HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE March 14, 1994 3:00 p.m. MEMBERS PRESENT Rep. Cynthia Toohey, Co-Chair Rep. Con Bunde, Co-Chair Rep. Gary Davis, Vice Chair Rep. Al Vezey Rep. Pete Kott Rep. Harley Olberg Rep. Bettye Davis Rep. Irene Nicholia MEMBERS ABSENT Rep. Tom Brice (Excused) OTHER LEGISLATORS PRESENT Rep. Jerry Sanders COMMITTEE CALENDAR Confirmation Hearing: Commissioner of Health and Social Services, Margaret Lowe HB 356: "An Act relating to living wills and do not resuscitate orders; and providing for an effective date." PASSED OUT OF COMMITTEE *HB 412: "An Act relating to facilities for the care of children; to child placement agencies; to maternity homes; to certain residential facilities for adults; and to foster homes for adults; and providing for an effective date." HEARD AND HELD (* First public hearing.) WITNESS REGISTER MARGARET LOWE, Acting Commissioner Department of Health and Social Services P.O. Box 110601 Juneau, Alaska 99811-0601 Phone: (907) 465-3030 Position Statement: Addressed the committee LYNNE SMITH, Committee Aide House HESS Committee State Capitol Juneau, Alaska 99801 Phone: (907) 465-6825 Position Statement: Answered questions regarding confirmation MARK JOHNSON, Chief Emergency Medical Services Section Division of Public Health Department of Health and Social Services P.O. Box H Juneau, Alaska 99811-0616 Phone: (907) 465-3027 Position statement: Testified on HB 356 PAT O'BRIEN, Social Services Program Officer Division of Family and Youth Services Department of Health and Social Services P.O. Box 110630 Juneau, Alaska 99811-0630 Phone: (907) 465-2145 Position Statement: Testified in support of HB 412 LARE, President Alaska Association for the Education of Young Children 1805 Bunker St. Anchorage, Alaska 99503 Phone: (907) 274-7793 Position Statement: Testified in support of HB 412 (spoke via teleconference) NANCY JOHNSON, Staff Person Division of Family and Youth Services Department of Health and Social Services 751 Old Richardson Hwy. Fairbanks, Alaska 99701 Phone: (907) 451-2650 Position Statement: Testified in support of HB 412 (spoke via teleconference) MARY MATTHEWS, Family Support Coordinator Fairbanks Resource Agency P.O. Box 80196 Fairbanks, Alaska 99708 Phone: (907) 456-8901 Position Statement: Testified in support of HB 412 (spoke via teleconference) JODY ENGELMAN, Executive Director P.O. Box 32839 Juneau, Alaska 99803 Phone: (907) 789-7610 Position Statement: Testified in support of HB 412 PREVIOUS ACTION BILL: HB 356 SHORT TITLE: LIVING WILLS AND MEDICAL CARE ORDERS SPONSOR(S): HEALTH, EDUCATION AND SOCIAL SERVICES JRN-DATE JRN-PG ACTION 01/10/94 2021 (H) READ THE FIRST TIME/REFERRAL(S) 01/10/94 2021 (H) HES, JUDICIARY 03/03/94 (H) HES AT 03:00 PM CAPITOL 106 03/03/94 (H) MINUTE(HES) BILL: HB 412 SHORT TITLE: COMMUNITY CARE FACILITIES SPONSOR(S): RULES BY REQUEST OF THE GOVERNOR JRN-DATE JRN-PG ACTION 01/28/94 2177 (H) READ THE FIRST TIME/REFERRAL(S) 01/28/94 2178 (H) HES, FINANCE 01/28/94 2178 (H) -FISCAL NOTE (DHSS) 1/28/94 01/28/94 2178 (H) GOVERNOR'S TRANSMITTAL LETTER 03/14/94 (H) HES AT 03:00 PM CAPITOL 106 ACTION NARRATIVE TAPE 94-48, SIDE A Number 000 CHAIR BUNDE called the meeting to order at 3:05 p.m., noted members present and announced the calendar. He then asked Commissioner Lowe to make an opening statement. Number 003 MARGARET LOWE, Acting Commissioner, Department of Health and Social Services (DHSS), stated that she has been in Alaska since 1951 and her major areas of training and professional expertise have been in education. She started working with people with special needs in the early 1960's. She indicated that in 1954 she walked up and down Fourth Avenue in Anchorage carrying a placard that said, "I am a little man for statehood." She strongly believes in democracy where all citizens are involved in their government. She also stated that she believes strongly in advocacy. COMMISSIONER LOWE further explained that she has mostly worked in the area of education, but she also involved herself in areas of advocacy and participated on many boards and commissions at local, state, and national levels. She indicated that she has been a registered Republican for all her voting years and she has been involved for many years in the processes of administration and with the needs of Alaskans. COMMISSIONER LOWE said that of all the administrative departments, the Department of Health and Social Services is the "people department," and she does the best that she can with the resources that she has to problem solve and to meet the needs of Alaskans. Number 145 (Chair Bunde indicated for the record that Representatives B. Davis and Nicholia arrived at 3:08 p.m.) CHAIR BUNDE said he was glad that the little man for statehood was gender neutral. COMMISSIONER LOWE responded that it was not in those days. REP. TOOHEY said it was her hope that if there is a change in the governorship in the next election, Commissioner Lowe would continue to serve her position and indicated that her job is on the line if and when a new governor is elected. COMMISSIONER LOWE indicated that she has not set any time limits on how long she would serve as commissioner and that she is not obligated in any way to leave. Number 212 REP. NICHOLIA asked Commissioner Lowe her views on the future of the Behavioral Health Aid Program, its potential for expansion, and its success rate in rural areas. COMMISSIONER LOWE asked if Rep. Nicholia was referring to the Human Resources Health program that is under the DHSS. REP. NICHOLIA replied yes. COMMISSIONER LOWE indicated that the program is one of the most cost effective programs going in the DHSS and that it does all the right things in that it trains paraprofessionals and uses their abilities as they climb the career ladder. She explained that the