Legislature(1997 - 1998)
04/25/1997 09:06 AM Senate HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION & SOCIAL SERVICES COMMITTEE April 25, 1997 9:06 a.m. MEMBERS PRESENT Senator Gary Wilken, Chairman Senator Loren Leman, Vice Chairman Senator Lyda Green Senator Jerry Ward Senator Johnny Ellis MEMBERS ABSENT All members present. COMMITTEE CALENDAR SENATE BILL NO. 170 "An Act relating to financial assistance for students attending certain graduate education programs; and providing for an effective date." - HEARD AND HELD SENATE BILL NO. 116 "An Act relating to welfare to work tax credits under the Alaska Net Income Tax Act; and providing for an effective date." - MOVED SB 116 OUT OF COMMITTEE CS FOR SENATE BILL NO. 152(L&C) "An Act relating to certified nurse aides; and providing for an effective date." - MOVED CSSB 152(L&C) OUT OF COMMITTEE PREVIOUS SENATE COMMITTEE ACTION SB 170 - No previous Senate action to record. SB 116 - See Senate State Affairs Committee minutes dated 3/25/97, 3/27/97. See Senate Health, Education & Social Services minutes dated 4/23/97. SB 152 - See Labor and Commerce minutes dated 4/15/97. WITNESS REGISTER Joe Ambrose, Staff Senator Taylor State Capitol Juneau, Alaska 99801-1182 POSITION STATEMENT: Read the Sponsor Statement. Laura Burleson, UAF Pre-Med Student 4758 Glasgow #1 Fairbanks, Alaska 99709 POSITION STATEMENT: Supported SB 170. Wendy Redman, Vice President University of Alaska Statewide System PO Box 755000 Fairbanks, Alaska 99775 POSITION STATEMENT: Urged the committee to continue WAMI. Diane Barrans, Executive Director Postsecondary Education Commission 3030 Vintage Boulevard Juneau, Alaska 99801-7109 POSITION STATEMENT: Answered questions. Jim Nordlund, Director Division of Public Assistance Department of Health & Social Services PO Box 110640 Juneau, Alaska 99811-0640 POSITION STATEMENT: Explained SB 116. Joseph Friedman, Director Trade Dollar Exchange 3820 Lake Otis Parkway Anchorage, Alaska 99508 POSITION STATEMENT: Discussed the Trade Dollar Exchange. Pam LaBolle Alaska State Chamber of Commerce POSITION STATEMENT: Supported SB 116. Annette Krietzer, Staff Senator Leman State Capitol Juneau, Alaska 99801-1182 POSITION STATEMENT: Reviewed SB 152. Teresa Lyons, Registered Nurse PO Box 477 Ester, Alaska 99725 POSITION STATEMENT: Supported SB 152. Gail McGuill, President Alaska Nurses Association 237 E 3rd Avenue Anchorage, Alaska 99501 POSITION STATEMENT: Supported SB 152. Ron Cowan Division of Medical Assistance Department of Health & Social Services PO Box 110660 Juneau, Alaska 99811-0660 POSITION STATEMENT: Supported SB 152. Catherine Reardon, Director Division of Occupational Licensing Department of Commerce & Economic Development PO Box 110806 Juneau, Alaska 99811-0806 POSITION STATEMENT: Supported SB 152. ACTION NARRATIVE TAPE 97-43, SIDE A SB 170 REPAY GRADUATE EDUCATION AID Number 001 CHAIRMAN WILKEN called the Senate Health, Education & Social Services Committee (HES) to order at 9:06 a.m. and introduced SB 170 as the first order of business before the committee. JOE AMBROSE , Staff to Senator Taylor, read the following Sponsor Statement into the record: Senate Bill 170 was introduced at the request of constituents interested in preserving the WAMI Medical Education Program. This is a companion measure to House Bill 193 and its introduction is intended to compliment that effort. These bills would convert the Alaska program into a loan program. The state of Montana has already made this conversion. WAMI has been a program of financial assistance named for the participating states of Washington, Alaska, Montana, and Idaho. It is intended to facilitate the education of medical professionals. Alaska participated to the tune of $1,309,000 in FY97. WAMI has been criticized because there has been no real incentive for a student to return to the state upon completion of their education. By converting this program to a loan program and including a provision for loan forgiveness, proponents feel young Alaskans will be more likely to bring their new skills back to Alaska. The House sponsor has been working with the Postsecondary Education Commission and has developed a committee substitute. Senator Taylor recommends adopting the same language as a substitute for SB 170. SENATOR GREEN moved that CSSB 170(HES) be placed before the committee. Without objection, CSSB 170(HES) was before the committee. SENATOR LEMAN inquired as to the impact on the borrower. When does the pay back schedule for the WAMI loan begin? JOE AMBROSE pointed out the language on page 2, lines 7-9 "Interest imposed under this subsection begins to accrue when the person terminates studies under the graduate education program." Mr. Ambrose believed the legislation allows for the internship. Mr. Ambrose directed Senator Leman to page 2, lines 27-29 "A person employed in a medical residency program is not required to begin repayment to the state as long as the person remains in the medical residency program." With