
consist of only one type of test. School districts need to use
multiple kinds of assessments tied to what we want children to know
and be able to do, and to test what is taught. Norm referenced
tests are already given in Alaskan schools, in grades 4, 8, and 11,
and students complete a writing assessment in grades 5, 7, and 10.
DOE has been advocating, in terms of a comprehensive assessment, to
keep the existing assessments and add a developmental profile when
a student enters school at the age of five or six. The
developmental profile would be done with the parent, and would look
at a child's physical, social, intellectual, and emotional
development to design a program based on the strengths and
weaknesses that each child brings to the school system. DOE has
also been advocating benchmark testing based on the standards for
ages 5-7, 8-10, 11-12, and then the qualifying high school exam.
Norm referenced tests are the least valued by teachers in our
school system because those tests are not tied to what is being
taught. DR. HOLLOWAY again asked legislators to reconsider tying
the assessments to the standards because it is inconsistent to
expect high school students to be successful on a qualifying high
exam based on state standards when they entered the system being
tested using a norm referenced test with nothing in between. She
asked legislators to consider designing a law that requires testing
at specific intervals, against academic standards in the areas of
math, reading, and writing, and that intervention programs be
required for all children. Nationally normed tests are built on a
bell-shaped curve and are designed so that 25 percent of students
score in the top and bottom quartiles. Testing should be done at
primary, intermediate, middle school and the high school levels,
and students' literacy skills need to be tracked throughout the
public school experience. Testing is a critical aspect of a sound
educational system, however testing is a waste of money unless the
results are used to fix the problems they discover.
Number 213
SENATOR GREEN asked Commissioner Holloway whether 90 percent of
students could score in the bottom quartile of a nationally normed
test if they were unprepared for the test.
COMMISSIONER HOLLOWAY said the test is designed with the
expectation that 50 percent of students will score above, and 50
percent will score below, the middle, and a good test sample will
have 25 percent at either end. Commissioner Holloway said DOE
wants all students to reach an independent reading level at the
third grade level, and DOE knows the skills that must be learned to
do that. Those skills should be the standards that students are
tested against so that the tests drive instruction on a consistent
basis, not only in the fall using one norm-referenced test.
CHAIRMAN WILKEN remarked the committee wants schools to be able to
find out whether a first, second, or third grader can read a book.
He commented he does not approve of using a test that sets up 25
percent of students to fail it and automatically fall into a new
system set up by the Legislature. The committee wants some sort of
a benchmark used to determine whether a child can read "Dick and
Jane." He stated the purpose of the test would simply be to learn
whether a child is entering school with basic reading skills. He
maintained this issue is being described as much more difficult
than it is.
COMMISSIONER HOLLOWAY stated it is her understanding that norm
referenced tests are just that, norm referenced so that they test
the normal distribution of children. She maintained a developmental
profile would determine both expressive and receptive language
development on day one so that the school system could begin
working with that child to address his/her needs. If children
enter school with a small vocabulary and a low comprehension rate
in terms of their basic language skills, they are already set up to
have problems. Steps need to be taken in kindergarten to enrich
and enhance the language development of those students. Formalized
assessment can take place down the road to be used as benchmarks.
SENATOR ELLIS asked if the term "reading comprehension strategies"
in line 2 of the title, is another phrase for the whole language
approach to reading instruction. Also, SENATOR ELLIS stated page
2, line 18, contains a reference to "a governing body." He asked
why that phrase was used instead of local school boards, or the
state school board, and who will decide which governing body shall
be used.
SENATOR GREEN replied reading comprehension has to do with the
ability to read and get meaning from what was read; to answer
questions and discuss the idea of the reading material, versus
being able to identify words, letter groups, or sound out words via
phonetic instruction.
SENATOR ELLIS commented the title refers to "phonemic awareness,"
which sounds like a phrase describing the phonics approach to
reading instruction, and "reading comprehension strategies," which
sounds like a phrase to describe the whole language approach. He
asked if the sponsor has combined the two approaches in the titleto
provide for a balanced approach.
SENATOR GREEN explained "reading comprehension strategies" does not
necessarily describe the whole language approach; it is the goal of
any form of language instruction.
SENATOR ELLIS asked whether phonemic awareness is the same as
phonics.
SENATOR GREEN stated many reading instruction approaches are
phonics-based which means students learn to put words together by
learning the sounds of the letters.
SENATOR ELLIS asked if the title of the bill then excludes whole
language as an instruction method.
