SENATE HEALTH, EDUCATION & SOCIAL SERVICES COMMITTEE March 5, 1997 9:06 a.m. MEMBERS PRESENT Senator Gary Wilken, Chairman Senator Lyda Green Senator Jerry Ward MEMBERS ABSENT Senator Loren Leman, Vice Chairman Senator Johnny Ellis COMMITTEE CALENDAR CS FOR HOUSE BILL NO. 45(HES) "An Act relating to runaway and missing minors; and providing for an effective date." - MOVED HB 45 OUT OF COMMITTEE SENATE BILL NO. 99 "An Act relating to health care data and registration of births." - MOVED SB 99 OUT OF COMMITTEE SENATE BILL NO. 100 "An Act relating to grant authority for services for developmentally delayed or disabled children and their families." - MOVED SB 100 OUT OF COMMITTEE PREVIOUS SENATE COMMITTEE ACTION HB 45 - No previous Senate action to record. SB 99 - No previous Senate action to record. SB 100 - No previous Senate action to record. WITNESS REGISTER Representative Kelly State Capitol Juneau, Alaska 99801-1182 POSITION STATEMENT: Prime Sponsor of HB 45. Monica Owen 980 Snowhill Avenue #1 Wasilla, Alaska 99654 POSITION STATEMENT: Disagreed portions of HB 45. Venessa Grenung 980 Snowhill Avenue #1 Wasilla, Alaska 99654 POSITION STATEMENT: Agreed with Ms. Owen's testimony Angela Salerno, Executive Director Alaska Chapter of the National Association of Social Workers 525 Main Street Juneau, Alaska 99801 POSITION STATEMENT: Discussed a flaw in HB 45. Al Zangri, Chief Vital Statistics Division of Public Health Department of Health & Social Services PO Box 110675 Juneau, Alaska 99811-0675 POSITION STATEMENT: Reviewed SB 99. Dr. John Middaugh, Chief Epidemiology Section Division of Public Health Department of Health & Social Services PO Box 240249 Anchorage, Alaska 99524-0249 POSITION STATEMENT: Answered questions. Mary Diven Department of Health & Social Services PO Box 110612 Juneau, Alaska 99811 POSITION STATEMENT: Reviewed SB 100. Elmer Lindstrom, Special Assistant Office of the Commissioner Department of Health & Social Services PO Box 110601 Juneau, Alaska 99811-0601 POSITION STATEMENT: Discussed SB 100. Gigi Pilcher, Parent Ketchikan, Alaska POSITION STATEMENT: Urged passage of SB 100. ACTION NARRATIVE TAPE 97-21, SIDE A HB 45 RUNAWAY AND MISSING MINORS  Number 001 CHAIRMAN WILKEN called the Senate Health, Education & Social Services Committee (HES) to order at 9:06 a.m. and announced that the meeting scheduled for Friday would be cancelled. Chairman Wilken introduced HB 45 as the first order of business. REPRESENTATIVE KELLY , Prime Sponsor, informed the committee that last year there were a number of bills dealing with juvenile issues, among those bills was SB 289 which became effective this past September. SB 289 sought to bring runaways into a protective environment by designating the child as a child in need of aid. SB 289 established a scenario in which a police officer could take custody of a child, bring the child to the parents, and if the parents agreed, the child would be accepted back into the home or placed in a shelter. The police officer could also decide whether there was an abusive situation in which case the child would be taken to a shelter. Representative Kelly explained that HB 45 is before the committee because last year HB 387, a rewrite of the juvenile code, separated in statute what constituted a child in need of aid or a delinquent child. HB 387 took statutes from Chapter 10 and created Chapter 12 in order to deal with delinquent children in one manner and abused children in another. When those statutes were moved a key portion of SB 289 was lost. Representative Kelly said that it was not intended for the statutes to read that a runaway minor must first consent to return home. The main thrust of SB 289 was to place a minor in a safe environment where monitoring could occur while the court or department determined what to do. Number 125 MONICA OWEN , testifying from Mat-Su, did not agree with the portion of the bill that would allow police to place minors in a shelter or back in the home. Shelters can be just as bad as the home. Ms. Owen mentioned that mental abuse as well as physical abuse can occur. VENESSA GRENUNG , testifying from Mat-Su, agreed with Ms. Owen's testimony. She mentioned that perhaps a mutual agreement to place the minor in a friend's house could occur. ANGELA SALERNO , Executive Director for the National Association of Social Workers, said that HB 45 has a flaw regarding the language pertaining to the officer's decision whether or not to bring a minor home. Ms. Salerno believed that in this case caution should be taken. Police officer's are not qualified to assess the presence of physical or sexual abuse. HB 45 could be improved by changing the language to "cause to suspect physical or sexual abuse." National research reports that 60-75 percent of runaways report serious physical abuse, furthermore sexual abuse is higher among young women. The 1988 Governor's Interim Commission on Children and Youth in Alaska reported that at least two-thirds of runaway youth say they have been abused at home. Each year in Alaska, there are 3,575 cases of abuse which have been verified. Ms. Salerno believed that the state could be opened up to some liabilities with the current language; liability, if a minor is returned to the home and suffers a serious injury or worse from the parents. Ms. Salerno was concerned with dysfunctional families. Number 201 REPRESENTATIVE KELLY said that police officers are recognized in statute as persons with a level of authority and experience in determining child abuse. Police officers are trained and must report such abuse. ANGELA SALERNO agree with Representative Kelly's comment regarding the physical manifestations of abuse, however sexual abuse is another matter. Ms. Salerno clarified that her testimony referred to sexual abuse. CHAIRMAN WILKEN asked Ms. Salerno if her suggestion was to change the word "believe" to "suspect" on page 1, line 14. He asked Ms. Salerno if she wanted the officer to take the child for an advanced interview to determine