successful programs are an incentive to other villages to start their own programs. She stated that she strongly believes that the young people in the rural villages must be professionally trained and she felt that every possible incentive is given to them through the program. She indicated that there has only been positive feedback, and if resources were to become available, she would triple the size of the program. Number 284 REP. G. DAVIS stated that the man in the street is saying cut the budget. He said the DHSS has one of the largest budgets for the entire state. He indicated that possibly up to $200 million could be cut from the DHSS budget and asked "could you do that and still be here, do you think?" COMMISSIONER LOWE asked if Rep. G. Davis was asking if she could live with a cut that deep. REP. G. DAVIS said yes. COMMISSIONER LOWE said she could, but indicated that as resources are continually being limited, the department is challenged to become more creative and to avoid duplication. She also said that integration of services in the most cost effective way would also help to ease the impact. She stated that all citizens need to understand that "we are where we are because we were all a part of the picture. It wasn't just I or just you who got us to this point." REP. G. DAVIS said it was a good answer that sounded quite like campaign promises or discussions. Number 353 (Chair Bunde indicated that Rep. Sanders was present and welcomed him to join the committee at the table.) CHAIR BUNDE referred to the significant travel budget within the DHSS and asked if Commissioner Lowe had any ideas as to how to reduce that budget. Number 355 COMMISSIONER LOWE indicated that most people do not fully understand just how much of that budget is used for moving sick clients, children, mentally ill patients and juvenile offenders. She said a great portion of the budget is actually direct services to people. She indicated that budget cutting in that area of the travel budget would be quite difficult. She also explained that DHSS staff people need to travel in order to do their job. She felt the more they travel the more they are capable of doing a better and more thorough job by visiting sites more often and providing more technical assistance. However, she did submit that the use of teleconferencing could be used more often and that she would take a closer look at the travel habits of their clinicians and professionals. Number 451 CHAIR BUNDE explained that the general public does not understand how difficult it would be to limit the travel of clients and encouraged her to find ways to curtail the travel expenses of department clinicians and professionals; i.e., more electronic communications and people working out of their homes. COMMISSIONER LOWE indicated that lap-top computers are very helpful and felt they are a step in the right direction toward efficiency. REP. NICHOLIA agreed that it is important that the clinicians travel to rural villages to continue their work. She then asked what strategies would be used by the DHSS to address the problems of alcoholism and suicide. Number 501 COMMISSIONER LOWE stated that she has been struggling with both issues for quite some time. She indicated that inhalant abuse is a profound problem among youths today. She explained that studies have shown that a heavy concentration on educational programs helps to reduce substance abuse among youths. Commissioner Lowe felt that programs that are in urban and rural areas and the use of paraprofessionals in the villages are contributing factors in the fight against addiction and the high suicide rate. She asserted that continuous contact between two people on an ongoing basis is very important to the recovery from addiction. However, she said, currently the programs do not allow them enough time to recover and indicated that up to twelve years is nothing. She also mentioned that an important aspect of proactive programs is the self- actualization of cities, towns, and villages. They must become involved in their own growth. However, she indicated that there must be support from the DHSS as most places cannot do that on their own. Number 575 CHAIR BUNDE asked Commissioner Lowe if progress is being made in the areas of public health and prevention regarding individual health. COMMISSIONER LOWE said that there has been much progress in the programs that address alcoholism and mental illness and noted that there are various programs that can address those issues. She felt that programs that address family support, such as families with a member who is mentally ill, families that have a member who is developmentally disabled, and families that are dealing with an elderly member, are very important and slowly making gains in the state. She asked Chair Bunde if his question had been answered. CHAIR BUNDE said he was asking if the state should be optimistic or pessimistic, but indicated that obviously the state should be optimistic. Number 655 COMMISSIONER LOWE also explained that the more the DHSS can learn, the more able they will be to overcome the scarcity of resources. CHAIR BUNDE reiterated that resources are scarce and agreed that a can do attitude will help to overcome the limiting factor of money. Number 664 REP. KOTT referred to the serious drug and alcohol problem in the state and said that many people believe that the state has "been throwing good money after what I would call... bad solutions." He asked Commissioner Lowe if she had any solutions that would turn the trend around. COMMISSIONER LOWE said she could not turn the trend around with less resources. She explained that recovery from addiction is a very long process and the philosophy is that a person must stay in recovery the rest of their life, they can never forget that they've been addicted. She