SENATOR GREEN answered it does not because word attack skills,
spelling, vocabulary, use of decodable text, and reading
comprehension strategies would be used in whole language
instruction as well.
Number 325
SENATOR ELLIS remarked his concern is that a balanced approach be
used, and that no one method be excluded. He again asked for
clarification of the governing body term.
CHAIRMAN WILKEN replied that is the Legal Services term for school
board.
SENATOR ELLIS asked if it is the local school board rather than the
state school board.
CHAIRMAN WILKEN clarified it is the local school board.
There being no further discussion on the bill, SENATOR LEMAN moved
to report CSSB 203(HES) from committee with individual
recommendations with a request for a revised fiscal note from DOE.
Number 338
SENATOR ELLIS objected because no accurate fiscal note was
available.
BARBARA THOMPSON, Director of Teaching and Learning Support, DOE,
commented the fiscal note submitted was based on the last version
of the bill. She noted she received a copy of the new committee
substitute late yesterday afternoon and did not have time to
prepare a new fiscal note. The new committee substitute does
contain provisions that will impact the cost.
SENATOR ELLIS maintained his objection. The motion to pass CSSB
203 from committee carried with Senators Green, Leman, Ward, and
Leman voting for the motion, and Senator Ellis against. CHAIRMAN
WILKEN announced the motion to pass CSSB 203, with a revised fiscal
note, to its next committee of referral, carried.
SB 160 - DENTAL RADIOLOGICAL EQUIPMENT
CHAIRMAN WILKEN informed committee members the version of the bill
being addressed is CSSB 160 as amended in the Senate Labor and
Commerce Committee.
MEL KROGSENG, staff to Senator Taylor, sponsor of the measure, read
Senator Taylor's sponsor statement for the record. She then
summarized the bill as follows. SB 160 changes the procedures for
inspecting and registering dental radiological equipment. Current
DHSS inspections have been erratic and are unnecessary because the
incidence of x-ray overexposure is so insignificant as to be non-
existent. Some states have no such requirement. SB 160 will
transfer those duties to the Board of Dentistry. Inspection
activities will be done by the private sector, and equipment owners
will be required to provide documentation to the board proving that
an inspection was done by a qualified individual within the
previous five years. Trained dental supply company technicians are
far more qualified to perform such inspections than representatives
from DHSS. SB 160 establishes criteria for inspector qualification.
The civil penalty for non-compliance, to be levied by the Board of
Dental Examiners, is a fine not to exceed $5,000 per violation.
MS. KROGSENG explained DHSS was without a technician for several
years delaying some inspections for seven years or more. She noted
Dan Anderson, a technician to Dr. Helmberg (ph), was available on
teleconference to answer technical questions.
Number 394
KATE COLEMAN, Radiological Health Specialist for DHSS, stated she
is one of two such specialists within DHSS. She made the following
comments. This week is national public health week. Alaska could
be diminishing the capacity of public health by diluting the
regulation of dental x-ray. On the international radiation
protection scene, the International Commission of Radiation
Protection would like to lower the exposure to occupationally-
exposed radiation workers. SB 160 will remove government
regulation aimed at keeping that exposure as low as reasonably
achievable. Questions about health effects and risks have been
raised and answers are difficult to quantify, but most people are
concerned about x-ray.
MS. COLEMAN read the following excerpts from a paper by Dr. Stuart
Smith of the UCLA School of Dentistry.
"While the risks from dental radiography is certainly small
compared to other risks that we assume in our daily lives,
such as driving, smoking, and eating fatty foods, there is no
basis to assume that it is zero. Prudence suggests we should
be cautious because of the large number of people that receive
dental x-rays. Recent studies suggest the lifetime cancer
risk from exposure to low levels of ionizing radiation may be
greater than previously estimated. The International
Commission for Radiation Protection data show that estimated
risk has increased four-fold. Cancers other than leukemia
typically start to appear ten years after exposure and remain
in excess for the lifetime of the exposed individuals."
