HB 164-PROTECT: VULNERABLE ADULTS/LONG TERM CARE  3:08:08 PM CHAIR SPOHNHOLZ announced that the first order of business would be HOUSE BILL NO. 164, "An Act relating to the protection of vulnerable adults and residents of long term care facilities." 3:08:28 PM TERESA HOLT, Long Term Care Ombudsman, Office of the Long Term Care Ombudsman, Alaska Mental Health Trust Authority, Department of Revenue, introduced HB 164 on behalf of the House Rules Committee on request of the Governor. She explained that the proposed bill would amend provisions of AS 47.62, Office of the Long Term Care Ombudsman, and AS 47.24, protection of vulnerable adults, to ensure alignment with the Older Americans Act of 1965 and its implementing regulations. She reported that the Older Americans Act was reauthorized in 2016 and new regulations for Long Term Care Ombudsman were created. As a result, the Administration for Community Living reviewed all states to ensure compliance with these changes, and this review identified two Alaska statutes as being out of alignment with the reauthorization and the Long Term Care Ombudsman regulations. She lauded these as good changes which would be helpful to her office. She stated that the proposed bill would align state and federal statutes and regulations to ensure that the Office of the Long Term Care Ombudsman only shared resident information with informed consent, and to ensure that the office can obtain records to investigate and make referrals when a resident was unable to provide informed consent. The proposed bill added new terms for residents and resident representatives and, due to a conflict of interest, it removed the option for mandatory reporters to meet reporting requirements by submitting reports to the office. The proposed bill clarified the separation of the role of the Long Term Care Ombudsman from the role of the Department of Health and Social Services, and clarified that the Office of the Long Term Care Ombudsman may serve residents in long term care facilities under the age of 60. 3:10:30 PM MS. HOLT paraphrased the Sectional Analysis [Included in members' packets], which read: Section 1 is a technical amendment to AS 47.24.010(a) to update the name of the entity responsible for receiving reports to the department "vulnerable adult centralized intake office". Section 2 is a technical amendment to AS 47.24.010(e) to update the name of the entity responsible for receiving reports to the department "vulnerable adult centralized intake office". Section 3 amends AS 47.24.013(a) to remove the requirement to forward reports of maltreatment to the Long Term Care Ombudsman's office. Adds passive language to allow the DHSS to transfer reports for Long Term Care Ombudsman's investigation as defined under AS.62.015. Section 4 amends AS 47.24.013(b) to delete reference to DHSS's obligation to investigate reports for vulnerable adult's age 60 or less. The Department of Health and Social Services is responsible for reports involving vulnerable adults ages 18 and older. Section 5 amends AS 47.24.013(d) to remove the Long Term Care Ombudsman's obligation to mandatorily provide a report to the DHSS Central Intake. Aligns state law with federal law requiring the Long Term Care Ombudsman's office to only forward information of a complainant or resident with appropriate consent or court order. (45 CFR 1327.11(e)(3)). Amended to reflect current Department of Human and Social Services responsibility for vulnerable adult centralized intake. Section 6 amends AS 47.24.015(a) to remove reference to reports transferred to the Office of Long Term Care Ombudsman under 47.24.013. Updates legislative language to appropriately reference subjects of reports are vulnerable adults. Removes requirement for face to face interview. Section 7 amends AS 47.62.015(a) to add language to align state law with federal law by providing the Long Term Care Ombudsman the authority to investigate and resolve a complaint for a person residing in a long term care facility who is not defined as an older Alaska. Section 8 amends AS 47.62.015(c) to include all residents of a long term care facility. Section 9 repeals and reenacts AS 47.62.025 to define access to long term care facilities, older Alaskan, and records. Title amended to include all ages of residents of long term care facilities. Section (a) amended to include all ages of residents of long term care facilities. Section (b) amended to include all ages of residents of long term care facilities and amended to allow for consent to be provided by the resident or the resident's representative or by subpoena. Section 10 repeals and reenacts AS 47.62.030(b) to include all ages of residents. Amended to allow for disclosures with consent. Adds authority for resident representative to give consent. Amended to align state law with federal law to clarify limited circumstances when the Office of Long Term Care Ombudsman has authority to report resident-identifying information without obtaining resident or resident representative consent. Section 11 amends AS 47.62.060 to include all ages of residents of long term care facilities. Section 12 amends AS 47.62.090 to revise