regard to the impact on the borrower, Mr. Ambrose deferred to the Postsecondary Education Commission. Number 115 LAURA BURLESON , UAF Pre-Med student, supported SB 170. WAMI is important to Alaskan pre-med students because WAMI gives Alaskans preference for admission and tuition. WAMI treats Alaskan pre-med students as residents for admission purposes. Ms. Burleson informed the committee that a school to which she recently applied had received over 10,000 applicants for 113 positions while another school had 8,000 applicants for 32 out of state positions. With those odds, Alaskan students do not have much of a chance because Alaska does not have a medical school to provide in state admission preference. SB 170 is a compromise to the alternative of eliminating the program. Without WAMI, the challenge of the numbers of getting into a medical school out of state would be very difficult. Furthermore, this bill could help WAMI students applying for the program. In the past the return rate for students returning to the state is relatively low. The return or repayment clause in SB 170 would help those students who do intend to return to the state and practice. WENDY REDMAN , Vice President of the University of Alaska statewide system, thanked Representative Bunde and Senator Taylor for their work on this issue. WAMI is very important to the university. The University of Alaska-Anchorage offers the first year of the medical program which provides the basis of a biomedical program. Ms. Redman was supportive of this legislation if it is a means to maintain WAMI. Ms. Redman hoped that the Senate action deleting WAMI will be worked out. Ms. Redman suggested that the pay back provision for the first year be eliminated. The first year of the program is offered in Alaska and is important to the university and the state by drawing medical research here. Ms. Redman recognized that the WAMI program is an expensive program, but it is substantially less expensive than having a medical school. The decision to bring back WAMI students to Alaska is a policy call which SB 170 addresses. Currently, 48 percent of the WAMI participants do return to Alaska which is higher than the national average for other medical schools. The WAMI program is a bargain for Alaska and Alaskan students. Ms. Redman urged the committee to continue the WAMI program and consider an amendment that would provide that the first year of pay back be eliminated. Number 263 SENATOR ELLIS asked if the return rate was expected to substantially increase with the Sisters of Providence family practice residency program. Senator Ellis projected that a substantial increase in the return rate would occur due to the availability of the residency program within the state. WENDY REDMAN agreed with Senator Ellis that students tend to become permanent residents in the community in which the student did residency. Therefore, the family practice residency in Alaska would make a big difference. SENATOR ELLIS inquired as to the average debt load of a student after seven years of medical training. WENDY REDMAN informed everyone that the average loan is $45,000 to $80,000 per the information of the Postsecondary Commission. With SB 170, $56,000 would be added if all four years pay back are included or $44,000 if the first year of pay back is eliminated. That would total about $100,000 to $130,000 of debt. Ms. Redman pointed out that these are family practitioners, not cardiac surgeons which could possibly absorb that debt. SENATOR ELLIS stated that the higher the debt load, the more likely someone is to specialize and practice in a major urban center in order to pay off the debt. The lower the debt load, the more likely someone would choose to deliver babies in a rural setting. SENATOR GREEN noted that students could accumulate $50,000 in post graduate debt before beginning the WAMI program as well as the debt the WAMI program would incur. When does repayment begin for the debt incurred in the post graduate education? WENDY REDMAN explained that the Postsecondary Commission would provide deferment on the baccalaureate loans while the student is attending medical school on a loan. Ms. Redman pointed out that the loans are additive. If a student has a loan from Alaska, the first baccalaureate loan would be deferred while the student continues his/her education. At the time the student graduates from medical school and one year afterwards, the entire loan would begin repayment. SENATOR GREEN asked if the student's record was clean with a deferment; is there a bad debt record being assessed against the student or the institution? Number 322 DIANE BARRANS , Executive Director of Postsecondary Education Commission (PSEC), stated that there are provisions for deferment that do not damage a student's credit history. SENATOR LEMAN inquired as to the tax consequences of WAMI; is the program treated like a scholarship which is nontaxable? DIANE BARRANS explained that it would be categorized as gift aid. Since