ALASKA STATE LEGISLATURE  HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  February 24, 2015 3:06 p.m. MEMBERS PRESENT Representative Paul Seaton, Chair Representative Liz Vazquez, Vice Chair Representative Louise Stutes Representative David Talerico Representative Geran Tarr Representative Adam Wool MEMBERS ABSENT  Representative Neal Foster COMMITTEE CALENDAR  PRESENTATION: OCS RESPONSE TO CRP ANNUAL REPORT - HEARD SPONSOR SUBSTITUE FOR HOUSE BILL NO. 27 "An Act relating to the duties of the Department of Health and Social Services; relating to hearings on and plans for permanent placement of a child in need of aid; relating to school placement and transportation for children in foster care; relating to foster care transition programs; relating to emergency and temporary placement of a child in need of aid; relating to the confidentiality of information regarding child protection; and amending Rule 17.2, Alaska Child in Need of Aid Rules of Procedure." - HEARD & HELD PREVIOUS COMMITTEE ACTION  BILL: HB 27 SHORT TITLE: DHSS DUTIES;CINA; FOSTER CARE; ADOPTION SPONSOR(s): REPRESENTATIVE(s) GARA 01/21/15 (H) PREFILE RELEASED 1/9/15 01/21/15 (H) READ THE FIRST TIME - REFERRALS 01/21/15 (H) HSS, JUD 02/11/15 (H) SPONSOR SUBSTITUTE INTRODUCED 02/11/15 (H) READ THE FIRST TIME - REFERRALS 02/11/15 (H) HSS, JUD 02/12/15 (H) HSS AT 3:00 PM CAPITOL 106 02/12/15 (H) Heard & Held 02/12/15 (H) MINUTE(HSS) 02/24/15 (H) HSS AT 3:00 PM CAPITOL 106 WITNESS REGISTER CHRISTY LAWTON, Director Central Office Office of Children's Services (OCS) Department of Health and Social Services Juneau, Alaska POSITION STATEMENT: Testified and answered questions during the OCS response to the annual Citizens Review Panel report (via teleconference). REPRESENTATIVE LES GARA Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Presented SSHB 27 as the sponsor of the bill. TREVOR STORRS, Executive Director Alaska Children's Trust Anchorage, Alaska POSITION STATEMENT: Testified during discussion of SSHB27. NAOMI HARRIS, Community Relations Manager and Legislative Contact Central Office Office of Children's Services Department of Health and Social Services Juneau, Alaska POSITION STATEMENT: Testified during discussion of HB 27. ACTION NARRATIVE 3:06:38 PM CHAIR PAUL SEATON called the House Health and Social Services Standing Committee meeting to order at 3:06 p.m. Representatives Seaton, Tarr, Wool, Talerico, Stutes, Vazquez, and Tarr were present at the call to order. ^PRESENTATION: OCS Response to CRP Annual Report PRESENTATION: OCS Response to CRP Annual Report  3:07:15 PM CHAIR SEATON announced that the first order of business would be a response by the Office of Children's Services to the annual Citizens Review Panel report. 3:08:20 PM CHRISTY LAWTON, Director, Central Office, Office of Children's Services (OCS), Department of Health and Social Services, directed attention to the 2014 OCS Response to the CRP Annual Report [Included in members' packets]. She spoke about Recommendation 1, suggestions for changes to the OCS intake policy, and noted that OCS had elected to adopt all of those suggestions. She noted that OCS had a long term plan for movement from the five regional intake units to a more streamlined, more efficient, and more effective centralized intake function. She stated that this would make the suggested CRP changes more easily adopted. 3:09:48 PM MS. LAWTON directed attention to the second recommendation, which focused on the development of a model for serving families when the children were in their own home, in-home cases. She reported that, with availability of the right services and the right safety network, OCS could prevent a child from being removed from their home. She stated that this took a much higher level of oversight, monitoring, and support services, and noted that OCS had struggled with this implementation, especially in rural areas. She reported that this was also a part of the OCS five-year plan with the federal government and that the division was seeking assistance from national resource centers for development of a model that would fit Alaska's unique needs. She reiterated her agreement with this recommendation. 3:11:48 PM CHAIR SEATON read from the OCS response: The reading of the cases revealed extensive involvement of village safety officers, school officials, tribal partners, and community leaders. This support will be an integral piece of building an in-home program with can effectively serve rural areas. CHAIR SEATON asked if there was any engagement with tribal entities for something similar to circle justice, or whether OCS was focusing specifically on state enforcement services. MS. LAWTON replied that OCS had worked closely with its tribal partners on this issue and had just finished a five year collaborative project with thirteen tribal organizations as well as the National Indian Child Welfare Association (NICWA). This project was for the development of increased tribal infrastructure with a unique model of practice to serve families in their own home. She declared that the project had been successful as many of the tribal organizations did develop their own model, which supported better communication during family referrals. She noted that there was still a challenge, as many of the organizations were stemming out of hub locations. She offered an example of the Bethel region as a hub for more than 52 individual tribes and communities. She noted that OCS only had offices in three of those communities in that region. She expressed