the definition of "older Alaskan" as an individual who lives in Alaska since definition of "resident" was added to mean individual living in a long term care facility. Adds new sections to define resident as an individual who resides in a long term care facility and to align state law with federal law to define resident representative and authority the resident representative has to act on behalf of the resident. Section 13 repeals AS 47.24.010(f), AS 47.24.013(c)(3), and AS 47.24.013(e). AS 47.24.010(f) is repealed as Federal statute and regulations prohibit representatives of the Office Long Term Care Ombudsman from abuse reporting requirements when such reporting would disclose identifying information of a complainant or resident without appropriate consent or court order. (45 CFR 1327.11(e)(3)). Therefor mandatory reporting to the Office of Long Term Care Ombudsman does not fulfill a mandatory reporter's obligation under law to make mandatory reports of maltreatment. AS 47.24.013(c)(3) repeals the requirement for the Office of the Long Term Care Ombudsman to provide results of investigation to the DHSS. OAA Section 712(d)(2)(B) establishes strict disclosure limitations. The Long Term Care Ombudsman program is intended to be a safe, person-centered place for residents to bring their concerns. Residents can be assured that their information will not be disclosed without their consent, the consent of the resident representative, or court order. AS 47.24.013(e) is repealed as the Office of the Long Term Care Ombudsman is not the appropriate agency to officially substantiate abuse or neglect complaints on behalf of DHSS. The Office of the Long Term Care Ombudsman represents the interests of residents, rather than the interests of the DHSS. (See OAA Section 712(a)(3)(E), (a)(5)(B)(iv); 45 CFR 1327.13(a)(5), 1327.19(a)(4)). 3:13:31 PM REPRESENTATIVE SULLIVAN-LEONARD asked about the rationale for the amendment in Section 3. MS. HOLT explained that often there were residents of long term care facilities who were 55 years of age, and the previous legislation only allowed that her office work with people over 60 years of age. This would allow the Office of the Long Term Care Ombudsman to serve people under the age of 60. REPRESENTATIVE SULLIVAN-LEONARD asked about removal of the requirement to forward reports of maltreatment to the Office of the Long Term Care Ombudsman. CHAIR SPOHNHOLZ clarified that Ms. Holt had been referring to Section 4, and that Representative Sullivan-Leonard had questions regarding Section 3. MS. HOLT directed attention to the original statute, which stated that Department of Health and Social Services (DHSS) would forward all reports on people over the age of 60 to the Office of the Long Term Care Ombudsman for investigation. She explained that the Office of the Long Term Care Ombudsman had different investigation priorities, and would investigate issues for residents of long term care facilities. She explained that Adult Protective Services and Licensing investigated to substantiate a report of harm. This would clarify that DHSS would conduct the verifications, and those reports would be forwarded to the Office of the Long Term Care Ombudsman. REPRESENTATIVE SULLIVAN-LEONARD suggested that the Office of the Long Term Care Ombudsman would want that information in order to assist in the process for helping. MS. HOLT replied that two years prior, there had been a meeting of people who worked with seniors living in long term care facilities, which resulted in a system of initial response for investigation. She relayed that this memorandum of agreement dictated that "if adult protective services, residential licensing, and quality assurance feels like it's a report that we should have a copy of, that they will forward that to us." She stated that the majority of the reports of harm were about residents who had fallen to the floor, but were checked and found to be fine. She pointed out that a review of each of these was very time consuming, and was not necessary for her office to review. 3:17:32 PM REPRESENTATIVE EASTMAN asked if the Office of the Long Term Care Ombudsman wanted to know about an incident for maltreatment of a person in long term care. MS. HOLT replied that her office did want to know, adding that the office received between 15-20 reports daily. She reported that central intake received about 50 reports daily, and, as many of these had already been resolved, her office did not need to receive those reports. She added that people could also call her office directly. She offered her belief that this proposed process would work. 3:18:35 PM CHAIR SPOHNHOLZ summarized that the proposed process would narrow the requirement for data reporting or reports of harm to only be those which were substantiated or needed more investigation. MS. HOLT expressed her agreement, and stated that the mandate of the Office of the Long Term Care Ombudsman was to resolve issues of residents that required assistance. CHAIR SPOHNHOLZ suggested that there could be language which would more specifically address the concern. 3:20:39 PM CHAIR SPOHNHOLZ announced that HB 164 would be held over.