ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 11, 2009
3:09 p.m.
MEMBERS PRESENT
Representative Bob Herron, Co-Chair
Representative Wes Keller, Co-Chair
Representative John Coghill
Representative Bob Lynn
Representative Paul Seaton
Representative Sharon Cissna
Representative Lindsey Holmes
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
CS FOR SENATE BILL NO. 32(FIN)
"An Act relating to medical assistance payments for home and
community-based services and provision of personal care services
in a recipient's home; and providing for an effective date."
- MOVED OUT OF COMMITTEE
HOUSE BILL NO. 223
"An Act relating to the qualifications for residential
psychiatric treatment center caregiver staff; and providing for
an effective date."
- HEARD AND HELD
HOUSE BILL NO. 50
"An Act relating to limitations on mandatory overtime for
registered nurses and licensed practical nurses in health care
facilities; and providing for an effective date."
- HEARD AND HELD
SENATE BILL NO. 13
"An Act relating to eligibility requirements for medical
assistance for certain children and pregnant women; and
providing for an effective date."
- BILL HEARING CANCELED
PREVIOUS COMMITTEE ACTION
BILL: SB 32
SHORT TITLE: MEDICAID:HOME/COMMUNITY BASED SERVICES
SPONSOR(s): SENATOR(s) ELLIS
01/21/09 (S) READ THE FIRST TIME - REFERRALS
01/21/09 (S) HSS, FIN
01/21/09 (S) PREFILE RELEASED 1/9/09
02/04/09 (S) HSS AT 1:30 PM BUTROVICH 205
02/04/09 (S) Heard & Held
02/04/09 (S) MINUTE(HSS)
02/23/09 (S) HSS AT 1:30 PM BUTROVICH 205
02/23/09 (S) Heard & Held
02/23/09 (S) MINUTE(HSS)
02/25/09 (S) HSS AT 1:30 PM BUTROVICH 205
02/25/09 (S) Moved CSSB 32(HSS) Out of Committee
02/25/09 (S) MINUTE(HSS)
02/27/09 (S) HSS RPT CS 4DP 1NR NEW TITLE
02/27/09 (S) DP: DAVIS, ELLIS, THOMAS, PASKVAN
02/27/09 (S) NR: DYSON
03/11/09 (S) FIN AT 9:00 AM SENATE FINANCE 532
03/11/09 (S) Heard & Held
03/11/09 (S) MINUTE(FIN)
03/30/09 (S) NR: STEDMAN, OLSON
03/30/09 (S) DP: HOFFMAN, THOMAS, ELLIS
03/30/09 (S) FIN RPT CS 3DP 2NR NEW TITLE
03/30/09 (S) FIN AT 9:00 AM SENATE FINANCE 532
03/30/09 (S) Moved CSSB 32(HSS) Out of Committee
03/30/09 (S) MINUTE(FIN)
04/07/09 (S) VERSION: CSSB 32(FIN)
04/07/09 (S) TRANSMITTED TO (H)
04/08/09 (H) READ THE FIRST TIME - REFERRALS
04/08/09 (H) HSS, FIN
04/11/09 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 223
SHORT TITLE: TRAINING FOR PSYCHIATRIC TREATMENT STAFF
SPONSOR(s): HEALTH & SOCIAL SERVICES
04/08/09 (H) READ THE FIRST TIME - REFERRALS
04/08/09 (H) HSS
04/09/09 (H) HSS AT 3:00 PM CAPITOL 106
04/09/09 (H) Heard & Held
04/09/09 (H) MINUTE(HSS)
04/11/09 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 50
SHORT TITLE: LIMIT OVERTIME FOR REGISTERED NURSES
SPONSOR(s): REPRESENTATIVE(s) WILSON, GARA, TUCK, PETERSEN,
LYNN, SEATON, GATTO, CISSNA, MUNOZ, GARDNER
01/20/09 (H) PREFILE RELEASED 1/9/09
01/20/09 (H) READ THE FIRST TIME - REFERRALS
01/20/09 (H) HSS, FIN
03/12/09 (H) HSS AT 3:00 PM CAPITOL 106
03/12/09 (H) Heard & Held
03/12/09 (H) MINUTE(HSS)
04/11/09 (H) HSS AT 3:00 PM CAPITOL 106
BILL: SB 13
SHORT TITLE: MEDICAL ASSISTANCE ELIGIBILITY
SPONSOR(s): SENATOR(s) DAVIS
01/21/09 (S) READ THE FIRST TIME - REFERRALS
01/21/09 (S) HSS, FIN
01/21/09 (S) PREFILE RELEASED 1/9/09
02/09/09 (S) HSS AT 1:30 PM BUTROVICH 205
02/09/09 (S) Moved SB 13 Out of Committee
02/09/09 (S) MINUTE(HSS)
02/11/09 (S) DP: DAVIS, THOMAS, ELLIS, PASKVAN
02/11/09 (S) HSS RPT 4DP
02/25/09 (S) FIN AT 9:00 AM SENATE FINANCE 532
02/25/09 (S) Heard & Held
02/25/09 (S) MINUTE(FIN)
03/11/09 (S) DP: HOFFMAN, THOMAS, ELLIS
03/11/09 (S) NR: STEDMAN, HUGGINS, OLSON
03/11/09 (S) FIN RPT 3DP 3NR
03/11/09 (S) FIN AT 9:00 AM SENATE FINANCE 532
03/11/09 (S) Moved SB 13 Out of Committee
03/11/09 (S) MINUTE(FIN)
04/06/09 (S) VERSION: SB 13
04/06/09 (S) TRANSMITTED TO (H)
04/07/09 (H) READ THE FIRST TIME - REFERRALS
04/07/09 (H) HSS, FIN
04/11/09 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
MAX HENSLEY, Staff
to Senator Johnny Ellis
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced SB 32 for the prime sponsor,
Senator Ellis.