reminded the committee that the population of Alaska has been growing consistently and that young people are becoming chemically dependent at younger ages. She further indicated that if she could have things her way, she would highly prioritize it as an area that the state should put a lot of resources into, as it is a very long and costly process. Commissioner Lowe explained that abstinence is the base of the programs under DHSS and she referred to twelve step programs as another source for recovery that also suggests the practice of abstinence. COMMISSIONER LOWE further stated that different things work for different people and pointed out acupuncture as another form of prevention that is a small part of a grant in Juneau. She again stated that the various types of treatment require a lot of resources. Number 739 CHAIR BUNDE referred to the high rates of teen pregnancy, sexually transmitted diseases, and AIDS cases and asked Commissioner Lowe if there was progress being made in those areas. COMMISSIONER LOWE felt that the DHSS was doing a good job in terms of surveillance, educational materials, and treatment. She said it takes more than a young student receiving a week of training or lessons to really teach them the impact that a disease or addiction can have on their lives. She said the process must be continual and that people must be inundated with education to counteract many misperceptions and wrong messages that she believes the public gains from television. She promoted one on one support and volunteer work. Number 779 CHAIR BUNDE said, "It might be helpful for every Hollywood production we have on RATNET, we could have an educational program to go hand in hand." COMMISSIONER LOWE said she felt the quality on public television was definitely higher than that of RATNET. REP. TOOHEY asserted that the state is edging on full blown AIDS epidemics in rural villages. She suggested that perhaps some type of programming be done on RATNET to educate villages. She then asked if the DHSS is ready for the devastation of the AIDS epidemic. COMMISSIONER LOWE said no. She felt that there is much planning to do and that the Healthy Alaskan 2000 document is almost back from the printers. She said the planning has not been costed out and much more work needs to be done. Number 831 REP. TOOHEY urged Commissioner Lowe to work with Indian Health Services and referred to the AIDS epidemic as a time bomb. CHAIR BUNDE asked for further questions. There being none, he asked the pleasure of the committee. REP. TOOHEY asked what the wording would be for the motion. CHAIR BUNDE said that perhaps the preferred phrasing would be to pass Commissioner Lowe's name to the Speaker with the committee members' individual recommendations. REP. TOOHEY said so moved. REP. OLBERG said for the record that he would make that motion with his personal strong support for the confirmation of Commissioner Lowe. CHAIR BUNDE repeated the motion and asked for any objections. REP. VEZEY objected. CHAIR BUNDE asked Rep. Vezey to speak to his objection. REP. VEZEY indicated that the format for the motion is to pass the nomination from the committee without any specific recommendations. CHAIR BUNDE said he believed it was with individual recommendations and asked for input from Lynne Smith, the House HESS Committee aide. Number 860 LYNNE SMITH said that individual recommendations were made on boards and commissions last year. She indicated it did not reflect an intent by any members to vote for or against the individual during any further sessions for purposes of confirmation. Number 865 REP. VEZEY said, "It's your call, Mr. Chairman." CHAIR BUNDE said, "It's not an indication of your intent to vote on the floor. If I might read this for the committee: Dear Madam Speaker, In accordance with AS 39.05.080 the House Health Education and Social Services Committee reviewed the qualifications of the following individual and recommends the appointment be forwarded to the joint session for our consideration. Commissioner... the Department of Social Services, Margaret Lowe, this does not reflect any intent by any member to vote for or against this individual during the further sessions for the purpose of confirmation." REP. VEZEY said, "I make a motion to that effect." CHAIR BUNDE indicated that Rep. Olberg had already made the motion and asked if Rep. Vezey still maintained his objection. REP. VEZEY said he felt a roll call vote should be taken. CHAIR BUNDE called for the vote. Representatives Toohey, Bunde, G. Davis, Vezey, Kott, Olberg, B. Davis and Nicholia voted Yea. There were no Nay votes. Chair Bunde indicated that Commissioner Lowe's confirmation would go forward to the Speaker. COMMISSIONER LOWE commented that a number of the people in the audience were from the Bridges Campaign for Mental Health. She thanked them for their support. CHAIR BUNDE thanked the members of the Bridges Campaign for attending. REP. TOOHEY said that the state was lucky to have Commissioner Lowe. Number 916 CHAIR BUNDE brought HB 356 to the table. HB 356 - LIVING WILLS AND DNR ORDERS CHAIR BUNDE indicated that Rep. Toohey was the prime sponsor of the bill which had been before the committee previously and asked for further discussion. REP. CYNTHIA TOOHEY indicated that the questions and concerns submitted by CRAIG LEWIS, Executive Director of Interior Region Emergency Medical Services Council (IREMSC), had been addressed. She further indicated that legal services felt that the legislation was "on the mark" and all relevant concerns were addressed in the legislation. CHAIR BUNDE asked if there was any additional public testimony for HB 356. There was none. REP. OLBERG asked what became of the recommended changes by Mr. Lewis. REP. TOOHEY indicated that the recommendations were not accepted. She said