SB 159-PAROLE FOR MEDICAL / COGNITIVE DISABILITY    CHAIR GARY STEVENS asked for a motion to adopt the committee substitute (CS) as the working document. SENATOR GRETCHEN GUESS made a motion to adopt work draft \D Luckhaupt 4/9/03 as the working document. There being no objection, it was so ordered. SENATOR LYDA GREEN, sponsor of SB 159, paraphrased from the sponsor statement: SB 159 gives the Alaska Board of Parole (ABP) flexibility to grant or deny medical parole to applicants. Thus the board will be better able to meet the needs of the prisoners, the department and communities. The ABP has a proven track record in their decision- making abilities. Over the past seven years, the ABP has granted parole to approximately 45 percent of all the discretionary parole applicants. Less than eight percent of these parolees have violated their conditions (i.e. missed a meeting with a parole officer) and approximately one percent has committed a new offense. This number is particularly compelling when compared to the 77 percent return rate of mandatory parole violators. This bill will allow the ABP and the Department of Corrections to work together to determine an appropriate and cost effective release plan. The cost of health care to the Department of Corrections has significantly increased over the last few years. Some of the factors causing these increases are: · The increased population of terminally ill inmates · The recent Seward Highway accident on November 19, 2002 · Hospitalization of prisoners for long-term assisted care When making a determination for medical parole the following are considered: · Department of Correction medical report · The seriousness of the criminal offense · Release plan · Parole officer/DOC recommendation Passage of this proposed legislation will allow the ABP to use its endowed power and authority to make responsible decisions regarding all the factors mentioned above, while still considering the safety of the community. CHAIR GARY STEVENS said he has visited several prisons in the last several months and has learned that because the state is fully responsible for the individual while incarcerated, the state may face enormous medical expenses. This bill would allow those seriously ill inmates to return home or move to a facility that provided less expensive treatment. SENATOR FRED DYSON noted the original law didn't allow for parole for someone who was convicted and incarcerated for sexually abusing a minor. He asked if it was correct that this bill removed that provision. SENATOR GREEN said it did; that is what the language on page 1, line 12 does. SENATOR DYSON asked for the reasoning for removing the prohibition for paroles for those guilty of sexual abuse of a minor. JACQUELINE TUPOU, staff to Senator Green, explained the inmates that are considered for medical parole are physically incapacitated. Also, not all medical parolees would simply be released; many would move to other secure facilities. SENATOR COWDERY asked where these inmates would be placed and would the type of crime come under consideration. MS. TUPOU said the bill provides flexibility so each case would receive individual consideration and the determinations would be different. Some inmates would move to another secure facility and others might go home. If parole would diminish the seriousness of the crime the inmate would be disqualified from consideration. CHAIR GARY STEVENS asked the department to come forward. LARRY JONES, Executive Director of the Alaska Board of Parole, said the Parole Board sees this as a corrective bill because the 1995 legislation is overly tight. The department can't legitimately bring inmates to the board to implement the decision making process. When a special medical parole applicant meets the criteria, the board must act quickly because the person is close to death. Since 1996 they have granted just nine medical paroles and have considered just 14 cases. Most died within two to three months of their parole. These inmates are so critically ill they aren't the same person that committed the crime for which they were incarcerated. In his judgment, this bill would not impact public safety. Every year the board makes hundreds of discretionary decisions; this would simply provide them increased flexibility. Medical paroles require that a plan be established for each parolee; inmates wouldn't be tossed "into the gutter." These people are still under the supervision of the Department of Corrections just as any other parolee would be. Whether a parole would diminish the seriousness of the crime is always a consideration and never taken lightly by the board. The Board of Parole stands as a very strong proponent of victim's rights. Victims are notified of the hearings and they may participate. CHAIR GARY STEVENS asked him for an explanation of who is on the Parole Board, the associated responsibilities and the connection with the department. MR. JONES replied it is complex and he would like to hear the question posed more frequently. The Alaska Board of Parole is an autonomous board with five