agreement that OCS was working with the tribes for what each could bring to the table for traditional services, not necessarily Western types of services, as well as looking to services from other state partners. She admitted that, even with the combined services, it was difficult to attain the necessary oversight for leaving a child in the home. 3:15:25 PM REPRESENTATIVE STUTES, suggesting that there were difficulties with the intake process, asked if the process offered any immediate accommodation for those walking in with a concern. MS. LAWTON replied that any walk in would immediately be connected with an intake worker. She declared that, as the OCS policy assumed there was child maltreatment, even if it was not clear, the report was documented electronically in the data management system. REPRESENTATIVE STUTES asked for clarification that she would be documented as reporting on an issue. MS. LAWTON replied that was exactly what would happen. 3:17:18 PM CHAIR SEATON asked if the schools in the community were involved in the case. MS. LAWTON replied that the schools were an integral part of the communication and partnership, especially in the communities where the school was a center of the community. She shared that often it was the school filing the report. She acknowledged that, as the school could be in a difficult role, OCS tried to be sensitive to that position during the process. CHAIR SEATON observed that, as the committee was not intimately familiar with this entire process, it was good for Ms. Lawton to share all the information for a better understanding. 3:18:56 PM MS. LAWTON addressed Recommendation 3, that OCS address the root of the initial assessment backlog problem. She explained that the initial assessment, also known as the investigation, was when the case worker would make the initial contacts, collect information, and make a decision for the child's safety and the direction of the case, usually within the first 30 days after the report. If there was not any safety threat, or reason to believe the child was in impending danger, then the worker would set aside the paperwork for officially closing the record while out working on other open investigations. It was this lag for the investigation closure paperwork within 45 days that had created a backlog. She said that OCS was continually addressing and monitoring this, as it was important for these cases to be closed; however, it was difficult when the resources were constantly stretched as thin as they were currently. REPRESENTATIVE STUTES asked for clarification that a case needed to be closed within 45 days. MS. LAWTON explained that most contacts and interviews for new cases of alleged maltreatment were conducted in the first one - two weeks. She said that the decision for whether to keep a case open or whether it was appropriate to close was made within 30 days, and then the supervisor had up to 45 days to make the final decision. REPRESENTATIVE STUTES asked if this included the disposition for whether or not the child remained in the home. MS. LAWTON said that an evaluation and assessment was made, but this was not a disposition in the legal sense in most cases. OCS did determine whether it was safe for the child to remain in their own home, with or without services, or if an out-of-home removal was required. REPRESENTATIVE STUTES asked if this was the determination necessary to be made within the 45 day period. MS. LAWTON said that the decision for removal was often made in the first few days. 3:23:29 PM REPRESENTATIVE TARR questioned whether, as the number of initial assessments was increasing, were the situations now more complex or more difficult to assess. She reported that the number of child sexual abuse allegations had increased and opined that this was true for all forms of child abuse. She asked whether a rise in awareness had resulted in more reporting of incidences. MS. LAWTON expressed agreement that there had been a gradual increase in the total number of reports received. She said that the rate for incoming reports; however, was not as striking as the rate for assigning new reports for investigation. She explained that OCS had made changes over the last several years to try to get ahead of the repeat maltreatment issues and causes by getting to those families sooner for an intervention. She offered that, although OCS had not studied the issue for severity and complexity, based on anecdotal reports, things were far more complex and severe in recent years. There were more challenging situations with domestic violence and substance abuse. REPRESENTATIVE TARR offered an example for a higher percentage of cases that needed more investigation. MS. LAWTON expressed her agreement. 3:26:22 PM REPRESENTATIVE WOOL asked if the number of calls had been increasing over the last several years. MS. LAWTON replied, "yes." REPRESENTATIVE WOOL reviewed the three phases: contact, assessment, and intervention if necessary. He asked whether all of these phases had increased proportionately. MS. LAWTON replied that the number of children being served on an on-going basis was proportionately "spiking up," though it was not proportional to the number of calls being received. She clarified that while there has been some growth in the total number of reports received, OCS had made changes to its practice which resulted in more reports being screened in for investigation sooner than previously. REPRESENTATIVE WOOL asked whether the same number of staff were addressing these increasing numbers. MS. LAWTON advised there had not been an increase in responding case workers. 