MARK JOHNSON from the Division of Public Health and representatives of the Division of Legal Services addressed the concerns and decided that they were not valid. Number 972 MARK JOHNSON, Chief of the Emergency Medical Services Section, Division of Public Health, Department of Health and Social Services, testified on HB 356. He stated that he had spoken with Mr. Lewis that morning and indicated that he had agreed to withdraw all of his objections on the bill. He said that it was agreed that some of Mr. Lewis' concerns would be addressed in the process of regulation and implementation. CHAIR BUNDE asked for further discussion. Hearing none, he then asked the pleasure of the committee. REP. B. DAVIS made a motion to move HB 356 out of committee with individual recommendations and accompanying fiscal note. Number 993 CHAIR BUNDE asked if there were any objections. There being none, Chair Bunde declared that HB 356 was so moved. CHAIR BUNDE then brought HB 412 to the table. HB 412 - COMMUNITY CARE FACILITIES CHAIR BUNDE asked PAT O'BRIEN to address HB 412. Number 995 PAT O'BRIEN, Social Services Program Officer, Division of Family and Youth Services (DFYS), Department of Health and Social Services (DHSS), testified in support of HB 412. She stated that she has been involved in licensing for more than 20 years and that she was grateful to the co-chairs for scheduling a hearing on the legislation. She reminded the committee that among them was an expert in the area of licensing, Rep. Bettye Davis. She asserted that the licensing of programs for vulnerable populations is a vital public function and one that the state has had difficulty keeping up with in recent years. She said the focus of the bill is to work smarter by consolidating a number of licensing procedures into one particular place to make it easier for licensers. MS. O'BRIEN explained that the there are over 2000 licensing facilities and referred to the pie chart in the bill packet which shows that foster homes and child and child care facilities take up the majority of the chart. She indicated that the smaller sections of the chart are very complex sections. She explained that when the legislation is passed along with the assisted living bill (HB 377), adult licensing will be removed from DFYS. She further stated that if HB 377 fails to be passed, HB 412 contains provisions that would enable DFYS to continue adult licensing until an assisted living bill could pass. MS. O'BRIEN said efficiency would be advanced by combining a variety of regulations, thereby making it easier for those who work in a one person office in rural areas. She felt that consolidation would also make it easier for communication between private licensing agencies, of which the division works with approximately twelve. MS. O'BRIEN pointed out another feature of the legislation as being a shared partnership with both parents and private agencies that would make it more clear to the parents that they have a shared responsibility with the state in monitoring the care of their children. She also indicated that private agencies have asked that liability protection be placed in the statute for them. MS. O'BRIEN explained that the proposal does not constitute many changes in licensing. She reiterated that the thrust of the bill is to consolidate for purposes of efficiency by combining various processes into the bill. She continued testimony with a sectional analysis. MS. O'BRIEN stated that Sections 1, 2 and 3 make no change at all except for numbering to make it compatible with child care laws, day care assistance programs, and child care grants. She explained that Section 4 makes a small change by allowing for a less onerous grievance procedure rather than a "full blown" administrative hearing. She said only the most serious enforcement steps taken will be an administrative hearing under the Administrative Procedures Act. MS. O'BRIEN said that Section 5 is what licensing is all about. She said instead of the term "private institutions" a new title of Community Care Licensing would be used. She also said the section clarifies the role of licensing and their responsibility of informing parents of what their roles are. She said the provision includes voluntary licensure, which is done on a time available basis. MS. O'BRIEN indicated that the ability to charge fees has been included in Section 6. She said she suspected that regulations would be promulgated that will provide for fees, but the department wanted it in statute as soon as possible. TAPE 94-48, SIDE B Number 000 MS. O'BRIEN further indicated that the division has contracted with agencies to perform licensing evaluations. She explained that with a village of 400 people there would be no agency there to perform an evaluation. She further indicated that the division would be able to enter into agreements with individuals as well as agencies to perform the evaluations. Ms. O'Brien said a subsection would delegate powers to municipalities, and indicated that currently Anchorage is the only municipality with the power to adopt state standards. MS. O'BRIEN continued on to say, "Section 7 has to do with applicability and exemptions. This is an important section, and I know it's a long section in the bill, but it pretty much reflects current practice with the exceptions that I'll point out. The four exceptions are... there was an exception for occasionally placing a child for foster care or adoption, and we've removed that exception. As far as we know, attorneys no longer are doing that without going through placement agencies. So, there will be no impact. We think this is good for children. "The exemption for governmentally operated programs has been removed. Only one local government, as I mentioned, the municipality of Anchorage, actually regulates day care