2003 Health & Welfare

Health/child care, welfare

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January 8, 2003
January 10, 2003
January 14, 2003
January 16, 2003
January 20, 2003
January 22, 2003
January 23, 2003 – Subcommittee
January 24, 2003
January 28, 2003
January 29, 2003 – Subcommittee
January 30, 2003
January 31, 2003 – Subcommittee

February 4, 2003
February 6, 2003
February 10, 2003
February 12, 2003
February 14, 2003
February 18, 2003
February 20, 2003
February 24, 2003
February 26, 2003
February 28, 2003

March 4, 2003
March 6, 2003
March 10, 2003
March 12, 2003
March 14, 2003
March 20, 2003
March 24, 2003
March 28, 2003

April 4, 2003
April 10, 2003
April 17, 2003

DATE: January 8th, 2003
TIME: 2:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez
ABSENT/EXCUSED: Rep. Mitchell
GUESTS: See attached sheet.
Chairman Sali called the first meeting of the Health and Welfare committee
to order at 2:50 P.M. He announced to the Committee that the purpose of
today’s meeting is to familiarize the Committee on two of the divisions within
the Department of Health and Welfare, the Division of Welfare and the
Division of Health. He asked that committee members hold their questions
until the end of the presentations.



Karl Kurtz, Director of the Department of Health and Welfare, addressed the
Committee. He briefly discussed the divisions within the Department and
introduced Quane Kenyon, who is the chairman of the Health and Welfare
advisory board.



Scott Cunningham, Administrator of the Division of Welfare, addressed the
Committee. He explained that the Division of Welfare administers various
programs that serve individuals and families with low incomes and those in
crisis situations to help them become and remain self-reliant members of
Idaho communities. The programs administered by the Division are termed
the Self-Reliance Program. This program includes, child support collection,
Food Stamps, child care and cash assistance. Those who receive these
services are required to become employed and self-reliant. He stated that in
the past five fiscal years, applications processed increased by 58,000 cases,
or 60 percent. In that same period, the number of regional staff determining
eligibility declined.



He then explained the various programs administered by the Divison of
Welfare The first program discussed was the Temporary Assistance for
Families in Idaho program, (TAFI). It provides cash assistance to needy
families with children. The Department partners with families, community
programs, employers and other agencies to help participants obtain jobs and
achieve self-reliance. He stated that there is a 24 month lifetime limit for
adults to receive cash assistance.



Aid to the Aged, Blind and Disabled(AABD) provides cash assistance to
certain low-income participants who are blind, disabled or age 65 or older.
In state fiscal year 2002, a monthly average of 10,942 people received cash
payments under this program.



The Food Stamp Program helps low-income families maintain good health
and nutrition. This is a federally funded program managed by the State. Mr.
Cunningham
explained that the benefits go directly from the federal
Government to the person. Approximately 58 million dollars in benefits were
paid in state fiscal year 2002.



The Idaho Child Care Program, (ICCP) subsidizes child care costs for low-income families while parents work or attend educational or training
programs.



Beginning in 1998, the Electronic Benefit Transfer(EBT) System was
implemented statewide to increase efficiency and reduce the cost of benefit
payments for the Self-Reliance Programs. Payments for Child Support,
Food Stamps, Temporary Assistance for Families in Idaho, and Aid to the
Aged, Blind and Disabled are made electronically.



The Department also provides a variety of Self Reliance programs. Adult
participants in the TAFI Program and certain adults in the Food Stamp
program are required to take part in these employment services to receive
benefits. The Department contracts with agencies and vendors to help
families search for, gain and keep employment. Mr. Cunningham stated
that these programs are also extended to non-custodial parents.



The Food Stamp Program includes the Job Search and Assistance
Program(JSAP) which was expanded throughout the state in 1998. The goal
of the program is to provide Food Stamp recipients with employment tools,
which they can use to become self-reliant. JSAP can help in job search and
referrals, unpaid work-experience opportunities, job skills training and
education. Approximately 5,900 food stamp recipients participate in the
JSAP program.



Adults participants who receive aid through TAFI are required to participate
in work preparation activities so they can become financially independent.
Approximately 65% of TAFI cases do not have work participation
requirements because they are “child only” cases. In these cases, adults do
not receive benefits.



The Child Support Program promotes physical and economic health of
families by ensuring parents are financially responsible for their chldren. The
program helps locate non-custodial parents and enforces their obligations
to provide financial and medical support for their children.



In 1999, the federal government mandated that all child support cases must
be administered by a single agency in each state. Health and Welfare was
chosen by the State Legislature to assume this responsibility. The
Department administered more than 92,000 child support cases, and
collected $140.3 million during state fiscal year 2002.



Child Support Services uses a variety of methods to enforce child support
orders. The primary tool for enforcing payments is Wage Withholding. Other
tools include New Hire Reporting through Electronic Date Matching, License
Suspension, and direct collection methods.






The Division of Welfare administers federal grant programs to improve living
conditions for low-income households and encourage self-reliance. These
programs include the following: Community Services Block Grant, the
Emergency Food Assistance Program, the Community Food and Nutrition
Program, the Low-Income Home Energy Assistance Program, the Telephone
Service Assistance Program, and the Weatherization Assistance program.



The Community Service Block Grant is distributed throughout all 44 counties
of Idaho by six Community Action Agencies and the Idaho Migrant Council.
The goals of the program are to revitalize low-income communities, reduce
poverty and empower families and individuals to become self-reliant.



The Emergency Food Assistance Program distributes USDA purchased
commodities through Community Action Agencies to help supplement the
diets of Idaho’s low-income population.



The Community Food and Nutrition Program provides education about food
distribution and nutrition through Community Action Agencies and the Idaho
Migrant Council to low-income people. The program helps coordinate
private and public food assistance programs to better serve low-income
populations. Funding comes through the Community Services Block Grant
and totaled $17,402 in State Fiscal year 2002.



The Low-Income Home Energy Assistance Program is federally funded and
helps Idaho’s low-income population pay a portion of their home heating
costs and provides energy conservation eduation through Community Action
Agencies. Payment is made to heating suppliers and vendors.



The Telephone Service Assistance Program provides assistance with
telephone installation and monthly service to low-income residents. Benefits
are provided by the telephone companies through charges included on their
customers’ phone bills. During State Fiscal year 2002, more than 32,000
households were served totaling $342,163.



The Weatherization Assistance program reimburses community action and
non-profit agencies that install energy conservation measures for low-income
people, particularly the elderly, disabled and families with small children. It
is a federally funded program and serves more than 1,400 households,
spending $1.8 million dollars in State Fiscal year 2002.



Mr. Cunningham then discussed with the Committee the faith-based
initiatives generated by President Bush. He explained that the goal of these
initiatives are to help more faith-based services to partner with the
Department of Human and Health services. He further explained that the
religious organizations must serve all individuals and federal funds cannot
be used for religious activities.



Mr. Dick Schultz, administrator of the Division of Health, addressed the
Committee. He explained that the Division of Health provides a variety of
services ranging from immunizations to food safety, and emergency medical
services to testing for communicable diseases.






The Division contracts with the District Health Departments to provide many
services throughout the state. Immunizations, epidemiology, sexually
transmitted diseases, food protection and oral health are all examples of
programs coordinated between State and local public health departments.



Mr. Schultz then discussed the various bureaus within the Division. They
include the following:



The Children’s Special Health Program contracts with clinics that are staffed
by physician specialists who diagnose and provide consultation for children
with special health care needs. The program also assists in paying, on a
sliding fee scale, for treatment of uninsured children. This program serves
approximately 2,400 children per year.



The Immunization Program provides around 500,000 doses of childhood
vaccine for all children in the state. The immunization rate at two years of
age is 75 percent and is 95 percent for school entry aged children.



The Newborn Screening/Genetics Clinic program provides physicians in the
state with access to laboratory analysis of blood samples collected on all
newborns for metabolic abnormalities. As there are no geneticists in the
state, the program contracts with geneticists from surrounding states. Mr.
Schultz
stated that newborn screening has been paid for by the State in the
past and this has now been transferred to the parents.



The Reproductive Health program contracts with District Health Departments
to provide family planning services to women throughout the state. The
program serves approximately 30,000 women per year.



The STD and AIDS program also contracts with District Health Departments
to hold clinics for the diagnosis and treatment of people with sexually
transmitted diseases(STD’s) and their partners. The clinics also provide
diagnostic services for the HIV virus and the AIDS virus. If an HIV-positive
patient is under 300 percent of the poverty level, they may qualify for the
AIDS Drug Assistance Program.



The Women Infants and Children program(WIC) contracts with District
Health Departments and some tribes to provide clinical assessment of the
nutritional status of perganant or breastfeeding women and children under
the age of 5 years, who are below 185 percent of the poverty level If the
patient is found to be nutritionally compromised, prescription food checks,
(worth approximately $38 dollars per month) are provided for specific food
items to meet the nutritional risk.

About 33,000 patients per year are served by this program.






Mr. Schultz then discussed the various health promotion programs. These
programs include; the Adolescent Pregnancy Prevention program, the
Arthritis program, the Breast and Cervical Cancer Early Detection program,
the Diabetes Control program, the Injury Prevention program, the Oral
Health program, the Rape Prevention program and the Tobacco Prevention
program.






The Environmental Health Bureau includes the following programs; the
Environmental Health Education and Assessment program, the Food
Protection program, the Indoor Environment program and the Worker Health
and Safety program.



The Bureau of Health Policy and Vital Statistics include the Health
Surveillance and Statistics program which converts health data into
information. It is responsible for producing the annual vital statistics report
for Idaho, which contains all the information on births, death, and divorces
in the state. Other programs include the Public Health Preparedness
program, the Vital Records Management program and the Vital Records
Services program.



The Bureau of Emergency Medical Services was then discussed. The
programs include the Certification and Licensure program which is
responsible for the licensure of all EMS units in the state(approximately 200)
and the certification of all EMS personnel which number approximately 4,500
of which 68 percent are volunteers.



The Provider Resource program administers grants to primarily rural EMS
units to purchase ambulances and other needed equipment.



The Bureau of Public Health Laboratory includes the following sections;
chemistry, laboratory improvement, microbiology, and virology/serology.



The Division of Health also includes the Office of Epidemiology and the
Office of Rural Health and Primary Care.



During a question and answer period with the presenters, the following
points were discussed; Mr. Cunningham explained that the Food Stamp
program has increased from previous years and that outreach programs
have not been aggressively pursued by the Department. He further
explained costs of various programs and the funding for each. The TAFI

program was also discussed. Mr. Cunningham stated that because the
monthly grants are low, there is no incentive to remain on the program.
Recipients choose work over welfare.



In response to Committee questions, Mr. Schultz made the following
clarifications; the reason for the low immunization rate was discussed. He
stated that cost was not the barrier. He explained the challenge of
registering newborns on the state immunization system. 93 percent of those
babies born in hospitals enroll in the system. The rate is not as high for
those babies born outside of the hospital and those born in other states. He
also discussed how the Division of Health has dealt with the possibility of the
West Nile virus reaching Idaho.






He explained that the Division has crafted a plan with the mosquito
abatement districts for mosquito surveillance. He further explained that there
is currently a debate on how to effectively deal with the mosquito problem.









In response to questions from the Committee, Mr. Schultz discussed the
media ads for tobacco prevention and teen pregnancy. He stated that the
tobacco prevention ads were evaluated and found not to be as effective as
the current programs that encourage teen peers for prevention help and
cessation programs for older smokers.



Mr. Schultz also discussed the bioterroism threat. He explained that the
Division has evaluated a need for an additional 42 positions at the state
laboratory and is currently remodeling the lab to provide for containment in
handling contaminates.



Director Karl Kurtz address the Committee to summarize. He stated that
in the Department’s 2004 budget request, no more money will be asked for
Medicaid. They are asking for an additional $400,000 for individuals that the
courts have assigned to the Department for their care. He made the
following three points:

1. The Department will ask for 26 million dollars in General Fund monies; 17
million dollars of which will be for caseload increases for Medicaid.

2. The Department will ask for a 7 million dollar increase for Welfare
programs.

3. The Department will ask for a 3 million dollar increase for changes in the
federal medical assistance programs.



Chairman Sali thanked the participants and introduced those present. He
announced to Committee members that the Committee will meet at 8:30
A.M. on Friday, January 10th to hear an overview of the Division of Family
and Community Services and the Division of Medicaid. Providers will also be
present at the meeting to address the Committee.

ADJOURN: There being no further business to be brought before the Committee;
Chairman Sali adjourned the meeting at 4:50 P.M.






DATE: Friday, January 10th, 2003
TIME: 8:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/EXCUSED: None
GUESTS: See attached list
MOTION: Rep. Garrett made a motion to approve the minutes of the January 8, 2003
as submitted. On a voice vote, the motion carried.



Chairman Sali announced that the rules will be heard by the entire
committee and that review will begin next week. He further announced that
if any members of the Committee would like to cover a topic in more detail
and serve on a subcommittee to do so, should contact him as soon as
possible.



Joyce McRoberts, Deputy Director of the Department of Health and
Welfare, addressed the Committee. She explained that the Committee will
hear from two division administrators and followed by a question and answer
period. The Committee will then hear several short presentations from
various providers.



Ken Diebert, administrator of the Division of Family and Community
Services, addressed the Committee. He explained that the Division is
designated as the lead agency for the operation of the system of care for
adult and children’s mental health, adult and children’s developmental
disabilities services, infant and toddler program, substance abuse services,
and child welfare services with the Department of Health and Welfare. The
Division is also responsible for the operations of the State’s three state
hospitals. He further explained that these hospitals, which include State
Hospital South in Blackfoot, Idaho State School and Hospital in Nampa, and
State Hospital North in Orofino, are operating at or near capacity and have
waiting lists of up to ten days. These hospitals provide intensive residential
services for persons with severe developmental disabilities.



He then discussed with the Committee budget concerns. He stated that in
State Fiscal Year 2002, there was a 9 percent increase in the number of
individuals who accessed the Division’s services and programs from the
previous fiscal year. The current budget for Fiscal Year 2003 is about 11
million dollars less than the appropriation the Department received in the
Fiscal Year 2002. Staff have been reduced in all areas with the exception
of Child Protective Services.



Mr. Diebert explained that the Division has been faced with many difficult
decisions related to how best to manage the reductions in funding. As they
considered how to best manage the current resources, they based they
decisions on the following priorities:

They worked to avoid major impacts in the programs that the Department
has statutory responsibility to provide, they made every effort to avoid
staffing and service reductions that would impact community, staff and
consumer safety, and tried to be mindful of the need to provide federally
required maintenance of effort funding for their mental health, substance
abuse, and infant and toddler programs. Had they not maintained a federally
prescribed level of state participation in these programs they would have
risked losing significant amounts of federal funding.



He then described the various programs that fall under the Division of Family
and Community Services.



The first program discussed was the Idaho CareLine 211. This is a bilingual,
toll free telephone information and referral service. Last year, there were
over 38,000 calls for information about health and human service providers
in the State.



The Children and Family Services Program is responsible for Child
Protection services, Foster Care, Adoption, Children’s Mental Health, Indian
Child Welfare, and Licensing of Children’s Residential treatment facilities.



The Child Protective Services program focuses on safety, permanence and
the well-being of children. They work cooperatively with the police,
prosecutors and the courts to address the safety need of children who are
abused or neglected. In 2002, there were 783 substantiated cases of abuse
and neglect in Idaho. He clarified that the Child Protective service staff do
not remove children who are abused or neglected from their parents. A child
can only be removed from their parents by the action of law enforcement or
a judge once the child is determined to be in imminent danger or cannot be
safely cared for within their current family structure. When this determination
is made, the staff is then responsible for providing a safe and nurturing
environment for the child to live until they can safely be reunited with their
family, or in some cases, adopted by other caring families.



The cornerstone of the child welfare system is the Foster Care Program.
Foster families provide for a supportive temporary home for children placed
in state custody. 2,260 children were placed in foster care in the state last
year. In Fiscal Year 2002, 92 children were adopted in the state.



The Children’s Mental Health program provides services to children who
experience serious emotional disturbances. These services are provided
through a system of public and private partnerships that offer out-patient, in-
patient and residential care. The State has been working to develop a broad
spectrum of care to meet the needs of children and their families with serious
emotional disorders based upon a monitored agreement with the Federal
Courts.



The State entered into this agreement as a result of a suit filed against the
State known as the Jeff D. case. 3,766 children were assessed this past
year, which is 1,200 more than the previous year. The Department’s staff
provides crisis services, assessments, service authorization, provider
enrollment, training, and quality assurance. Approximately 85 percent of the
children who qualify for children’s mental health services are eligible for
Medicaid.



Other vital services provided by the Division come within the programs for
adults who are mentally ill. Services include crisis response, evaluation,
case management, treatment, psychiatric evaluations, medication
management and counseling. The Division also provides court-related
support services and placement coordination with hospital or residential care
as required. The majority of treatment services for Medicaid patients are
provided through a network of private providers. In State Fiscal year 2002,
over 6,000 individuals received services from the Division’s mental health
programs. This number reflects an 8 percent increase. The staffing in the
regional mental health programs has decreased by 23 staff. The Division
has accomplished cost saving by reducing administrative staff and shifting
some of the assessment function of the regional mental health authority to
private providers. They have fewer staff to respond to crisis calls, work with
courts, support resource development and to manage and evaluate program
effectiveness.



The substance abuse services program with the Division contracts out all
treatment services for their clients to private providers. Through
collaborative efforts with the courts, schools, Department of Correction,
Juvenile Corrections and the community, the system of care based on the
best practice models is being established in our state. In State Fiscal year
2002, 6,153 clients were served in this program. This is an 8 percent
increase from last year.



The substance abuse staff partnerships with the Idaho State Police for the
State’s Tobacco Project. This program is designed to reduce the sale of
tobacco to minors by education of merchants, retail permitting and
inspections. Since 1999, there has been a 12 percent drop in tobacco sales
to minors.



Mr. Diebert then discussed the group of programs that provide services to
people who are developmentally disabled. These programs are designed to
provide care and support of individuals and their families with developmental
disabilities. The programs are designed to provide services for everyone
from infants to the elderly.



The Idaho Infant Toddler Program serves children from birth to three years
of age. It coordinates early intervention and treatment services for children
and their families. The program partners with families to plan and provide
comprehensive services including speech, occupational, developmental,
medical and social work services to enhance each child’s developmental
potential. 2,424 children were served last year, which is a 4 percent increase
from the previous year.