MS. COLEMAN provided the following information. There is an
association with leukemia and radiation, the risk to children being
greatest. Thyroid cancers increase in humans following exposure to
ionizing radiation. About ten percent of individuals with thyroid
cancer die from that disease. A case controlled study has shown an
association between brain cancer and previous medical or dental
radiography. Several studies have shown an association between
salivary gland cancer and dental radiography. As long as there is
a risk, it needs to be monitored. DHSS is responsible for
protecting public health. SB 160 will create an absence of checks
and balances. The credentials of inspectors contained in the bill
are lax and do not address whether these individuals are qualified
to calculate skin dose, film quality, to operate radiation
measuring equipment, and to perform shielding calculations and
scatter radiation measurements. A state certification program for
inspectors should be in place to keep the standards high. She
questioned whether the Board of Dental Examiners will provide the
inspection procedures. The majority of problems in dental x-ray
are a result of film processing and operator error. SB 160 creates
duplicate functions within two state agencies. The type of
organization proposed by SB 160 is unusual by any state's standards
since the expertise of the professional board is so distant from
radiation protection. It is wasteful to establish parallel lines
of expertise in two separate agencies. AS 18.60.475(a)(7)
authorizes DHSS to assist other state agencies in performing
functions that require radiation expertise. This authorization
shows cognizance of the unique qualifications necessary to
understand and implement a responsible radiation control program.
Alaskan citizens will not benefit from the passage of SB 160.
Number 461
CHAIRMAN WILKEN stated he has trouble believing that dentists are
not concerned about risks to people who work for them and would not
take this on as part of their responsibilities. He noted he has
received quite pointed comments from several dentists about how the
current program does not work.
MS. COLEMAN pointed out 25 percent of her job is radiological
equipment testing. Last May, DHSS hired an additional inspector
who inspects full time. She and the other inspector plan to
inspect all of the facilities in the state on a three-year basis.
She noted this is the first time the state has hired two
inspectors, so they have actually just begun this program.
Number 479
CATHERINE REARDON, Director of the Division of Occupational
Licensing (DOL), indicated that DOL provides staff support to the
Board of Dental Examiners who will be given the responsibility of
ensuring that private inspections of equipment take place under SB
160. She stated from her perspective, she believes this bill
originated as the result of frustration on the part of some
dentists about paying a $50 per year per tube fee to DHSS for its
radiologic inspection program. The frustration was due to the fact
that state officials were not inspecting some dentists'
radiological equipment for significant periods of time. Dentists
have always had the option to hire private inspectors but they
still had to pay the $50 fee. DHSS has not had enough staff to
visit and inspect all dental offices, but it may now have that
ability. Ms. Reardon expressed two concerns. First, she
questioned whether the current system could be improved and stay
within DHSS since the expertise for the inspections is within DHSS.
The Board of Dental Examiners does not have detailed knowledge
about radiologic health issues. The Board opposed the original
version of SB 160 which differed significantly from the committee
substitute in that it would have required the Board to actually do
the inspections. The committee substitute leaves the inspection to
the private sector. Regarding the qualifications of the private
sector inspectors, she stated she was unable to determine whether
the training requirements listed on page 1 of the bill would be
sufficient. She pointed out rural dentists will need to pay the
transportation cost of inspector visits. She indicated the DOL
fiscal note reflects more staff time during the first two years,
with a decline in staff assistance in the following years. She
concluded her testimony by asking again whether it might be better
to improve and fix the existing system.
Number 529
SENATOR GREEN asked how long the current program has been in place.
MS. COLEMAN informed committee members that Sid Heidersdorf
originally came to Alaska in the 1960's as part of the U.S. Public
Health Service and performed this function until he was employed by
the state government in the 1970's.
SENATOR GREEN asked if he worked as a private inspector.
MS. COLEMAN stated he was a government employee who retired in the
early 1990's.
SENATOR GREEN said she would like to confirm whether there have
been no inspections or sporadic inspections during the last 10
years.
Number 542
MS. COLEMAN replied Mr. Heidersdorf was in her position, and spent
about 25 percent of his time doing radiological inspections.
Because he was the only state employee doing this work, he
circulated film to dentists through the mail to be exposed and then
he determined the radiation level. He prioritized which places to
visit depending on the radiation levels, therefore he did not visit
some places more frequently than every seven years.
SENATOR GREEN asked if the same procedure continued after Mr.
Heidersdorf's retirement.
MS. COLEMAN explained there have been gaps in filling the
radiological specialist position because it is difficult to find
people with the appropriate qualifications. She offered to send
committee members the list of DHSS inspections of dental facilities
which is on a data base.
SENATOR GREEN commented it is not too hard to see why a certain
degree of frustration exists among equipment owners.