centers and they do not operate any programs. The age of a child has been changed from 16 years to 18 years of age, and as far as we can tell, there will be no known impact or no programs impacted by that change. And, probably the most important change, there was a clause in there that allowed you to operate for ninety days without a license, which undercut the whole idea of licensing. The idea of licensing is to get in there before children are in care, reduce risk, check things out, and then have children come into care. So, we think that's an important amendment." MS. O'BRIEN indicated that she was not going to go through Sections 8, 9 and 10 because they are current to what is in statute now. She did mention that Section 10, regarding orientation and training, was made applicable to all facilities and indicated that only parents are currently included in current statute provision. She further indicated that it is very important that people know what is confidential and what is not. She explained that there has been much conflicting advice from attorneys. She said for the most part licensing records are "open" but there are a few things that should be confidential. She explained that potential foster parents give the division very personal background information that should remain confidential. MS. O'BRIEN further stated that Section 11 encourages parents to participate in monitoring child care facilities. She also mentioned that there is a lot of support across the state for there to be inspections before every license is issued. She said Section 11 requires that there be an on- site inspection before any license is issued. MS. O'BRIEN said Section 12 addresses complaints and investigation enforcement. She asserted that a complainant would get a copy of the report upon request and that retaliatory action is prohibited. She said often an employee is afraid to report a violation of regulation. She explained that enforcement actions which are currently in the licensing manual would be included in the legislation. Number 197 REP. TOOHEY referred to the $65,000 for fiscal year (FY) 1995 and $35,000 for FY 1996. She said every new facility would have to be inspected and indicated that the financial impact is not reflected in any of the other fiscal notes. She asked if it should be reflected. MS. O'BRIEN said no. She explained that current practice is not being changed within the bill and that there would be no increased cost in inspections. She said currently a number of licensers are experiencing an overload. She said badly needed relief will be afforded when adult licensing is removed from the division. Also, the consolidation of procedures will provide more relief. She maintained that the division would not be doing more than they are now, so a fiscal note was not attached to the activity of licensing. Number 242 REP. TOOHEY asked if a questionnaire is sent to those who apply for a license. MS. O'BRIEN explained that a questionnaire is sent out to applicants for foster home. REP. TOOHEY asked how many pages are in the questionnaire. MS. O'BRIEN replied that the application is one page; however, there are different attachments depending on the type of facility. She indicated that the application with a background questionnaire for foster care is about six pages, which includes criminal history background information. REP. TOOHEY asked if police records are requested to verify the criminal histories of applicants. MS. O'BRIEN explained that in a child foster home licensing situation the division receives a signed application, a personal history background statement, and child protection background or a criminal history background. All applicants must get their fingerprints rolled. She indicated that the state pays for the criminal history background checks. Number 293 CHAIR BUNDE asked if the fiscal note reflects new money or a transfer. MS. O'BRIEN responded that the fiscal note would cover the transition and would allow the division to be more creative in working with the providers and developing revised regulations. She said approximately six regulations would be changed and a task force would be formed of those who would be affected. She then said the division would promulgate the regulations, draft them, go through the public hearing process, and then conduct regional training. Number 348 CHAIR BUNDE indicated that there was teleconference testimony from Anchorage and Fairbanks. He then referred to the statutory ability to charge fees and urged Ms. O'Brien to exercise that right to offset the fiscal note. Number 365 MS. O'BRIEN continued on with the sectional analysis. She stated that Section 13 addresses the licensing of adult facilities and said if HB 377 does not pass, the division would not put the section into effect. MS. O'BRIEN further stated that the remaining sections address liability and definitions. She then indicated that the DHSS had brought forward four amendments and that Rep. Kott also had submitted amendments. She asked Chair Bunde if she should address those or wait until after further testimony. Number 390 CHAIR BUNDE said teleconference testimony would be heard and asked for testimony from Anchorage. Number 392 LARE, President of the Alaska Association for the Education of Young Children (AK-EYC) testified via teleconference in support of HB 412. She stated the AK-EYC supports HB 412, provided that the fiscal note of $100,000 for a statewide task force for implementation and training is also passed. She said that early childhood professionals welcome regulation that reduces risks to young children in out-of- home care. She then referred to the ability to charge fees and said she suspected that many Alaskans feel that they have not paid their fair share for a number of years; however, she felt that the area of