The Division provides intake, eligibility, determination, service authorization,
provider enrollment, and training for providers for developmental disabilities
services. Of the adults receiving services through the Developmental
Disabilities Program this past year, 93 percent of them qualify for the
Medicaid program. 79 percent of the children and 63 percent of the
individuals served in the Infant and Toddler Program are eligible to receive
Medicaid funds. More than 11,857 people with developmental disabilities
received services funded by Medicaid than last year. State staff available to
administer these services have decreased by 17.



He then discussed the various core services that the Division provides or
contracts out and the key functions that must be in place to assure the
efficient operation of the various programs and services that the Division
manages.



He explained that the work performed by the Division is complex and
challenging. The individuals served have multiple and complex needs that
the Department strives to find effective interventions that will assist them in
developing life skills so they may function as independently as possible.



Kathleen Allyn, deputy administrator of the Division of Medicaid, addressed
the Committee. She explained that the Division of Medicaid administers the
state’s Medicaid program. This includes developing and implementing
program policy consistent with federal requirements, managing the quality
and utilization of services, and overseeing the payment process for services.
She further explained that there are several areas of overlap with the other
divisions within the Department that also provide Medicaid functions.



Within the Division of Medicaid, they also carry out the statutory state
licensing of health care facilities through the Bureau of Facility Standards.
This includes inspections of any state-licensed facility, whether or not it
cares for Medicaid clients, as well as investigations of complaints about the
facilities.



She then explained the difference between the Medicare program and the
Medicaid program. Medicare is also known as Title XVIII and is a federal
program that serves the elderly. Medicaid is a state program also known as
Title XIX which serves low income clients.



Medicare was established to cover the specific medical care needs of the
elderly and is available to most people over age 65 regardless of income.



Medicaid is the nation’s health insurance program for many low-income
Americans. Medicaid is a jointly-funded federal/state entitlement program,
administered by the states, that pays for medical assistance for certain
individuals and families with low incomes and resources.



In Medicaid, each state, within federal guidelines, establishes eligibility
standards; determines the type, amount, duration, and scope of services;
sets the rate of payment for services; and administers the state’s program.

Idaho has a basic program. There is currently on average, about 150,000
people on Medicaid, which includes about 105,000 children. The state has
chosen not to cover all of the groups or services that would be matched by
federal dollars. Idaho is projected to spend about $849 million on Medicaid
in State Fiscal year 2003, about $234 million of that in State General Funds.



Most people who use Medicaid can’t afford private insurance or need
services that are not available from private insurers such as services for
persons with developmental disabilities or traumatic brain injury.



The Department provides few direct healthcare services. Through Medicaid,
they support the existing health care structure. Idaho Medicaid pays more
in benefits in Idaho than Blue Cross and Blue Shield combined.



Because of the escalating costs of the program, Medicaid has intensified its
focus on the development of quality improvement processes and care
management tools that can create a healthier public and result in a more
efficient use of tax dollars.



Those eligible for Medicaid fall into three low income groups. These include
parents and children, the elderly and persons with disabilities.



Ms. Allyn explained that pregnant women and children in families with
incomes below 134 percent of the federal poverty limit must be covered by
Medicaid.



Medicaid primarily covers hospital and physician care of the elderly. It does
not cover most nursing home or other long term care costs or most
outpatient prescription drugs. But Medicaid pays for these and other
services not covered by Medicare when someone is covered by both
Medicare and Medicaid.



Many elderly people must be covered by Medicaid because they receive
cash assistance through the Supplemental Security Income (SSI) program.
Others have too much income to qualify for SSI but “spend down” to
mandatory Medicaid eligibility by incurring high medical or long-term
expenses.



Many people with disabilities also must be covered by Medicaid because
they receive cash assistance through the SSI program or because they incur
large medical expenses and meet their “spend down” obligation.



She further explained that it is not enough just to be poor to qualify for
Medicaid; an individual must also fit into a covered eligibility category. Many
people with low incomes, including childless couples and single, childless
adults who are not aged or disabled cannot receive Medicaid even though
they are poor.



Additionally, in 1997, Congress enacted Title XXI of the Social Security Act
which allowed states to provide health insurance for children in families with
incomes over the Medicaid eligibility level. This is the State Children’s
Health Insurance Program or S-CHIP. Rather than developing a separate
insurance program for CHIP kids, Idaho insures them through the Medicaid
program. Children from families with household incomes from 134 percent
to 150 percent of the federal poverty limit qualify for S-CHIP. At the end of
State Fiscal year 2002, there were over 12,000 children enrolled in S-CHIP.



By choosing to participate in Medicaid, Idaho must cover a minimum set of
benefits. These federally mandated benefits include: hospital care(inpatient
and outpatient), nursing home care, physician services, laboratory and x-ray
services, early and periodic screening, diagnostic, and treatment services for
children, family planning services, and federally qualified health center and
rural health clinic services. Idaho has also chosen the option of covering
additional services and receiving federal matching funds for those services.
These optional services include; prescription drugs, institutional care for
individuals with mental retardation, home and community based care for the
frail elderly and people with physical or developmental disabilities, personal
care services, services for people with developmental disabilities, mental
health services, and adult dental care.



Medicaid pays medical care providers directly for services provided to
Medicaid clients. Providers participating in Medicaid must accept Medicaid
payment rates as payment in full.



The Federal Government pays a share of the medical assistance
expenditures under each State’s Medicaid program. Idaho receives about
a 70 percent federal, 30 percent state match. For S-CHIP the federal match
rate is higher, with 80 percent of the program paid for with federal dollars and
20 percent with state general funds.



Ms. Allyn explained that federal legislative requirements have increased the
scope of the program to the point that about 45 percent of the Idaho
Medicaid budget goes toward meeting federal mandates. She further
explained that approximately 43 percent of the Idaho Medicaid budget is
governed by state law. In all, 88 percent of the Idaho Medicaid budget is
driven by either federal or state law.



Ms. Allyn then discussed with the Committee managing the cost of
Medicaid. She explained that because Medicaid is an entitlement program,
the state is required to pay for all medically necessary covered services that
are provided to persons enrolled in the program. The Department has seen
four budget cuts since 2001. In Medicaid alone, this has meant $115 million
in cost avoidance.



The Medicaid program is now undertaking more intensive review of
programs and services primarily focused on the high cost areas of the
program. The top six spending areas in the program are hospitals, nursing
facilities, prescription drugs, developmental disability services, physician
services and mental health services.



Ms. Allyn stated that Medicaid is working to increase enrollment in the
Healthy Connections program which links Medicaid clients with primary care
providers who manage their care. Through this program, Medicaid avoids
spending about $31 per month for each Healthy Connections enrollee.



She further stated that management steps are being developed for the
prescription drug program that could reduce the Medicaid pharmacy budget
by $42 million. These steps include denying early refill of prescriptions,
requiring prior approval of certain therapeutic drug classes, reviewing high
prescription volume clients, and the implementation of a preferred drug list.



Also, the Medicaid program has developed lower cost alternatives to
institutional care such as nursing home care or intermediate care facilities
for persons with mental retardation. Known as home and community based
waivers(HCBS), these programs allow eligible elderly and disabled
individuals to receive the services they need without having to be placed in
an institution. The costs for supplying the waiver services must be no
greater than the cost of the institution.



She explained that the Aged and Disabled Waiver or A&D Waiver is the most
widely implemented waiver in the state with an average of 3,600 enrollees.
The average annual cost of someone on the A&D Waiver is $13,000 per
year compared with the nursing home average annual cost of $38,000.



In summary, Ms. Allyn, explained that the economic predictions for fiscal
year 2004 show the need to maintain the current reductions and find more
ways of managing costs. But, unless the current projected revenues
increase, the state may also need to make significant reductions in the
people or services that are covered or the amount that is paid for services.



In response to questions from the Committee, the following points were
clarified by Mr. Diebert; the prevention programs for tobacco prevention is
focused on school-aged children and tobacco sales to minors are tracked
with a partnership program with the Idaho State Police. The reasons why the
Sate hospital is overcrowded was also discussed. Mr. Diebert explained
that in addition to population growth, there has been a decrease in bed
capacity in the past ten years. There is a decrease in staff and a significant
decline in federal and state funding.



In response to questions posed by Committee members, Gary Broker, from
the Department of Health and Welfare, addressed the Committee. He
discussed the overall funding of the Department and the overlapping of
services provided.



Also in response to questions from Committee members, Dr. Tom Young,
medical director for the Division of Medicaid, addressed the Committee. He
discussed rising prescription drug costs. He explained that Medicaid is
going to an evidence-based preferred drug list, which will bring substantial
savings to the program. It will provide guidelines to physicians of various
prescription drugs that can be used by patients.



Kathleen Allyn discussed the eligibility determinations for the Medicaid
program with the Committee. She also discussed the fraud and abuse unit
which investigates both provider and clients.



Randy May, an administrator from the Division of Medicaid, spoke to the
Committee in response to questions. He discussed the eligibility of children
enrolled in the States’ CHIP program. He stated that 98 percent of CHIP
kids are eligible.



Rick Sutton, a pharmacist for 30 years, addressed the Committee. He
discussed the preferred drug list. He explained that it is scientifically based.
A profile is submitted to a scientific body and evaluated on specific criteria,
then evaluated by a panel of physicians and pharmacists and a
determination is made. He further explained that Medicaid will pay for a
product on the preferred drug list.



Dr. Ted Epperly, a family physician and chairman of the Family Practice
Residency Program, discussed the residency program the Committee. He
explained the program takes nine residents from other states and trains them
in family practice medicine. He explained that the residency program has
impacted the state’s Medicaid program in the following areas, education,
practicing physicians, and physician care. He further stated that the
residency program is tremendously underfunded and it is a challenge for the
state to make it work. He further stated that because of low Medicaid
reimbursement rates, many physicians choose not to treat Medicaid patients.
Most physicians treat zero to five percent Medicaid patients. He said that
every citizen has the right to quality health care and citizens must be willing
to pay more taxes to fund needed programs.



Jon Ball, an administrator and provider of Residential Habilitation services,
addressed the Committee. He discussed what a provider has to do to qualify
to be a provider for the state. He stated that he has received a 70 percent
reduction in his wages from the state. He further stated that a client in a
residential habilitation home is treated as a family member; and the facility
has an excellent ratio of care with providers to clients.



Bill Benkula, an administrator of intermediate care facilities for the mentally
retarded and facilities for the those with developmental disabilities,
addressed the Committee. He explained that ICFs/MR form a long term
care and training delivery system for individuals with mental retardation and
or developmental disabilities. These facilities provide a wide variety of
services based on client needs, which vary according to age and level of
mental retardation. In addition to providing a home like environment with
personal and support services, ICFs/MR serve as teaching and training
facilities. Many individuals who reside in these facilities live there from youth
to old age.



ICFs/MR vary from facility to facility and state to state, but are all bound by
federal regulations. A common goal among facilities is to assess what
individuals are capable of doing and to help them maximize their potential.



Mr. Benkula discussed the levels of mental retardation which include; mild
(IQ of 50-70), moderate(IQ of 35-49), severe(IQ or 20-34) and profound(IQ
below 20).



He then discussed the federal guidelines that define mental retardation as
significant subaverage general intellectual functioning resulting in or
associated with concurrent impairments in adaptive behavior and manifested
during the developmental period.



He further stated that the trend in caring for these individuals over the past
20 years has been marked by a dramatic shift from large state-run
institutions to smaller, privately run facilities. The population of the Idaho
State School and Hospital has dropped from 1,200 down to approximately
100 patients today. Home and community based (HCB) waivers are also
growing.



He stated that individuals admitted to ICFs/MR must be receiving active
treatment services. Within 30 days following admission, an assessment is
made from facility interdisciplinary teams.



He further stated that because adults with developmental disabilities require
lifelong support, these adults are highly dependent on public programs to
finance their long term care needs.



Mr. Benkula also discussed with the Committee the Developmental
Disabilities Agencies(DDA’s) He explained that these agencies provide
rehabilitative and habilitative services to individuals diagnosed has having
a developmental disability. Services are provided in community based
settings in natural environments such as home, work, leisure, or center-based settings. Services provided by DDA’s promote independence,
participation and inclusion of people with developmental disabilities in their
neighborhoods and communities.



DDA’s are required to provide the following services; developmental therapy,
psychotherapy, speech and hearing therapy, physical therapy, occupational
therapy and evaluation and diagnostic services.



Kathy Gneiting, chairman of the Community Integration Committee, and
mother of an 8 year old son with autism, addressed the Committee. She
explained that the Committee first met in September of 2000. The CIC
makes recommendations to the Governor. The purpose of the committee is
to integrate people with disabilities in the community, school and workplace.
The four objectives of the committee are, to launch an anti-stigma campaign,
a state-wide assessment program, economic analysis and an effectiveness
study.



Marilyn Sword, representing the Idaho Council of Developmental
Disabilities, addressed the Committee. She explained that the board
consists of 23 members who are appointed by the Governor for a three year
term. The board are policy advocates and collaborate with other agencies.



Greg Dickerson, president of the Mental Health Providers Association of
Idaho, addressed the Committee. The goals of his association include the
avoidance of the high cost of institutional care and the avoidance of
homelessness. There is a full menu of services available. He explained that
Targeted case managers are available to help clients cut through the
government red tape and get the services they need.



Ida May Whitman, immediate past chairman of the Mental Health Planning
Council, spoke to the Committee. She stated that the council meets three
times a year and reports to the Governor on the mental health needs in the
state. She further stated that there are approximately 43 members on the
council. There are three standing committees which include the children’s
mental health committee, administrative education committee, and a
committee to monitor and check statistics. She explained that the council is
in favor of having the “Jeff D.” lawsuit stay on the books.



Bill Southerland, president of the Idaho Assisted Living Association,
addressed the Committee. He explained that Assisted Living provides
assistance, where needed, to the Aged and Disabled population in a
dignified community setting. Persons who are not comfortable living alone
because of physical, mental or developmental limitations may receive the
personalized help they need to live as independently as possible.
Assistance offered includes, but is not limited to, housekeeping services,
transportation, bathing, grooming, dressing, toileting, walking, meal
preparation, access to health and medical services, 24-hour security, 24-hour staff availability, in-room emergency call systems, health promotion,
exercise programs, medication management, personal laundry services, and
social and recreational activities. He stated that there are 260 facilities in the
state and that most are in the 8 to 15 bed capacity range. He further stated
that the Aged and Disabled waiver patients, under strict federal guidelines,
can access certain Medicaid services to specific populations with slightly
above-normal restrictions. The Federal government sees waivered
programs as a long term savings so they provide an attractive match.



Keith Holloway, a nursing home provider, addressed the Committee. He
explained that nursing homes provide care for the most frail of the elderly.
There are approximately 85 nursing homes in the state, 30 of which are in
small rural towns and often the town’s largest employer. He further
explained that with the growth of waivered programs, the number of patients
in nursing homes has decreased in the last five years.



Steve Millard, president of the Idaho Hospital Association, addressed the
Committee. He explained that there are 46 public hospitals in the state and
18 are critical access hospitals. 50 to 60 percent of hospital patients are
Medicare patients, and 10 to 15 percent are on Medicaid. 30 to 35 percent
are privately insured.



Chairman Sali thanked the presenters and asked Committee members to
contact any of today’s speakers on their own if they had any questions. He
announced that the Committee will start rules review the following week.

ADJOURN: There being no further business to be brought before the Committee, the
Committee was adjourned at 12:25 P.M.






DATE: Tuesday, January 14th, 2003
TIME: 1:15 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/EXCUSED: Rep. Eberle
GUESTS: See attached sheet.
Vice-Chairman Block called the meeting to order at 1:25 P.M. She
announced that the minutes from the January 10th meeting will be approved
at the next committee meeting.



Karen Gustafson, assistant administrative rules coordinator for the
Department of Administration, addressed the Committee and gave a brief
explanation to Committee members of how docket numbers are assigned,
the different types of rules, and the actions that the Committee members can
take on the rules.



She explained that every agency is assigned a two digit number, which is the
first two numbers of each docket. The next four numbers of the docket refer
to a specific division, and the last numbers refer to when the rule was
published.



She then described the three kinds of rules. These include; pending rules,
which are published by the agencies during the calendar year 2002 and are
submitted for legislative review. Pending rules will go into effect unless the
Committee takes negative action. Both Houses have to agree to reject a
pending rule.



The pending fee rules are published during the calendar year 2002 that
impose a fee or charge. They also have to be rejected by both Houses.



Temporary rules are ones that are approved by the Governor that went into
effect during calendar year 2002 without legislative review. These rules will
die at the end of the session unless they are extended by the Legislature.



Rayola Jacobsen, bureau chief of Occupational Licensing, addressed the
Committee. She gave a brief overview of the Bureau. She explained that
the Bureau of Occupational Licensing was established in 1974 and serves
18 different boards.



The Bureau administrates, investigates, and provides legal representation
for those boards. It is funded by dedicated funds and use no State General
funds. She further explained that there are 17 staff which include five
investigators. The Bureau oversees over 20,000 licensees. She further
explained that the Bureau has several hearing officers to hear cases.

Docket 19-0101-0201: Michael Sheeley, executive director of the Board of Dentistry, addressed
the Committee. This Docket is a pending fee rule that related to the
anesthesia permit evaluation process. This rule would increase the fee
for anesthesia permit renewal or reinstatement to $300.00 based upon the
recognition that the Board of Dentistry’s administrative costs in connection
with a permit renewal or reinstatement are identical in amount to the costs
incurred in connection with an initial application. Mr. Sheeley explained
that there are currently 1,100 licensed dentists in the state, and 63 hold
an anesthesia permit. This permit requires additional postgraduate
training and additional malpractice insurance. The dentist applying for the
permit has to be evaluated and staff is also evaluated. He further
explained that these evaluations are done within a matter of days after the
permit is requested. The rule also includes a requirement for CPR
training for those seeking a dentists license. He stated that this training
has always been required, but has not been in rule before. There were
various other clarifications in the rule. He further stated that the Board
had received no adverse comments to the rule.



The Committee did not find any basis to reject Docket 19-0101-0201.



Sarah Scott, from the Office on Aging, presented the following dockets
to the Committee. She explained that the Office provides services to
adults 60 years of age and over. There are no income requirements and
more than 50 percent of the funding is federal. There are six planning
and service areas in the state and there are 18 staff.