3:28:16 PM MS. LAWTON directed attention to Recommendation 4 that OCS make improved relationships with its community partners a priority. She opined that this focused on many of the rural communities, although, as the partnerships were essential to serve the families, OCS could not do the work alone. She concurred with and promoted the recommendation. She relayed that the extensive turnover in OCS did not allow the relationships to blossom. She explained that the workload in many of the rural communities did not allow the time necessary to be in the community to promote these relationships. She shared that in some communities, as the staff had been there for a long time, there were wonderful relationships; however, it was very striking and very problematic when it was not there. She stated that OCS continually worked with staff and managers to find more ways to promote these relationships. REPRESENTATIVE TARR asked about the prevention efforts, noting that the CRP believed that this was beyond the scope of the OCS mission. She asked how prevention efforts fit into the overall workload and whether more work should be done on prevention and should include the community partners. 3:30:48 PM MS. LAWTON said that it was within the OCS purview and responsibility to have these relationships with key community partners and service providers. She pointed out that prevention was a mandate for OCS, and that there were prevention programs; however, the average caseworker did not have the time to focus in this area. CHAIR SEATON asked whether the higher percentage of Alaska Natives in foster care related to the in-home model, or was the inability to have sufficient contact within the rural communities a part of the driver for more Alaska Natives to be placed in out-of-home care. MS. LAWTON replied that there was a relationship, and if there were more efficient, effective models and ways to deliver services around in-home, more children would be able to remain safely in their own home, which she deemed to be a good thing for those families and communities. She stated that, when those services were not available, especially in the most rural and economically challenged communities, children did not fare as well when they were moved from their home to another location. 3:33:25 PM MS. LAWTON reported that OCS had an array of new initiatives and work efforts currently under way, many of which were spelled out in its five-year Child and Family Services plan. This plan had been tailored to address the most challenging areas for outcomes families were experiencing. She pointed to the centralized intake plan as one goal, as well as a review for innovations to a birth parent mentoring program, which would help to engage parents and lead to more success within the system. She expressed a desire to arrive at some strategies for team decision making to use in the urban areas, which she described as a mechanism for bringing together all the key participants to support a family around critical issues and placement decisions. She said that OCS had struggled in its efforts to expand this statewide because of the striking differences among the regions, though the agency was working to find a model that worked everywhere and included cultural norms. She noted that much of the success was from an increase to the transparency of agency decisions. HB 27-DHSS DUTIES;CINA; FOSTER CARE; ADOPTION  3:37:06 PM CHAIR SEATON announced that the next order of business would be SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 27, "An Act relating to the duties of the Department of Health and Social Services; relating to hearings on and plans for permanent placement of a child in need of aid; relating to school placement and transportation for children in foster care; relating to foster care transition programs; relating to emergency and temporary placement of a child in need of aid; relating to the confidentiality of information regarding child protection; and amending Rule 17.2, Alaska Child in Need of Aid Rules of Procedure." REPRESENTATIVE LES GARA, Alaska State Legislature, noting that the proposed bill had a zero fiscal note, explained that this was an evidence based and cost effective bill. He acknowledged there were many problems with the foster care system, although many of these would require a lot of money to fix. Instead, as there was limited funding, it was necessary to "live with overworked social workers" with caseloads that were 50 percent higher than they should be. He stated that the proposed bill would address evidence based aspects. He declared that studies revealed that foster youth who were removed from their homes, and often bounced among many homes, suffered emotional damage. He referenced the Adverse Childhood Experiences studies (ACE), and pointed out that foster youth tended to have very high adverse experiences scores, which got worse when youth were bounced from home to home. He stated that Alaska now allowed youth to stay in a foster care home until 21 years of age, and that OCS should have to show it is in the best interest of the child to release them prior to this age. He declared that this was the standard for children, "is it in the best interest of the child." He shared that the proposed bill required that the court ask about this standard for evidence based practice for foster youth. He referenced a study by the Casey Foundation which stated that kids released from foster