the loan is not associated directly with an individual, there is simply a contractual fee paid to the University of Washington. Therefore, the WAMI loan would not relate to an individual's scholarship or loan limits. SENATOR LEMAN ascertained then that there is no obligation by the party benefiting to pay the IRS any portion of that benefit. DIANE BARRANS replied no. SENATOR LEMAN asked if a loan program with forgiveness was created, would that be a taxable benefit? DIANE BARRANS understood that in the past, the tax code made some provisions for those receiving a benefit related to specific employment or service. In the early 1990s, the IRS did contact PSEC and required the disclosure of forgiveness benefits upon which people were taxed. However, Ms. Barrans said that at that time there was no provision in the tax code for people to receive a benefit simply because the person resided in a particular area. Ms. Barrans said that it is difficult to receive tax advice from the IRS, therefore a tax accountant or tax attorney should be contacted. SENATOR LEMAN did not want to inadvertently establish a cash drain away from Alaska or Alaskans to the IRS. Senator Leman expressed the need to make the tax consequences benefit Alaska or Alaskans who participated. Number 370 In answer to the first half of Senator Leman's question, DIANE BARRANS explained that the student with a WAMI loan would be borrowing the differential between the resident and the non- resident University of Washington School of Medicine rate of tuition. Currently, the student pays the resident rate of tuition which is about $8,000 per year. The student would be borrowing the additional amount that is charged to residents. Ms. Barrans pointed out that was calculation 2 in the committee packet. SENATOR LEMAN determined then that the student is responsible for the resident tuition rate and may borrow that under other loan programs, but not specifically under the WAMI loan program. DIANE BARRANS agreed with that assessment. CHAIRMAN WILKEN requested that the concerns with SB 170 be addressed and the Chair held SB 170. SB 116 WELFARE TO WORK TAX CREDITS CHAIRMAN WILKEN announced that SB 116 was the next order of business before the committee. Number 402 JIM NORDLUND , Director of the Division of Public Assistance, informed the committee that he was present to testify on the behalf of the Administration in support of SB 116. SB 116 will provide tax credits to Alaska corporate employers who hire disadvantaged workers. Mr. Nordlund has a particular interest in SB 116 because of the challenge of the division and the state as a whole to find work opportunities for up to 4,000 individuals in the next year due to state and federal mandates. This is a multi-departmental effort. Mr. Nordlund noted his work with the employer community to review incentives for employers to hire welfare recipients and SB 116 is a key to this goal. Mr. Nordlund mentioned that a representative from the Department of Revenue and the Department of Labor are present for questions regarding the respective departments. SB 116 is modeled after federal legislation that provides a tax credit on the federal income tax to businesses that hire welfare recipients. SB 116 would require a state tax credit of up to $1,000 per employee and an additional $500 if the employer provides job training to the recipient. The employee must be on the job for 180 days or 400 hours, and those need not be consecutive days which recognizes the seasonal employment in Alaska. Mr. Nordlund mentioned that the federal law and SB 116 are not limited to welfare recipients, but are available to other categories of disadvantaged workers. For the number of employers who hire recipients, there is a significant cost savings in terms of welfare benefits that would have otherwise been paid offsetting the cost to the Treasury of providing that tax credit to employers. Mr. Nordlund noted that SB 116 makes it as administratively simple for employers as possible. SENATOR LEMAN said that he liked the idea. Senator Leman noted that a few years ago, he introduced a welfare reform bill which included a provision similar to the concept of SB 116. Senator Leman was concerned with limiting the tax credit to the corporate income tax. Perhaps, there is a way in which to broaden the base to include more employers to participate in employing welfare recipients. The number of corporate tax payers in Alaska is small in comparison to the number of business licenses. JIM NORDLUND recognized that SB 116 would only benefit Alaskan corporations because corporations are the only businesses that pay income taxes. Mr. Nordlund emphasized that SB 116 is one of several incentives being utilized to encourage employers to hire welfare recipients. Mr. Nordlund informed the committee that a program modeled after the Green Star program is being reviewed. The Work Star program which recognizes businesses hiring disadvantaged workers or welfare recipients is also being reviewed. Under