Docket 15-0101-0201: This Docket is a pending rule. The substantive changes include, a
definition added of an “Assessment Instrument”, provides that clients shall
be assessed using the approved assessment instrument rather that the
Uniform Assessment Instrument, changed to allow Area Aging Agencies,
rather than homemaker providers, to reserve emergency service funds,
and adds a paragraph providing guidance in eligibility determination.



The Committee did not find any basis to reject Docket 15-0101-0201.

Docket 15-0102-0201: This is a pending rule. The substantive changes in this Docket include,
changed the definition of “injury” to “serious injury”, added definition of
protective action plan, changed the definition of serious physical injury to
include severe bruising, decubitis ulcers, and malnutrition resulting in
serious medical consequences, deletes reference to scratches, clarifies
that report involving nursing facilities will be immediately forwarded to the
Department of Health and Welfare per Idaho Code, clarifies that resident
to resident incidents exempted under Idaho Code need not be
investigated, clarifies that all other reports shall be investigated, and adds
a paragraph that substantiated cases may be closed if the client refuses
to consent to services or if no services are available to reduce or
eliminate risk.



The Committee did not find any basis to reject Docket 15-0102-0201.

Docket 15-0121-0201: This is a pending rule that deletes unnecessary reference to the obsolete
Older Americans Act.

The Committee did not find any basis to reject Docket 15-0121-0201.

Docket 23-0101-0201: Sandra Evans, executive director of the Idaho State Board of Nursing,
presented the following two dockets to the Committee.



This Docket is a pending fee rule. Ms. Evans explained that this rule is
necessary to implement provision of House Bill 393 passed by the
Legislature last session and which became effective on July 1, 2002. HB
393
established an emeritus status license for nurses who have retired
from active practice, but who wish to continue to use the protected titles of
licensed practical nurse, registered nurse, certified nurse midwife, clinical
nurse specialist, nurse practitioner and registered nurse anesthetist.



The rule provides for the following; established the process for the
biennial mailing of renewal notices and applications for LPNs and Rns
who hold emeritus status licenses; differentiates the process for
application to reinstate to unrestricted status a license disciplined by the
Board from an emeritus license; establishes requirements for
reinstatement of an emeritus license to unrestricted status; and
establishes a fee of $25.00 for initial application for the emeritus license, a
fee of $20.00 for biennial renewal of the license, and a fee of $35.00 for
late renewal or reinstatement of a lapsed emeritus license.



After Committee discussion the Committee did not find any basis to reject
Docket 23-0101-0201.

Docket 23-0101-0202: Ms. Evans presented this docket to the Committee. This Docket is a
pending rule of the Board of Nursing. This rule is the result of the final
year of a five year effort to review and revise the full docket of
administrative rules of the Board. The purpose of these proposed
changes is to clarify the practice of registered and licensed practical
nurses, to delete unnecessary detail in defining practice and to reformat
the order of practice definition from the broadest, which is that of the
registered nurse, to that of licensed practical nurses, and finally to that of
unlicenced assistive personnel.



The rule consolidates and renumbers existing rules. They provide
clarification and structure to defined scopes of practice for RNs and LPNs.
The delete language detailed listings of nursing functions for each
category of licensure, replacing them with a standard for decision making
within each respective scope of practice. They clarify parameters for and
responsibilities when delegating nursing functions to unlicenced assistive
personnel.



Ms. Evans explained that in general, this rule is a revision of existing
rules defining the practice of licensed professional nurses, licensed
practical nurses and unlicenced assistive nursing personnel.



They do not represent a change in defined scope of practice, but instead
serve to clarify the currently defined scopes for these licensees.



In addition, they modify, add and delete definitions for terms used
throughout the Board’s rules. Finally, they allow for administration of
training programs for nursing assistants in education institutions
accredited by organizations recognized by the U. S. Department of
Education.



In discussing this rule, Vice-Chairman Block put the Committee at ease.



Vice-Chairman Block called the meeting to order at 3:25. After
Committee discussion, the Committee did not find any basis to reject
Docket 23-0101-0202.

Docket 27-0101-0201: Richard Markuson, executive director of the Board of Pharmacy,
presented the following Dockets to the Committee.



This is a fee rule that sets out specific criteria for ephedrine products that
can be sold without a prescription. These criteria include maximum
dosage requirements and label disclosures and warnings. Mr. Markuson
explained that the fee being imposed is justified and necessary to avoid
immediate danger. He further explained that an immediate danger is
inherent in ephedrine products if they are sold in dosage amounts in
excess of the rule or containing synthetic rather than naturally occurring
ephedrine alkaloids. He stated that the fee charge under this rule is
necessary to ensure compliance with the requirements of the rule. This is
a temporary rule that is now in effect and is similar to rules on other
states. The $1,000 registration fee is charged to manufacturers and
wholesalers who must register with the Board of Pharmacy and that fee is
good for one year. Registration is renewed each year for $1,000. Mr.
Markuson
explained to the Committee that a yearly registration fee has
always been charged to wholesalers and retailers. The $1,000 fee would
help the Board keep close tabs on the product.



Lengthy Committee discussion followed, with the following point clarified
by Mr. Markuson; ephedrine is a prescription drug, but there are over the
counter drugs that contain ephedrine and that is what this rule is referring
to.



Chairman Sali stated that he wanted to get more information before the
Committee took action on the Docket.

Docket 27-0101-0202: Mr. Markuson also presented this Docket to the Committee. This Docket
clarifies that the time restriction applies only to Schedule II controlled
substances. Most Schedule II prescriptions are filled in a very short time.
This rule changes that time from seven days to thirty days. The thirty day
change will allow for the few exceptions when patients are not in the
immediate need of the prescription or completing a similar prescription
before filling the new one.



The Committee did not find any basis to reject Docket 27-0101-0202.

Docket 27-0101-0203: This docket clarifies that students enrolled in pharmacy technician training
courses and volunteers at hospital pharmacies may register as pharmacy
technicians and be authorized to act as pharmacy technicians even
though they are not formally employed by the pharmacy. The proposed
rule changes the definition of pharmacy technician to one who is
employed or otherwise authorized to participate in preparing,
compounding, distributing, or dispensing of medications at a pharmacy.



The Committee did not find any basis to reject Docket 27-0101-0203.

Docket 27-0101-0204: This rule change formalizes what has previously been an informal practice
of allowing carryover of continuing education credits earned in June but
not necessary for meeting the prior reporting period’s education
requirements. The proposed rule allows continuing education units
earned during June of any given licensing period to be carried over into
the next licensing period to the extent the pharmacist’s total hours for the
given licensing period exceed that required by rules.



The Committee did not find any basis to reject Docket 27-0101-0204.

Docket 27-0101-0205: This Docket recognizes revised controlled substance prescription forms
authorized by House Bill 331 in the 2001 legislative session, as well as
Senate Bill 1417 in the 2002 legislative session. The proposed rule
changes outline the requirements for controlled substance prescription
blank forms, as well as discipline to be assessed by the Board of
Pharmacy in the event practitioners fail to follow the requirements of
statute and rule with respect to controlled substance prescription blanks.



The Committee did not find any basis to reject Docket 27-0101-0205.

MOTION: Rep. Nielsen made a motion to adjourn the meeting. After Committee
discussion, he withdrew that motion.



Vice-Chairman Block put the Committee at ease.



Vice-Chairman Block call the meeting to order at 5:20 P.M.

MOTION: Rep. Henbest made a motion to approve Docket 19-0101-0201.



After Committee discussion, Chairman Sali made a Unanimous
Consent Request
to have the minutes reflect the official committee
action after each rule docket as the following; The Committee did not find
any basis to reject the Docket. Rule Docket 27-0101-0201 was excepted
from the request. There were no objections.

ADJOURN: As there was no further business to be brought before the Committee,
Chairman Sali adjourned the meeting at 5:30 P.M.






DATE: Thursday, January 16, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/EXCUSED: None
GUESTS: See attached list
Chairman Sali called the meeting to order at 1:35 P.M.
MOTION: Rep. Nielsen made a motion to approve the minutes of the January 14th,
2003 meeting as submitted. On a voice vote, the motion carried.
MOTION: Rep. McGeachin made a motion to approve the minutes of the January
10th, 2003 meeting with the following correction, on page 3 , change
“imposted” to “imposed”. On a voice vote, the motion carried.
RS 12559: Rep. Henbest presented this RS to the Committee. She explained that
the purpose of this resolution is to declare the months that the Legislature
is in session Obesity Awareness Months and to urge communities,
businesses and schools to develop an awareness of the causes,
symptoms and long-term consequences of the condition and how it can
be prevented. She explained that obesity is a huge national problem and
increased cases of childhood obesity have led to an increase in type two
diabetes in children.
MOTION: Rep. Ring made a motion to print RS 12559.
SUBSTITUTE
MOTION:
Rep. Martinez made a Substitute Motion to print RS 12559 and send it
directly to the Second Reading Calendar.
AMENDED
SUBSTITUTE
MOTION:
Rep. Kulczyk made an Amended Substitute Motion to return RS 12559 to
the sponsor.
Committee discussion followed in which the following points were made;
the laws in the state need to be reduced, the methods are limited as to
how to deal with health issues, and awareness campaigns do have
effects and is the worth the attempt.
AMENDED
SUBSTITUTE
MOTION:
On a Roll Call Vote, the Amended Substitute Motion to return RS 12559
to the sponsor failed on a 7 to 4 vote. Representatives Kulczyk, Eberle,
McGeachin, and Nielsen voted AYE; Representatives Sali, Block,
Garrett, Ring, Henbest, Martinez and Mitchell voted NAY.



SUBSTITUTE
MOTION:


The Substitute Motion to send RS 12559 to print and directly to the
Second Reading Calendar passed on a voice vote. Rep. Henbest will
sponsor the Resolution on the House Floor.
Nancy Kerr, executive director of the Idaho Board of Medicine, presented
the following rule Dockets to the Committee.
Docket 22-0101-0101: This Docket is a pending rule that contains a section that is changed to
comply with Federal guidelines for the processing fingerprints. The rule
also allows those physicians that have obtained board certification and
other demonstrated competency the opportunity to obtain licensure and fill
needed physician vacancies throughout the state.
Chairman Sali made a Unanimous Consent Request to have the minutes
reflect that after each rule docket that the Committee did not find any
basis to reject the Docket if members have unanswered questions. There
were no objections. He further stated that Committee members could
bring up previous rule dockets if they had questions and the Committee
would revisit that rule.
The Committee did not find any basis to reject Docket 22-0101-0101.
Docket 22-0101-0201: This is a pending rule that defines the requirement for continuing
education for physicians, specifies the number of hours of education
required in a two year license cycle, identifies acceptable alternatives to
continuing education and defines the method of reporting continuing
education.
The Committee did not find any basis to reject Docket 22-0101-0201.
Docket 22-0105-0201: This pending rule changes are minor housekeeping and clarification
changes to correct the term of office of the chairman of the Physical
Therapy Advisory Committee, provide clarification regarding applicants
who fail the examination and for those who apply for licensure by
endorsement and clarifies the requirements for reinstating an expired
license.
The Committee did not find any basis to reject Docket 22-0105-0201.
Docket 22-0103-0201: Ms. Kerr explained that the Board of Medicine requests that the
Committee reject Docket 22-0102-0201. She stated that the level of
supervision for physician assistants needs to be further clarified.
MOTION: Rep. Henbest made a motion that the Committee reject Docket 22-0103-0201. On a voice vote, the motion carried.
Docket 22-0109-0201: This is a fee rule that clarifies licensure requirements and fees for
reinstatement for Occupational Therapists and Occupational Therapy
Assistants. No fees are added or changed, only clarified.
The Committee did not find any basis to reject Docket 22-0109-0201.



Docket 22-0113-0201:


This is a fee rule that clarifies the process and the fees for converting an
inactive license to an active license for dietitians. There are no fee
changes.
The Committee did not find any basis to reject Docket 22-0113-0201.
Chairman Sali put the Committee at ease and then called the meeting to
order at 3:35 P.M.
Rayola Jacobsen, bureau chief of Occupational Licensing, presented the
following rule dockets to the Committee.
Chairman Sali announced that by agreement of the interest parties, rule
Docket 24-1401-0201 on today’s agenda will be heard at a later date.
Docket 24-0301-0201: This pending rule changes the expiration date and reinstatement of
licenses for chiropractic physicians. It establishes a requirement for
licenses canceled over five years to be in accordance with Idaho Code.
The Committee did not find any basis to reject Docket 24-0301-0201.
Docket 24-0501-0201: This pending rule repeals the obsolete rules containing references to the
Environmental Health Specialists law.
The Committee did not find any basis to reject Docket 24-0501-0201.
Docket 24-0901-0201: This pending rule refers to nursing home administrators. It deletes the
reference under nursing home administrator-in-training requriement to the
facility administrator not being the preceptor.
The Committee did not find any basis to reject Docket 24-0901-0201.
Docket 24-1101-0201: This pending rule relates to the Board of Podiatry. It deletes reference to
annual renewal date, changes the passing grade on the examination from
75 percent to 70 percent and changes the standards of ethical practice
shall be the American Podiatric Medical Association’s code of Ethics.
The Committee did not find any basis to reject Docket 24-1101-0201.
Docket 24-1201-0201: This is a pending rule that refers to the Board of Psychologist Examiners.
It adds that the reexamination fee shall be charged by the national
examination entity plus a $25 processing fee and changes reciprocity to
endorsement fee.
Roger Hale, an attorney from the Bureau of Occupational Licensing,
addressed the Committee. In response to questions from Committee
members, he clarified that endorsements set objective standards.
The Committee did not find any basis to reject Docket 24-1201-0201.
Docket 24-0201-0202: This is a pending rule that refers to the Board of Psychologist Examiners.
It allows a one-year carryover of continuing education hours; deletes
unnecessary record keeping requirements, requires the training faculty to
be on site and of adequate size and clarifies the definition of a
professional psychology program.
The Committee did not find any basis to reject Docket 24-0201-0202.
Docket 24-1501-0201: This is a fee rule that relates to the Board of Professional Counselors and
Marriage and Family Therapists. It establishes a fee for the Marriage and
Family Therapist Intern registration at $25. Ms. Jacobsen explained that
the internship position is a new classification.
The Committee did not find any basis to reject Docket 24-1501-0201.
Ms. Jacobsen then discussed with the Committee the various cost-
savings tools she has implemented at the Bureau since she started there
a year and a half ago. These include; revamping the licensing system for
cosmetologists, changing the time for license renewal from the beginning
of each year to individual’s birthdays, and working with staff to explore
other areas in which to save money.
Docket 24-1601-0201: This is a fee docket that relates to denturity. It inserts rules for
Administrative Appeals, adds Bureau contact information, adds Public
Records section, adds Bureau definition, adds that the board may meet
and have examinations at such other times as determined by the board,
establishes the examinations shall include a theory examination,
establishes grading and re-examination requirements, establishes grading
and re-examination requirements, and establishes the re-examination fee
shall be the same as the original examination fee.
The Committee did not find any basis to reject Docket 24-1601-0201.
Docket 24-1901-0201: This is also a fee rule and relates to the Board of Examiners of
Residential Care Facility Administrators. It increases the application fee
from $25 to $50.
The Committee did not find any basis to reject Docket 24-1901-0201.
Docket 24-1701-0201: This is a pending rule relating to the Board of Acupuncture. It adds
Bureau contact information, defines Bureau, updates qualification for
licensure to be has received certification from NCCAOM(National
Certification Commission for Acupuncture and Oriental Medicine) changes
renewal of license to be in accordance with Idaho Code, establishes
continuing education requirements, and establishes waiver of continuing
education requirements for an inactive license.
The Committee did not find any basis to reject Docket 24-1701-0201.
Docket 24-1901-0202: This is a temporary rule that refers to the Board of Residential Care
Facility Administrators. This rule establishes that an applicant for
examination shall be required to register with and pay the examination fee
to NAB(National Association of Boards), deletes contents of examination,
establishes that the passing score to be determined by the NAB, deletes
requirements for retakes, and adds approved courses of study for
licensure.
The Committee found no basis to reject Docket 24-1901-0202.
Chairman Sali passed out to Committee members a copy of SCR 130
and SCR 131, which are the omnibus resolutions from the 2002
Legislature regarding rule approval. He explained to the Committee that
the resolution when passed by the full House approves the rule, the
Committee does not.
Chairman Sali announced that the Committee will meet Monday, January
20th, and Wednesday January 22nd to consider the rules from the
Department of Health and Welfare. The Committee will not meet on
Friday January 24th.
ADJOURN: As there was no further business to be brought before the Committee,
Chairman Sali adjourned the meeting at 4:35 P.M.






DATE: Monday, January 20th, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/EXCUSED: None
GUESTS: See attached list
Chairman Sali called the meeting to order at 1:40 P.M.
MOTION: Rep. Eberle made a motion to approve the minutes of the January 16th,
2003 as submitted. On a voice vote, the motion carried.
Lloyd Forbes, manager of the State Plan and Waivers section of the
Bureau of Benefits and Reimbursement Policy of the Division of Medicaid,
addressed the Committee. He presented the following rule dockets to the
Committee.
Docket 16-0309-0206: This docket involves changes to the way that the Medicaid program pays for
Medicare. This is a pending rule. He explained that this rule was developed
to reduce Medicaid expenditures to meet the funds available following the
budget shortfall and to provide services at the right price. Before this rule
change, Medicaid automatically paid the total amount of the Medicare Part
B coinsurance and deductible amount on all Medicare claims, for persons
eligible for both Medicare and Medicaid, which “crossed over” to Medicaid.
As Medicaid generally pays less than Medicare, the amount paid is generally
reduced, resulting in savings to the Medicaid program. These rules
specifically address physicians, hospital outpatient, and ambulance
providers. This change in payment methodology is projected to save $2.3
million during the current fiscal year.



The Committee did not find any basis to reject Docket 16-0309-0206.

Docket 16-0309-0207: This is a temporary rule which addresses the employment status of
Independent Residential Habilitation providers. Before this rule change,
individuals were paid for Residential Habilitation services in the home of the
participant under both of the Department’s Developmental Disability waivers.
Because this arrangement was allowed, the Department was found to be
responsible for the withholding of FICA, FUTA, and SUTA payments. As
pointed out by the Legislative Auditors, this practice was time consuming and
costly.

