Legislature(1993 - 1994)
03/09/1994 01:55 PM Senate HES
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
March 9, 1994
1:55 p.m.
MEMBERS PRESENT
Senator Steve Rieger, Chairman
Senator Bert Sharp, Vice-Chairman
Senator Loren Leman
Senator Jim Duncan
Senator Johnny Ellis
Senator Judy Salo
MEMBERS ABSENT
Senator Mike Miller
COMMITTEE CALENDAR
SENATE BILL NO. 249
"An Act relating to assisted living homes; repealing references to
residential facilities for dependent adults; and providing for an
effective date."
SENATE BILL NO. 298
"An Act relating to licensure by the State Medical Board."
SENATE BILL NO. 270
"An Act creating the Alaska Health Commission; relating to the
delivery, quality, access, and financing of health care; relating
to review and approval of rates and charges of health insurers;
relating to certain civil actions against health care providers and
health insurers; repealing Alaska Rule of Civil Procedure 72.1; and
providing for an effective date."
SENATE BILL NO. 284
"An Act establishing the Alaska Health Insurance Corporation and
requiring licensed health care providers to comply with certain
statutes and regulations relating to the corporation; relating to
disability insurance claims processing and to approval of rates for
disability insurance, including health insurance; and providing for
an effective date."
PREVIOUS SENATE COMMITTEE ACTION
SB 249 - See Health, Education & Social Services minutes dated
2/2/94, 2/4/94, 2/16/94, and 2/23/94.
SB 298 - No previous action to record.
SB 270 - See Health, Education & Social Services minutes dated
2/9/94, 2/18/94 and 3/2/94.
SB 284 - See Health, Education & Social Services minutes dated
2/14/94, 2/18/94 and 3/2/94.
WITNESS REGISTER
D. R. Lehmann, President
Alaska State Medical Association
Family Practitioner
700 Katlian
Sitka, Alaska 99835
POSITION STATEMENT: Offered a change to SB 298.
Roy A. Box
16185 Lena Loop Road
Juneau, Alaska
POSITION STATEMENT: Explained amendment to SB 249.
Connie Sipe, Executive Director
Division of Senior Services
P.O. Box 110209
Juneau, Alaska 99811-0209
POSITION STATEMENT: Reviewed SB 249.
Dave Williams
Division of Medical Assistance
Department of Health and Social Services
P.O. Box 660
Juneau, Alaska
POSITION STATEMENT: Reviewed the fiscal note for SB 249.
Nancy Usera, Commissioner
Department of Administration
P.O. Box 110200
Juneau, Alaska 99811-0200
POSITION STATEMENT: Answered questions regarding Pioneer Homes.
Mary Lou Mieners, Chairperson
State Legislative Committee
Amemrican Association of Retired Persons
P.O. Box 020412
Juneau, Alaska 99802
POSITION STATEMENT: Supported SB 249.
ACTION NARRATIVE
TAPE 94-16, SIDE A
Number 009
CHAIRMAN RIEGER called the Senate Health, Education and Social
Services (HESS) Committee to order at 1:55 p.m. He introduced
SB 298 (LICENSING OF PHYSICIANS) as the first order of business
before the committee.
D. R. LEHMANN, President of the Alaska State Medical Association
(ASMA) and a family practitioner, stated that SB 298 is a good bill
that can be improved upon. He discussed an example that
illustrates that the current system requiring interviews for
medical licensure is a burden, especially in rural areas where
there are not members representing the State Medical Board. The
licensure interview tends to last less than five minutes. He
explained that SB 298 should correct much of the licensure problems
by allowing the board's designated representative to conduct the
licensure interview. He suggested changing "shall" to "may" on
page 1, line 4, which would allow the board to collect all
necessary data for screening applicants. If everything was in
order after the data collection, the interview could be omitted.
He pointed out that omitting the interview was not a radically new
approach; only twenty-two states of the fifty-three state entities
require interviews. Omitting the interview or having it at the
board's discretion would allow the board more time to fulfill
disciplinary and investigatory functions. He said that the
interviews do not seem to serve any major purpose.
Number 095
ROY BOX, optometrist, stated that he was present to testify on an
amendment to SB 298 that would be similar to section 3 of HB 507.
SENATOR LEMAN informed everyone that the amendment to be offered
was in their packet.