SB 98 from last year, the actual welfare benefit can be used as a wage subsidy to businesses not limited to corporations hiring welfare recipients. Mr. Nordlund pointed out that most who work outside of government work for a corporation. The bigger businesses who hire more are generally corporations. SENATOR LEMAN inquired as to the numbers of employees hired by the corporations covered under the corporate income tax versus the total number of employees in Alaska. JIM NORDLUND said that could be provided. Number 489 SENATOR GREEN inquired as to how the wage subsidy would work. JIM NORDLUND explained that for a business, such as KMART, who pays $7 an hour and who hires a welfare recipient for six months to a year; the business would receive $2 an hour. The welfare benefit would be utilized to subsidize $2 an hour of the wage. Mr. Nordlund pointed out that the program has been used in other states. Due to the combination of the residual benefit and the wage, the person would do better than with the welfare benefit alone. The employer experiences a reduced payroll cost. The wage subsidy is good for the State Treasury because the needs of the family are being provided for partially through wages as opposed to 100 percent through the welfare benefit. Mr. Nordlund noted that the wage subsidy will be placed in regulation by October 1997. SENATOR GREEN asked if this would be part of the training component or the work requirement. How does this impact the two year and five year time limit with regard to the individual's participation in the tax credit? JIM NORDLUND said that presuming the individual is working, the individual would not be subject to the two year time limit which is the requirement for people to be in a job. If the job has a low wage and the individual is eligible for welfare, the individual would receive a reduced benefit. Between now and five years, hopefully the individual would be at a point to support themselves without any assistance. SENATOR GREEN asked if this could be construed to be a disincentive to get off welfare. JIM NORDLUND did not think so. This is invisible to the recipient, except that employers would be willing to hire the recipient. SENATOR LEMAN asked if the Work Star program is a recognition program and there is no money involved. JIM NORDLUND agreed that the Work Star program is a recognition program that is being tested with employers. A steering committee of employers has been formed in order to receive advice from employers. SENATOR LEMAN encouraged Mr. Nordlund to recognize businesses who help programs such as Bootstraps which is designed to move folks from welfare to work. Number 539 JOSEPH FRIEDMAN , Director of the Trade Dollar Exchange, informed the committee that he represented about 100 small businesses in Alaska. The Trade Dollar Exchange is a program allowing small businesses to actively participate in the hiring of persons through trade. Mr. Friedman pointed out that the Tax Equity & Fiscal Responsibility Act of 1982 said that trading or bartering must be declared as income, but businesses can deduct the income as it is spent for business expenses. The Trade Dollar Exchange provides a forum for low income persons to trade skills amongst each other and are awarded trade dollars. With those trade dollars, the individual can go to participating businesses and redeem the trade dollars for goods and services. For example, the People Mover in Anchorage will provide bus passes for trade dollars. The YMCA is part of the Trade Dollar Exchange. The Trade Dollar Exchange is a debit-credit banking system. Mr. Friedman noted that the Trade Dollar Exchange comes from the Time Dollar Programs. In St. Louis, the largest Time Dollar Program has over 8,000 people trading skills. If those 8,000 people participated 10 hours a week, that results in 80,000 of hours of services delivered without asking for money from the government. If those hours were paid at $10 an hour, that would result in $800,000 in savings. Mr. Friedman noted that in Michigan and Missouri, the state has paid for services that cannot be provided by the system itself. Mr. Friedman said that the Trade Dollar Exchange makes Alaskan businesses more competitive and profitable. Businesses can employee these people using trade dollars. This program allows the private industry group to present the program to small businesses and enlist support. SB 116 is important in that it moves corporations into the arena. Mr. Friedman noted that the Trade Dollar Exchange had contacted the Democratic and Republican State Parties and inquired as to donations of time and skill. TAPE 97-43, SIDE B Mr. Friedman stated that the program is looking for the opportunity, amendment to SB 116, to have the trade dollars be disregarded for income analysis for AFDC, ATAP and SSI. SENATOR LEMAN asked if there are other similar exchange programs in Alaska. If so, why would those programs not be eligible for income disregard as Mr. Friedman suggested for the Trade