MS. COLEMAN said yes, but that there is also a big misunderstanding
about DHSS's function versus a repair persons'. DHSS does not do
repairs, service people do. Service people do actual electrical
work on the equipment. DHSS staff are health physicists. They
take measurements with radiation detection equipment from the
operator's point of view and the skin of the patient's point of
view. They look at the film processing to determine where problems
may exist and why a practitioner might have to use higher radiation
levels, which is usually a processing problem. Under CSSB 160,
technicians will not be looking at processing.
CHAIRMAN WILKEN asked how many tubes are located in the state.
MS. COLEMAN replied there are about 250 facilities; the average
facility has three tubes.
CHAIRMAN WILKEN asked if that meant three x-ray units.
MS. COLEMAN said that was correct.
DAN ANDERSON provided the following summary of Dr. Helmberg's
written testimony via teleconference from Fairbanks. The first
paragraph states that dentists themselves have been trained about
radiation dangers which is usually a problem caused by sudden
changes in film density, therefore dentists will not ignore the
problem. Dr. Helmberg also questioned how, if a person can get
cirrhosis of the liver from drinking alcohol, one could calculate
the risk of getting it from drinking one glass of wine every New
Year's Eve. He compared the dental x-ray danger to the person who
drinks one glass of wine per year. As for DHSS's most recent
concern about the financial hardship to remote dental facility
owners, Senator Taylor has already put this concern to rest.
Medical equipment technicians are regularly called upon to serve
other medical and dental equipment in private and government
facilities throughout the state.
There being no further discussion on CSSB 160, SENATOR LEMAN moved
to report CSSB 160 from committee with individual recommendations.
SENATOR ELLIS objected. The motion carried with Senators Green,
Leman, and Wilken voting for the motion, and Senator Ellis voting
against it. CHAIRMAN WILKEN announced CSSB 160(L&C) was moved to
the Senate Finance Committee.
SENATOR ELLIS asked if a fiscal note accompanied the bill.
CHAIRMAN WILKEN stated a fiscal note of about $12,000 was attached.
TAPE 98-32, SIDE B
SB 272 - CRIMES AGAINST CHILDREN/FOSTER CARE
REPRESENTATIVE FRED DYSON joined the committee to testify on SB
272, and introduced his assistant, Lisa Torkelson. Representative
Dyson noted they have been working on this issue as part of the
Governor's Task Force since last August. A portion of HB 375
responds to changed federal legislation, another portion contains
recommendations to problems identified by the task force and
tragedies that occurred during the past year. His office and the
Administration have spent at least 50 hours thrashing through this
bill since the legislative session began. The House HESS committee
passed out CSHB 375(HES) which represents the agreement between his
office and the Administration. Some of the criminal provisions as
well as some of the Child Support Enforcement Division provisions
were removed from the committee substitute to more narrowly focus
the bill. He urged committee members to consider the House HESS
Committee version of HB 375. He informed the committee he plans to
meet with Administration staff to hash out a few more details
before the bill is heard in the Senate Judiciary Committee.
Number 552
CHAIRMAN WILKEN stated the effort behind the development of this
bill has included staff from each floor of the Capitol Building.
He asked those who would be presenting the bill on behalf of the
Administration to follow Representative Dyson's lead and discuss
the current status of the legislation so that the committee can
begin to tie up loose ends.
BRANT MCGEE, Director of the Office of Public Advocacy, DEL SMITH,
Deputy Director of the Department of Public Safety, SUSAN WIBKER,
Assistant Attorney General with the Department of Law, RUSS WEBB,
Deputy Commissioner of the Department of Health and Social
Services, and DEAN GUANELI, Chief Assistant Attorney General of the
Criminal Division of the Department of Law, joined committee
members at the table to present SB 272 on the part of the
Administration.
MR. MCGEE presented the following brief history of this issue. The
Office of Public Advocacy was the agency that brought to the
public's attention last fall five cases that dramatized the
ineffectiveness of the child protection system in those cases, as
well as hundreds of others. The Office of Public Advocacy had
court permission to release the facts of those cases which shed
light on what had previously been a very secretive system, and
secretive by law. The fact is, the system utterly failed those
children. As the result of rising public concern, a Child
Protection Task Force was formed. It included a lot of people who
worked at an intensive series of meetings throughout the fall. All
of the state agencies in the system were represented, as well as
social work non-profit organizations, judges, guardians ad litem,
Representative Dyson and other legislators. The task force
discussed policy and resource questions; those issues are well
presented in the child protection report. The task force then
developed legislative recommendations based on real life, practical
experience. SB 272 is the collective best thinking of dozens of
experts in the field of child protection.