JON SHERWOOD, Medicaid Special Projects
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Spoke in support of SB 32.
MARIANNE MILLS, President
AgeNet
POSITION STATEMENT: Spoke in support of SB 32.
STEVE LESKO, President
KEY Coalition of Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 32.
MATT JOHNSON, Staff
to Representative Wes Keller
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Explained the proposed amendment to HB 223
labeled C.3.
JEFF JESSEE, Chief Executive Officer
Alaska Mental Health Trust Authority (AMHTA)
Department of Revenue (DOR)
Anchorage, Alaska
POSITION STATEMENT: Testified about HB 223.
MYRA MUNSON, Attorney
The Boys and Girls Home of Alaska
Fairbanks, Alaska
POSITION STATEMENT: Spoke in support of HB 223.
PAT HEFLEY, Deputy Commissioner
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified about HB 223.
STACIE KRALY, Chief Assistant Attorney General;
Statewide Section Chief
Human Services Section
Civil Division (Juneau)
Department of Law (DOL)
Juneau, Alaska
POSITION STATEMENT: Answered questions during testimony about
HB 223.
REPRESENTATIVE PEGGY WILSON
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As the prime sponsor of HB 50, answered
questions on the bill.
NANCY DAVIS, President
Alaska Nurses Association (ANA)
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 50.
LANETTA LUNDBERG, Director
Human Resources
Ketchikan General Hospital
Ketchikan, Alaska
POSITION STATEMENT: Testified in opposition to HB 50.
MICHAEL SMITH
Tanana Chiefs Conference (TCC)
Fairbanks, Alaska
POSITION STATEMENT: Testified about HB 50.
STACY ALLEN, Health Care Representative
Laborers Local 341
POSITION STATEMENT: Testified in support of HB 50.
JUANITA DIAMOND
Ketchikan, Alaska
POSITION STATEMENT: Testified in support of HB 50.
CHRISTINA VANCLEVE, RN
POSITION STATEMENT: Spoke in support of HB 50.
PATRICIA SENNER, RN
Anchorage, Alaska
POSITION STATEMENT: Testified about HB 50.
DEBBIE THOMPSON, Executive Director
Alaska Nurses Association (ANA)
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 50.
KATHLEEN GETTYES, President
Providence Registered Nurses Bargaining Unit
Providence Hospital
Anchorage, Alaska
POSITION STATEMENT: Spoke in support of HB 50.
LEE ANN COX, Human Resources Manager
Wildflower Court
Juneau, Alaska
POSITION STATEMENT: Spoke in opposition to HB 50.
ANGEL DOTOMAIN, President & CEO
Alaska Native Health Board (ANHB)
Anchorage, Alaska
POSITION STATEMENT: Spoke in opposition to HB 50.
ACTION NARRATIVE
3:09:27 PM
CO-CHAIR WES KELLER called the House Health and Social Services
Standing Committee meeting to order at 3:09 p.m. Representatives
Keller, Herron, Holmes, Coghill, Cissna, and Lynn were present
at the call to order. Representatives Seaton arrived as the
meeting was in progress.
SB 32-MEDICAID:HOME/COMMUNITY BASED SERVICES
3:09:55 PM
CO-CHAIR KELLER announced that the first order of business would
be CS FOR SENATE BILL NO. 32(FIN), "An Act relating to medical
assistance payments for home and community-based services and
provision of personal care services in a recipient's home; and
providing for an effective date."
3:10:21 PM
MAX HENSLEY, Staff to Senator Johnny Ellis, Alaska State
Legislature, explained that SB 32 was a collaborative effort.