ROY BOX explained that the proposed amendment would allow the
Optometry Board to allow locum tenens licenses to optometrists in
the state. The locum tenens license would basically operate the
same as the Medical Board's locum tenens license. A locum tenens
is a licensed temporary doctor who fills in for a practicing
doctor. The practicing doctor would be responsible for the
temporary or locum tenens doctor. He pointed out that locum tenens
are needed since there are only about fifty practicing optometrists
and of those about forty are in private practice. This amendment
would allow specialty care from visiting doctors, as well as
allowing a solution for ill or vacationing doctors in small towns.
SENATOR SHARP set aside SB 298.
Number 163
SENATOR SHARP introduced SB 249 (REGULATION OF ASSISTED LIVING
HOMES) as the next order of business before the committee.
SENATOR LEMAN moved to adopt for discussion the CSSB 249 (HES), the
Lauterbach J version. Hearing no objections, it was adopted.
CONNIE SIPE, Executive Director of the Division of Senior Services,
stated that the CS appears consistent with their recommendations
and the committee's recommendations.
SENATOR LEMAN asked if Ms. Sipe was aware of the Anchorage Pioneer
Home's desire to be excluded from SB 249.
CONNIE SIPE said that she was aware of the Anchorage Pioneer Home's
position. She explained that some of the nurses of the Anchorage
Pioneer Home seem to be concerned about the gradual shift in
Pioneer Homes having more assisted living beds with fewer
residential and nursing home beds. They are also concerned that
unlicensed staff would be used in pioneer homes to provide nursing
care. She referred to the health related services portion of
SB 249 which allows a registered nurse to train an unlicensed
individual to perform tasks as approved by the State Board of
Nursing. She explained that the nurses are confused because the
State Board of Nursing, who have the legal power to define the
scope and practice of nursing in the state, issued an opinion that
goes beyond SB 249. The State Board of Nursing issued an opinion
stating that nurses may train and delegate tasks to unlicensed
personnel in any setting. This position reverses a 1991 opinion.
She specified that the State Board of Nursing 1994 opinion, which
is currently in effect, has nothing to do with SB 249. The opinion
relates to all nursing practice in the state of Alaska. She
asserted that SB 249 does not require the state of Alaska to do
assisted living in the Pioneer Homes, SB 249 only licenses what is
currently being done and allows it to be done in other settings
besides the Pioneer Homes.
Number 306
DAVE WILLIAMS, Division of Medical Assistance in the Department of
Health and Social Services, reviewed the reasons an assisted living
facility which can offer medical services was created. He pointed
out that assisted living facilities will increase access to
services for which Medicaid will pay. The alternative to assisted
living facilities would be nursing homes which are more expensive.
Assisted living facilities and pioneer homes would be considerably
less. SB 249 increases access which would increase costs.
Mr. Williams explained that the fiscal note assumes that a
certificate of need would be required prior to conversion of any or
part of any assisted living facility into a nursing home. He
pointed out that the CS work draft left out some essential
suggested language; the words "Not withstanding the expenditure
threshold" were left out at the beginning of section 4 on page 27.
He explained that someone should not be able to spend $1 million to
convert a building into a nursing home when the building is already
built, only the new license is needed to convert. He stated that
the fiscal note would not be valid without that language because
conversion to a nursing home carries a $78,000 yearly cost.
SENATOR ELLIS asked why those words were left out of the work
draft.
CONNIE SIPE said that she read section 4 as stating that no part of
the building may be converted without a certificate of need. She
explained that the drafter may have felt that the language was
strong enough legal language so that "regardless of the expenditure
limit" was not necessary. She believed that putting the language
in would not hurt the bill.
DAVE WILLIAMS explained that perhaps Lauterbach was being
economical with words. He reiterated the need to have that
language added, especially on a technical level.
Number 392
SENATOR ELLIS recommended that Mr. Williams' concerns should be
addressed before the bill moves out of the committee. He asked for
the number of seniors who qualify under Medicaid waivers now and
how many people to date have been served.
DAVE WILLIAMS clarified that the waivers come in a graduated scale
over the next three years. In the third year, this would come into
effect due to the time for an assisted living home to be built. He
stated that 401 people could be served under the Aged Person
Waiver.
CONNIE SIPE stated that nine seniors are being served. There are
forty-five slots reserved. She explained that by the end of this
fiscal year the half year mark would be reached, sixty people. She
noted that the program was six months late because the regulations
were in the Department of Law longer than expected.
SENATOR ELLIS asked if the Hickel administration had considered any
initiative making the Pioneer Homes Medicaid eligible.