MR. MCGEE discussed two of the basic themes contained in SB 272:
time and accountability. SB 272 establishes time lines based more
on a child's sense of time rather than an adult's. Two weeks, or
six months can seem like a very long time to a young child. The
time lines give a clear directive to all participants in the child
protection system: the Division of Family and Youth Services
(DFYS); parents; and the courts. The directive requires those
participants to take action more quickly either to ensure that the
child returns to a safe home or is permanently placed with a
relative or other safe alternative. Changes in federal law require
initiation of certain types of proceedings; SB 272 closes in the
end points of that. The child protection system would have to deal
with a case at the adjudication level within 120 days. Currently,
those cases, because they are in the court system and involve
multiple parties, take a very long time. It is not unusual for
cases to last four to six years, and sometimes over ten years.
Under SB 272, that will no longer happen. This bill has been
nicknamed the "no-excuses bill." It establishes specific time
lines and holds everyone involved accountable. DFYS will have to
provide direct and timely services to the family to keep the family
together and promote reunification. If those services are not
successful, DFYS must make documented efforts to find a permanent
safe home for the child. The bill preserves all legal safeguards
in current law for parents, but parents will only have one year to
get treatment and make the necessary behavioral or lifestyle
changes that will allow them to safely parent their children.
Parents can no longer wait for years to get treatment and they can
no longer stop the legal process, or a termination trial, merely to
start another treatment series. SB 272 requires the courts to
conduct adjudication hearings within 120 days, and permanency
hearings within one year, and decisions must be made at the trial
and appellate court levels in a timely manner. Judges will no
longer be able to treat children's cases as just another case. It
prioritizes children's cases in court. Under federal law, DFYS
will have to initiate termination proceedings if the child has been
out of the home for 15 of the last 22 months. DFYS will have six
months to initiate the termination trial itself. The judge has 90
days to issue a decision after the trial and the appellate court
has 90 days to reach a decision after the case has been briefed.
These requirements will dramatically shorten the lifespan of a case
and will dramatically shorten the period of uncertainty and anguish
that many children experience. Most importantly, this bill says to
children that their interests are paramount. Children will no
longer have to wait for years and years in foster care while their
parents are given chance after chance to make changes in their
lives. Mr. McGee urged the committee's swift and serious
consideration of SB 272.
Number 463
DEL SMITH stated his entire career, since the age of 18, has been
in law enforcement, and he assumed when he began his career that
the solution was always to build more jails to lock up criminals.
His opinions have evolved since then. Ninety percent of chiefs of
police surveyed believe that investing in children is a good crime
prevention technique and he agrees. He stated it is common sense
that victims of child abuse will have anger issues as they get
older. In a recent case in Anchorage, an individual received a
sentence of 115 years. The public record indicates that this
individual was the victim of sexual abuse and other very unpleasant
experiences during his childhood. That is not an excuse, but
everything that can possibly be done to prevent crime should be,
with an eye out for 15 years from now, or our society will be in
substantially worse shape than it is now. The state cannot build
enough jails or hire enough police to meet those needs. He
strongly urged the Legislature to enact the provisions in SB 272.
The law enforcement community views this bill as a crime prevention
tool. He repeated it is time to get serious about what will happen
in 15 or 20 years if abuse prevention measures are not implemented
now.
Number 435
SUSAN WIBKER informed committee members she is an assistant
attorney general in the Anchorage office and does the human
services cases, which are the child abuse and neglect cases. Both
the Departments of Law and Health and Social Services asked her to
work on this project, because, for one reason, she spent five years
working in the Anchorage District Attorney's Office where she
specialized in prosecuting child abuse cases. What she attempted
to do in pulling this bill together was to use the recommendations
of the team that both Brant McGee and Del Smith served on. In
addition, several Supreme Court opinions came down that strongly
recommended that Alaska's laws be changed because those laws were
resulting in decisions that left children unprotected. Also,
Congress just passed a law changing the way child protective
service workers will practice with their cases. Some of those
changes are drastic for social workers, one being the
implementation of time lines. Cases will no longer be able to sit
in the system for five or ten years anymore. For every case
sitting in the system, there is a child languishing in a foster
home or somewhere outside of their own home. SB 272 makes the
child's health and safety the paramount concern, which is what will
drive the system. If a child can go home, then DFYS will need to
get the services in place to get that child home within one year to
15 months. If the level of violence in the family is so great that
the child cannot return home, DFYS will have to find a permanent
safe home for the child in the same amount of time. The time lines
are important to the development of children. Children need to
attach and bond in a place that they can call home where they know
they will grow up. When that does not happen, children grow up
with no attachments, no conscience, no ability to have empathy, and
these are the homicidal children who commit violent crimes at very
young ages. Research studies are showing that the way children are
cared for at very young ages is directly related to how violent our
streets are going to be later.