Dollar Exchange. JOSEPH FRIEDMAN explained that exchanges work by a profit incentive. Moving low income people from welfare to work does not appeal to many. Mr. Friedman pointed out that the Trade Dollar Exchange is a program that offers training in order that people would come in for four of the six weeks and become part of a community and then move to a job. Within the trading industry many do not view this as a business opportunity. Number 561 PAM LABOLLE , Alaska State Chamber of Commerce, informed the committee that the chamber represents about 700 employers and businesses statewide who support SB 116. SB 116 would encourage businesses to hire persons without current experience and would alleviate some of the on the job training costs. Ms. LaBolle believed that the costs of on the job training is a major deterrent for hiring persons on the welfare rolls. SENATOR LEMAN inquired as to how many of the 700 members of the chamber were corporate taxpayers. PAM LABOLLE said that she could survey the members. Ms. LaBolle believed that at a recent chamber breakfast, Mike Abbott indicated that about 3,500 corporations pay corporate taxes in Alaska. A huge percentage of that is paid by 11 corporations. SB 116 is an opportunity to join in a partnership with the state and there is an incentive to do so. SENATOR LEMAN asked Ms. LaBolle how she viewed expanding this to other costs that businesses incur such as fuel taxes and business license fees to those that are employers, but are not corporate tax payers. PAM LABOLLE believed that could be explored amongst the membership of the chamber. The cost-benefit relationship may be an obstacle. SENATOR WARD asked if the chamber has a position on carrying the credit for 2-3 years. PAM LABOLLE replied no. CHAIRMAN WILKEN stated that he would like to move SB 116 to Senate Finance. SENATOR GREEN moved to report SB 116 out of committee with individual recommendations and accompanying fiscal notes. Without objection, it was so ordered. SB 152 CERTIFIED NURSE AIDES CHAIRMAN WILKEN introduced CSSB 152(L&C) as the final order of business before the committee. ANNETTE KRIETZER , staff to Senator Leman, said that the legislation is introduced at the request of the Alaska Nurses Association. Ms. Krietzer reviewed the sectional analysis included in the packet. She noted that the sectional analysis for Section 2 had a mistake the statute referenced, AS 08.68.33(c), should actually be AS 08.68.333(c). In Section 5 Sec. 08.68.333(b), Ms. Krietzer pointed out that the revocation of a nurse aide's certification can occur if the board finds "abuse, neglect, or misappropriation of property in connection with employment as a nurse aide"; the "in connection with employment as a nurse aide" was added to be specific. Therefore, a CNA can be placed on the registry one of two ways. A CNA can be placed on the registry due to "abuse, neglect, or misappropriation of property in connection with employment" which is governed by the Administrative Procedure Act (APA). However under subsection (c), upon a notice of finding from DHSS, a CNA can be placed on the registry under AS 47.05.055 which is not subject to APA. Ms. Krietzer expressed concern with Section 10 and directed the committee to page 6, lines 20-21. If DHSS has reason to believe a CNA in a facility licensed by DHSS has committed abuse, neglect, or misappropriation of property, DHSS investigates to determine whether a finding should be made. As the legislation is currently written, these proceedings are exempt from APA. Ms. Krietzer directed the committee to page 3, lines 28-31 which states that the board can revoke a nurse aide's certification without a hearing and enter the finding in the registry and notify the nurse aide of the actions taken by the department. The department does not have a procedure in place. In conversations with DHSS, the department indicated that it will probably follow APA, but would look for an alternate procedure. This is of concern and the committee may want to contemplate whether these proceedings should be exempt from APA. Ms. Krietzer noted that Sections 14-16 are conforming amendments that add this agency investigation into statutes where necessary to comply with federal law. Number 400 SENATOR LEMAN understood that those sections addressing the exemption from APA were suggested by DHSS during the department's assistance in drafting. Senator Leman requested that DHSS inform the committee as to why those suggestions were made. TERESA LYONS , registered nurse, supported SB 152. Ms. Lyons informed the committee that she has worked as a registered nurse throughout Alaska and the nation and has worked with many certified nursing assistants and aides. Of those CNAs, some did prey upon the vulnerable populations being served. Ms. Lyons pointed out that the lack of public oversight for CNAs in home care agencies and hospitals leaves the policing to the employer. Unfortunately because of the structure, people move from agency to agency or