He stated that home and community based services were the key to
improving the quality of life for seniors and the
developmentally disabled. He emphasized that SB 32 was not
intended to take anything away from care providers, but instead
to create an equitable and predictable process. He observed
that home and community based services were less expensive than
institutional care. He pointed out that long term care costs
were a very large percentage of projected Medicaid expenses. He
stated that most providers had not seen an increase to payment
structure since 2004. He explained that SB 32 gave Department
of Health and Social Services (DHSS) the flexibility to devise a
cost based system for all providers. He explained that Section
1 set rates for home and community based services, as well as
personal care services. He shared that it also reviewed the
rates of payment, but he emphasized that nothing in the bill
appropriated money for the future. He explained that DHSS would
forward its cost proposal survey of suggested rates, which would
become part of the budget process. He noted that there would be
an annual rate review, but that the cost survey would only be
every four years. He pointed out that the inflation rate would
also be considered.
3:15:17 PM
MR. HENSLEY directed attention to Section 2, and confirmed that
DHSS would report the trends and the elements in established
payment rates. He explained that Section 3 repealed Section 2
on June 30, 2014. He pointed out that Section 4 made the bill
effective on July 1, 2011, in order to allow DHSS the time to
develop the methodology. He reviewed the fiscal notes and said
that one was for three DHSS positions, of which 50 percent would
be federally funded. He explained that the second fiscal note
was a projection for the rate increases, in anticipation of the
cost survey results.
3:18:19 PM
JON SHERWOOD, Medicaid Special Projects, Office of the
Commissioner, Department of Health and Social Services (DHSS),
said that the department had worked with the sponsor, and DHSS
was comfortable with the bill language.
3:18:51 PM
CO-CHAIR KELLER opened public testimony.
3:19:02 PM
MARIANNE MILLS, President, AgeNet, explained that AgeNet was a
group of 25 statewide organizations which provided services in
the homes of the elderly, the community centers, and the adult
day facilities. She reported that AgeNet, along with the
Beneficiary Boards of Alaska, Alaska Mental Health Trust
Authority (AMHTA), and other provider groups, had declared
regular rate reviews to be the first priority. She noted that
this coalition had met with Commissioner Hogan (DHSS) and
Senator Ellis. She offered her support for SB 32. She
expressed that the goal of the coalition was to find good
objective data for the actual costs of home and community based
services. She indicated that this would allow for the best
decisions.
3:21:08 PM
REPRESENTATIVE CISSNA said that rate reviews were very
important. She asked if this would study potential care giver
positions, as well as existing ones.
MR. HENSLEY explained that SB 32 covered rate reviews for the
service providers listed under the four current Alaska Medicaid
waivers, as well as rate reviews for the providers of personal
care attendants.
3:22:31 PM
REPRESENTATIVE CISSNA asked if other potential positions would
be covered.
MR. HENSLEY replied that an earlier study had reviewed a broader
group of DHSS funded service providers. He clarified that the
providers referenced in SB 32 were currently ready for rate
reviews. He agreed that other care givers may be included in
future rate reviews.
3:23:29 PM
REPRESENTATIVE CISSNA asked how long this would take to put into
effect.
MR. HENSLEY said that the prior study was for a year. He noted
that DHSS requested 2 years to develop the rate methodology. He
reported the annual rate review would go into effect in FY2012.
3:24:23 PM
STEVE LESKO, President, KEY Coalition of Alaska, said that it
was urgent to pass SB 32 right away. He shared that the goal to
eliminate the wait list [for services] was restrained by the
lack of a rate review process for the community programs. He
opined that this had resulted in difficulties for the programs
with recruitment and retention of staff. He noted that benefit
cuts, increases in deductibles, and the inability to staff had
resulted in a lack of service. He cited that the community
programs did not have equal access to the rate increase reviews
which hospitals were allowed. He declared that this was a labor
intensive profession with big challenges to ensure an adequate
workforce. He stressed that the health and safety of Alaska's
most vulnerable citizens was the paramount concern. He
emphasized that the KEY Coalition supported SB 32.
3:27:38 PM
CO-CHAIR KELLER stated that he was a cross sponsor for SB 32.
3:27:59 PM
REPRESENTATIVE COGHILL suggested that the rate review and the
methodology review should go hand in hand. He noted that the
pressure to raise rates would necessitate that all were treated
fairly.
3:29:58 PM
REPRESENTATIVE CISSNA agreed that it was necessary to address
the work force issue immediately.
3:30:25 PM
CO-CHAIR HERRON posed that the legislation should oblige DHSS to
implement the program in 2012.
MR. HENSLEY replied that there was every reason to believe that
DHSS would do the required methodology work to institute a cost
rate when the bill takes effect.
3:31:22 PM
MR. SHERWOOD asked that DHSS have administrative support in
order to start in two years. He declared that the providers
were not prepared to submit the cost reporting which the
department needed for analysis. He explained that it was
necessary to tell the providers in advance what information was
necessary, and then collect and analyze the responses. He
opined that DHSS had the authority to move forward prior to the
effective date of the bill.