MS. WIBKER explained one of the changes recommended by the federal
law is that the system should not operate solely with the goal of
preserving and reunifying the family which has been DFYS' mandate.
At least half of the children who have died from abuse were
reported to the child protection system but were left in, or
returned too quickly to, dangerous homes. SB 272 prohibits leaving
children in situations that involve a high level of violence. In
other situations, the state is able to get involved early enough so
that family preservation and reunification is the right goal, and
it is the right goal for most of the children in the system. Those
are the cases in which the treatment dollars spent are worthwhile.
She repeated that the guiding force of the system will be the
safety of the child. She asked committee members to please
seriously consider the bill.
Number 380
SENATOR LEMAN referred to Ms. Wibker's statement that in many
cases, if the state intervenes early enough to change behavior,
successful reunification can occur. He asked if SB 272 contains
any provisions that allows groups, such as churches or other
support structures other than the state, to help keep people
accountable. He stated he has found that whether the problem is
alcohol, substance abuse, or sexual misconduct, when people are
accountable to others it helps reduce recidivism. He questioned
whether SB 272 recognizes and/or encourages the use of churches or
other groups instead of, or in addition to, state involvement.
MS. WIBKER replied one of the items in the bill is the creation of
a multidisciplinary team. One of the task force's recommendations
was that information be shared more openly and that people from
more disciplines be involved in the team that makes the decisions
about a child. DFYS has been involved in forming those teams
around the state. By working with child care providers, Alaska
State Troopers, VPSOs, social workers, pediatricians, nurses, and
others when there is a call of child abuse, teams can make
decisions. That approach solves two problems: information is
shared so that all involved know what the others are doing; and the
expertise from people in many different disciplines will be used to
help make the decisions rather than leaving the decision to one
worker who is often isolated.
SENATOR LEMAN questioned whether some team members can be people
who are not part of the formal state system, but maybe ancillary to
the state system, such as members of Big Brothers and Big Sisters.
He stated he favors anything that can be done to enhance those
relationships.
Number 334
MR. MCGEE commented the task force spent a good deal of time
talking about that possibility. He did not think there was
anything in the bill that specifically addresses that concern. He
stated SB 272 deals with the relatively small number of cases,
eight percent, in which an investigation results in the filing of
a petition. In the other 92 percent of cases, some of the
allegations are determined to be unfounded, but it is obvious that
the system falls down in the cases where evidence of family
problems exists but not enough to warrant the filing of a petition.
DFYS will form a family support unit to work with those kinds of
families. The Office of Public Advocacy is supposed to help DFYS
create a volunteer program to plug folks into a network, whether it
be a church, school, or other community groups. Many of these
folks do not have those attachments. Churches could help to
arrange visitation with parents whose children are in custody. A
lot of thought was given to the use of community resources on a
policy level and a practical level, but the issue is not addressed
in SB 272 because it primarily deals with the smaller fraction of
cases.
CHAIRMAN WILKEN noted he passed out, for the benefit of the
committee, a document showing which legislators have worked on
this whole issue and which legislators have picked up the ball in
specific areas that need to be addressed. He also noted an audit
of DFYS is in the committee packet.
Number 301
DEAN GUANELI stated the primary thrust of SB 272 is civil child
protection proceedings, to ensure that the child's best interests
are paramount and that the timelines are shortened. Because abuse
and neglect of children often spills over into criminal law, SB 272
contains criminal law provisions in those areas that the task force
felt needed to be tightened. The bill makes a number of changes to
the homicide law. Senator Halford introduced a bill that came to
similar conclusions, adopted from many of the Governor's ideas.