hospital to hospital and the abuse continues. SENATOR ELLIS asked if some specific event spurred this legislation because this has been discussed for a number of years. ANNETTE KRIETZER noted that there have been some changes in federal law requiring that each state establish procedures to deal with the revocation of certificates of CNAs. SENATOR ELLIS asked if there were any problems through the board that could not be dealt with through the existing statute. ANNETTE KRIETZER understood that the current program does not have any statutory authority in existing statute to deal with what the board is required to under federal law. SENATOR ELLIS asked if there have been any problems. ANNETTE KRIETZER said that currently, CNAs are issued certificates not licenses. Ms. Krietzer understood that there have been some problems, but the board does not have the ability to deal with them. Number 349 GAIL MCGUILL , President of the Alaska Nurses Association(ANA), informed the committee that she is also a registered nurse, a licensed nursing home administrator and Director of quality management at Columbia Alaska Regional. Ms. McGuill supported SB 152. For seven years, ANA has worked with the Alaska Board of Nursing to achieve the public protection encompassed in SB 152. In 1989, the Governor signed EO 115 which called for the Department of Commerce to take responsibility for the training, certification, and registration of nurse aides that is required by the federal government. The ANA believes that the statutory and regulatory authority for nurse aides should rest with the Board of Nursing, the state agency responsible for regulating nursing care in Alaska. SB 152 will strengthen the board's ability to protect the public and will allow the board to establish standards for certification for defining competency for nurse aides. SB 152 provides the board with the ability to discipline nurse aides and revoke certification when appropriate. Although the board has had standards for education and competency testing for nurse aides since 1989, the board has been unable to perform any disciplinary actions due to its lack of statutory authority. DHSS has had the responsibility to do investigations, but only when the allegations involve client abuse, neglect, or misappropriation of funds. Over the past seven years, the Board of Nursing has provided professional consultation to DHSS and the senior ombudsman in investigation of complaints related to CNAs and nursing care of senior citizens. SB 152 provides protection to the public from all CNAs. RON COWAN , Division of Medical Assistance, supported the comments related to the need for this legislation. Mr. Cowan reiterated Ms. McGuill's comments regarding the history of CNAs and the process that has led to this legislation. EO 115 provided limited authority to the state and Occupational Licensing in the Board of Nursing to develop certain standards. Those standards were limited to the federal government, the only statutory authority available at that time, which was limited to nursing homes. The CNA population has increased and are working in many other settings besides nursing homes. The problem has been that when a hearing takes place, the department does not have statutory authority to enact any disciplinary actions. Mr. Cowan directed the committee to Section 9, lines 7-9 and Section 10, lines 18-19 of the bill when discussing the exemption from APA. The department will ensure protection of the due process rights of individuals the department takes action against. Mr. Cowan explained that an APA hearing for a CNA utilizes the same criteria used to revoke a physician's license or that of a higher practitioner. In the APA hearing, malpractice and the like are the subject, while CNA hearings revolve around physical abuse. The burden of proof under the APA is of such stringent nature that it is difficult to take action against someone that should not be a CNA. Mr. Cowan said that this exemption is not a breaker for the department, but something more effective than APA for this type hearing should be reviewed. There is a difference between the revocation of the certification of a CNA versus that of a physician. Mr. Cowan supported SB 152. Number 230 SENATOR GREEN inquired as to the training of a nurse aide. RON COWAN explained that a minimum of 75 hours is required of which certain skills are learned and competency tests must be passed. There is a didactic test requirement and continuing education is also required. SENATOR GREEN asked if certification is the only method available to discipline these people. RON COWAN pointed out that even certification cannot be used. The only basis for discipline is found in federal statutes which says that an individual cannot continue to work in a nursing home if the individual was found to have committed violations. Therefore, that individual can go any place else in the state and work as a CNA. Unless the action falls into criminal activity, there is no further