3:33:03 PM
REPRESENTATIVE COGHILL cautioned to be aware of the cost to
providers for collecting information.
MR. SHERWOOD replied that the current language allowed for a
less burdensome cost survey for the providers.
3:34:12 PM
CO-CHAIR HERRON moved to report CSSB 32 (FIN) out of committee
with individual recommendations and the accompanying fiscal
notes. There being no objection, CSSB 32 (FIN) was reported
from the House Health and Social Services Standing Committee.
3:34:40 PM
HB 223-TRAINING FOR PSYCHIATRIC TREATMENT STAFF
3:34:58 PM
CO-CHAIR KELLER announced that the next order of business would
be HOUSE BILL NO. 223, "An Act relating to the qualifications
for residential psychiatric treatment center caregiver staff;
and providing for an effective date."
[The committee had previously adopted Version C, as the working
document.]
3:35:39 PM
CO-CHAIR HERRON moved to adopt the amendment labeled C.3,
4/10/09, which read: [original punctuation provided]
[Included in the members' packets.]
Page 1, line 14 - page 2, line 3:
Delete all material and insert:
"residential treatment for children, inpatient
long-term treatment for children, or other
treatment of severely emotionally disturbed
children; and"
Page 2, lines 9-13:
Delete all material and insert:
"(A) at least four years of increasingly
responsible caregiver experience in residential
treatment for children, inpatient long-term treatment
of children, or treatment of severely emotionally
disturbed children; and"
Page 2, lines 24-27:
Delete all material and insert:
"(C) be assigned to work at the center only
during hours in which supervision or mentorship is
available on- site from an individual
(i)who has a bachelor's degree in a
human- services-related field or meets the
requirements of (2) or (3) of this subsection,
provided
(ii) there must be no less than 1
person on-duty who meets the criteria under (i)
of this paragraph for each 6 caregivers who are
qualified only under this subsection."
Page 2, line 28
Following "training"
Insert "in residential child care"
Page 3, line 3:
Delete all material and insert:
"*Sec.2. The uncodified law of the State of Alaska is
amended by adding a new section to read:
TRANSITIONAL PROVISIONS; REGULATIONS. The
Department of Health and Social Services may proceed
to adopt regulations necessary regarding standards for
residential child care facilities, including the
qualifications of caregivers in residential
psychiatric treatment centers. The regulations take
effect under AS 44.62 (Administrative Procedure Act),
provided that regulations inconsistent with this Act
may not be adopted with an effective date earlier than
April 15, 2010.
*Sec. 3. AS 47.32.055 is repealed.
*Sec. 4. Sections 1 and 2 of this Act take effect
immediately under AS 01.10.070(c).
*Sec. 5. Section 3 of this Act takes effect April
15, 2010.
3:35:49 PM
REPRESENTATIVE HOLMES objected for discussion.
3:36:42 PM
MATT JOHNSON, Staff to Representative Wes Keller, Alaska State
Legislature, said that the amendment, labeled C.3, was an
attempt to consolidate all of the proposed amendments. He
discussed each of the provisions offered in the amendment. He
explained that the Page 1 and the Page 2, lines 9-13 provisions
would make the statute conform exactly to current standards. He
stated that Page 2, lines 24-27 would ensure that caregivers who
were qualified under the new standard in subsection (c) could
only work when a supervisor who had at least a bachelor's degree
in a human-service-related field or experience in treatment of
children was on-duty. He also noted that the ratio of
supervision could be no less than 1 to 6. He pointed out that
Page 2, line 28, would ensure that the training would be
equivalent to that currently provided. He summarized that the
new Section 2 would authorize DHSS to adopt regulations which
might be inconsistent with Section 1, provided they did not go
into effect prior to April 15, 2010. He said that the new
Section 3 would repeal some of the qualifications required of
caregivers in RPTCs [residential psychiatric treatment center],
as of April 15, 2010. He presented the new Section 4, which
conferred authority upon DHSS to adopt regulations for caregiver
qualifications and other standards for RPTCs, and would be
immediately effective. He finished the amendment discussion and
reported that the new Section 5 would delay the effective date
of the repealer in Section 3 until April 15, 2010.
3:40:07 PM
REPRESENTATIVE CISSNA asked if DHSS was going to comment.
MR. JOHNSON replied that DHSS had just received a copy of the
proposed amendment.
3:40:33 PM
REPRESENTATIVE COGHILL opined that DHSS could already solve the
problem without SB 32. He announced that he would oppose the
bill, provided DHSS arrived at a solution. He offered his
support of the proposed amendment if it would facilitate a
solution to the workforce entrance barrier problem.
3:42:25 PM
CO-CHAIR KELLER stated that he wanted only one working document.