Senator Halford's bill recently passed the Senate so the changes to
the homicide laws in SB 272 have already been addressed by the
Senate. SB 272 also contains provisions to deal with neglect by
parents that seriously jeopardizes children. Neglect will be an
infraction so parents will not go to jail, but the provision will
be a way to identify people who are passed out drunk time and
again, or people with infants who have drugs in their homes. The
provision will allow police officers to issue an infraction, notify
DFYS, and provide the court the opportunity to order the person to
treatment. It also holds a person criminally responsible if he/she
leaves a child with a person who has previously abused the child
and does so again. There are many situations in which one spouse
is aware that the other spouse is abusing the child. Prosecutors
find it very frustrating that they cannot take some action against
the person who could have stopped the situation before a child died
or was severely injured. He emphasized the criminal aspect of SB
272 is a small part of the bill; its main thrust is civil.
Number 256
CHAIRMAN WILKEN commented it is obvious how important this issue is
by the number of people working on it. He agreed with Mr. Smith's
remark that we can build all of the jails we want, but the problem
will not stop until it is addressed from the other end. He
commended everyone who has taken up this effort.
RUSS WEBB discussed the magnitude of the problem today. DFYS
receives about 16,000 reports of child abuse or neglect each year.
DFYS currently has about 1700 children in its custody in out-of-
home care. DFYS will not be able to deal with the long term impact
of this situation because children who are abused and neglected are
67 times more likely to become victimizers when they become
juveniles or adults. Early intervention procedures must be
established and SB 272 provides the tools to create those
procedures. One of the key elements of today's discussion is that
child protection is not any single agency's responsibility. It
takes a team effort, involving not only government agencies but
communities as well. This bill provides opportunities to use that
teamwork more effectively, sharing information and working with
communities.
SENATOR ELLIS asked if the committee is in the process of
formulating the committee's work plan on the child protection bill.
CHAIRMAN WILKEN said a lot of people have already picked this issue
up. He thought it was important to advise the committee of all of
the different efforts taking place. Whether the Senate HESS
committee does anything has yet to be determined.
SB 266 - MEDICAID COVER/HEALTHY FAMILIES AK PROGRAM
JAY LIVEY, Deputy Commissioner of DHSS, gave the following overview
of SB 266 with Bob Labbe of the Medicaid Division and Pam Muth from
the Division of Public Health. The Kennedy Hatch bill passed
Congress last fall. That legislation made federal money available
to states to expand health care coverage for children. Alaska's
allotment from that bill is about $5.6 million. A state match is
required which will amount to $2.2 million. DHSS has estimated that
23,000 children in Alaska are uninsured, of which about 11,500 are
under the 200 percent poverty level. The 200 percent poverty level
in Alaska amounts to $33,000 for a family of three. The federal
requirements for implementation are as follows. The benefit
package that is provided to children through this program must meet
certain standards. It must contain a certain amount of prevention
coverage for children and well-child care. Second, each child
served must be screened for medicaid eligibility; Congress does not
want medicaid eligible children to be on the child health program
because of its higher federal match. Third, the federal law
requires that any Indian Health Service (IHS) eligible children,
who are also eligible for the new child health program, must be
served by the child health program.
Number 148
SENATOR GREEN asked if families with IHS coverage cannot be
encouraged to use that coverage instead.
MR. LIVEY replied DHSS could discuss the options available for
health care with those families but the federal law requires that
if an individual, who is eligible for IHS, wants to sign up for the
child health program, that individual could not be refused based on
the IHS eligibility.
MR. LIVEY continued the overview. The state did get considerable
flexibility in designing the new program. DHSS can decide the
level of eligibility for the coverage and the delivery mechanism
for the program itself. The state has the option of impementing
the child health program through a medicaid expansion, a private
coverage expansion, or a combination of the two. The Governor's
bill uses a medicaid expansion and increases the level of
eligibility to 200 percent of the poverty level for children and
pregnant women. Currently, the Alaska medicaid program is at the
federal minimum levels of coverage. DHSS chose to implement this
program through the medicaid program for two reasons. First, the
state will get a lot more bang for each general fund dollar spent,
and second, an administration has already been established for the
medicaid program that is serving 50,000 children.
MR. LIVEY discussed a few other related points. The first is the
relationship between child health expansion and welfare reform.
The welfare reform program has helped people get off of public
assistance and into jobs but many of those jobs do not provide
health care coverage. The child health program will allow many of
those families to continue their health care coverage while
improving their job skills and prospects. DHSS does not want
people to quit their jobs just to go back on public assistance to
get health care coverage. Second, DHSS thinks the child health
program is associated with the federal matching assistance
percentage change. Last year, Congress changed Alaska's federal
matching assistance percentage rate for medicaid which allows the
state to collect more federal dollars for the medicaid program.