In addition, the Department was considered to be the Common Law
employer of such individuals, creating a potential liability risk.



All other independent providers have been required to be employees of an
agency for some time. This rule change treats all providers of similar
services consistently by the Department. These rules also clarify that
RESHAB providers who provide services in their own homes as Certified
Family Homes must be affiliated with a RESHAB Agency for training and
oversight.



The Committee found no basis to reject Docket 16-0309-0207.

Docket 16-0309-0208: This pending rule addresses the method of reimbursement used to pay for
services in federally qualified health centers and rural health clinics. This
change is required by a change in federal law. Previously, these providers
were paid on a retrospective, cost settlement basis. This rule clarifies the
types of encounters which can be reimbursed by Medicaid, including the
addition of a Dental encounter. The description of what service constitutes
an encounter is updated to conform the federal requirements and actual
industry practice. Mr. Forbes explained to the Committee the difference in
retrospective versus prospective payments. Retrospective payments are
made when the provider is paid monthly and at the end of the year a cost
report is filed. The Department then settles with the provider and may pay
more or less based on the service provided. A prospective payment is audit-
based and bases the monthly payments on past costs and estimated costs.
There is no yearly settlement.



The Committee found no basis to reject Docket 16-0309-0208.

Docket 16-0309-0210: This Docket primarily deals with clarifying the language and consistently
using the term “participant” throughout the affected section of rule. In the
section of rule that covers Personal Care Services, the requirement for a
supervised RN visit at least every 90 days was eliminated, and it is left up
to the participant and the Department’s Nurse Reviewer to determine the
frequency of the RN visits, or if any such visits are necessary for the
particular individual. Changes in the section that covers “client contribution
for waiver services” essentially condenses a page of verbiage on how to
calculate the participant’s personal needs allowance into a single chart. This
is designed to make this section of rule much more understandable for both
the Department and the public.



The Committee found no basis to reject Docket 16-0309-0210.

Docket 16-0310-0201: This docket refers to payment for federally qualified health center and rural
health clinic services. It revises the reimbursement method from a
retrospective payment method to a prospective payment method. This
docket deletes the old language dealing with the retrospective payment
method.



The Committee found no basis to reject Docket 16-0310-0201.

Docket 16-0310-0204: This rule change removes wheelchairs from the content of care for
Intermediate Care Facilities for the Mentally Retarded. This change has
three positive effects.



First; eliminating the cash flow problem experienced by small ICF/MR
facilities when a participant requires a highly specialized and expensive
wheelchair, as the Medicaid program pays for such chairs on a fee schedule
rather than billed charges; second, the cost is less to the Medicaid program,
and third, the participant is more readily accepted for admission into the
small facilities and keeps the wheelchair, no matter if he moves between
facilities or into a community placement.



The Committee found no basis to reject Docket 16-0310-0204.

Docket 16-0310-0301: This temporary rule states that Medicaid will reimburse for out-of-state
nursing home placements when services are not available in Idaho to meet
the recipient’s medical need, or in a temporary situation for a limited period
of time required to safely transport the recipient to an Idaho facility.
Reimbursement for out-of-state nursing homes will be at the per diem rate
set by the Medicaid Program in the state where the nursing home is located.



The Committee found no basis to reject Docket 16-0310-0301.

Docket 16-0309-0212: This is a temporary rule that addresses the Department’s Traumatic Brain
Injury Waiver rules. The changes in the rule are basically technical in nature
and clarify provider qualifications and updates terminology to make these
rules more consistent with the terminology found in the Department’s other
Home and Community-Based waivers. The term “participant” is used
throughout to identify a person using services to standardize the language.
Diagnosis Codes for “concussion” and “intercranial injury of other and
unspecified nature” are added to the list of qualifying diagnoses. The term
“individual support plan” is replaced by the term “plan of care.”



The Committee found no basis to reject Docket 16-0309-0212.

Docket 16-0309-0216: This is a temporary rule that addresses dental services for adults. These
rules are required to comply with legislative intent language in the
Department’s FY 2003 appropriation bill and essentially limit adult dental
procedures to emergency situations. Mr. Forbes explained that following
the implementation of temporary rules which limited adult dental services to
a specific set of dental procedures, Medicaid staff were confronted with
many requests for exceptions and special considerations. In addition, the
Governor gave the Department direction to take additional factors into
consideration. After conferring with the Department’s dental consultants and
working with the Idaho Dental Association, changes have been incorporated
into this docket to rely on dentists and oral surgeons for the determination
of a dental emergency. Based on appropriate documentation from the
dentist or oral surgeon, under these rules, the Department may now
authorize adult dental procedures which are not on the list of covered
services. The Department is requesting that the Committee extend this
temporary rule. If the extension is not granted, there would be a projected
$8.4 million increase in funding required for State Fiscal Year 2004. Thirty
percent of that increase would come from the State General Fund.



Terri Sterling, a member of the Idaho Community Action Network(ICAN),
addressed the Committee. She testified against this docket. She stated that
because of this rule change, 37,000 people were cut off for adult dental care.
She further stated that it is good for the State’s economy to invest in
Medicaid. She related a personal experience that she could not find a
dentist in northern Idaho who will take Medicaid patients due to the low
reimbursement rates.

Bryson Herrera, also a member of ICAN, addressed the Committee. He
testified against this docket. He stated that dignity does not mean dentures;
it means dental care.
Peggy Peterson, a member of ICAN addressed the Committee. She also
testified against this docket. She stated that she has various health
problems which causes dental problems. She further stated that she is
scared for her health because she cannot have preventative dental care
under Medicaid. She said that she is a native Idahoan and feels that the
state is letting her down.
Maureen O’Leary, a licensed social worker who works with low-income and
Medicaid clients, addressed the Committee. She also testified against this
docket. She stated that this issue is not black and white, it is a dignity issue.
She related her experience in taking clients to emergency rooms for
emergency dental care and being turned away because they do not treat
dental problems. She further stated that emergency dental care in Boise is
very limited. She said that the Terry Reilly Clinic in Boise does take
Medicaid patients, but is overrun.
J.L. Byington, a residential habilitation provider and mother of a daughter
with mental disabilities, addressed the Committee. She also testified against
this docket. She related her personal experiences in trying to get emergency
dental care for her daughter. She stated that emergency dental care is very
difficult to find.
Gloria Lara, a member of ICAN from Burley, spoke to the Committee. She
also testified against this docket. She stated that she is disabled and is not
able to get any dental services. She further stated that if she is hospitalized,
those costs are far higher than dental costs.
Retta Green, a member of ICAN, addressed the Committee. She told of her
personal experience with denture pain and now needs an expensive dental
treatment because she could not get preventative dental care.
In response to questions by Committee members, Ms. O’Leary, clarified
that her clients are taught dental hygiene at an early age and their diets
are also monitored.
Bill Foxcroft, executive director of the Idaho Primary Care Association,
addressed the Committee. In response to questions from Committee
members, he stated that the Terry Reilly Clinic in Boise receives federal
dollars and there is a sliding fee scale for patient charges. He further stated
that some clinics do offer dental services, but are more likely to see children
for dental care.
In response to questions from the Committee, Kathleen Allyn, Deputy
Administrator for the Division of Medicaid, addressed the Committee. She
stated that if this rule docket is rejected by the Committee, the temporary rule
would remain in effect until the end of the current legislative session, and the
pending rule would not take effect. The legislative intent language from last
year’s appropriation bill would be in effect until June 30th of this year. If the
rule docket is approved, only emergency dental services would be covered
for adults on Medicaid.



Committee discussion followed with the following points covered; new rules
would have to be promulgated if this docket is rejected, and new legislation
would have to be drafted to amend the legislative intent language in the FY
2003 appropriation bill. Also funding for up to $7 million would have to be
found for FY 2003 and $8.4 million for FY 2004.

MOTION: Rep. Eberle made a motion to reject rule Docket 16-0309-0216.
After Committee discussion, Chairman Sali made a Unanimous Consent
Request that if the Committee votes to reject Docket 16-0309-0216,that
would not be the final action of the committee and a subcommittee would be
appointed to further study this docket and bring recommendations to the full
Committee.
ROLL CALL
VOTE:
On a roll call vote, the motion to reject Docket 16-0309-0216 passed on a
vote of 7 to 3. Representatives Kulczyk, Garrett, Eberle, McGeachin,
Henbest, Martinez, and Mitchell voted AYE. Representatives Block, Ring,
and Nielsen voted NAY.
Chairman Sali appointed a subcommittee to further study Docket 16-0309-0216. Rep. Block will chair the Committee, and Representatives Ring,
Nielsen, Martinez, and Mitchell will serve on the Committee.
Docket 16-0309-0218: This docket eliminates Medicaid payment for the entry of laboratory results
into the Clozapine National Registry for participants who require this
medication for the treatment of their mental illness. In October of 2001, the
Department reduced its payment for this service from $29.07 to $5.00 to
more accurately reflect the complexity of the service and bring the state’s
payment into line with what other states are paying. During State Fiscal
Year 2002, Medicaid paid $39,143 for this service.
Eileen Farley, a member of the National Alliance for the Mentally Ill, and
parent of a son who takes Clozapine, addressed the Committee. She
discussed the serious side-effects of this drug and the need for close
monitoring.
The Committee found no basis to reject Docket 16-0309-0218.
Docket 16-0309-0301: This docket describes the payment methodology used to reimburse out-of-state nursing home for care provided to Medicaid eligible persons. Because
of the complexity of our current acuity-based reimbursement for in-state
nursing homes, the Department has elected to pay out-of-state facilities the
same rate as they receive from the Medicaid program in their home state.
This simplifies their billing and claim submission and is the method
previously and currently used by the Department.



The Committee found no basis to reject Docket 16-0309-0301.

Docket 16-0311-0101: This Docket was presented by Kathleen Allyn, deputy Administrator for the
Division of Medicaid. This docket is a temporary rule that sets a cap on beds
in community intermediate care facilities for persons with mental retardation
at 486 beds. Of that 486, 12 are reserved for time-limited emergency use.
The purpose of the rule is to put a temporary cap on expansion of this
service as a cost-control measure. She explained that the Department has
consulted with the Idaho Association of Community Options and Resources,
the ICF/MR association, and there is no objection to this request from the
associations.



The Committee found no basis to reject Docket 16-0311-0101.

ADJOURN: There being no further business to be brought before the Committee,
Chairman Sali adjourned the meeting at 4:25 P.M.






DATE: January 22, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

None
GUESTS: See attached list
Chairman Sali called the meeting to order at 2:15 P.M.
MOTION: Rep. Ring made a motion to approve the minutes of the January 20th
meeting as submitted. On a voice vote, the motion carried.
Vice-Chairman Block discussed with the Committee the
WWAMI(Washington, Wyoming, Alaska, Montana, Idaho) conference she
attended. She explained that the states involved in this group, with the
exception of Washington, do not have medical schools. WWAMI affords
those students living in these states an opportunity to attend the University
of Washington’s medical school and pay only the in state tuition cost. Idaho
has 18 slots and students who have received the highest test scores can
apply for medical school. The in-state tuition cost is $12,000 and the state
pays for the out-of-state tuition cost of $44,000. The first year of medical
school is spent at the University of Idaho, the second year is at the University
of Washington in Seattle, and the last two years are spent on a rotation in
various states. 42 percent of the graduates return to Idaho, and 70 percent
of those who do their rotation in our state, return to Idaho to practice
medicine. She further explained that one-third of the state’s $44,000 follows
the student back to the state. She stated that this is a highly successful
program and avoids the expense of having a medical school in Idaho.
Karen Gustafson, assistant rules coordinator for the Department of
Administration, addressed the Committee. She explained that the following
docket; Docket 16-0205-0201 uses “plain language” and is a product of the
new rule-writers unit within the Department. She asked for feedback from
Committee members as to how they liked the new format.



Ms. Gustafson also further clarified the action that the Committee can take
on rule dockets. She explained that pending rules will go into effect unless
negative action is taken. The Chairman of the Committee sends a letter to
the Speaker of the House indicating which rule dockets the Committee has
rejected. She further explained based on an opinion from the Attorney
General’s Office, that the Legislature cannot amend or modify the rules.



The Committee can reject an entire rule, section or subsection.

She also discussed negotiated rule-making. She explained that this is not
mandatory process. Negotiated rule-making brings all of the players to the
table before the rules are published and the meetings do not have to meet
the open public meeting law. It is an informal process, and tries to bring
consensus before the rule is drafted.

Docket 16-0205-0201: Russ Duke, bureau chief with the Department of Health, presented this
Docket to the Committee. This is a pending rule that relates to HIV related
services. The Idaho STD/AIDS Program receives federal and state funding
to provide HIV related services to eligible individuals. These rules help guide
the planning and disbursement of funds of the federal Ryan White CARE Act
and the state supported AIDS Drug Assistance Program. Mr. Duke
explained that this program has a $1.3 million budget and $180,000 of that
budget comes from the state’s General Fund. He further explained that
these funds are used to help stop the spread of AIDS and the majority of the
participants have an income less than $9,000 per year. The program is
administered by the Department of Health and services are contracted out
to various providers. To be eligible for this service ,the participant must have
a medical diagnosis of HIV, reside in Idaho, a monthly income of less than
200 percent of the federal poverty level, not currently an inmate of any state
correctional institution, and must not have available other sources sufficient
to pay for HIV related services. The services include an assessment of the
participant’s needs and personal support systems, development of an
individual service plan, coordination of services, monitoring of services
received, and re-evaluation of the participant’s service plan periodically to
make revisions if needed. He further explained that this is not an entitlement
program, it is a payer of last resort. He also stated that the number of HIV
cases in the state has been level with the increase in population. He further
stated that there has not been a dramatic increase in cases in the last
several years. The program has been in place since 1992 and the $180,000
state General Fund monies have not increased since that time.
MOTION: After Committee discussion, Rep. Nielsen made a motion to forgo action
on Docket 16-0205-0201 subject to the pleasure of the Chair to
reschedule hearing at another time. On a voice vote, the motion failed.
MOTION: After Committee discussion, Rep. Ring made a motion to have the
minutes reflect that the Committee found no basis upon which to reject
Docket 16-0205-0201.
SUBSTITUTE
MOTION:
Rep. Kulczyk made a Substitute Motion to reject section 200, subsection
(06) of Docket 16-0205-0201. On a voice vote, the motion failed.
ORIGINAL
MOTION:
The Original Motion to have the minutes reflect that the Committee found
no basis upon which to reject Docket 16-0205-0201 carried on a voice
vote.



The Committee found no basis upon which to reject Docket 16-0205-0201

Docket 16-0210-0201: Dick Schultz, administrator of the Division of Health, presented this
docket to the Committee. This temporary rule regulates Idaho’s
reportable diseases.






Definitions are clarified and the five conditions detectable by newborn
screening were added to the reportable disease list, as were three
infectious diseases. The reporting period was shortened from seven days
to three days. Mr. Schultz discussed section 23 of the rule that relates to
isolation. The rule adds that “persons who may have been exposed to a
highly contagious infectious agent” may be isolated. He explained that
this is an attempt to limit the spread of the disease and each individual
reacts differently to exposure.

MOTION: Rep. Henbest made a Motion to approve Docket 16-0210-0201.
The Committee then discussed the isolation issue, with the following
points being made; there is no scientific way to prove exposure and each
disease reacts differently.
Rep. Eberle made an Unanimous Consent Request to have the
minutes reflect that the Committee found no basis upon which to reject
Docket 16-0210-0201. There were no objections.



The Committee found no basis upon which to reject Docket 16-0210-0201.

Docket 16-0212-0201: Russ Duke presented this Docket to the Committee. This Docket repeals
the existing rules dealing with screening for newborns.
Docket 16-0212-0202: Mr. Duke also presented this Docket to the Committee. This pending rule
is the rewrite of the above docket. He explained that this rule was rewritten
due to a change in funding. As of July 2002, the state no longer funds this
program. This program requires infants to be tested for five metabolic
conditions before being discharged from the hospital. These conditions
include; bitinidase deficiency, congenital hypothyroidism, galactosemia,
maple syrup urine disease, and phenylketonuria. He explained that the lab
charge fee for the test kits for all of these tests is $18.00. The parents are
responsible for this fee. He further explained that approximately 20,000
babies are born in Idaho each year and 8 to 10 of them have one of these
conditions. The test is done 48 hours to five days after birth and prior to
discharge. Some followup tests are also performed. He stated that the
original rules have been in place for over 30 years. He also stated that 97
percent of births occur in hospitals.
The Committee found no basis upon which to reject Docket 16-0212-0201 and Docket 16-0212-0202.
Docket 16-0000-0201: Ray Millar, an Alternative Care Coordinator for Medicaid’s Bureau of
Benefits and Reimbursement Policy, presented this Docket to the
Committee. The changes in this pending rule are non-substantive in nature
and will not negatively impact service recipients, service providers, or the
Department of Health and Welfare. Titles and designations of social workers
were changed as a result of HB 406 passed by the 2002 Legislature.
“Certified Social Worker” was changed to “Licensed Master’s Social Worker”
and “Certified Social Worker-Private Practice” to “Licensed Clinical Social
Worker.” Another name change as a result of administrative rules of the
licensing board of Professional Counselors and Marriage and Family
Therapists, is “Licensed Professional Counselor-Private Practice” to
“Licensed Clinical Professional Counselor.”



The rules are changed to be consistent with the new professional titles. He
explained that providers and consumers will notice a name change but no
other substantive change in the new rule. He further stated that the
Department will incur a cost of about $280 for publication.