3:42:35 PM
REPRESENTATIVE SEATON referred to Page 2, lines 24-27, and asked
for an explanation to the amendment percentage of 1 to 6, or 16
percent, which was substantially higher than the DHSS ratio of
10 percent.
MR. JOHNSON replied that the 1 to 6 ratio conformed to the norm
of other states.
3:43:54 PM
REPRESENTATIVE SEATON asked who suggested this ratio.
MR. JOHNSON replied that Myra Munson supplied that language.
3:44:15 PM
REPRESENTATIVE SEATON asked for supporting data to this lower
level, as it did not agree with the DHSS suggested ratio.
3:44:46 PM
CO-CHAIR KELLER announced that the objection to the amendment,
labeled C.3, would remain while the House Health and Social
Services Standing Committee listened to public testimony.
3:45:23 PM
JEFF JESSEE, Chief Executive Officer, Alaska Mental Health Trust
Authority, Department of Revenue (DOR), opined that the
amendment discussion was proof that trying to write regulation
into statute was not a good idea. He pointed out the disparity
in suggested ratio mentioned earlier was an example of poor
process. He noted that DHSS Commissioner Hogan had committed to
work on these regulations. He suggested that DHSS be given the
opportunity to respond over the interim, and if DHSS had not
made satisfactory progress, to move forward with the bill during
the next session.
CO-CHAIR KELLER replied that DHSS had not yet responded with a
proposal.
3:48:12 PM
REPRESENTATIVE CISSNA asked what AMHTA was doing for the Bring
The Kids Home program. She asked specifically if AMHTA had
discussed the workforce shortages, analyzed the needs, and
offered any suggestions.
MR. JESSEE, in response to Representative Cissna, said that the
work group met regularly, discussed these issues, and had placed
an emphasis on work force development, not just the RPTC levels
of care. He allowed that it was challenging for AMHTA and DHSS
to work on everything at once. He reported that these
regulations were a priority, in order to recruit people with
reasonable qualifications. He explained that the Bring the Kids
Home program had invested in work force development. He pointed
out that the work force would review what other states had done,
and would report back to the committee with a set of regulations
that would meet the needs of the kids and the providers.
3:52:18 PM
MYRA MUNSON, Attorney, The Boys and Girls Home of Alaska,
reiterated that there was an ongoing problem of hiring enough
direct care providers. She noted that a Fairbanks RPTC would
need variances, or passage of HB 223, for hiring its staff. She
opined that the amendment, labeled C.3, reflected a reasonable
standard, based upon her research and past experience. She
explained the reasons for the staffing standards. She expressed
her trust for DHSS and AMHTA intent, but reflected that the
process could be interminably slow. She proposed that HB 223
should be passed, take immediate effect, and have an August 15,
2009, repeal date. She reported that it took nine months for an
assisted living regulation to take effect after the published
first notice, and that it was thirteen months for a barrier
crimes regulation. She pointed out that the first notice of a
Medicaid re-write was published in July, 2006, with a
supplemental notice published in September, 2008, and there was
still not a published regulation. She agreed that this work was
hard, and that there were a lot of issues for review. She
reported that there was currently a "real life problem with a
real life provider who received a Certificate of Need from the
state." She reported that without sufficient response, the
ability to provide care would be compromised. She expressed a
lack of confidence that variance would solve the problem. She
suggested that HB 223 should be passed, with a sunset clause for
one year. She referred to the fiscal note, and relayed that
Alaska Children's Services (ACS) had offered its residential
care training program, which met the current standard, to any
other providers at no charge.
4:00:54 PM
REPRESENTATIVE COGHILL asked how many individual variances would
be requested by the Fairbanks RPTC.
MS. MUNSON replied that she did not know about the process for
granting variances, but that she had heard the ACS testimony of
refusal to its variance request.
REPRESENTATIVE COGHILL replied that DHSS had testified that a
variance was available. He asked if The Boys and Girls Home of
Alaska had applied for a variance.
4:01:42 PM
MS. MUNSON said that one variance was pending, but not in regard
to the direct care giver staff. She relayed that the Boys and
Girls Home was waiting for a DHSS report that identified the
DHSS concerns.
4:02:26 PM
REPRESENTATIVE COGHILL observed that DHSS should be questioned
about responding. He suggested that The Boys and Girls Home of
Alaska should immediately apply for a variance.
4:02:58 PM
MS. MUNSON reported that the variance process was described as a
regulatory process. She opined that The Boys and Girls Home of
Alaska and DHSS needed to develop a collaborative relationship.
4:04:04 PM
REPRESENTATIVE COGHILL noted that there appeared to be economic
duress.
MS. MUNSON replied that she was not aware of any financial
sanctions. She stated that it was a necessary facility, it was
granted a 44 bed Certificate of Need, and it would close without
Medicaid approval, which was contingent on the licensing.
4:05:04 PM
CO-CHAIR KELLER said that this had been an ongoing process.