care before the age of 21 will be "less likely to complete high school, more likely to have physical, developmental and mental health challenges, most lose their existing support system when they reach 18 and are discharged into state custody." He stated that, in Alaska, this manifested itself by the person living on the street, and he shared that 40 percent of foster youth in Alaska end up homeless or couch surfing, while 24 percent end up in jail. He emphasized the importance for giving a child stability, and reducing the number of placements and disruptions in a child's life. He reported that in 12 states the average child was staying with their parents at home until 25 years of age. He stressed that a key part of the proposed bill was that a judge needed to be shown that it was in the child's best interest to be released from foster care before they were 21 years of age. He declared that this was a cost savings program and a measure of our humanity as a society. REPRESENTATIVE GARA emphasized that permanency was a key in foster care, that foster children needed a stable home. He reported that the national standard for foster youth placement in a permanent home was between 12 and 24 months, depending on whether the youth was being re-united with their family. He said that OCS did well with reunification for some youth, although with others this could take longer than 10 years. He explained that the proposed bill ensured that the court would ask if all reasonable efforts had been taken to find a permanent home for a youth. He shared that "all reasonable efforts" was the same standard as used in other sections of the statutes. He explained that this was important as the social workers were young, and often only lasted in the job for 18 months before they burned out. He opined that it could take more experience to get a foster child placed into a permanent home, so this would act as a check in the system to ensure that OCS was doing everything possible for finding a permanent home. He stated that children being bounced around homes created institutional child abuse and neglect, even if it was not intentional. 3:44:50 PM REPRESENTATIVE GARA referenced the Permanente Journal, a nursing publication, which stated that the more foster homes a foster child lived in, the higher their adverse childhood experiences (ACEs) score, the more damage to them, and the higher likelihood for the need of public assistance in the criminal system or in social services. 3:45:33 PM REPRESENTATIVE GARA directed attention to the third part of the proposed bill, which also reflected a nationally recognized standard. He stated that moving a child from school to school during the school term caused them to fall up to three months behind in the curriculum. He stressed that this would make any academic achievement worse than if they were allowed to finish the term in their original school. He reported that there was a national standard for homeless children which required they stay in their school of origin for the remainder of the term, if it was reasonable and in the child's best interests. He acknowledged that, although there should not be a high burden placed on the understaffed foster care system at OCS, there was a national duty that when a child was taken from their parents, within the first 30 days they were placed in an emergency placement home, which tended to be a larger home and often not the best homes for youth. He explained that these emergency homes were often limited to a 30 day stay and youth could sometimes "bounce from one 30 day home to another 30 day home." He surmised that sometimes the best placement for a child was with a member of the extended family, and that, in some cultures in Alaska, these family members could be as important as the immediate parents. He noted that current law required that a 30 day search for friends and family members start when a child was taken from a home. He stated that the proposed bill would extend this by adding that it was necessary for a constant look out for family members even beyond the first 30-day period, for as long as the child was in foster care. He declared his desire to include the standard for a continual search for family members both before and after the emergency placement, as OCS was able. He emphasized that, as there was a shortage of foster care parents, a loving relative who was willing to take care of the child was best, as this would save a lot of money and be more humane. REPRESENTATIVE GARA relayed that a portion of the proposed bill was really a message to the governor and to OCS. He noted that, although money had been placed in the capital budget over the last few years to advertise for more foster and adoptive parents, there were still 849 youth waiting for adoptive homes in Alaska, which he deemed to be "way out of proportion of many other states." He asked that the governor and OCS staff pitch the need for foster care and adoptive parents, noting that this had been placed in the proposed bill. REPRESENTATIVE GARA explained that there was a provision in the proposed bill important to Alaska Natives which allowed OCS to negotiate a confidentiality agreement and share information with the local tribal organization. REPRESENTATIVE GARA directed attention to two other small provisions in the proposed bill. He pointed out that, under statute, foster youth were only entitled to a "basic education," whereas everyone else was entitled to an "adequate education." The proposed bill changed this in statute to