The Committee found no basis upon which to reject Docket 16-0000-0201.
Docket 16-0307-0101: Debby Ransom, from the Bureau of Facility Standards, presented this
docket to the Committee. The rule change is to bring the Department into
compliance with the HCBS (Home and Community-Based Services) Waiver
for the aged and disabled and for changes that have been made in the
federal regulations governing home health agencies. It also clarifies who
must be licensed as home health agencies.
The Committee found no basis upon which to reject Docket 16-0307-0101.
Docket 16-0309-0201: Leslie Clement, bureau chief of Medicaid Benefits and Reimbursement
Policy, presented this docket to the Committee. This pending rule affects the
way some payments are processed for care received in residential care
facilities and certified family homes. Cash payments were previously paid
to residents through the Division of Welfare. Because of legislation in 2001,
the Division of Medicaid now pays providers directly. Generally, this change
in payment methodology created an opportunity to leverage Medicaid funds
and improve the reimbursement for personal care services. The net savings
to the state general fund in 2002 was approximately one million dollars. This
change has been in effect since January 2002. The only barrier in
implementation was the unwillingness of several facilities to enroll as
Medicaid providers. Department administrators decided to allow recipients
in these non-Medicaid facilities to remain in these homes and continue to
receive cash payments rather than force residents from these homes.
The Committee found no basis upon which to reject Docket 16-0309-0201.
Docket 16-0309-0215: Leslie Clement presented this docket to the Committee. She explained that
the purpose of this temporary rule is to meet budget hold back directives
while continuing to meet the department’s commitment to providing access
to the right care for the right price. These temporary rules relax some of the
provider requirements for targeted service coordinators and targeted case
managers because of reduced reimbursement and benefit limitations.
Medicaid attempted to minimize the impact on recipients by reducing
reimbursement and limiting benefits rather than eliminating services. The
services identified in this rule docket are case management services for
developmentally disabled and mentally ill Medicaid recipients. The services
are brokerage services in which case managers help direct individuals to
resources. These are not diagnostic or treatment services. These changes
do not affect any other developmental disability or mental health services
that Medicaid recipients are currently receiving or may need in the future.
For disabled individuals, crisis case management services continue to be
available through Medicaid.



For mentally ill individuals, crisis hours are contained in the new four hours
per month limitation. As of December 2002, there were 64 providers actively
providing mental health case management services to 1,800 Medicaid
recipients. In fiscal year 2002, Medicaid spent approximately $6 million for
this service. Negotiated rule-making was not conducted because rule-making occurred to comply with executive mandate and because of the need
to implement the reductions to achieve projected savings.

Committee discussion followed with the following points clarified; case
management prevents people from falling through the cracks, a telephone
call instead of a face to face visit with the service coordinator can cause
some problems with service, but offers flexibility for the provider, providers
may have less time to spend with clients due to the elimination of caseload
requirements, and the providers now receive 30 percent less in
reimbursement. Ms. Clement stated that the Department hopes that these
reductions in services would not be permanent and that the economy would
improve so they can be restored.
Steve Hansen, representing the Case Managers Association of Idaho,
addressed the Committee. He explained that the monthly reimbursement
rates have been reduced by 30 percent and in the past 13 years have been
frozen while state employees have received cost of living raises. He stated
that the Department should continue to negotiate these rules regarding
reimbursement rates. He further stated that when the four hour cap for
services is reached, the service coordinator has three options; refer the
client to the Department, provide no additional services until the next month,
or the provider can volunteer his time to provide his services. Mr. Hansen
asked that the Committee adopt this rule docket with strong language
directing the Department to continue negotiated rule-making. He also
explained the job of a service coordinator. This individual assesses
available services, develops a plan and links to communities, advocates for
needed services, and monitors the entire plan.
Committee discussion followed and compensation to targeted service
coordinators was clarified.
Rep. Henbest made an Unanimous Consent Request that the minutes
reflect that the Committee found no basis upon which to reject Docket 16-0309-0215 and a letter be sent to the Department of Health and Welfare to
direct them to do research on the feasability and cost for prior authorization
for crisis services. There was an objection.
Chairman Sali made a Unanimous Consent Request to refer Docket 16-0309-0215 to a subcommittee for additional study. There were objections.
MOTION: Rep. Kulczyk made a motion that the minutes reflect that the Committee
found no basis upon which to reject Docket 16-0309-0215 and that a letter
be sent to the Department of Health and Welfare to direct them to do
research on the feasibility and cost for prior authorization for crisis services.
On a voice vote, the motion carried. Rep. Martinez voted NAY.
The Committee found no basis upon which to reject Docket 16-0309-0215
Docket 16-0309-0202: Sharon Duncan, bureau chief for Medicaid Operations, presented this
docket to the Committee. This rule was implemented as a part of the
Division’s cost containment plan for the Governor’s one percent hold- back
in fiscal year 2002. This rule governs non-emergency transportation
providers. She explained that provider rates for commercial, non
commercial, and individual transportation providers will be reimbursed on a
per mile basis, at a rate established by the Department after a study of costs
has been conducted. These studies will be conducted no less than every
three years. Meal reimbursement for Medicaid clients will also be at a rate
established by the Department.
The Committee found no basis upon which to reject Docket 16-0309-0202.
Docket 16-0309-0217: Ms. Duncan presented this Docket to the Committee. This temporary rule
has a technical update replacing the term “Peer Review Organization” with
the new term “Quality Improvement Organization” in compliance with the
change in federal code. The other change in the rule relates to the
assessment of late penalties. At the current time, the Department is allowed
to assess a penalty to providers for submitting a late review to the contracted
quality improvement organization. This rule would allow a penalty to be
assessed by the Department for internal reviews. This would ensure that all
procedures are submitted in a timely manner for review.
The Committee found no basis upon which to reject Docket 16-0309-0217.
Because of the lateness of the hour, Chairman Sali announced that the
remainder of the dockets on the agenda will be heard by the Committee
on Friday, January 24th. The Committee will meet at 9 A.M.
ADJOURN: As there was no further business to be brought before the Committee, the
meeting was adjourned at 6:30 P.M.






DATE: January 23, 2003
TIME: 8 A.M.
PLACE: Room 404
MEMBERS: Chairman Block, Representatives Eberle, Nielsen, Ring, Martinez and
Mitchell
ABSENT/

EXCUSED:

Rep. Mitchell
GUESTS: See attached list
Chairman Block called the meeting to order at 8 A.M. She informed the
members that the meeting was informal, for organizational purposes only.
No public testimony or vote will be taken at this meeting.



The first objective of the subcommittee is to further consider the rejection of
rule Docket 16-0309-0216. The subcommittee will present their
recommendations to the full Health and Welfare Committee.

Karen Gustafson, an assistant rules coordinator with the Department of
Administration, spoke to the Committee. She discussed the omnibus
concurrent resolution that the Legislature will vote on regarding the rules.
She explained that the legislature could accept the rules with the
exception of one or more particular dockets.
The following points were clarified; the decision to cut adult dental care was
made by JFAC and did not come through the Health and Welfare Committee
and no public testimony was taken; even if this rule is rejected, the
Department is still bound by the legislative intent language in last year’s
appropriation bill(SB 1490) which stays in effect through the end of the
current fiscal year which ends on June 30th, 2003. The Concurrent
Resolution to accept the rules usually is voted upon on the House Floor near
the end of the session.



The Committee cannot take any action by itself. JFAC has the authority to
restore funds to the adult dental program.



The second objective of the subcommittee is to address legislation that
amends the intent language of the Budget Appropriation Bill(SB 1490).



The language that would be stricken in Docket 16-0309-0216 is found on
page 83, section 900, sub section b, and the language on page 84,
subsection (05).



Kathleen Allyn, deputy administrator for the Division of Medicaid, spoke to
the Committee. In response to questions from Committee members, she
discussed various cost-saving methods within the Department of Health and
Welfare. One of these discussed was the refunding of unused prescriptions
in assisted living facilities. This could result in a one million dollar savings
in general fund monies. Low participation from these facilities is a concern,
and the need for an incentive to participate was discussed. Other
suggestions from Ms. Allyn included; more management of Developmental
Disability programs, and reductions in other kinds of services,
reimbursements, and eligibilities. She explained that the 30 percent cuts are
not across the board and the programs within the Department have not been
built as a whole. She further explained that there are about 25 different
eligibility categories and it is difficult to try to reduce in this area. She stated
that the Department is $200,000 in the black for the current fiscal year out
of an $800 million budget.



In response to questions from the Committee, Jim Baugh, executive director
of Co-Ad, Inc., disability advocacy services, addressed the Committee. He
explained that illegal aliens are not entitled to Medicaid services.



Ms. Allyn further discussed the idea of refunding unused prescriptions. She
stated that this could be implemented by July 1st or earlier, but not in time
to help with the additional funding for 2003. She further stated that currently,
nursing homes are the only facilities who return unused prescriptions. The
Committee discussed other facilities who could participate including
correctional facilities.



Chairman Block asked that the members of the subcommittee decide what
area they would like to work on which include; working on draft language to
amend the intent language of the Appropriation bill, and researching ways
to come up with funding alternatives.



Jim Baugh offered to Committee members a copy of a report outlining the
economic impacts of Medicaid. The report discusses how jobs and the
economy are affected by cuts in the Medicaid program.



Chairman Block told Committee members that she would let them know the
date of the next meeting.

ADJOURN: As there was no further business to be brought before the Committee,
Chairman Block adjourned the meeting at 8:50 A.M.






DATE: January 24, 2003
TIME: 9 A.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

Representatives Henbest and Mitchell
GUESTS: See attached sheet
Chairman Sali called the meeting to order at 9:15 A.M.
MOTION: Rep. Ring made a motion to approve the minutes of the January 22, 2003
meeting as submitted. On a voice vote, the motion carried.
Docket 16-0309-0204: Larry Tisdale, supervisor of the third-party recovery program in Medicaid
Operations, presented this Docket to the Committee. He explained that the
changes made in this rule add birth costs as a service for which the
Department will make reasonable attempts to discover liable third parties.
The changes also remove the absent parent without a second valid resource
and prenatal services from the group of exceptions to which the Department
will seek reimbursement from liable third parties. This rule facilitates a
collaborative effort between child support services and Medicaid. The
changes come as a result of a legislative audit finding. This is a pending
rule. In response to questions from Committee members, Kathleen Allyn,
deputy administrator of the Division of Medicaid, addressed the Committee.
She explained the EPSDT(Early periodic screening diagnosis and treatment)
service discussed in this rule docket. She explained that this service is a
requirement for children to become Medicaid eligible.



The Committee found no basis upon which to reject Docket 16-0309-0204.

Docket 16-0314-0201: Debby Ransom, the chief of the bureau of Facility Standards, presented this
docket to the Committee. This is a pending rule. She explained that this rule
change was initiated in partnership with the Idaho Hospital Association. This
change updates the rules to the current standard of practice and reflects
federal guidelines and standards. The current rule requires a history and
physical exam to be performed within 72 hours of admission. This pending
rule allows physicians to complete a history and physical exam up to 7 days
prior to a planned admission and shortens the completion time to 48 hours
for all other patients except emergency admissions.



The Committee found no basis upon which to reject Docket 16-0314-0201.

Docket 16-0319-0101: Ms. Ransom also presented this docket to the Committee. She explained
that during the 2000 Legislative session, the Board and Care Act and the
Residential Care Act for the Elderly were amended to allow a provider to
make application to care for up to four residents in a certified family home.
She further explained that these rules were developed with input from
providers, advocates, and consumers through public meetings and members
of the Board and Care Council and the Residential Care Council for the
Elderly. The rules address three major areas; resident needs and safety,
care-giver availability, training, and physical structure of the home. She
stated that these rules will assist in ensuring residents receive the right care,
in the right setting with the right outcomes in the most cost-efficient manner.
Committee discussion followed with the following points clarified; certified
family homes allow people to remain in a home in a family setting and certain
criteria have to be met for these homes to become certified. There are
currently 17 of these homes in the state. Originally Certified Family Homes
were only one to two beds. There was a statutory change to allow three to
four beds. The three types of waiver services were discussed. These
include the HCBS(Home and Community-Based Services) waiver, the
DD(Developmentally Disabled) waiver, and the TBI(Traumatic Brain Injury)
waiver. Most certified family homes serve those on one kind of waiver, but
there can be a mix. Certified family homes have less stringent rules and the
client is a member of the family.
Chairman Sali discussed with the Committee the ongoing debate about
going to the three to four bed homes. Some have expressed concerns
about level of care and level of supervision.
Kathleen Allyn responded to Committee questions. She stated that the
average daily costs of waivered services are, for the Aged and Disabled
waiver, $35 per day per person, and for the Developmentally Disabled
waiver, $75 per day per person. She further explained that waiver services
give options as to where to live. Those options include, certified family
homes, their own homes, and residential care facilities. She stated that
Idaho is among the leaders in the nation in options for people with
disabilities. She further stated that if someone is on the A&D waiver, the
cost cannot be more that nursing home costs(which is $103.00 per day).
Also, someone on the DD waiver cannot cost more that what the cost of
being in an Intermediate Care Facility(which is $191.00 per day).
The Committee found no basis upon which to reject Docket 16-0319-0101.
Docket 16-0319-0102: Ms. Ransom also presented this docket to the Committee. She explained
that this pending rule was developed in response to a recommendation by
the Board and Care Council for the Elderly and the Residential Care Council.
This rule requires a Certified Family Home care-giver to arrange for
emergency transportation of residents with medical and/or behavioral
emergencies. Providers are not equipped or trained to provide this type of
service. This rule change will help ensure residents who have emergent
needs are met. The provider has the discretion as to what the particular
situation requires.
The Committee found no basis upon which to reject Docket 16-0319-0102.
Docket 16-0322-0101: Ms. Ransom presented this docket to the Committee. She explained that
this docket is identical to the previous docket except it applies to those
care-givers in Residential or Assisted Living Facilities.
The Committee found no basis upon which to reject Docket 16-0322-0101.
Docket 16-0322-0201: Ms. Ransom continued her presentation to the Committee. She explained
that the changes were made to align the rules with statutory changes made
by SB 1365 to the Board and Care Act and the Resident Care Act for the
elderly during the 2000 Legislative session. The following changes are in
the rule; corrects the name to residential or assisted living facilities, adds a
new definition, Authorized Provider to recognize nurse practitioners and
clinical nurse specialists licensed by the board of Nursing and physician
assistants licensed by the Board of Medicine in addition to a physician;
updates the definition of “substantial compliance” reducing the frequency of
review of the Negotiated Service agreement, and changes the frequency of
facility inspections and the un-announcement of initial inspections or
surveys. Changes were also made to reflect the current standards and
name changes of National Board or Councils. Other areas of change
include; menu cycle, recognition of industry standards to allow shorter menu
cycles and reduces the need for providers to request a waiver from current
rule; all residents, not just the elderly, are to be informed of their right to
develop advanced directives (living wills); and modifies and adds rules
regarding administrators qualifications to be consistent with Department
rules governing criminal history clearance.
The Committee found no basis upon which to reject Docket 16-0322-0201.
Docket 16-0310-0202: Kathleen Allyn presented this docket to the Committee. She explained that
this pending rule follows removal of legislative intent language that capped
intermediate care facility rates from July 1, 2000 through June 30, 2002. The
changes also allow the existing rate methodology which relies on the
prospective payment system to be restored beginning July 1, 2002. She
further explained that intermediate care facilities provide services to mentally
retarded individuals. There are 64 of these facilities in the state that serve
approximately 470 individuals. The cost of providing care in fiscal year 2002
totaled $34.5 million. By lifting these caps, the total annual cost to Medicaid
is estimated at $35.5 million in fiscal year 2003 and $36.2 million in fiscal
year 2004. This reflects an average annual increase of approximately 2.3
percent. Medicaid has been meeting routinely with industry representatives
to ensure requirements are reasonable, costs are managed and care is
safely and effectively rendered.
The Committee found no basis to reject Docket 16-0310-0202.
Docket 16-0310-0203: Ms. Allyn continued her presentation. She explained that the purpose of
these rules is to meet budget hold-back directives.



The Governor directed state agencies to reduce State General Fund
expenditures by 3.5 percent. The 3.5 percent reduction in hospital
reimbursement, as reflected in these rules, is anticipated to save
approximately $2.5 million in Medicaid’s state fiscal year 2003 budget. She
further explained that all individual hospitals received prior notice of the
reduction in their interim payments and the related change that will occur
during the cost settlement process. The following changes were outlined;
the percentage will be 96.5 percent of covered charges rather than 100
percent; all hospitals will be affected by this reimbursement reduction; re-basing occurs prior to setting the new interim rates; and the reimbursement
floor percentage will be 81.5 percent rather than 85 percent. In addition,
hospital representatives and Medicaid staff are exploring the feasibility of a
prospective payment system in order to enhance planning, minimize
payment delays, and ensure that Medicaid has the right price for the right
care.

Steve Millard, president of the Idaho Hospital Association, addressed the
Committee. He stated that the Association does not want Docket 16-0310-0203 rejected, and understands why the rule change was made. He made
the following points; because of the lower reimbursement rates, hospitals will
have to shift costs to insured patients, thus increasing insurance rates, and
if government payers do not pay their fair share, everyone else’s rates will
go up.
After discussion, the Committee found no basis upon which to reject
Docket 16-0310-0203.
Docket 16-0309-0209: Leslie Clement, bureau chief of Medicaid Benefits & Reimbursement Policy,
presented this docket to the Committee. This pending rule establishes the
Department’s authority to determine when cancer treatment has ended for
women diagnosed with breast or cervical cancer. The Breast & Cervical
Cancer Prevention & Treatment Act of 2000 created a new optional Medicaid
eligibility group who were not previously eligible for Medicaid. The new
option allows states to provide full Medicaid benefits to uninsured women
under age 65 who are identified through the program and are in need of
treatment for breast or cervical cancer. She explained that one of the issues
identified shortly after implementation was the absence of a definition of what
constituted “end of treatment”. By defining the end of treatment, the Division
of Medicaid can better manage the benefit coverage extended to Medicaid
eligible women based on their medical condition. Prior to these rules, a
woman who qualified for services had unlimited access to Medicaid benefits
even after cancer treatment had successfully been completed. Further, in
the absence of these rules, individuals in this program could use unproven
cancer treatments. By adding the definition of “end of treatment”, the
Medicaid Division has been able to close 28 cases, including those who
have moved, through the end of December 2002. She further explained that
if there is a reoccurrence of cancer, the patient can have Medicaid coverage
again.
The Committee found no basis upon which to reject Docket 16-0309-0209.
Docket 16-0309-0211: Ms. Clement continued her presentation. The purpose of this rule is to
establish clear standards for professionals rendering Medicaid services.
This rule refer to the Developmental Disability Agency rules found in rule
Docket 16-0411-0201 that specifies the details of these requirements. This
rule clarifies the professional requirements for individuals providing intensive
behavioral intervention to children in schools and in developmental disability
agencies. Intensive behavioral intervention is only available to children,
ages 0-21 years old that have self-injurious aggressive or severely
maladaptive behavior and severe deficits in areas of verbal and non-verbal
communication. These services require prior authorization, periodic and
annual review. Provider qualifications include specific degree requirements
and experience. The existing rules allowed for various interpretation and
these pending rules help clarify professional experience, educational, and
training requirements.
The Committee found no basis upon which to reject Docket 16-0309-0211.
ADJOURN: There being no further business to be brought before the Committee,
Chairman Sali adjourned the meeting at 11:25 A.M.