4:05:35 PM
CO-CHAIR HERRON asked if the "statutory fix" would alleviate a
cash flow problem for The Boys and Girls Home of Alaska.
MS. MUNSON said that the bill was not necessary for economic
protection, except to make The Boys and Girls Home of Alaska
eligible for the care payments that other RPTCs received. She
affirmed that HB 223 was a quicker, more effective, more certain
means than the variance process. She related that the motive
would be to stay open and provide quality care.
4:07:03 PM
CO-CHAIR HERRON opined that a "statutory fix" would give The
Boys and Girls Home of Alaska a better cash flow.
MS. MUNSON replied that HB 223 would allow them to provide care
consistent with state requirements.
4:07:26 PM
CO-CHAIR KELLER said that DHSS was determined to work
collaboratively with The Boys and Girls Home of Alaska.
4:07:42 PM
REPRESENTATIVE CISSNA asked if The Boys and Girls Home of Alaska
was operating in good standing.
MS. MUNSON replied that, to her knowledge, DHSS had taken no
action to revoke its license. She confirmed that they had
received a letter from Medicaid stating a necessity for further
training and monitoring. She acknowledged that there had been
start up problems which needed to be fixed, and that there was
an ongoing staffing review. She emphasized that the staffing
requirements were higher than The Boys and Girls Home of Alaska
had been able to meet.
MS. MUNSON, in response to Representative Cissna, said that the
only effect of the bill would be for staffing to be based on the
new standard.
4:10:58 PM
REPRESENTATIVE SEATON asked about the economic impact of going
out of business for lack of Medicaid funding as opposed to the
economic impact of a few caregivers with a different experience
level. He asked for a clarification.
4:11:38 PM
MS. MUNSON explained that this was a 44 bed unit, with only 33
percent of the staff meeting the existing direct caregiver
licensing standards. She noted that fewer staff resulted in
fewer available beds. She indicated that the facility had a
financial breakeven number for occupied beds, in order to remain
open.
REPRESENTATIVE SEATON responded that this was the first
notification that only one third of the staff met the existing
requirements. He asked for clarification for the proposed
Section 3, contained in the amendment, labeled C.3.
MS. MUNSON, in response to Representative Seaton, noted that
testimony during SB 32 had affirmed that a solution was best
attained through regulation. She pointed out that many
testifiers had admitted that there was a long standing problem.
She explained that Section 3 allowed an operative one year
window, which would then be repealed. She pointed out that
during the interim, DHSS could write new regulations, which
would go into effect after April 15, 2010.
4:16:54 PM
PAT HEFLEY, Deputy Commissioner, Office of the Commissioner,
Department of Health and Social Services (DHSS), acknowledged
that DHSS was asked to re-write regulations in 24 hours. He
shared that his team met, collected documents, and concluded
that the responsibility was to keep the places safe, to bring
the kids home, and to work with the private agencies for
success. He relayed that DHSS did not know about these specific
work force shortages. He reiterated an earlier stated DHSS
mission for workforce development. He shared that there were
many more issues than could be addressed in 24 hours. He
stressed that DHSS was serious about its mission, and he offered
his belief that DHSS had systems to address most of the issues
concerned. He confirmed that DHSS had a variance system which
approved almost 100 percent of requested variances. He said
that DHSS had offered The Boys and Girls Home of Alaska a
variance the prior October.
REPRESENTATIVE COGHILL asked for a definition to that variance.
4:20:42 PM
MR. HEFLEY said that currently there was not an institutional
variance for employment. He acknowledged that it was not
unusual for a work force challenge, and that there was a system
for accommodation to individuals. He shared that a conclusion
of the recent work group was for a return to the principles. He
acknowledged a work force shortage in this particular area. He
expressed a desire for DHSS to work with the provider groups and
the family members, and to review the issues and requested
changes. He explained that he did not want to put the kids at
risk for a year. He requested to maintain the current system,
while working to build a new system during the next 9 months.
He offered a letter outlining this plan from the commissioner,
which read in part:
The department commits to enhancing and expediting the
process by which a residential psychiatric treatment
center can apply for and obtain a decision on a
variance application regarding caregiver
qualifications. The department commits to
promulgating and adopting new regulations by January
19, 2010, related to the qualifications for caregivers
in residential psychiatric treatment centers. The
department commits to reporting to the legislature on
August 1, 2009, and November 1, 2009, with the
department's progress in promulgating and adopting the
aforementioned regulations. The department commits to
the report that shall provide information relating to
all of the efforts that we have done in terms of
soliciting input from agency provider groups,
families, and other shareholders efforts in developing
and expanding the caregiver workforce pool through
increasing options for people to obtain DHSS approved
training and information on the standards and we will
evaluate and change the regulations pertaining to
information on the standards in other states for
education and training for qualifications for
caregiver staff and requirements for direct
supervision, mentoring, and staffing ratios.