NANCY USERA, Commissioner of the Department of Administration,
explained that the subject of Medicaid has often been a topic of
discussion regarding maintaining the quality of service of Pioneer
Homes in a cost effective manner. The people eligible for Medicaid
in the Pioneer Homes are few under the current structure. If
individuals are Medicaid eligible, there are private nursing
facilities available for them. She stated that the Pioneer Homes
fulfill the moderate income seniors and alzheimers disease or
related dementia seniors, who are not Medicaid eligible. She said
that they are not pursuing an initiative to make Pioneer Homes
Medicaid eligible.
SENATOR ELLIS asked if poor individuals would go to private nursing
homes, while wealthy individuals would go to Pioneer Homes. NANCY
USERA said that Pioneer Home residents cross the spectrum of the
senior community. She discussed the change in the Pioneer Homes'
population, they do not need twenty-four hour nursing but rather
they need the assisted living type of situation. Alzheimers is not
a Medicaid eligible diagnosis so currently, there is no funding for
them. She reiterated that the Pioneer Homes serve a moderate
income level population.
SENATOR ELLIS inquired as to what level of the administration was
the decision made not to pursue an initiative to make Pioneer Homes
Medicaid eligible. NANCY USERA explained that for the past three
years the administration has explored, with consideration to budget
concerns, how to maintain the financing structure of the Pioneer
Homes. The benefits of making Pioneer Homes Medicaid eligible do
not out weigh the costs.
SENATOR ELLIS pointed out that the rates of the Pioneer Homes have
been increasing which indicates, to him, the need to bring in more
money in order to lessen the general fund obligation. He stated
that there was a lack of consistency.
NANCY USERA explained that to convert to a Medicaid system would
require significant structural changes to the Pioneer Home. The
rates are adjusted on an annual basis with respect to the cost of
living in order to keep up with the additional cost of running the
homes. She noted that Pioneer Home residents only pay 13 percent
of the cost of nursing, they pay 23 percent with assisted living,
and 35 percent with residential. She said that these rates are not
unreasonable. She believed that the residents are still receiving
the best deal in Alaska in terms of quality of care at the price.
SENATOR ELLIS disagreed with Ms. Usera on the issue that SB 249 has
nothing to do with Pioneer Homes regarding rates and such.
Number 492
DAVE WILLIAMS referred to a 1990 December Report which illustrates
the avoidance of approximately 200 nursing home constructions by
emphasizing home rather than institutional care. Since the current
facilities are full, waivers should be acquired and used as well as
going forward with assisted living homes. He asserted that unless
those alternatives were utilized, nursing homes would be
constructed. Such circumstances would leave Medicaid responsible
for paying for the nursing homes.
SENATOR SHARP asked if Mr. Williams was referring to section C
regarding the omitted language. DAVE WILLIAMS said no and
specified that the language was omitted in the work draft on page
27, line 11 after subsection (b). He reiterated his recommendation
to insert the language, "Not withstanding the expenditure threshold
in AS 18.07.031," at the beginning of subsection (b), before "A."
SENATOR SALO moved to adopt Mr. Williams suggestion.
Page 27, line 11, after "(b)":
Insert "Not withstanding the expenditure threshold in AS
18.07.031,"
Hearing no objections, it was adopted.
MARY LOU MIENERS, Chairperson of the State Legislative Committee
(SLC) for American Association of Retired Persons (AARP), stated
their support for SB 249. She envisioned this as an opportunity to
assist seniors in their communities on a smaller scale. She urged
passage of SB 249.
SENATOR DUNCAN moved CSSB 249 (HES) as amended out of committee
with individual recommendations and the accompanying fiscal note.
Hearing no objections, it was so ordered.
Number 556
CHAIRMAN RIEGER introduced SB 270 (COMPREHENSIVE HEALTH CARE) and
SB 284 (COMPREHENSIVE HEALTH INSURANCE ACT) as the next order of
business before the committee. He stated that he intended to
discuss the liability reform proposals of both bills. He noted
that there had been a hearing on Senator Duncan's bill of last year
and it would be available for discussion as well.
SENATOR DUNCAN specified that the Tort Reform bill was left to move
on its own. Therefore, there is no companion bill to SB 284.
CHAIRMAN RIEGER asked Ms. Usera to discuss the proposals of SB 270
regarding civil procedures, arbitration.
NANCY USERA pointed out the two civil provisions of SB 270. The
first provision is, section 4, page 8, a non-binding court ordered
arbitration for malpractice suits. She noted that this alternative
dispute resolution has been successfully used in other states.
This would resolve a malpractice suit before going through a costly
litigation process. The second provision in section 6 addresses a
similar concept for claims against insurance companies.