DATE: January 28, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/
EXCUSED:
None
GUESTS: See attached list
Chairman Sali called the meeting to order at 1:40 P.M.
MOTION: Rep. Kulczyk made a motion to approve the minutes of the January 24,
2003 meeting as submitted with the following change; on page one,
change the definition of EPSDT from “early periodic screening and
treatment diagnosis” to “early periodic screening diagnosis and treatment”.
On a voice vote, the motion carried.
Blake Hall, contract Administrator for the Catastrophic Health Care cost
Program, addressed the Committee. He gave a brief overview of the
Program and provided copies of the 2002 annual report to Committee
members. He explained that the Catastrophic Health Care Cost (CAT)
Program is incident-based, not an entitlement program. The CAT program
was first established in 1984 as a county program with each county paying
$4.50 per capita for those who are medically indigent and not qualifying for
any other programs. The Legislature assumed funding responsibility for
the Program effective October 1, 1991, as a means of providing property
tax relief to Idaho residents. The county pays the first $10,000 of medical
bills from each incident, and the rest is paid by the CAT fund. The CAT
program is administered by seven members consisting of six county
commissioners elected annually on a rotating basis, each serving a two-year term, plus one member appointed by the Governor. In the last fiscal
year, the CAT fund has paid on 771 claims for a total of over $12 million.
The CAT fund also collects reimbursement payments for many of the
claims paid by the program. The individuals who benefit from participation
in the CAT fund are those who fall through the cracks of the state welfare
system. They are faced with a catastrophic illness or injury and do not
have any or adequate health insurance and do not qualify for public
assistance. Many of these individuals are willing to reimburse both the
county and the CAT program. The Board meets every six weeks to
determine eligibility.






They carefully review each case to ensure compliance by the counties and
the applicants. The CAT board does not spend any money other than
what is required by statute. Whenever possible, they return surplus funds
to the general account. In Fiscal Year 2000, the CAT fund returned over
$4 million. The Board operates without any reserves. The majority of
those served by this program are single member families. Mr. Hall further
explained that for tobacco-related incidents counties can use funds from
the millennium fund money and then only pay the first $5,000 instead of
$10,000.

RS 12435C1: Chairman Sali announced that the sponsor of RS 12435C1 has requested
that this been returned to him and not be heard by the Committee. By
unanimous consent that action was taken.
RS 12589C1: Scott Burpee, CEO of Valley Vista Care Services, presented the RS to
the Committee. He explained that this bill would allow those who provide
residential care, assisted living services, certified family home services,
nursing facility services and services offered pursuant to the Medicaid
program, a cause of action to recover against fiduciaries that do not
properly use funds of public assistance recipients for payment of such
services. It also allows for attorney fees and costs for the necessity of
bringing an action against a fiduciary. He discussed the problems of
facilities having to collect from those persons who are handling the
finances for the patients. This proposed legislation would hold them
accountable for those additional payments that Medicaid does not pay.
Mr. Burpee explained that there are some changes in the RS that need to
be addressed. The word “conservator” in the title needs to be removed,
and volunteers under the county board of guardians program need to be
added to the list of those who stand in a fiduciary relationship to recipients
of public assistance.
MOTION: Rep. Henbest made a motion to return RS 12589C1 to the sponsor for
language clarifications. On a voice vote, the motion carried.
Carolyn Oakley, regional director of the U.S. Department of Health and
Human Services, addressed the Committee. She gave an overview to the
Committee of the various areas that the Department of Health and Human
Services is currently involved with. These include; bio-terrorism
preparedness, expanded access to health care, disease prevention
initiative, improving quality of care, discussion of the next steps for helping
those in need, the recent decline in smoking and teen substance abuse,
protecting patient privacy, and regulatory reform. One of the highlights
included discussion of the President’s faith-based initiative. She explained
that HHS provided $30 million in funding to help level the playing field of
religious and other organizations seeking to use HHS funds to help those
in need. This money could be used to help with the writing of federal
grants. Ms. Oakley asked for suggestions from Committee members to
include in her weekly report to Secretary Thompson. She stated that she
would be a resource for any Committee members who may have questions
regarding Federal programs.
RS 12614: Rep. Mitchell presented this RS to the Committee. Rep. Ring is also a
sponsor. The proposed legislation is a memorial to Idaho’s Congressional
Delegation urging their support of equalizing Medicare payments to
physicians and other healthcare providers in Idaho and other less
populous, rural states by the removal of geographic practice cost indexes
that are currently part of the Medicare payment formula. Rep. Ring
explained that just because a physician is on one side of the border, he will
get paid less. Being in a rural area does not mean that the cost of care is
less.
MOTION: Rep. Henbest made a motion to send RS 12614 to print and directly to the
second reading calendar. The motion was seconded by Rep. Eberle. On
a voice vote, the motion carried.
Docket 16-0301-0201: Phil Gordon, from the Division of Welfare for the Department of Health
and Welfare, presented the following rule dockets to the Committee. He
explained that when the Temporary Assistance for Families in Idaho (TAFI)
grant was increased last year, some families had the potential of losing
their Medicaid coverage. This rule ensures that those families can
continue to receive Medicaid while receiving TAFI benefits. This rule also
assists families who go off of cash assistance due to work, to continue
receiving Medicaid for six months with up to an additional six months if the
participant remains employed. These changes will help transition these
individuals to work and move families off welfare. He further explained that
this docket also adds back rules that specify those items that are not
counted in determining income available to the participant, these include;
commodities and food stamps, housing subsidies, and income tax refunds.
The Committee did not find any basis upon which to reject Docket 16-0301-0201.
Docket 16-0304-0103: Mr. Gordon continued his presentation. This puts into rule the annual
Food Stamp cost of living increases to income limits and benefit amount
for 2001. Food Stamp families will receive an increase in their benefits
ranging from $5 to $30 depending on the size of the family. This rule
corrects the language that aligns with federal policy related to aged and
disabled individuals who cannot buy and prepare their own meals separate
from others in the home. He explained that the Department has been
applying the correct policy and the automated system is correctly
calculating benefits, but now the rule is changed to comply with the
increase.
The Committee did not find any basis upon which to reject Docket 16-0304-0103.
Docket 16-0304-0201: Mr. Gordon continued his presentation. This rule revises and clarifies
policy regarding the Food Stamp work programs including who must
register for work, what costs can or cannot be paid for work program funds,
when to apply penalties for individuals quitting a job or reducing their
hours, and how to re-establish eligibility.



It also lengthens Food Stamp eligibility for some households in high
unemployment areas beyond the three-month limit if complying with the
work plan.

The Committee did not find any basis upon which to reject Docket 16-0304-0201.
Docket 16-0304-0202: Mr. Gordon continued his presentation. This rule reflects the annually
federally mandated Food Stamp cost of living increases for 2002. These
increases include; income limits, standard utility allowance, and Food
Stamp allotment amount. The asset limit for disabled individuals increased
from $2,000 to $3,000. Asset limits are now considered the same for both
the elderly and disabled. Also by federal requirement, the standard
deduction for larger families has been increased. Finally by federal
requirement, now lawful non-citizens, who are blind or disabled, can
receive Food Stamps.
Docket 16-0305-0201: Mr. Gordon continued his presentation. He explained that this rule
impacts some elderly or disabled individuals living in a home-like setting.
They can have their care paid for with federally matched dollars instead of
general funds. The rule also allows providers to be paid directly for these
services.
The Committee did not find any basis upon which to reject Docket 16-0305-0201.
Docket 16-0305-0202: Mr. Gordon continued his presentation. He explained that this rule does
the following: tightens the rule regarding asset transfers, increases the
personal needs allowance for Veterans in nursing homes, and clarifies
“end of treatment” for breast and cervical cancer patients.
The Committee did not find any basis upon which to reject Docket 16-0305-0202.
Docket 16-0305-0203: Mr. Gordon explained that this temporary rule provides an easier
application and benefit renewal process for elderly and disabled individuals
by allowing and encouraging telephone interviews instead of those
individuals having to go to the welfare office. The rule also eliminates a
Medicaid eligible group who’s federal funding ended December 31, 2002.
It clarifies and aligns eligibility rules between programs in an effort to
simplify those rules.
The Committee did not find any basis upon which to reject Docket 16-0305-0203.
Docket 16-0308-0201: Mr. Gordon explained that this rule adds back into rule a policy
inadvertently omitted that requires parents who receive TAFI cash
payments to assign legal rights to any Child Support payments to the
State. He further explained that this is not a new policy.






The Committee did not find any basis upon which to reject Docket 16-0308-0201.
Docket 16-0414-0301: Mr. Gordon continued his presentation. This docket places in rule the
formula for calculating energy assistance benefits. The specific benefit
calculations will be placed in the Intake Manual after finding out the annual
funding level from the federal government. He explained that the manual
is updated annually and is out on the web site. He further explained that
this would eliminate the need to update the rules every year and will save
the costs associated with the rule making process.
The Committee did not find any basis upon which to reject Docket 16-0414-0301.
Docket 16-0612-0101: Mr. Gordon completed his presentation with this docket. He explained
that there are three significant rule changes in this docket. These changes
include: requiring a Child Care agreement between the provider and the
Department, extending minimum health and safety guidelines to all ICCP
(Idaho Child Care Provider) providers including family and relative
providers, and specifying that Child Care payments will be made directly to
providers.
The Committee did not find any basis upon which to reject Docket 16-0612-0101.
Docket 16-0309-0213: Kathleen Allyn, deputy administrator for the Division of Medicaid,
presented this docket to the Committee. She explained that this rule
implements a statutory change and subsequent court ruling on state-funded abortions. She further explained that in 2001, the legislature
amended Idaho law to remove a requirement that the state pay for
abortions to save the health of the mother. Implementation was delayed
until July 1, 2002, because of a court suit challenging the legality of the
amended statute. The court upheld the amendment. This temporary rule
implements both the statutory amendment and court decision by removing
the state payment for abortions to save the health of the mother and
changing the two-physician certification requirement to certification by one
physician. There were no other parties present to testify on the docket.
The Committee did not find any basis upon which to reject Docket 16-0309-0213.
Docket 16-0309-0214: Leslie Clement, bureau chief of Medicaid Benefits and Reimbursement
Policy, presented this docket to the Committee. She explained that the
purpose of this temporary rule is to support the Department’s cost
containment efforts. Medicaid paid $114 million for prescription drug
benefits in fiscal year 2002. She further explained that Medicaid’s existing
prescription drug rules do not include the necessary management tools to
control spending. The current rules list the specific names of excluded
drugs that must be prior authorized by the Department.






The number of new brand name drugs and classes of drugs that
continuously become available make it impossible to continue listing each
specific drug in rule. These temporary rules allow Medicaid to review
brand name prescription drugs for medical necessity and determine when
there may be a less expensive and equally effective drug available. These
rules describe when a prescription is considered medically necessary and
clarify coverage and limitations. Additionally, by identifying categories of
drugs that must be prior authorized rather than identifying each specific
drug, the Department does not need to update rules every time a new drug
is introduced by the pharmaceutical industry. Further, under the existing
rules, early refill of prescription drugs has been identified an unnecessary
and costly practice that needs to be controlled to reduce unnecessary
Medicaid spending. These temporary rules allow Medicaid to require that
75% of the estimated-days supply of prescription medication have been
used before Medicaid will pay for a refill. Medicaid identified three
therapeutic drug classes, including prescription antihistamines, antacids,
and antidepressants. Finally, she explained that without these rules, the
Department’s ability to manage pharmaceutical costs will be severely
restricted.

Dr. Young, with the Department of Health and Welfare, addressed the
Committee in response to questions. He clarified the following points:
physicians would make a decision on the equivalency of a drug and use
the least costly drug available. This will fit with the department’s intended
move to a preferred drug list, and these determinations will be based on an
evidence-based process. He further explained the process that would be
taken to determine the drug equivalency list. He further stated that the
oversight group would have individuals on it with no conflict of interest with
pharmaceutical companies.
David Blackwell, representing the Epilepsy Foundation, addressed the
Committee. He stated that the Foundation is seriously concerned with the
changes in this rule docket. He further stated that there are significant
differences between generic and brand name drugs and some could
produce adverse side-effects. He also stated his concern about a group in
Boise making decisions about medications for seizure control.
Dr. Young responded to the concerns raised by Mr. Blackwell. He stated
that the board that would review these medications would be made up of
four physicians and two pharmacists from around the state and would
follow an evidence-based formula.
Bill Roden, representing PhRMA (Pharmaceutical Research and
Manufacturers of America) addressed the Committee. He testified against
this docket. He stated that this docket contains a Preferred Drug List. He
further stated that there needs to be more expansive rule language in this
docket. He explained that the areas of concern include: inadequate
patient protection, no appellate rights, and prior-authorization.






Mr Roden raised the following issues regarding the rule:1. He questioned
whether the department has authority to implement a preferred drug list; 2.
He stated there were no appeal rights in this rule if a request for prior
authorization request was denied; 3. He questioned whether the drug
rebates were be accounted for properly as non-cognizable funds; 4. He
stated that the definition of “medically necessary” should not include the
concepts of “more conservative or substantially less costly”. He stated he
did not understand what those terms meant in that context; 5. He stated
that the process for a preferred drug list is not adequately spelled out in
the rule docket; 6. He stated that the the requirement in paragraph
821.03.v that a prescribed medication must be the least costly is confusing
because a doctor would not know the exact costs for a medicine at the
time he prescribed it. He also stated that while most physicians
understood what generic interchange is, therapeutic interchange was not
defined in the rule and is not a standardized concept that physicians would
understand. Mr. Roden also explained that the process for this docket has
not been transparent and that there is nothing in this rule that requires it to
be transparent. He stated that this issue needs to be discussed in an open
manner, with all interested parties participating in that discussion. He also
discussed the rebates that are paid to the State for pharmaceuticals. He
further discussed the extensive paperwork that is involved with prior
authorization.

Dan Heincy, representing the MERCK pharmaceutical company,
addressed the Committee. He urged Committee members to reject this
rule docket. He explained that his company is concerned with the
definition of “medically necessary” in the rule. He questioned who would
make that determination. He also discussed rebates given to the State for
certain pharmaceutical drugs. He explained the average wholesale price,
which is determined by guides that survey the market price of drugs. He
stated that most Medicaid programs are currently receiving about 25
percent of their cost for prescriptions in rebates. He further stated that
unless a drug has been on the market for a long time, there is not need to
have a study to show equivalency to other drugs. Finally, he explained
that the Department of Health and Welfare should account for the rebates
they have received.
Kathleen Allyn, deputy administrator of Medicaid for the Department of
Health and Welfare, addressed the Committee. She clarified the following
points; these rules are not Preferred Drug List rules, they only implement
the hold-backs that the Department was directed to implement by the
Governor, they are not the complete pharmacy rules, and that the appeal
process is in the complete pharmacy rules. She further explained that the
hearing in February is on the pending rules that will be heard in the next
Legislative session, and changes could be made. She stated that these
rules are not intended to create a Preferred Drug List. That will appear in a
future rule docket.






ADJOURN: Rep. Nielsen made a Motion to adjourn the meeting. The motion passed
by a show of hands. The meeting adjourned at 6:20 P.M.






DATE: January 29, 2003
TIME: 3:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Block, Representatives Eberle, Nielsen, Ring, Martinez and
Mitchell
ABSENT/

EXCUSED:

None
GUESTS: See attached sheet.
Chairman Block called the meeting to order at 4:35 P.M.
MOTION: Rep. Eberle made a motion to approve the minutes of the January 23,
2003 meeting as submitted. On a voice vote, the motion carried.
Chairman Block announced that the Committee would hear public
testimony today regarding Rule Docket 16-0309-0216 relating to Medicaid
coverage of adult dental care. She further announced that questions would
be taken from Committee members after all of the testifiers have been heard.
She stated that those wishing to testify should focus their remarks to the
question, should Medicaid provide emergency dental care or preventative
dental care for adults?
Jason Wells, representing the Idaho Citizens Action Network(ICAN),
addressed the Committee. He stated that preventative dental care for adults
is cost-effective and on-going health problems can be lessened by that care.
He discussed his personal experience with his mother who has had
extensive health problems that could have been helped with proper
preventative dental care.
Jerry Davis, executive director of the Idaho Dental Association, addressed
the Committee. He stated that the Association would like to have adult
dental care reinstated by Medicaid. He explained that the dentists would like
the opportunity to work with Medicaid to discuss what dental procedures
could be done at a lower cost.
Emily Jones, representing ICAN, spoke to the Committee. She stated that
she would like preventative dental care restored. She further stated that she
would have less trips to the dentist if her dentures could be properly fitted.


Krista Zebarth, also representing ICAN, addressed the Committee. She
stated that she has epilepsy and the medication that she takes to control
it causes dental problems. She would like to have the preventative dental
care for adults on Medicaid restored.
Bill Foxcroft, executive director of the Idaho Primary Care Association,
addressed the Committee. He discussed the Terry Reilly Health Services
offices in Boise and Nampa. These offices serve Medicaid patients and
provide dental care on a limited basis. He stated that these clinics are full
and receive up to 300 calls per month from persons needing preventative
dental care. He further stated that there are 25 to 75 people wanting dental
appointments within the first half hour of the opening of the clinic.
Marie Herrera, representing ICAN, addressed the Committee. She stated
that she would like to have preventative dental care restored for Medicaid
adults. She explained that she cannot afford dental care and needs to have
her four remaining teeth fixed or she will need dentures. She further
explained that she is not concerned with cosmetics, just basic dental
coverage.
Roger Sherman, representing the United Vision of Idaho, addressed the
Committee. He explained that ten years ago the counties were paying more
for indigent dental care, then Medicaid picked up the costs. He stated that
he was concerned that if preventative dental care is not offered to Medicaid
patients, the cost would now shift back to the counties.
In response to questions from Committee members, Jerry Davis clarified the
following points. Approximately 80 percent of the dentists in the state have
signed up to care for Medicaid patients. The average payment from
Medicaid for dental services is about 50 percent of the fee. Those who do
not show up for an appointment is a concern. Dental hygiene is taught to the
patients, but there is no data to show how effective it is. He also explained
that his organization is willing to look at anything to help solve the problem.
He further explained that a recent survey shows that dentists have given
approximately $20 million in free and discounted services. Mr. Davis stated
that he knows of no dentist who has raised his fees because of treating
Medicaid patients. He further stated that if the preventative dental program
is reinstated, the Medicaid patients will have lost ground and it will not solve
all of the problems. He also discussed the idea raised about mobile dental
services. He explained that these services can be very costly, but do have
value. Finally, he explained that the best dental prevention program starts
at age four.
Jesse Johnson, representing ICAN, addressed the Committee. He stated
that he would like the preventative adult dental program be reinstated.
Jason Wells clarified that his mother’s health problems have not been
caused by poor dental hygiene, rather by other factors that have caused
dental problems.