He added that this plan would not be a huge document.
4:26:37 PM
CO-CHAIR HERRON remarked that the legislative process could be
clumsy, and he asked if this would still be in effect if HB 223
did not become law.
MR. HEFLEY, in response to Co-Chair Herron, said that DHSS
wanted to make an improvement, and that this issue needed to be
addressed.
4:27:23 PM
CO-CHAIR HERRON asked if this was an accelerated regulatory
process, or in any way different than the normal regulatory
process.
MR. HEFLEY responded that it was a priority, and would receive
special attention.
4:28:21 PM
REPRESENTATIVE CISSNA remarked that the upcoming interim was a
time for the committee to help develop a system for healthier,
shorter stays.
MR. HEFLEY voiced appreciation for the comment, but said that
DHSS did not want to redesign the entire Bring the Kids Home
program. He agreed that there would be a separate process for
addressing the issues she advocated.
4:30:28 PM
REPRESENTATIVE CISSNA asked if The Boys and Girls Home of Alaska
was operating in good standing. She also asked if HB 223 would
affect any action or consideration from DHSS toward The Boys and
Girls Home of Alaska.
MR. HEFLEY suggested that the DHSS attorney respond.
4:32:19 PM
STACIE KRALY, Chief Assistant Attorney General; Statewide
Section Chief, Human Services Section, Civil Division (Juneau),
Department of Law (DOL), in response to Representative Cissna,
said that The Boys and Girls Home of Alaska was currently open
and operating. She revealed that it had been issued a sanction
letter under the state Medicaid program which was related to the
programmatic side of caregiver qualifications. She indicated
that a report was forthcoming on a licensing investigation. She
responded to the second question from Representative Cissna, and
replied that the bill, as originally proposed, had a retroactive
provision, which would have nullified any action by DHSS. She
opined that removal of the transitional language, should this
bill pass and a licensing action take place, could be used as a
defense against any licensing enforcement action from DHSS.
4:33:58 PM
REPRESENTATIVE SEATON opined that this bill did not solve the
problem.
MR. HEFLEY, in response to Representative Seaton, said that he
was correct in his assessment. He said that the intent was to
find a solution. He explained that DHSS wanted the kids to be
safe.
4:38:05 PM
CO-CHAIR KELLER reminded Mr. Hefley to send the letter from the
DHSS Commissioner.
4:39:43 PM
The gavel was passed from Co-Chair Keller to Co-Chair Herron.
The committee took an at-ease from 4:39 p.m. to 4:40 p.m.
4:40:54 PM
[The proposed amendment, labeled C.3, was held for further
discussion.]
[HB 223 was held over.]
The committee took an at-ease from 4:40 p.m. to 4:42 p.m.
HB 50-LIMIT OVERTIME FOR REGISTERED NURSES
4:42:53 PM
CO-CHAIR HERRON announced that the final order of business would
be HOUSE BILL NO. 50, "An Act relating to limitations on
mandatory overtime for registered nurses and licensed practical
nurses in health care facilities; and providing for an effective
date."
4:43:31 PM
REPRESENTATIVE PEGGY WILSON, Alaska State Legislature, declared
that HB 50 was a patient and nurse safety bill. She referred to
the earlier hearing on the bill, and announced that the changes
to the bill addressed the four major concerns.
4:44:48 PM
CO-CHAIR HERRON said that he would continue to work with the
sponsor on HB 50.
4:45:16 PM
NANCY DAVIS, President, Alaska Nurses Association (ANA), said
that the ANA was aware of the proposed changes to the bill, and
that the ANA supported the bill. She stated that nurses,
employers, and health care facilities should all assure the
safety of patients. She declared that a statewide standard
would protect patients and nurses, and that patient safety
should not be a negotiable issue. She expressed support for
flexible staffing, and said that employers and nurses could
agree on the shift length. She pointed out that an important
part of HB 50 was the protection against retaliation for a nurse
who spoke up for safety. She noted the challenges for rural
staffing. She directed attention to the limitations placed by
other professions to the number of hours worked. She said that
ANA had worked for five years to limit excessive work hours and
overtime, and that ANA offered its support for HB 50.
4:51:16 PM
LANETTA LUNDBERG, Director, Human Resources, Ketchikan General
Hospital, said that HB 50 placed unwarranted regulation and
management, and that it was a response to isolated situations.
She opined that HB 50 was structured for a few people, but would
place an undue hardship on the majority.
4:53:23 PM
MICHAEL SMITH, Tanana Chiefs Conference (TCC), explained that
Tanana Chiefs Conference (TCC) was a tribal consortium that
provided health care services to the Interior Native community.
He acknowledged the shortage of nurses, but stated that HB 50
exacerbated the problem for Native non-profit health services.