community care facilities is one of the most vulnerable populations. She also stated that the people who care for and educate those children are paid much less than parking lot attendants or garbage collectors. She said she was concerned that if a fee is charged it would be passed on to the parents. REP. VEZEY referred to Lare's statement that child care workers are paid less than garbage collectors and asked her which job she thought was more difficult to perform. MS. O'BRIEN asserted that caring for a young child for eight to ten hours a day was a far more difficult task. She said it may appear to be a lot of fun, and in many ways it is, but it takes an extraordinarily high skill level to care for someone else's child. REP. VEZEY said, "My question then would be, why don't those people get jobs as garbage collectors instead of working in child care facilities?" MS. O'BRIEN responded, "Well, I guess it's because that there are some among us who find that our real talents are working with the very young child and their families. That's why we went to college, that's why we have the degrees that we have, and we choose to stay in that position." Number 508 CHAIR BUNDE asked for teleconference testimony from Fairbanks. Number 509 NANCY JOHNSON, Staff Person, Division of Family and Youth Services, Department of Health and Social Services, testified via teleconference in support of HB 412. She stated that she has worked in the area of licensing for 23 years. She said the licensing that she performs represents a valuable preventive function. She indicated that often licensers have to perform several different kinds of licensing, especially in rural areas. She asserted that the legislation is designed to simplify regulations and implementation. She said the proposal also includes concepts that other states are using and indicated that Alaska belongs to many national associations for regulatory administrators and has participated in projects that have allowed key personnel to stay current with national trends and recommendations. She further stated that the legislation would make it easier for licensing to work with community groups for recruiting and evaluating service providers. CHAIR BUNDE asked Ms. Johnson, if HB 412 was passed, would she be personally involved in setting up the study groups? MS. JOHNSON said she expected to be. REP. TOOHEY referred to the $45,000 budget for travel and asked Ms. O'Brien if perhaps the questionnaires could be sent to local public health nurses or community health aids so they would be responsible for the procedure rather than spending $45,000 on travel. MS. O'BRIEN indicated that the travel budget is specifically for the task force. She said if the travel budget is not supported, the participants will not be able to meet face to face. She said she is hoping that there will be much involvement from Bush communities and Native organizations and that the only way to address those concerns is to meet face to face. REP. VEZEY referred to the statement made by Ms. O'Brien regarding Section 7 which changes the age of children from 16 to 18 years of age. He said he was unable to find that provision. MS. O'BRIEN indicated that the language is actually in definitions under Section 17. She said the definition of a child would be up to age 18 and would affect the application of the statute. REP. VEZEY asked what page the definitions section was on. MS. O'BRIEN said page 19. Number 637 REP. VEZEY asked why the definition of child was being changed from 16 to 18 years of age. MS. O'BRIEN explained that the division licenses a number of programs that serve children ages 16 and 17 and over 17 years of age in foster homes. She said it only makes sense to include that age range because the division is regulating facilities with those age ranges anyway. REP. VEZEY said the language is really referring to unemancipated minors. REP. TOOHEY asked if developmentally disabled persons were also included. MS. O'BRIEN replied yes. She said, "...and since adult licensing has been in our division, we have found that children move from a child foster home then and it becomes an adult foster home. And, I suspect if the assisted living bill passes, we will continue to collaborate with them to make sure that there's a smooth transition there." Number 668 CHAIR BUNDE asked for further testimony from Fairbanks. Number 669 MARY MATTHEWS, Family Support Coordinator, Fairbanks Resource Agency, testified via teleconference in support of HB 412. She stated that she was pleased to see the clarification of immunity from liability for private agencies provided for in the proposal. Number 684 CHAIR BUNDE asked for testimony from JODY ENGELMAN. Number 685 JODY ENGELMAN, Executive Director, Juneau Youth Services, testified in Juneau in support HB 412. She stated that the legislation would provide consistency among the various types of regulations and would ease up the job of licensers by making definitions consistent. She also felt that the regulations that she was currently working under were very old fashioned and cannot address the current or future concerns and changing services. She further stated that she supports the attached fiscal note, as it will enable the division to be in contact with families and their needs. CHAIR BUNDE indicated that to address the amendments that have been put forth, HB 412 must be adopted by the committee as a working draft. REP. VEZEY concurred. CHAIR BUNDE then asked for a member to move Amendment 1 so the department could discuss it. REP. TOOHEY said so moved. REP. KOTT asked if the committee was addressing his amendment. CHAIR BUNDE indicated that Amendment 1 was from the DHSS. He asked if Rep. Kott felt it would be more productive to address his amendments first. REP. KOTT said the decision was up to Chair