Chairman Block thanked those who participated in today’s meeting and
announced that the subcommittee will meet Friday, January 31, at 8:00
A.M.
ADJOURN: As there was no further business to be brought before the subcommittee,
Chairman Block adjourned the meeting at 5:20 P.M.






DATE: January 30, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

None
GUESTS: See attached sheet.
Chairman Sali called the meeting to order at 2:00 P.M. He announced that
the minutes of the January 28, 2003 meeting will be available for the
Committee members at the next meeting. He further announced that he
would like ideas from members concerning ways to cut costs within the
Department of Health and Welfare, so he can present those ideas to the
Joint Finance and Appropriation Committee.
Marilyn Sword, executive director of the Idaho Council of Developmental
Disabilities, addressed the Committee. She explained that the Council is
made up of 23 members who serve three year terms. Sixty percent of the
Council are individuals with disabilities or parents of children with disabilities.
The vast majority of funding for the Council comes from federal dollars. She
discussed with the Committee the pamphlet entitled “A Medicaid Primer”
provided to the members. This pamphlet was prepared by the Consortium
of Idahoans with Disabilities. The Consortium is made up of 35 advocates
and providers who meet monthly. She discussed the following topics
described in detail in the pamphlet; the definition of Medicaid, Medicaid
versus Medicare and private insurance, and people with disabilities and
long-term care services.
Jim Baugh, executive director of CO-AD(Comprehensive Advocacy, Inc.),
addressed the Committee. He is also a member of the Consortium of
Idahoans with Disabilities. He described the various waivers for the disabled
in the state as outlined in the pamphlet. These waivers include; A&D
Waiver(Aged and Disabled), HCBS/DD Waiver(Home and Community-Based
Services and Developmentally Disabled), HCBS/ISSH Waiver(State School
and Hospital), and HCBS/TBI(for those with a traumatic brain injury). He
made the following points; one-third of the beds in Idaho’s nursing homes
are empty because of the number of people using these waivers and the
cost of care under the waiver has to be lower than the cost of care in an
assisted living facility. He further outlined what was in the pamphlet
including, what kind of services are provided through waivers, why is
Medicaid an issue for Idaho, and how Idaho compares to other states in
Medicaid spending.
Kelly Buckland, executive director for the Idaho State Independent Living
Council, addressed the Committee. He is also a member of the Consortium.
He explained that the Council is made up of 23 members who are appointed
by the Governor and the Council is required by federal law. 51 percent of
the Council is made up of people with a variety of disabilities. He discussed
the other ways to contain costs, increase consumer control and improve
quality of services as outlined in the pamphlet. He made the following
points; there is a general bias toward institutional care, waivers need to be
more flexible, and there needs to be a better quality assurance program. He
also discussed President Bush’s proposal for $1.75 billion, five-year program
to help Americans with disabilities transition from nursing homes or other
institutions to living in the community. These proposals include; “money
follows the individual” re-balancing demonstration, and the New Freedom
Initiative Demonstrations. In response to questions from Committee
members, Mr. Buckland discussed the proposed rule dealing with the cap
on hours for targeted case managers. He felt that those who need the
services would not receive it, and those who do not need the services would
receive them.
Jim Baugh made the following point to Committee members; circumstances
are now changing for baby boomers born with disabilities because their
aging parents unable to care for them which will cause a rise in Medicaid
costs and services.
Docket 16-0411-0201: Mary Jones, the acting chief of the Bureau of Developmental Disabilities,
presented this docket to the Committee. She explained that the purpose of
this rule is to establish clear standards for professionals rendering Medicaid
services. It clarifies the requirements in the Developmental Disability Agency
rules regarding the professional requirements for individuals providing
intensive behavioral intervention to children in developmental disability
agencies and in schools. These services require prior authorization, periodic
and annual review. Provider qualifications include specific degree
requirements and experience. The rule includes a provision to grandfather
currently certified professionals who continue to provide intensive behavioral
intervention services.
The Committee found no basis upon which to reject Docket 16-0411-0201.
Docket 16-0601-0101: Chuck Halligan, Bureau Chief for Children and Family Services, presented
this docket to the Committee. He explained that this rule is the result of state
and federal changes. In 2001, the Legislature passed two bills that are
reflected in this rule. One is the Safe Haven Act, which allows a parent to be
exempt from being placed on the child abuse registry if they follow the
procedures of abandoning an infant within 30 days of birth. The other
legislation deals with subsidized guardianship. Other federal changes now
require the Department to report on children adopted from foreign countries
that are placed in the Department’s care.
The Committee found no basis upon which to reject Docket 16-0601-0101.



Docket 16-0601-0201:

Mr. Halligan continued his presentation. This rule deals with disposition of
child abuse and neglect referrals. The rule proposes changing from five
disposition codes to two. Having two disposition codes will result in greater
inter-rater reliability, reflect more accurately the actual incidents of child
abuse and neglect in the state and more importantly helps protect children
from individuals that should be on the central registry. The rule also adds
the words “family services” to clarify that the incident has to be witnessed by
a Department worker. Mr. Halligan further explained that persons placed
on the central registry have the right to appeal that decision and have their
name removed from the registry.
The Committee found no basis upon which to reject Docket 16-0601-0201.
Docket 16-0601-0301: Mr. Halligan continued his presentation. This rule adds better language
around the word parent, the term” Certified Adoption Professional” was
added in place of the term “qualified individual”, and provides the standard
appeal process for Certified Adoption Professionals should they be
decertified by the Department.
The Committee found no basis upon which to reject Docket 16-0601-0301.
Docket 16-0602-0201: Jim Pruett, Licensing Program Specialist for the Department of Health and
Welfare, presented this docket to the Committee. He explained that last
year, the Legislature approved the revisions to the Child Care Licensing Act,
giving the Department the authority to oversee children’s therapeutic outdoor
programs in Idaho. This rule is the result of a three-year project to update
all of the child care licensing standards and to include therapeutic outdoor
programs.
The Committee found no basis upon which to reject Docket 16-0602-0201.
Docket 16-0603-0301: Pharis Stanger, Substance Abuse Program Manager for the Department of
Health and Welfare, presented this docket to the Committee. This docket
contains changes to the Rules and Minimum Standards Governing
Alcohol/Drug Abuse Prevention and Treatment Programs. He explained that
the section pertaining to outpatient drug court treatment facilities was the
result of negotiated rule making with the Idaho Supreme Court’s Drug Court
Coordinating Committee. Some of these changes include; term clarifications
and definitions, qualifications for staff composition, clarification of
reimbursement schedules, clarification of admission policies and procedures
and clarification of Drug Court Outpatient Treatment Facilities.
The Committee found no basis upon which to reject Docket 16-0603-0301.
Docket 16-0641-0201: Decker Sanders, a Program Specialist from the Department of Health and
Welfare, presented this docket to the Committee.

He explained that this rule change provides the Department with the ability
to refuse to renew a retailer’s tobacco sales permit when the retailer has
unpaid civil money penalties for violations on the permit. A permit would be
issued when the penalty paid in full. This rule also adjusts the date used to
determine the number of permits from January 1 of each year to December
31 of the previous year.

The Committee found no basis upon which to reject Docket 16-0641-0201.
Docket 16-0504-0101: Celia Heady, executive director of the Idaho Council on Domestic Violence
and Victim Assistance, presented this docket to the Committee. She
explained that the last update of the rules of the council was in 1990.
Recent legislative changes to Idaho Code need to be incorporated into the
rules as well as updating existing rules. The rule change will incorporate the
name change and additional assigned responsibilities of the Council as
enacted by the Legislature. Other changes include updating the formatting
of the chapter.



In response to questions from Committee members, Ms. Heady explained
that the Council operates on a shoestring budget with only three staff
members. Also in response to questions, she explained that the number of
domestic abuse cases are difficult to track, but seem to be staying at the
same level for several years.

The Committee found no basis upon which to reject Docket 16-0504-0101.
Docket 16-0506-0201: Susan Altman, representing the Department of Health and Welfare,
presented this docket to the Committee. She explained that this rule
removes an incorrect date associated with the fee change for the rules
governing the ombudsman for the elderly program. The fee change became
effective January 2001, but the last printing of the rule indicated an effective
date of July 1, 2001. She further explained that the fee change was
implemented in conjunction with the 2 percent hold back and was necessary
to cover a portion of the Department’s administrative overhead for the
background check.
The Committee found no basis upon which to reject Docket 16-0506-0201.
ADJOURN: There being no further business to be brought before the Committee,
Chairman Sali adjourned the meeting at 5:00 P.M.






DATE: January 31, 2003
TIME: 8:00 A.M.
PLACE: Room 404
MEMBERS: Chairman Block, Representatives Eberle, Nielsen, Ring, Martinez and
Mitchell
ABSENT/

EXCUSED:

None
GUESTS: See attached list
Chairman Block called the meeting to order at 8:10 A.M. She announced
that the minutes from the January 29, 2003 meeting would be approved at
a later date.



She explained that the purpose of the meeting is to consider the rejection of
Rule Docket 16-0309-0216 and to make a recommendation to the full
Committee. She further explained that an opinion from the Attorney
General’s office states that Idaho Code overrides the intent language of the
2002 appropriation bill concerning coverage of emergency adult dental
services.

Jeanne Goodenough, representing the Attorney General’s Office,
addressed the Committee. She suggested that if the committee wants to
clean up Idaho Code 56209d and avoid any conflict in the future, it could do
so by listing the services covered by Medicaid in the Idaho Code.
Chairman Block outlined the options that are available for the Committee.
These include; recommend to the full Committee to accept the rule for Fiscal
Year 2003; recommend that the committee reject the rule docket; or
compromise to recommend that we accept the rule and voice our concerns
to the Department of Health and Welfare to ask that the Department rewrite
the rule to accommodate our concerns. She then explained the details with
each option. If the rule is accepted, the committee does nothing else. If the
rule is rejected, it would require a Concurrent Resolution, a repeal of Section
6 of the 2002 Appropriation Bill, and a Supplemental Bill from JFAC to cover
the cost for FY2003 and FY2004. If the committee compromises and asks
the Department to rewrite the rule, we would need no Concurrent Resolution,
no Code repeal, and no Supplemental from JFAC.
Kathleen Allyn, Deputy Administrator of the Division of Medicaid,
addressed the Committee in response to questions. She stated that if the
rule was rewritten for 2003, the Department is still bound by legislative intent
language from last year’s appropriation bill. If the rule is rewritten for 2004,
certain populations (like the mentally ill) cannot be carved out, coverage
would have to be applied uniformly to all mandatory adult Medicaid
recipients.
Karen Gustafson, from the Administrative Rules Office, addressed the
Committee in response to questions. She stated that the Committee needs
to take some action on the rule, even with the rewriting option. She further
clarified that the rule can either be rejected or accepted, or subsections can
be rejected or accepted. She explained that the Legislature cannot amend
or modify a rule.
Dr. Kido, a dentist representing the Idaho State Dental Association, spoke
to the Committee also in response to questions. He clarified that dentists
cannot just do teeth cleaning even if the patient requests it. He explained
that the dentist needs to diagnose potential problems and if this is not done,
it puts the dentist at risk and subjects him to possible lawsuits.
Dr. Cutler, a dentist who also is a consultant for the Department of Health
and Welfare, addressed Committee questions. He discussed various
services that can be deemed as emergency dental services. He also stated
that emergency costs that show up in different areas are not tracked.
MOTION: Rep. Ring made a motion to recommend to the full committee to accept
Docket 16-0309-0216, but direct Medicaid to reinstate such adult
preventative dental care as preventative care for patients with periodontal
disease such as those on anti-seizure medication, dental infections, and
those who have grave susceptibility to bacteremia, such as those with heart
valve disease or heart valve replacements; these conditions should be
declared as emergency dental care.
Committee discussion followed with the following point clarified; Ms. Allyn
explained that if the rule is accepted, it would stay in effect until time
certain and services cannot be added because the cost would be higher.
SUBSTITUTE
MOTION:
Rep. Eberle made a Substitute Motion to recommend to the full Committee
to accept Docket 16-0309-0216 and send a letter to the Department of
Health and Welfare to address the concerns of the Committee at a future
time.
Committee discussion followed. Possible sources of funding was discussed
by Rep. Martinez who provided to Committee a handout outlining the
Division of Medicaid’s additional response to the Coalition for Long Term
Solutions Proposals. One of the ideas discussed was the refunding of
unused prescriptions in nursing facilities which could result in $1.3 million in
savings, $400,000 of which is General Fund monies.
AMENDED
SUBSTITUTE
MOTION:
Rep. Nielsen made an Amended Substitute Motion to recommend to the full
Committee to reject Docket 16-0309-0216 and to direct the Department of
Health and Welfare to restore adult dental care to those in the high risk
population and to have this accomplished by July 1, 2003.



After Committee discussion, Rep. Nielsen amended his AMENDED
SUBSTITUTE MOTION
. His motion was to recommend to the full
Committee to accept Docket 16-0309-0216 and to direct the Department of
Health and Welfare to provide adult dental care for fiscal year 2004 for the
high-risk population and to provide adequate reimbursements to providers.

After discussion, Rep. Nielsen withdrew his AMENDED SUBSTITUTE
MOTION
.
Chairman Block recessed the meeting at 9:30 A.M. She called the
meeting to order at 9:40 A.M.
Rep. Mitchell discussed with the Subcommittee the State funds that may be
available for adult dental care. He explained that there may be up to
$700,000 from the Liquor Dispensary fund available subject to approval from
the Joint Finance Appropriation Committee.
ROLL CALL
VOTE:
On a roll call vote, the SUBSTITUTE MOTION by Rep. Eberle to
recommend to the full Committee to accept Docket 16-0309-0216 and send
a letter to the Department of Health and Welfare to address the concerns of
the Committee at a future time, failed on a tie vote. Representatives Block,
Eberle, and Ring voted AYE. Representatives Nielsen, Martinez, and
Mitchell voted NAY.
ORIGINAL
MOTION:
The Original Motion by Rep. Ring to recommend to the full Committee to
accept Docket 16-0309-0216, but direct Medicaid to reinstate such adult
preventative dental care as preventative care for patients with periodontal
disease such as those on anti-seizure medication, dental infections, and
those who have grave susceptibility to bacteremia, such as those with heart
valve disease or heart valve replacements; these conditions should be
declared as emergency dental care. On a voice vote, the motion carried.
MOTION: Rep. Eberle made a motion to adjourn the meeting.
ADJOURN: Chairman Block adjourned the meeting at 10:05 A.M.






DATE: February 4, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

None
GUESTS: See attached sheet
Chairman Sali called the meeting to order at 1:40 P.M. He announced
that minutes of January 28, 2003 will be approved later in the meeting.
Docket 24-1401-0201: Rayola Jacobsen, bureau chief of the Board of Occupational Licensing,
presented this rule to the Committee. She explained to the Committee that
those opposing this pending rule have since met and resolved their
concerns. This rule deletes obsolete social work classifications and
establishes current classifications and definitions to be in compliance with
current law changes and adds the board/bureau contract is to include
investigative, legal and fiscal responsibilities. It clarifies reimbursement
expenses for board members, deletes that expired licenses will be cancelled
on July 1st, updates the classifications under fees to reflect those in the
current law change, changes board meeting dates to be at least three times
each year and at such other times and places as deemed by the board,
clarifies endorsement requirements, changes application deadline date to be
at least 10 days prior to the next board meeting and clarifies continuing
education requirements.
Greg Dickerson, president of the Mental Health Providers Association,
spoke in support of Docket 24-1401-0201. He explained that his
organization will be involved with the Bureau to draft rules for the next
legislative session to clarify the language in the rule regarding social work
classifications and definitions.
The Committee found no basis upon which to reject Docket 24-1401-0201.
Docket 27-0101-0201: Mick Markuson, executive director of the Idaho State Board of Pharmacy,
presented this docket to the Committee. This rule deals with ephedrine
products and the maximum dosage requirements and label disclosures and
warnings. Mr. Markuson explained that due to Committee concerns about
the fee charged to the manufacturers and wholesalers of this product, a new
temporary rule will be written and asked that the Committee reject this rule
docket.

The registration fee will be changed from $1,000 to $100 in the new
temporary rule, and that fee will be charged to the manufacturers,
wholesalers or other entity which first produces or brings the product in
Idaho.

Chairman Sali asked for Unanimous Consent to reject Docket 27-0101-0201. There were no objections.
RS 12734: Kelly Buckland, executive director of the State Independent Living Council,
presented RS 12734 to the Committee. He gave a brief history of the
background of this RS and RS 12735. He explained that Idaho child custody
laws, as currently written, reflect the historical bias against parents with
disabilities and present an unrealistic view of the disability community. In
early 1999, the Idaho State Independent Living Council established the
Committee for Fathers and Mothers Independently Living with their
Youth(FAMILY). The committee has held numerous meetings to review and
revise current laws pertaining to Child Protection and Termination of Parental
Rights. RS 12734 and RS 1235 are the result of these meetings. RS 12734
proposes to do the following; removes from current law any inappropriate
disability language, builds into current law protections against discriminatory
actions because of a parent’s disability in child protection legal proceedings,
and creates an evaluation system that is consistent and takes into
consideration the use of adaptive equipment and supportive services. Mr.
Buckland
briefly discussed the fiscal impact of the proposed legislation.
There is a total impact of $1,000,000 to cover the cost of training of staff to
implement these provisions. He asked that the Committee change on page
6, line 20 delete “provision” and change to “consideration”.
MOTION: Rep. Eberle made a motion to print RS 12734 and on page 6, line 20, strike
“provision” and substitute “consideration”. On a voice vote, the motion
carried.
RS 12735: Mr. Buckland presented this RS to the Committee. He explained that
legislation was introduced and passed in the 2002 Idaho State Legislature
that amended the law regarding termination of parental rights for parents
with disabilities. This proposed legislation will amend language that was not
amended last legislative session. He explained on page one, line 24, which
reads, “the parent is failing to discharge parental responsibilities and such
a failure will continue for a prolonged indeterminate period and will be
injuious to the health, morals or well-being of the child”. This language
reflects the consensus of the FAMILY Committee.
MOTION: Rep. Mitchell made a motion to print RS 12735. On a voice vote, the
motion carried.
RS 12799: Marilyn Sword, representing the Council on Developmental Disabilities,
presented this RS to the Committee. She explained that the purpose of this
legislation is to convene a group of individuals to develop a waiver to the
Medicaid program that would permit up to 200 qualified individuals with
developmental disabilities, who choose to do so, the option of receiving
services using a self-directed model.