members that report to the governor. There is a certain judicial requirement so there is a geographic representation. Ethnicity and gender are also considerations for appointment. Members serve five year staggered terms and legislative approval is not necessary. Members typically serve for more than one term. The board travels to the hearing sites, which entails considerable travel. They don't hear mandatory parole cases, but 96 percent of their hearings are the revocation hearings for those mandatory paroles. When the board travels this includes five board members, two staff, the parolee and attorney, the state parole officer, the victims and the witnesses. SENATOR COWDERY asked how many inmates might take advantage of a special medical parole. MR. JONES deferred to Mr. Tupou. LEITONI TUPOU, Special Assistant to the Commissioner of Corrections, explained the board would review 13 applications if the bill passes. SENATOR COWDERY asked if that would save $500,000. MR. TUPOU replied it would. MR. JONES added the savings would be greater in the long term. MR. TUPOU referred to a spreadsheet to show how much the state currently spends on those inmates. Under current law, the board would not hear these cases. SENATOR COWDERY asked if the savings would come from transferring the inmates from their present location. MR. JONES said that is correct. SENATOR COWDERY asked if the $500,000 is a medical savings. MR. JONES said the impact of this bill is a matter of who is bearing the cost. 4:00 pm KEVIN HENDERSON, Eligibility Program Officer for the Division of Medical Assistance, advised the department is generally supportive of the bill. Part of the intent is a cost shift because many of these inmates will be looking for a way to pay for continuing medical care. The department sees Medicaid as the likely recipient. At the state level it makes sense to put these people on Medicaid and get federal matching money for at least part of the costs. As long as they are incarcerated the state pays 100 percent of the health care costs. He pointed to the fiscal notes and cautioned it was likely only nine of the 13 would qualify for Medicaid. Some would probably qualify for expensive long-term care and some for adult public assistance. The bill is a good idea for the state but it's important to clearly look at careful discharge planning for each individual to ensure they are provided for. SENATOR LYMAN HOFFMAN made reference to the fiscal note from Health and Social Services and asked if they believe Medicaid expenditures would grow at just ten percent per year. If that's true, he asked how that fits with the data on page 1 of the fiscal note. MR. HENDERSON replied the fiscal note reliability after two years is difficult. They made some assumptions that may or may not be true. Historically Medicaid costs have been increasing at ten percent or more per year. That rate has nothing to do with the 13 Alaska inmates; it's just the rate that health care is increasing. An assumption was made that the nine inmates identified as likely to be eligible for Medicaid would continue to live and that there would be a linear growth of nine new Medicaid recipients each year thereafter. Admittedly, those people are medically fragile and probably wouldn't survive for years, but he was reluctant to project just how long they would live. They were unsure how many inmates would be medically paroled every year or the level of care that might be needed. SENATOR HOFFMAN noted FY09 costs would be $2.7 million, which would be $2.2 million over and above the $500,000 savings. MR. HENDERSON advised him to look at the GF Match line. SENATOR HOFFMAN observed the breakeven point ends in FY06; after which it would cost the state. MR. HENDERSON replied the numbers were probably high and the Department of Corrections would likely make the case that all the parolees would not live five years. SENATOR HOFFMAN rhetorically questioned how many would have to not live that long for it to make sense. ROBERT BRIGGS, staff attorney with the Disability Law Center of Alaska, reported they provide services for Alaskans with disabilities including those in institutions. With the closure of the Harborview institution in Valdez, they now provide protection and advocacy services for nursing homes, prisons and mental institutions. They believe the bill makes sense in terms of saving general fund dollars. He suggested amending the bill to require discharge planning that would address the basic life domains of the prisoner. Because the intended population would be functionally impaired, a plan needs to be in place before they are released. Both Montana and Rhode Island require medical discharge planning in the statute that is parallel to what this bill would do. Appropriate discharge planning would also address the safety concerns. Cost shifting is good because institutional costs are the highest costs. Some of these individuals are likely to be eligible for home and community based waivers meaning a family member could provide care for the individual. Care coordination could certainly be