Bunde. CHAIR BUNDE indicated that DHSS Amendment 1 had been moved and asked Ms. O'Brien to speak to the amendment. Number 743 MS. O'BRIEN indicated that there are a number of child care facilities on military bases in Anchorage and in Fairbanks and also the Kodiak Island Coast Guard facility. She explained that in those facilities there are one or more staff persons that perform evaluations and provide training to those facilities. Ms. O'Brien maintained that they are better staffed than the state is. She said the division stopped regulating the facilities a number of years ago. She said the purpose of the amendment is to clarify that military bases and Coast Guard facilities are not included in regulations. However, she said a side agreement was made with the Coast Guard relative to small communities like Sitka and Cordova that have a number of homes that provide family child care and have been previously licensed by the division. The division will continue to do the licensing for those areas. Number 774 CHAIR BUNDE asked for discussion or questions. REP. VEZEY said he doesn't have a problem with the amendment, but felt the wording was unclear. He said it is not the ownership of the property that the division is interested in, it's the guidelines that the federal agencies operate under that the division is trying to not "reregulate." MS. O'BRIEN responded that the wording was given to her by Commander Gary Palmer. She said he recommended that the language be included and she did not object. CHAIR BUNDE asked for further discussion or objections. Hearing none, Chair Bunde announced that DHSS Amendment 1 was adopted. He then brought DHSS Amendment 2 to the table. REP. B. DAVIS made a motion to adopt DHSS Amendment 2. CHAIR BUNDE asked Ms. O'Brien to speak to the amendment. MS. O'BRIEN indicated that two mistakes were made in the drafting process and encouraged the committee to adopt the amendment to ensure that the relatives are exempted from becoming licensed. She further indicated that Rep. Kott had an amendment that would add a subsection 8, which the division would support because she felt the division amendment does not go far enough. Number 823 CHAIR BUNDE asked for questions. REP. KOTT said he would offer a friendly amendment to DHSS Amendment 2, which was his Amendment 1. CHAIR BUNDE asked to see a copy of the amendment. REP. KOTT stated that all members should have a copy and further explained that the amendment does go further in exempting relatives from being licensed. He said if a grandmother is caring for five grandchildren, she should be exempt. He also stated that great grand parents are included. REP. TOOHEY asked if there is a limit on how many biological grandchildren a person can care for. She asked, if a woman is caring for four or more grandchildren, can she also care for four or more day care children? MS. O'BRIEN explained that anyone can care for four children whether they are related or not without a license, as it is a total exemption. She asserted that the division does not want to license homes where there are relationships and said that is why the clause was added. She said, "Then you may care for up to eight children as a family child care home. And, those could all be related and shouldn't be licensed. But, in order for that to occur, Rep. Kott's amendment is also needed, amendment to my amendment." Number 869 REP. TOOHEY asked if a person does not need a license to care for four children. MS. O'BRIEN said, "Any related child or for four children related or not." REP. TOOHEY said that a person could have eight children in the home without a license. MS. O'BRIEN said, "You can have four children in the house, and you don't need a license. If there... you can have additional children. Four of them can't be related to you, but you could have as many related to you..." REP. TOOHEY said, "And you don't need a license. I mean you can have eight children in the house, four of them can be your grandchildren and four you're caring for in the neighborhood. So, you have eight children of eight children. You do not need a license." MS. O'BRIEN said, "You can take care of four children, without a license, who are not related to you and you're living there. And then, you can take care of additional (four) related children." REP. TOOHEY said there is no limit. REP. B. DAVIS said there used to be a limit. MS. O'BRIEN said, "If all the children are related, then there's no limit. That's what there's no limit on." REP. TOOHEY said, "But, if you take care of four children... you can take care of four unrelated children without a license. And, then you have four grandchildren who come and visit, and you're taking care of them also. That means you have eight children in the house. I mean, you're not saying that this person has to have a license to have eight children in the house." CHAIR BUNDE indicated that the answer is no according to Commissioner Lowe. Number 906 MS. O'BRIEN stated that it is confusing and read from current regulation: "A facility is exempt if they're regularly providing child care only to a child or children related to the resident care giver." CHAIR BUNDE reiterated that a person can take care of a "flock" of children, but no more than four that are not related. TAPE 94-49, SIDE A Number 000 CHAIR BUNDE stated that DHSS Amendment 2 had been moved and that Rep. Kott submitted his Amendment 1 as a friendly amendment. REP. G. DAVIS asked if the motion before the committee was to adopt Rep. Kott's amendment. REP. KOTT said it would be DHSS Amendment 2 as amended. CHAIR BUNDE indicated that it would be DHSS Amendment 2 as amended. REP. TOOHEY asked if DHSS Amendment 2 had to be adopted first before making a friendly amendment. CHAIR BUNDE replied no. He said, "We have an amendment to the amendment before