TAPE 94-16, SIDE B
Number 593
NANCY USERA summarized that they are attempting to uncover more
cost effective ways to resolve these disputes short of the courts.
CHAIRMAN RIEGER asked if the possibility of strengthening the
burden of proof, or the penalties on either party that rejects the
arbitrator's claim had been considered. NANCY USERA said no. Ms.
Usera explained that the premise of SB 270 is to do what can be
done now. This was the first step towards finding alternative
dispute resolutions.
CHAIRMAN RIEGER indicated that he may want to introduce something
similar. He noted a discussion with the legal counsel who
explained that one cannot mandate that an arbitrator's ruling is
deemed to be true nor can the burden be placed on the individual to
disprove the ruling. The stakes, such as court costs and attorney
fees, can be raised. He asked Senator Duncan to discuss SB 123
regarding an OB statute of limitations.
SENATOR DUNCAN explained that there were no recommendations on Tort
Reform in SB 284 because of the constitutional single subject rule.
He pointed out that there were recommendations in SB 123:
(1) reducing the statute of limitations for birth related injuries
from current law to the eighth birthday of the child;
(2) court ordered non binding arbitration process be used to
replace existing pre-trial screening process for medical
malpractice suits; and
(3) change the pre-judgement interest rate from 10.5 to the
prevailing interest rate.
CHAIRMAN RIEGER inquired of the expert advisor provision. SENATOR
DUNCAN believed that was part of the non binding arbitration
process.
NANCY USERA stated that changes a court rule which requires a
different vote of the legislature to do that. She explained that
SB 270 converts from a three person panel to a one person expert
advisor for the resolution. She referred to an article which would
be given to the committee which illustrates the success of
arbitration versus litigation; 89 percent of the cases were settled
prior to hearings. She clarified that the provisions in SB 270 do
not limit anyone's liability, but only provide an alternative to
dispute resolution; therefore, the single subject rule does not
seem to apply.
SENATOR DUNCAN requested a legal opinion.
Number 539
CHAIRMAN RIEGER offered an amendment for discussion regarding
raising the stakes which would clarify that court costs and
attorney fees would go against the party who attempts to appeal the
arbitrator's decision if nothing changes. The amendment was
written for SB 270 because the drafter needed somewhere to start,
but Chairman Rieger did not know where it would be used. Chairman
Rieger asked if there were any questions or objections to the basic
ideas of the proposals by Senator Duncan, Nancy Usera, and his
amendment.
SENATOR ELLIS stated opposition of the proposals being proposed
separately. The recommendations Senator Duncan discussed were
adopted in the context of a comprehensive health care reform
package. He pointed out that many of the recommendations were
adopted because other parts of the Task Force's recommendations
were adopted. The Tort Reform recommendations of the Task Force
proposed individually would not be supported by the majority of the
Task Force. He stated that he would support the provisions in the
context of comprehensive health care reform.
CHAIRMAN RIEGER acknowledged the need to review the proposals case
by case and not always refer to them in context of the entire
package. He advised the committee that the provisions regarding
regulation of insurers, the standardized claims form, and the
fiscal notes of both SB 270 and SB 284 would be addressed at the
next meeting. He said that the civil procedure aspect of the bills
could be discussed today.
SENATOR DUNCAN clarified that the work group did not endorse any of
the Tort Reform proposals even those in SB 123. There was no
formal recommendation from the work group.
SENATOR ELLIS added that he believed that most physicians thought
Tort Reform was going to pass this year and time should not be
wasted discussing or negotiating other liability and compensation
limits in the health care reform context.
CHAIRMAN RIEGER explained that he did not realize that Tort Reform
was not part of the work group's proposal. The February 9, 1994
draft of the Health System Reform Work Group, Alaska Proposal SB
284 lists Tort Reform as item ten. SENATOR DUNCAN informed
Chairman Rieger that he had an old copy, there is a newer copy that
would be provided.
Number 469
SENATOR ELLIS asked if Mr. Walsh would be discussing the Division
of Insurance's portion of the fiscal note for both bills.
CHAIRMAN RIEGER reiterated that the standardized claim form, the
regulation of insurers, and the fiscal notes would be before the
committee on Friday.
SENATOR DUNCAN requested that Kim Busch and others of the
Department of Health and Social Services be present on Friday to
discuss the various Medicaid claim costs and administrative costs.
He expressed concern with a fiscal note being prepared by AETNA; he
would review that aspect.
There being no further business before the committee, the meeting
was adjourned at 2:55 p.m.
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