whether a problem exists at home. ANGELA SALERNO replied yes. If the police officer suspected child abuse, the officer would be compelled to report that abuse to DFYS and take the child to a safe environment. In response to Chairman Wilken, REPRESENTATIVE KELLY specified that he had referred to Title 47 Chapter 17.020. SENATOR GREEN moved to report HB 45 out of committee with individual recommendations and accompanying fiscal notes. Without objection, it was so ordered. SB 99 HEALTH CARE DATA; BIRTH REGISTRATIONS  Number 252 CHAIRMAN WILKEN introduced SB 99 as the next order of business before the committee. AL ZANGRI , Chief of the Bureau of Vital Statistics for DHSS, explained that Sections 1 and 2 of SB 99 establish civil immunity for institutions and providers who report diseases and conditions to the department as required under other portions of the statute. Without SB 99, the department could lose $300,000 to $400,000 per year in cancer grants. Sections 3 and 4 clarify the language in the Vital Statistics Act regarding the reporting requirements for births and institutions as well as shortening the time period from seven to five days. There is also a language change in determining how reports are made for moving conveyances. Mr. Zangri noted the most important change as being the elimination of a signature for every birth certificate produced in a hospital. This would allow the bureau to operate its electronic birth certificate system. All but two hospitals in the state have electronic birth certificate systems. Currently, each hospital must send a paper copy of the birth certificate with a hand signature. SB 99 would allow electronic signatures or group signatures for all the births during a week. In response to Senator Green, AL ZANGRI clarified that SB 99 does not release information. SB 99 grants civil immunity to facilities already required to report that information. Current law requires that providers report this information to the department, however if the information has not been properly used then the individual can be sued. SB 99 grants civil immunity for providing that information unless the case is pure negligence. Mr. Zangri pointed out that this immunity is required under federal statutes if the cancer grant is to continue. Number 318 DR. JOHN MIDDAUGH , Chief of the Epidemiology Section in DHSS, explained that the immunity protection is only for those reporting in compliance with state law. The data is being reported to the Division of Public Health. The data is not disclosable under Alaska's public records law and can only be released if there is an eminent and direct public health threat to another person. Dr. Middaugh noted that the data is provided with identifiers only so that duplicate reporting can be eliminated. Dr. Middaugh reiterated that the data is protected by the Alaska statutes regarding confidentiality. SENATOR GREEN expressed concern with the sectional analysis of Section 1 which says that, "This immunity protects the person reporting the information regardless of how the Department uses the information." Senator Green did not know if that accurately reflected the intent of the bill. Senator Green wanted to be sure that a medical provider would not be required to provide information that would not ordinarily be provided. DR. JOHN MIDDAUGH said that the bill only provides protection for the information required to be reported under Alaska statutes and regulations. CHAIRMAN WILKEN pointed out that he had a list of the diseases required to be reported on a daily basis. SENATOR WARD asked if this was necessary to receive the first of five increments of $420,000; is this a new program? DR. JOHN MIDDAUGH clarified that the grant was awarded in October of 1994. During the first year, regulations were revised in order to be in compliance with establishing the cancer registry component of the reporting requirements. The regulations went into effect in January of 1996. The first year of collection of this information on cancer statewide has been completed. The other disease reports for infectious disease in some cases go back to territorial days. The funds received to establish the cancer registry are part of the federal legislative program, the Cancer Registries Amendment Act, which establishes uniform cancer registries in all 50 states. Dr. Middaugh noted that work to establish a cancer registry in Alaska had been going on for 20 years; these funds allowed such a registry. In order to maintain compliance of the requirements of the federal law, these three provisions require statutory changes and cannot be dealt with in regulation. Dr. Middaugh informed the committee that SB 99 has been endorsed by the Alaska Hospital & Nursing Home Association, the Alaska State Medical Association, and the Alaska Division of the American Cancer Society. Number 375 SENATOR WARD asked if the program comes out of the $420,000 or is this an additional program. Are there matching funds? DR. JOHN MIDDAUGH said that there are no matching funds involved. This is an ongoing grant which is now in the third year of a five year project. Without these additional statutory changes, there may be a risk in losing the award. Dr. Middaugh noted that this really protects the data, the patients, and the providers. In response to Senator Ward, Dr. Middaugh replied that there has not been any implication that the money would be withdrawn without the implementation. However as part of the federal law and the grant award, the department has to certify that efforts attempting to comply with the federal legislation have been made. SENATOR WARD inquired as to what portion of the funds goes towards the cancer reporting. DR. JOHN MIDDAUGH specified that all of the funds are used for cancer reporting. All other diseases are required to be reported to the Division of Public Health for public health protection. Dr. Middaugh noted that the other diseases were included due to the rationale for uniformity and protection for patients, physicians, and