provided cheaper than services in a nursing home. Representative Berkowitz pointed out the language on page 3, line 17 appears to limit the concept of who can be discharged to those who have a cognitive condition that is impaired due to irreversible dementia. The medical officer for the correctional system testified he had no problem eliminating the phrase "due to irreversible dementia." Based on his testimony, the House State Affairs Committee eliminated the phrase. DR. JOHN ROBERTSON, Medical Director and Health Services Administrator for the Department of Corrections, advised the inmates selected for medical parole would be likely to live less than a year. Although there has been mention of cost shifting, all ways have not been addressed. For instance, some inmates would qualify for veteran benefits if they were out of the state system. While this legislation would give the department and the parole board more flexibility, each applicant would be carefully scrutinized and wouldn't be considered for medical parole without adequate discharge planning. SENATOR HOFFMAN asked what he estimated the annual savings to be if parolees lived between six months and a year after parole. DR. ROBERTSON admitted he assisted in drafting the numbers. When he reviewed actual costs for the last three years he found the state spent from $20,000 to $500,000 depending on the medical condition. Statistically medical expenses are the greatest at the end stage of life and it isn't uncommon to accrue a $200,000 bill in the last two weeks of life. Another cost to the department that isn't reflected in the numbers is that while the inmate is institutionalized there are associated officer costs. For every day that someone is in a hospital or nursing home rather than in the correctional system there would be a salary savings for one or two officers. SIDE B 4:25 pm ANNA FAIRCLOUGH from Anchorage expressed concern that sexual assault offenders might be considered for medical parole under SB 159. The proposal is particularly indefensible with regard to those who committed offenses against minors. She questioned whether any of the 13 inmates that might be eligible for medical parole had sexually assaulted a minor. CHAIR GARY STEVENS called Ms. Tupou forward to address the question. SENATOR DYSON asked Ms. Fairclough whether she heard the response when he asked that question. MS. FAIRCLOUGH replied she interpreted his question more globally as confirmation that they were revoking the inability to release sexual perpetrators. Her question specifically asked whether there was a sexual perpetrator in the group of thirteen under discussion. MS. TUPOU replied one inmate was convicted of a sexual offense of a minor. MS. FAIRCLOUGH urged members to be aware that sexual offenders are high repeaters and even though they are on their death bed they might still present a danger because they aren't "hard wired" the same. If they are exposed to children or have any opportunity they will repeat the offense. She supported a discharge plan and asked whether there was a definition in state statute for corrections to use for "severely medically disabled." She asked Senator Dyson to pay particular attention to this bill because it would be a step in the wrong direction to allow a sex offender back on the street. CHAIR GARY STEVENS remarked he was certain that was not the intention of the department. He asked Ms. Tupou to respond to the proposed amendments. For discussion purposes he labeled the discharge plan amendment #1 and the irreversible dementia amendment #2. MS. TUPOU explained the sponsor has no specific problem with either amendment. She opined amendment #1 is redundant since the new regulations became effective on March 29, 2003. CHAIR GARY STEVENS advised the bill would go to the Finance Committee and he would be comfortable passing it along in the present form giving the sponsor the opportunity to address the amendments there. SENATOR GUESS stated she would like to hear from the Disability Law Center whether they were comfortable with the new regulations. She added Ms. Tupou didn't speak to amendment #2. CHAIR GARY STEVENS asked Mr. Briggs to comment on adopting the amendments or passing the bill in the present form with the recommendation that the sponsor carefully review them in the Finance Committee. MR. BRIGGS had no problem passing the bill without the amendments. That the new published regulations require discharge planning, he would take as represented. Further, the point that Dr. Robertson made that a medical officer be charged to ensure there is appropriate continuity of service is reasonable and makes his job easier. There were no further questions. CHAIR GARY STEVENS asked for a motion to move the bill without amendments. SENATOR DYSON made a motion to move SB 159 from committee with attached fiscal notes with individual recommendations. SENATOR GUESS added the points Ms. Fairclough made regarding sex offenders were valid and she would appreciate the sponsor's attention on the issue. There being no objection, SB 159 moved from committee.