recourse available. CATHERINE REARDON , Director of the Division of Occupational Licensing in the DCED, supported SB 152. Ms. Reardon informed the committee that the department already certifies approximately 2,000 nurse aides and SB 152 allows the existing program to work better. The bill establishes a two track system which is mandated by federal law. The federal law required nursing homes to hire CNAs and if a CNA was found to have committed abuse, neglect, or misappropriation of funds that CNA could no longer work in a nursing home. Since that time, the nurse aide system has expanded. Therefore, SB 152 would allow the discipline of nurses in other settings and revocation of the nurse's certificate. The federal law only places names on a registry and the nurse retains the certificate. Ms. Reardon pointed out that there are other types of incompetencies that the department would like to investigate and possibly take disciplinary corrective action. SB 152 allows the board to place a nurse aide on suspension, probation, or monitoring for other offenses that do not fall under abuse, neglect or misappropriation of funds. Ms. Reardon explained that by federal law DHSS deals with findings of abuse or neglect in nursing homes while the Board of Nursing will deal with allegations against nurse aides in other settings and for reasons besides the three specified. The second half of the bill makes the nurse aide system conform to the requirements of other agencies. SB 152 does not mandate licensure nor certification. Number 117 SENATOR WARD inquired as to Ms. Reardon's impression of the lack of process for the revocation of a license. CATHERINE REARDON pointed out that all of the Board of Nursing and the Department of Commerce activities fall under APA with one exception. In the case that DHSS has had a due process hearing and reports the results to the Board of Nursing, a second hearing would be redundant. The policy issue is whether DHSS should fall under APA for its hearing. In further response, Ms. Reardon said that under APA one can appeal to Superior Court. SENATOR WARD noted the growth of nurses aides when asking if any consideration had been given to the upcoming nurses aides to have their own surety bonds and be self supporting. Senator Ward noted that the fiscal note indicates that someone will be hired. CATHERINE REARDON explained that the cost of that employee is being paid by the license fees of the nurse aide. SB 152 references AS 08.01.065 which is the self-sufficiency mandate. SENATOR WARD asked if there will be enough fees collected to cover the cost of grievances, proceedings and other projected costs. CATHERINE REARDON expected fees will be between $100-$135 every two years. The division will establish those fees based on cost. The increase from $30 to $100-$135 in the fees is due to the increased activity provided. SENATOR WARD ascertained then that this system would allow the public to believe that those holding licenses are reliable and can be trusted. CATHERINE REARDON specified that this will assure the public that the nurse aide completed the training program and that no complaints against the nurse aide resulted in disciplinary action. In further response to Senator Ward, Ms. Reardon said that physicians are not mandated to carry insurance and SB 152 does not include an insurance requirement either. Ms. Reardon noted that most health care professions do not have insurance requirements. SENATOR LEMAN remained convinced that the APA provisions need not be changed and the APA provisions are actually incorporated earlier. CATHERINE REARDON explained that when the Department of Commerce receives the complaint, the individual has already received due process from DHSS. TAPE 97-44, SIDE A Number 011 In response to Senator Ward, RON COWAN said that any administrative procedures or appeals process provided is under APA. DHSS wanted the opportunity to explore other systems incorporated by other states with the CNA program which were found to more effective than under APA in protecting due process. There will be circumstances in which DHSS will not take action against a CNA unless that CNA in question happens to be working with an entity that has licenses or certification under Medicaid. Otherwise, the action would be taken by the Board of Nursing and under APA per the board's request. Mr. Cowan said that the APA due process provisions will be followed until the time another procedure is approved. SENATOR LEMAN expressed the need to hear from a CNA regarding the CNA. GAIL MCGUILL said that in discussions with colleagues there has been no concern expressed by CNAs or the employer. CHAIRMAN WILKEN said that question would be worked on as it passed on to Senate Finance. SENATOR LEMAN moved to report CSSB 152(L&C) out of committee with individual recommendations and accompanying fiscal notes. Without objection, it was so ordered. There being no further business before the committee, the meeting was adjourned at 10:45 a.m.