us." REP. TOOHEY said, "But we haven't adopted the second amendment have we?" CHAIR BUNDE said, "No, but we have an amendment to the amendment and then we go to the main amendment. The amendment to the amendment and the main amendment will read as Rep. Kott's Amendment 1 currently reads. It inserts unrelated caregiver, plus the additional insertion that Rep. Kott has... a facility in which the caregiver is related, is a relative of all the children. And, it inserts after grandparents, great grandparents. Do we have some clarity here?" REP. KOTT stated that maybe he should have addressed his amendments first. CHAIR BUNDE said, "We have an amendment to the amendment which is Rep. Kott's Amendment 1. Do you understand that?" REP. B. DAVIS said yes. REP. KOTT moved the amendment. CHAIR BUNDE asked for any objections. REP. B. DAVIS said she would like to hear from the department as to whether they supported the amendment as amended. MS. O'BRIEN said yes. CHAIR BUNDE said, "So, now are there objections?" REP. B. DAVIS said no. CHAIR BUNDE said, "Hearing no objections, we've adopted the amendment to the amendment which brings us to Amendment 2 which is the very same amendment that we... to the amendment that we've just adopted, so are there any objections to Amendment 2?" Number 114 REP. KOTT said, "I'll move Amendment 2." CHAIR BUNDE said, "It was previously moved and so if there are just no objections..." REP. TOOHEY said, "Excuse me, because we have amendments before us that are both labeled, we have two labeled..." CHAIR BUNDE said, "We have Rep. Kott's Amendment 1, which is now Department Amendment 2. Who's on first What's on second? We are now moving on to Department Amendment 3. Rep. Kott, you have something to say on this?" REP. KOTT said no. Number 138 CHAIR BUNDE asked for a member to move DHSS Amendment 3. REP. KOTT said so moved. CHAIR BUNDE asked Ms. O'Brien to speak to the amendment. MS. O'BRIEN indicated that before the bill was brought forward to the committee, the division had two teleconferences with various organizations, including Native organizations. She stated that the Native organizations were concerned as to how difficult it is to license in very small communities and pointed out the difficulties involved when a child must be removed from a home in an emergency situation. She said Amendment 3 would address those concerns. Number 186 CHAIR BUNDE asked for discussion or objections. Hearing none, Chair Bunde declared that DHSS Amendment 3 was adopted. He brought DHSS Amendment 4 to the table. He then said, "And, the reason I was thinking we needed to adopt a CS becomes more apparent with each amendment." He asked for a member to move the amendment. REP. G. DAVIS said so moved. CHAIR BUNDE asked Ms. O'Brien to address the amendment. MS. O'BRIEN explained that in the teleconferences that she mentioned it was pointed out that some variances are allowed for only seven days. She said there would be a lot of extra paper work if a license had to be issued each time a variance was given. She asserted that the amendment is an efficiency amendment. REP. TOOHEY said she was troubled with the proposal because "we can no longer rely on the good will of the village or a neighbor to take care of the child. We are regulating care... the thing just smacks of regulating care of our fellow man out of existence. Does this bother anybody else?" Number 286 CHAIR BUNDE explained that the legislation addresses situations when an official comes and removes and then places the child. He said it does not address the neighbor or relative or grandparent who wants to care for the child. He said the legislation does not preclude voluntary action. REP. TOOHEY said, "Yes, we are." CHAIR BUNDE stated, "I don't think so. Only when an official comes in and says that child's in jeopardy, now I'm making him a ward of the state, basically. It's not saying that neighbors and relatives can't say, `Well, wait a minute, you need some help. Let me give you a hand.'" REP. G. DAVIS indicated that almost any law is on request. People can commit crimes, but if nobody asks that a person be arrested, there will be no arrest unless there is a request for the state to step in. Number 325 CHAIR BUNDE asked for further discussion. He then asked for objections on DHSS Amendment 4. Hearing none, Chair Bunde declared that DHSS Amendment 4 was so moved. He then brought Rep. Kott's Amendment 2 to the table. He asked Rep. Kott to speak to his amendment. (Note: Rep. Kott's testimony pertaining to Amendment 2 is inaudible. Refer directly to Rep. Kott's Amendment 2, as submitted and on file, which refers to page 19, lines 22-23. The amendment suggest deleting the words "whose parents are not" and insert "who does not have a parent.") Number 350 CHAIR BUNDE asked Ms. O'Brien to speak to the amendment. MS. O'BRIEN stated that prior to the meeting she was able to look over all of Rep. Kott's amendments and said she felt comfortable with all of them. CHAIR BUNDE asked if the committee understood the amendment. He asked if there were any objections. Hearing none, Chair Bunde stated that Rep. Kott's Amendment 2 was adopted. He then brought Rep. Kott's Amendment 3 to the table. Number 374 REP. KOTT made a motion to adopt his Amendment 3. He said the amendment addresses page 20, line 19, and would delete the words "have been arrested" and would insert "are under arrest." CHAIR BUNDE said that the amendment would provide that a person's past would not be held against them. He asked for objections. Hearing none, Chair Bunde stated that Rep. Kott's Amendment 3 was adopted. He indicated that it was his intent to have the committee substitute (CS) before the committee before the legislation is passed out. Seeing no further business before the committee, CHAIR BUNDE ADJOURNED the meeting at 4:30 p.m.