allow for an education that involved a traditional school or vocational education, and deleted the word "basic." He addressed the independent living program, part of the OCS system which affected youth ages 16 - 23, and reported that there were only six staff responsible for helping older youth with this transition into the community. He reported that there were 300 - 400 of these youth. He said that the proposed bill required a simple annual report from OCS for whether the funds for employment and training vouchers for youth were adequate for the need. He explained that these vouchers were used by youth for vocational education, college, or general education degrees and helped keep youth off the street, supporting their success. He stated that the proposed bill did not include any costs, as the legislature would only review "low and no cost bills right now." 3:53:46 PM REPRESENTATIVE STUTES directed attention to page 4, line 23, of the proposed bill, "another suitable person" and asked if there was a definition somewhere in statute. She noted that the word "reasonable" was also frequently used in the proposed bill, and asked if that also had a definition in statute. REPRESENTATIVE GARA, in response, explained that "another suitable person" was not a change from existing law and that OCS would interpret this, as they always did, as a person who was in the child's best interest. He pointed to page 5, line 11, and said that "making reasonable efforts" was a standard which OCS had worked with throughout the statutory system, and was defined as the kind of efforts that a reasonable person would engage in. He said that this was the statutory standard by which OCS currently operated, and this would keep the language consistent with existing law. 3:55:35 PM REPRESENTATIVE STUTES asked where she could find the OCS definition of reasonable. REPRESENTATIVE GARA relayed that reasonable efforts was defined in the statute. 3:56:16 PM REPRESENTATIVE WOOL asked if foster kids over 18, but under 21 years of age, were allowed to be released from the system upon request. REPRESENTATIVE GARA said that current law made it mandatory for OCS to allow a foster youth to leave after 19 years of age. REPRESENTATIVE GARA, in response to Representative Wool, said that existing law was confusing, but that the proposed bill was not changing any existing law. He stated that a youth could request to leave once they were 19 years of age. He opined that there might be an exception for a youth with a mental challenge who had a conservator. REPRESENTATIVE VAZQUEZ asked if OCS had commented on the proposed bill. REPRESENTATIVE GARA said that he had worked closely with OCS on the proposed bill to make it workable and had changed the language where possible to meet their needs, but he did not know their position. CHAIR SEATON relayed that a person from OCS was available. He referenced page 7, line 27, and asked for a definition to the "disclosure of appropriate information" and whether this referred to confidential information. 3:59:43 PM REPRESENTATIVE GARA directed attention to line 30, and noted that, as this would all be subject to a confidentiality agreement, it would be confidential information. He acknowledged that some federal laws, such as the Health Insurance Portability and Accountability Act (HIPAA) could not be violated, but that the intent was to give OCS and the tribal entities flexibility to agree on a confidentiality agreement to allow for information that could be used by the tribal entity to help the child that lived in their community. CHAIR SEATON directed attention to page 8, [line 28] which changed from "a child" to "or person," and asked if there was any limitation that ended at 21 years of age. REPRESENTATIVE GARA replied that foster care had only been extended to 21 years of age in Alaska, and he was not aware of any other state which had extended it past this age. He explained that the words "or person" referenced a person over 18 years and one day of age. REPRESENTATIVE WOOL asked if the requirement for searching beyond 30 days for family members to provide foster care was an added burden on OCS that it may not be able to fulfill. REPRESENTATIVE GARA replied that this additional time period was proposed as a much more relaxed standard than the current federal standard which required a comprehensive family search and was a very strict standard. He reported that the proposed bill suggested that OCS should always be looking for a family, but it was not the same comprehensive search standard as for the first 30 days. CHAIR SEATON moved to adopt the zero fiscal note from HB 27 to SSHB 27. There being no objection, it was so ordered. 4:04:30 PM REPRESENTATIVE VAZQUEZ offered her support for the conceptual direction of the proposed bill, but she expressed concern to the possibility of a zero fiscal note. CHAIR SEATON replied that the fiscal note had been written by the department, and he suggested to next query the department. [Public testimony was opened] 4:05:23 PM TREVOR STORRS, Executive Director, Alaska Children's Trust, declared that kids were the number one resource in Alaska, and that they defined us for who we would be tomorrow. He stressed that the treatment for kids today would determine the future. He stated that the proposed bill reduced trauma in kids' lives, ensured resiliency, and leveled the playing field. He said that, although most children did not experience this level of trauma, it was sometimes necessary for OCS to step in and remove children from