That action freed up a lot of general fund monies in the budget.
The federal matching assistance percentage rate change will be
reviewed by Congress in three years. One of the cases made when
Senator Murkowski got the bill through was that Alaska would use
some of that money to expand health care coverage. DHSS was
previously unable to do because of the expense. When the rate
change comes up for reauthorization in three years, DHSS believes
having health care expansion on the books will help the
reauthorization effort. Third, DHSS chose to expand coverage for
pregnant women in SB 272 at up to 200 percent of the poverty level
for a couple of reasons. First, research has shown that prenatal
care results in better birth outcomes. Second, it makes sense to
insure the children before birth if coverage is going to continue
afterward so that the children are healthy starting out. A state
plan must be approved by the federal government by September 30 to
guarantee the state's allotment of $5.6 million for this year. The
federal government told DHSS the state plan must be submitted by
July 1 so that it can be reviewed and enacted on by September 30,
therefore legislation needs to pass during this session to give
DHSS adequate time to prepare the plan.
Number 029
MR. LABBE gave the following explanation of the sections of the
bill, and action taken by the House HESS committee. The same bill
was introduced in both bodies. Section 1 expands coverage under
the medicaid program for children under age 19, and pregnant women,
at up to 200 percent of the federal poverty level. Currently the
state is providing coverage mandated under the federal program for
pregnant women and children up to age 6, whose income is up to 133
percent of the poverty level, to children ages 6 to 14 living at up
to 100 percent of the poverty level, and to children over 14 if
their family receives cash assistance, which is at about 70 percent
of the poverty level.
TAPE 98-33, SIDE A
MR. LABBE continued. DHSS had a choice of going with the private
model or the medicaid model. If DHSS used the private model, it
would have screened children first for medicaid eligibility. If
eligible, those children would be placed on the medicaid program.
DHSS's reason for choosing the medicaid model was largely
influenced by the fact that more children could be served. Under
the medicaid program and new child health block grant, American
Indians and Alaska Natives can be eligible for medicaid, and
medicaid will be the primary payer rather than IHS. SB 272 will
allow IHS providers to bill the medicaid program for services to
clients who are eligible for medicaid. The federal government will
reimburse the state for 100 percent of those medicaid costs, so no
general fund money will be involved. DHSS estimates that anywhere
from 25 to 40 percent of the children who will be covered in this
expansion will be Alaska Natives. If DHSS chose the private
option, it would not get the 100 percent reimbursement, so state
funds would have to be used. DHSS also looked at the fact that the
child health program will serve a relatively small group and Alaska
already has a large medicaid population so there will be some
efficiency in pooling. Other provisions were added to the child
health program to allow for continuous health care coverage for
children for up to 12 months a year. Currently, medicaid
eligibility is on a month to month basis which causes a certain
amount of administrative confusion and interrupts treatment. DHSS
has proposed up to six months of continuous eligibility so that if
a child qualifies at the month of application, he/she would be
covered for six months. That provision applies not only to the new
group but to the entire child medicaid population.
MR. LABBE stated the third section of the bill contains language to
allow the state to cover, as a medicaid service, targeted case
management, a service for pregnant women and children under age 5,
in an effort to support the Healthy Families Program. DHSS does
not plan to provide that service in the short run but it wants to
have the authority to reimburse the Healthy Families Program for
medicaid eligible children that it serves. A number of states have
used a similar provision as a refinancing vehicle. DHSS also added
a section for comprehensive pregnancy related services in an effort
to help cover services of direct entry midwives which has been
taken care of in another bill. Section 4 amends the current
statute to allow DHSS to do managed care without getting a federal
waiver. DHSS has had authority to do a managed care model since
the Balanced Budget Act passed Congress last year, but it has not
implemented anything yet. Section 5 contains a technical change.
Section 6 is tied to the child health program. Under the block
grant, states are able to charge premiums for pregnant women and
children between the 150 and 200 percent poverty level. DHSS has
been advised, however, that if it does a medicaid expansion, it
cannot charge premiums. DHSS felt cost sharing on a sliding fee
basis was reasonable so it is included in the bill in case Congress
revisits this issue.
CHAIRMAN WILKEN asked Mr. Labbe to return on Wednesday morning at
9:00 a.m. to finish the sectional analysis. MR. LABBE agreed.
CHAIRMAN WILKEN adjourned the meeting at 10:50 a.m.
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