He directed attention to the unique challenges of Alaska. He
listed some of the TCC major concerns for regulation, which
included the application to federal facilities and the Indian
Health Services. He noted the ambiguity for travel time in the
proposed bill. He offered to listen to the proposed amendments
and then to work with the sponsor for changes that would not
adversely affect rural healthcare providers.
4:58:22 PM
STACY ALLEN, Health Care Representative, said that HB 50 was
about patient safety. She stated that unlimited overtime was
not a safe nursing practice. She offered support for HB 50.
5:00:08 PM
REPRESENTATIVE LYNN noted that he had a conflict of interest, as
his daughter was a registered nurse.
5:00:31 PM
JUANITA DIAMOND stated that the bill was for the promotion of
better patient care and nurse safety. She pointed out that 15
states had already adopted similar legislation. She said that
she supported HB 50.
5:01:55 PM
CHRISTINA VANCLEVE, RN, said that the passage of HB 50 was
crucial to protect the health and safety of Alaskans, and to
protect the occupational safety of nurses.
5:02:54 PM
PATRICIA SENNER, RN, said that HB 50 had a lot of workforce
implications. She noted that the average age of nurses was 48,
and that extending the number of hours worked could impact the
decisions for nurses to stay in the work force. She noted that
younger nurses had families and could not work long hours and
overtime. She shared an example of mandated overtime at Alaska
Psychiatric Institute which resulted in the departure of the
young nurses. She stated that the other states in the Pacific
Northwest had eliminated mandatory overtime.
5:04:35 PM
DEBBIE THOMPSON, Executive Director, Alaska Nurses Association
(ANA), said that ANA supported HB 50, and she offered assistance
with the draft work for any changes to the bill.
5:05:30 PM
KATHLEEN GETTYES, President, Providence Registered Nurses
Bargaining Unit, Providence Hospital, shared a personal story
about nursing care. She spoke in support of HB 50, and she said
that Alaskans should expect that nurses are alert and properly
rested. She stated that HB 50 would protect the patients, the
nurses, and the health care facility.
5:08:02 PM
LEE ANN COX, Human Resources Manager, Wildflower Court, said
that Wildflower Court opposed HB 50. She explained that
Wildflower Court did not have any mandatory overtime, or
mandatory on-call, and did not have any complaints. She stated
that HB 50 "would eliminate our ability as a healthcare provider
to responsibly staff in a time of need if it was to arise." She
detailed its staffing schedule options. She pointed out that
the bill would set a needless precedent for government
intervention for Wildflower Court, and many other facilities.
She questioned the need to report on a non-existent issue at
Wildflower Court, especially with the myriad of already required
reports and forms.
5:12:28 PM
ANGEL DOTOMAIN, President & CEO, Alaska Native Health Board
(ANHB), agreed with the concerns raised by other tribal health
care services. She acknowledged the concerns by the ANA, and
its goal to improve the workplace and patient safety. She
listed the concerns of ANHB, to include: similar legislation had
not been implemented in any rural states; there was not a
documented need for HB 50, as the shortage of nurses allowed the
freedom to move; ANHB organizations did not agree that mandatory
overtime was an issue, as there were existing processes for
addressing nurse concerns; the exemption for some facilities
raised legal questions, especially for any impact on the Alaska
Native Medical Center (ANMC) Level II trauma center; the
legislation did not address the regional recruitment concerns.
She commented on the onerous and costly reporting requirements.
She explained that the Fair Labor Standards Act was recently
revised to recognize the need for flexibility with some nurse
scheduling. She pointed out that Tribal Health facilities would
be adversely impacted by HB 50. She offered to work with all
the stakeholders to meet the needs for patient safety.
5:19:26 PM
CO-CHAIR HERRON asked to see some data that supported the
assumption that patient safety was at risk. He referred to the
current bargaining discussions between Providence Hospital and
its nurses, and questioned whether mandatory overtime was an
issue.
5:21:39 PM
REPRESENTATIVE WILSON referred to a power point and a nurses'
survey [included in the members' packets.] and pointed out that
these were a good source for many answers.
5:22:25 PM
REPRESENTATIVE CISSNA expressed her concern for the rural
communities.
REPRESENTATIVE WILSON acknowledged that there was a problem for
the rural areas, and she posed the possibility that an exemption
might be allowed.
REPRESENTATIVE CISSNA said that she would like to work with
Representative Wilson on that possibility.
5:23:48 PM
CO-CHAIR HERRON reflected that it was important to not create
two types of nurses, based on federal and private facilities.
5:24:01 PM
REPRESENTATIVE SEATON expressed concern with the allowable
working hours and the reporting requirements of HB 50.
[HB 50 was held over.]
5:25:00 PM
ADJOURNMENT
There being no further business before the House Health and
Social Services Standing Committee, the meeting was adjourned at
5:25 p.m.