their families. He shared that even though these traumas would have lifelong impact if not addressed, removal from the family could add to the trauma. He stated that society recognized that it was important to remove children from an unsafe environment, but that it was done in such a way as to reduce the trauma and provide a resiliency and strength to overcome this experience. He referenced the ACE study which showed the relationship of impact that toxic stress such as child abuse and neglect had on the development of a child's brain, which would then lead to a higher increase of risk for experiencing the many physical, social, and behavioral ills with which communities had to deal. He listed diabetes, obesity, child abuse, failure to graduate from high school, substance abuse, and suicide as costs to the state. He observed that the proposed bill was an opportunity to change policy and strengthen these children. As soon as a child had permanent residency, the sooner they would be able to deal with their trauma and the issue of separation from their family. Placement closer to their family made it much easier. He stated that the proposed bill ensured that the State of Alaska, OCS, and individuals would take the responsibility to work hard and make sure these children were as close to family as possible. He said that the connection to an adult loved one offered the resiliency to adversity. He pointed out that the family connection offered even more resilience. He declared his support for the proposed bill, even if there was a new fiscal note. He declared that "this is priority, because either we pay today or we will be paying tomorrow." He pointed out that there were many individuals without a high school diploma, in the correctional facilities, or receiving treatment for substance abuse who were kids that had experienced life in the foster care system. He emphasized that "it does take a village to raise a child" and that passage of the proposed bill would ensure that children would have the resiliency to overcome trauma and become true, productive members of the community. 4:11:44 PM NAOMI HARRIS, Community Relations Manager and Legislative Contact, Central Office, Office of Children's Services (OCS), Department of Health and Social Services, in response to Representative Vazquez, said that the department had worked with the bill sponsor and that the administration was neutral on the proposed bill. In response to Representative Wool, she explained that efforts to continue to search for relatives throughout the life of the case was already in policy. CHAIR SEATON asked if the actions of the department would change with passage of the proposed bill. MS. HARRIS offered her belief that it would not change existing practice. 4:13:39 PM REPRESENTATIVE VAZQUEZ asked if OCS projected any additional cost to implement the proposed bill. MS. HARRIS replied that the fiscal note was in response to this version of the proposed bill. REPRESENTATIVE WOOL asked for an explanation to the neutral stand by the department. MS. HARRIS explained that many of the activities were already federally mandated or observed in policy or practice. REPRESENTATIVE WOOL asked if passage of the proposed bill would change the current day to day procedures and practices. MS. HARRIS offered her belief that this would not change any of the practices that the agency already observed in response to federal mandates, state statutes, or OCS internal practices, although it did provide some alignment or clarification. 4:15:37 PM REPRESENTATIVE VAZQUEZ asked for clarification that children were currently in custody up to 18 years of age. MS. HARRIS stated that children could remain in care until 21 years of age. REPRESENTATIVE VAZQUEZ asked if the proposed bill would make that mandatory and result in more children in foster care. MS. HARRIS explained that there would not be any increase, and, in response to Representative Vazquez, said that this was existing practice, whereas the proposed bill outlined when a child could be released with their consent or in their best interest. 4:16:44 PM REPRESENTATIVE STUTES asked if education and vocational training was currently provided. She expressed her concern for the lack of a fiscal note. MS. HARRIS explained that the proposed bill had been thoroughly reviewed and that the fiscal note was accurate for the proposed bill. She stated that education and vocational training were currently provided, and that the expansion was in the language from "basic education." CHAIR SEATON asked if this would change the practice for current educational opportunities. MS. HARRIS replied that this was correct. REPRESENTATIVE STUTES offered her assumption that, with the absence of a fiscal note and the department's neutral stance, the proposed bill did not make any difference for [Due to technical difficulties, part of the testimony was unclear.] or the relationship with any individuals at this time. MS. HARRIS replied that many pieces of the proposed bill already existed in federal mandate or state statute, or were existing best practice policies, and that an overall alignment existed. REPRESENTATIVE STUTES asked for clarification that the proposed bill did not offer any significant changes to current practice. MS. HARRIS replied "not at this point." 4:19:25 PM CHAIR SEATON said that HB 27 would be held over. 4:19:36 PM ADJOURNMENT  There being no further business before the committee, the House Health and Social Services Standing Committee meeting was adjourned at 4:19 p.m.