the state. In response to Senator Ward, Dr. John Middaugh agreed that the inclusion of the other diseases was not necessary to receive the funds. DR. MIDDAUGH reiterated the strong support for SB 99 from the medical community. CHAIRMAN WILKEN said that he would entertain a motion to report SB 99 to its next committee of referral. SENATOR WARD moved to report SB 99 out of committee with individua recommendations and a zero fiscal note. Without objection, it was so ordered. SB 100 DEVELOPMENTALLY DISABLED CHILDREN/GRANTS  Number 419 CHAIRMAN WILKEN announced that the final order of business before the committee was SB 100 . MARY DIVEN , with the Department of Health & Social Services, explained that SB 100 is a technical change that would place the grant authority for the Infant Learning Program into the authorizing statute. This change was requested by the Department of Law in order to have all the statutes consistent; so that the grant authority is in the authorizing statute rather than the general department authority to issue grants. CHAIRMAN WILKEN requested that Ms. Diven give an example of what SB 100 would accomplish. MARY DIVEN said that the department would like to update the regulations making them consistent with federal law. The regulations were last updated in 1982. The Department of Law will not allow the regulations to be open to public comment until this technical correction occurs. The bill will allow the updating of regulations. SENATOR GREEN asked what happens with the Infant Learning Program (ILP) now. MARY DIVEN clarified that the department has general grant authority to issue grants and the Legislature puts the funds in the grant line. However, at this point, the department cannot revise any regulations until this technical change is made. SENATOR WARD asked if the current regulations were inadequate. MARY DIVEN replied yes, the regulations were last updated over 15 years ago and the federal law has changed. Ms. Diven noted that the statute was revised in 1992 or 1993, but the regulations need to be revised in order to be consistent with the current statute. In response to Senator Ward, Ms. Diven said that the regulations are causing administrative problems and problems for local service providers. There is a small list of eligible providers in the existing regulations. The local providers must request waivers of the state in order to be eligible providers. The federal statute and regulations has a more extensive list. Number 452 SENATOR WARD noted that Representative James has a Joint Regulatory Task Force. He believed this would be an appropriate item for the task force to review in order to determine that regulations that are necessary are being created. Senator Ward did not believe that more regulations were necessary if people were being served under the existing regulations. CHAIRMAN WILKEN informed the committee that he was a member of the Joint Regulatory Task Force whose agenda is full. This bill seems to be more of an alignment than a creation. If this bill was given to the task force, the task force would most likely not have time for its consideration. ELMER LINDSTROM , Special Assistant in DHSS, agreed that SB 100 does raise some questions because what is being done now, what has been done in the past, and what is desired for the future is to run the ILP as a grant program. When the need arose to update regulations consistent with the recommendations of the regulations group, the Department of Law said that the department did not have specific statutory authority to make grants and therefore could not update the regulations. The Department of Law denied such although, DHSS has done that in the past and the Legislature has appropriated those grant lines in the budget. Mr. Lindstrom believed that the provisions in SB 100 were included in a bill that passed out of Representative James' committee last year. This was also included in an omnibus bill last year which created administrative efficiencies and ultimately did not pass the Legislature. Mr. Lindstrom pointed out that if this is not done, at some point the programs would have to be implemented through a contract mechanism which would be very inefficient. SENATOR GREEN asked if there would be any increased cost if the legislation did not pass. MARY DIVEN said that there was a possibility that there would be questions from the federal funding source because of the inconsistency of the regulations with the federal regulations or existing statute. There has been no indication that funding would cease, but the potential is present if the inconsistency continues. SENATOR GREEN asked if any exponential growth of the program could occur once this is in statute. MARY DIVEN replied no. Number 511 SENATOR WARD asked if anything in law would stop this grant process and allow it to become an RFP. MARY DIVEN stated that the existing grant regulations require nonprofits and believed that the departments authorizing statute requires that it be nonprofits. SENATOR WARD believed that an RFP could go out to profit corporations in order to supply this service. Could the grant process be issued in a public bidding process through RFPs to for- profit corporations? MARY DIVEN said that the existing departmental regulations do not allow such nor do the ILP regulations. ELMER LINDSTROM offered to provide that information to Senator Ward. In response to Chairman Wilken, MARY DIVEN specified that the ILP served children ages zero to three. GIGI PILCHER , parent, informed the committee that she was the mother of six children two of which are disabled/developmentally disabled children. Ms. Pilcher urged the passage of SB 100 in order to comply with federal legislation and continue to serve disabled children. SENATOR GREEN moved to report SB 100 out of committee with individual recommendations and accompanying fiscal notes. Without objection, it was so ordered. There being no further business before the committee, the meeting was adjourned at 9:50 a.m.