Once developed, the Department would have the responsibility for submitting
the waiver for approval. Once approved, the waiver would be demonstrated
for a period of at least two years, allowing participants adequate opportunity
to determine its usefulness and allowing the state the time needed to
analyze its cost effectiveness. Ms. Sword further explained that other states
have this model in effect and by having this in a resolution from the
Legislature, it would increase the likelihood for this project going forward.
She also discussed the fiscal impact and possible changes. The Committee
asked that the cost for training be further clarified.

MOTION: Rep. Nielsen made a motion to print RS 12799. On a voice vote, the
motion carried.
RS 12822: Victoria Paulson, representing the Idaho Medical Association, presented
this RS to the Committee. She explained that out of 2,200 practicing
physicians in the state, 80 percent are members of the Idaho Medical
Association. The purpose of the proposed legislation is to increase the
number of physicians the Idaho Medical Association nominates for the
Governor’s consideration for appointment to the Board of Medicine from
three nominees to six nominees. She gave Committee members a copy of
a resolution passed by the Idaho Medical Association House of Delegates
in July of 2002 which states that the process of nominating three physicians
to serve on the Board of Medicine has been criticized as limiting the field of
potential candidates to the membership of the IMA. In response to questions
by Committee members, Ms. Paulson clarified that the list submitted to the
Governor is non-ranked, and the intent of the Idaho Medical Association is
to open up the nominations to those who are not members of the
Association.
Bob Seehusen, executive director of the Idaho Medical Association, spoke
to the Committee in response to questions. He stated that IMA would
oppose any change in the proposed legislation that would include
broadening the language to include all physicians or self-nominations. He
stated that currently the IMA sends letters to all the physicians in the state
when there is a vacancy on the Board and that those who want to serve are
those that are leaders in the community.
Rep. Henbest stated that the Board of Medicine has been reviewed by the
Joint Legislative Oversight Committee and reforms have been suggested.
These reforms include removal of a member of the Idaho State Police as a
member of the Board and the length of time served shortened to four years
instead of six. She stated that this proposed legislation does not address
those changes.
MOTION: Rep. Mitchell made a motion to print RS 12822. By a show of hands, the
motion carried.
Michael Bogert, from the Governor’s office, briefed the Committee on the
status of the “Jeff D” litigation. He explained that this lawsuit is entering in
it’s 23rd year of litigation. He gave a brief background of the suit. The suit
was filed in 1980 on behalf of over 2,000 indigent children and adolescents
who suffer from emotional and mental disabilities.

The Defendants named in the suit included the Governor of Idaho, the
Director of the Department of Health and Welfare, the Clinical Director and
Administrator of State Hospital South and the State Department of
Education.

Jody Carpenter, a deputy Attorney General, addressed the Committee.
She explained that the two main issues that were argued in the suit included;
the state was violating the rights of juveniles placed at State Hospital South
by mixing them with the adult population and not providing specialized
educational and mental health services, and that the state is required to
provide community-based mental health services to children. She then
discussed the timeline of the lawsuit. She explained that the state has
satisfied the issue of mixing juveniles with adults, but is still implementing
and expanding community-based mental health services to children. The
state has been ordered by a federal judge to develop a plan to implement 50
recommendations. Out of these recommendations, some have been met,
others need additional funding, and some will require time to be put in place.
She further explained that the state will meet with the plaintiff’s counsel in
March to discuss these implementations. The state is currently awaiting a
decision by the 9th Circuit Court of Appeals regarding this case. The state
has argued that no current plaintiff is identified and that there is no federal
right to community-based services and the Federal Court’s oversight of
Idaho’s Children’s Mental Health Services system is a violation of the
separation of powers.
Karl Kurtz, director of the Department of Health and Welfare, addressed the
Committee. He stated that three years ago, the Governor put together a
council on children’s mental health chaired by the Lieutenant Governor which
was charged with implementing the needs assessment for children’s mental
health. He further stated that there are seven regional mental health
councils around the state who decide how to put this system of care in each
region. In addition, there are 30 local councils to address the needs of
children’s mental health. He explained that there have been quantum leaps
made in services to these children, but there are still changes to be made.
The Department has made good progress but is trying to stretch resources
and there are not adequate funds to treat all children with mental illness.
Mr. Bogert read to the Committee a letter from the plaintiff’s counsel
requesting additional services. He stated that the position of the state is that
it is time to return the act of policy making to the people of Idaho.
MOTION: Rep. Kulczyk made a motion to approve the minutes of the January 28,
2003 meeting as submitted. On a voice vote, the motion carried.
ADJOURN: As there was no further business to be brought before the Committee,
Chairman Sali adjourned the meeting at 4:20 P.M.






DATE: February 6, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

None
GUESTS: See attached sheet.
Chairman Sali called the meeting to order at 1:35 P.M.
MOTION: Rep. Ring made a motion to approve the minutes of the January 30, 2003
meeting as submitted. On a voice vote, the motion carried.
MOTION: Rep. Kulczyk made a motion to approve the minutes of the February 4,
2003 meeting as submitted. On a voice vote, the motion carried.
Vice-Chairman Block reported to the Committee on the subcommittee’s
recommendation regarding Docket 16-0309-0216. (See attached letter).
She explained that after much discussion, the subcommittee voted to
recommend to the full Committee to approve Docket 16-0309-0216 and
send a letter to the Department of Health and Welfare requesting that the
Department include, in current emergency services, care to adults with tooth
and gum conditions at high risk for periodontal infection likely to lead to
bacteremia or other serious health concerns.
The Committee found no basis upon which to reject Docket 16-0309-0216
and will send a letter to the Department of Health and Welfare outlining their
concerns.
Docket 16-0309-0214: Robert Vande Merwe, executive director of the Idaho Health Care
Association testified in favor of this docket.
Rick Halloway, president of Western Health Care, and owner of several
assisted living facilities, testified in favor of this docket. He stated that he
was skeptical of the rule at first, but now embraces prior-authorization. He
further stated that he has seen no negative outcomes and that the
Department has been willing to work with the providers.
Jim Alexander, a pharmacist for over 30 years, also testified in favor of this
docket. He stated that the rule is important and is a good rule. He further
stated that generic drugs are tolerated as well brand name ones. He
explained that pharmacists, under this rule, can dispense 72 hours of
emergency medication, and no one is denied medication if there is a logical
explanation.
Jack Lewis, a pharmacist since 1962, also spoke in support of this rule. He
stated that Medicaid is not unique in requiring prior authorization. He further
stated that there has been a quick turnaround from Medicaid in prior
authorization. He stated that he feels the rule is fair.
Scott Burpee, CEO of Valley Vista Care Services, addressed the
Committee. He also testified in support of the rule docket. He explained that
one-third of health care costs is from prescriptions. He further explained that
other insurance plans are more restrictive than the Medicaid rule. He stated
that this rule has been operating since May and the Department has been
very flexible in the implementation of it.
William Silvius, a pharmacist, also spoke in support of this docket. He
explained that patient care has not been compromised by the
implementation of this rule.
Chuck Bosen, a registered nurse who works at a skilled nursing facility,
testified in support of this docket. He made the following points, the rule
does not limit access to care and it does not impede quality of care. He
further stated that he does not know about any negative outcomes related
to the implementation of this rule.
Bill Roden, representing Pharmaceutical Research and Manufacturers of
America, addressed the Committee. He stated that Docket 16-0309-0214,
as written, has the potential to cause harm to patients. He explained that the
major problem of the rule is that the terms of “therapeutically
interchangeable” and “more conservative” are not defined and should be
clarified. He stated that there will be a public hearing on this rule by the
Department on February 12th and hopefully changes will be made. He
further stated that the Department can adopt a new temporary rule
immediately if this rule is rejected. He also stated that he is not asking the
Department to abandon prior authorization as the department intends by this
rule or the idea of exploring a Preferred Drug List. He further explained that
the Legislature will have the opportunity to look at this rule next session as
a pending rule.
Michelle Glasgow, executive director of the Idaho Assisted Living
Association, addressed the Committee. She explained that she had studied
this rule and felt that the Department is taking the most prudent action and
other states are not approaching the problem as carefully.
Dr. Thomas Young, part-time consultant for the Department of Health and
Welfare and a practicing physician, addressed the Committee. He explained
that prior authorization does not change the process between patients and
their physicians. He stated that this rule needs to go forward.
Kathleen Allyn, deputy administrator for the Division of Medicaid, addressed
the Committee. She provided a handout to Committee members (see
attached). The handout contained responses to concerns raised during the
hearing of Docket 16-0309-0214. She explained in detail the main concerns
outlined in the handout.

These concerns include; whether the Department has the authority to
implement prior authorization and other care management measures, the
term “therapeutically interchangeable” is not defined in the rules, the rules
do not specifically provide for emergency refills, the rules do no specify a
turnaround time for prior authorizations, the client appeal rights are not
specified in the rule, and the definition of “medical necessity” included the
phrase “substantially less costly”. She further stated that the Department will
listen to public comments and can amend the temporary rule.

Karen Gustafson, representing the Administrative Rules Office, addressed
the Committee in response to questions. She explained that if this
temporary rule is rejected, it will die when the Legislature ends and the
Department of Health and Welfare will have to immediately adopt a new
temporary rule to replace it. The rule will be reviewed by the Legislature next
session as a pending rule. She further explained that there may be a gap in
services if the rule is rejected.
Kathleen Allyn clarified in response to Committee questions, that if the rule
is rejected, there may be a need to ask for a supplemental appropriation
from the Joint Finance and Appropriation Committee.
MOTION: Rep. Garrett made a motion to approve Docket 16-0309-0214. In speaking
to her motion, Rep. Garrett provided to Committee members a packet of
information regarding this rule which she also provided to the department.
She stated that she had spoken with physicians, pharmacists, providers and
recipients and have heard their concerns. She outlined the concerns which
include the definition of “medically necessary”, the potential for the rule to
inappropriately become a preferred drug list, definition of “more
conservative” and delays and confusion regarding prior authorization. On a
voice vote, the motion carried.
MOTION: Rep. Kulczyk made a motion to print RS 12791, RS 12792, RS 12834, RS
12709
, RS 12846, RS 12672C1, and RS 12886C1. After conferring with
Rep. Henbest, the sponsor of RS 12709, Rep. Kulczyk amended his motion
to send all of the above RS’s to print with the exception of RS 12709 which
will be printed with the following change; “9-340F Exemption from
Disclosure-Records of court proceedings regarding judicial authorization of
sterilization procedures.” On a voice vote, the motion carried.
ADJOURN: As there was no further business to be brought before the Committee,
Chairman Sali adjourned the meeting at 3:40 P.M.






DATE: February 10, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

None
GUESTS: See attached list
Chairman Sali called the meeting to order at 1:40 P.M.
MOTION: Rep. Kulczyk made a motion to approve the minutes of the February 6,
2003 meeting as submitted. On a voice vote, the motion carried.
MOTION: Chairman Sali explained that HB 18, a pre-filed bill relating to optometry
license fees, has been requested by the sponsor to be held in Committee.
Rep. Henbest made a motion to HOLD HB 18 in Committee. On a voice
vote, the motion carried.
RS 12868: Rep. Douglas presented this RS to the Committee. She explained that the
purpose of this legislation is to state that breast-feeding has significant
health benefits for both mother and child, and that a woman should not be
prohibited from breast-feeding in any public or private location where she
has the right to be. She stated that this proposed legislation has the support
of the La Leche League and Women Infants and Children(WIC). She further
stated that health care costs could be reduced by more mothers breast-feeding their children.
MOTION: Rep. Martinez made a motion to print RS 12868.
SUBSTITUTE
MOTION:
Rep. McGeachin made a Substitute Motion to return RS 12868 to the
sponsor. By a show of hands, the motion failed.
ORIGINAL
MOTION:
By a show of hands, the Original Motion to print RS 12868 passed.
RS 12896: Rep. Douglas also presented this RS to the Committee. She explained that
the purpose of this legislation is to require that all employers allow their
female employees who are breast-feeding the time and place to express
milk. She further explained that other states have similar legislation. She
stated that mothers could return to work sooner if allowed by their employers
a place and time to express milk.
MOTION: Rep. Mitchell made a motion to print RS 12896. After Committee
discussion, in which Committee members expressed their concern over a
possible contradiction in the proposed legislation, the Motion failed by a
show of hands.
RS 12690: Robert Vande Merwe, executive director of the Idaho Health Care
Association, presented this RS to the Committee. He explained that
passage of this legislation will allow Canadian trained nurses to apply for an
Idaho license without having to sit for a burdensome and expensive
international nursing test. He further explained that Idaho currently has a
severe nursing shortage and this legislation will help Canadian trained
nurses to more easily acquire an Idaho nursing license. He stated that the
required test is only offered in three places in Canada and only given three
times a year. Mr. Vande Merwe explained that this bill may not do what he
had hoped it would do after talking with Sandra Evans, executive director
of the Board of Nursing. He stated that amendments would have to be made
and problems worked out with the Board of Nursing. Chairman Sali
explained that the Committee could vote to print this RS and then make
amendments to the bill, or return the RS to the sponsor and a new RS would
be drafted and could be printed in a privileged committee.
MOTION: Rep. Henbest made a motion to return RS 12690 to the sponsor. In
speaking to her motion, she stated that the sponsor should work out
problems with the Board of Nursing and come back with a new RS.
SUBSTITUTE
MOTION:
Rep. Nielsen made a Substitute Motion to print RS 12690. By a show of
hands, the motion carried.
RS 12904C1: Rep. Frances Field presented this RS to the Committee. She explained this
proposed legislation adjusts the schedule of controlled substances in Idaho
to match schedule adjustments by the federal Drug Enforcement
Administration. She further explained that this proposed legislation was
prompted by a letter she had received from a constituent who has
narcolepsy and the drug that has been successful in treating her condition
is a controlled drug that she is not able to obtain because of where it is
placed on the schedule of controlled drugs. She stated that the Board of
Pharmacy has promulgated a temporary rule to allow her to use this
medication, and this proposed legislation would replace the temporary rule.
Mick Markuson, executive director of the Board of Pharmacy, addressed
the Committee in response to questions. He explained the Drug Schedules
to Committee members. Schedule I contains drugs that have the most
probability of abuse and includes most street drugs, Schedule II contains the
next most potent drugs, Schedule III contains drugs such as ibuprofen,
Schedule IV contains some tranquilizers, and Schedule V contains drugs
such as cough syrups. He further explained that all of the drugs on these
schedules require a prescription. He stated that the proposed legislation
moves the substance Buprenorphine from Schedule V to Schedule III,
revises Schedule I to allow specific products containing gamma
hydroxybutyric acid to be placed in other schedules, adds to Schedule III any
drug product containing gamma hydroxybutyric acid, and provides for
penalties for using or being under the influence of any drug product
containing gamma hydroxybutyric acid.
MOTION: Rep. Ring made a motion to print RS 12904C1. On a voice vote, the
motion carried.
RS 12952: Rep. Gagner presented this RS to the Committee. He explained that the
purpose of this proposed Concurrent Resolution is to further establish a cost-effective Utilization Management Program for the Developmentally Disabled
within the Department of Health and Welfare. It would also require a system
of checks and balances to be utilized along with prior-authorization by the
Regional Health and Welfare Access Units. It also establishes consistency
of service, through a system of objective standards, to be used throughout
the state for plan development, and ensures that the right services for the
Developmentally Disabled are delivered in the right setting at the right cost.
He further explained that this legislation is intended to generate debate
between the Department of Health and Welfare and providers and give
policy direction to the Joint Finance and Appropriation Committee.
MOTION: Rep. Nielsen made a motion to print RS 12952. On a voice vote, the
motion carried.
RS 12951: Skip Smyser, representing the Idaho State Dental Association, presented
this RS to the Committee. He explained that there are those that have come
into the state of Idaho and held themselves out as qualified licensed dentists,
who were not. This proposed legislation would provide for a civil penalty that
would eliminate the financial incentive in practicing dentistry without a
license in the state of Idaho. The proposed legislation would also allow for
reasonable attorney’s fees and costs if injunctive relief was sought pursuant
to Idaho Code.
MOTION: Rep. Martinez made a motion to print RS 12951. On a voice vote, the
motion carried.
RS 12971: After yielding the gavel to Vice-Chairman Block, Chairman Sali presented
this RS to the Committee. This proposed legislation recognizes Natural
Health Care as a modality of health care and provides for registration,
certification and licensure of practitioners at various levels; establishes a
board, provides for scope of practice and authorizes unconventional care
under certain circumstances. Chairman Sali explained that currently some
naturopaths are probably practicing medicine without a license.
MOTION: Rep. Henbest made a motion to print RS 12971. On a voice vote, the
motion carried.
RS 12959C1: Chairman Sali also presented this RS to the Committee. This proposed
legislation revises the manner in which and the grounds on which a child
may be removed for shelter care on an emergency basis. It adds an
objective standard for review, promotes protection of parental rights
wherever possible and adds recognition of non-medical health care as a
consideration by the judge. He explained that this proposed legislation is a
result of a situation in which an infant was put into shelter care for 48 hours
because of a dispute between the parents and a physician. This proposed
legislation gives the parents every opportunity to go before a judge before
a determination is made.
MOTION: Rep. Kulczyk made a motion to print RS 12959C1. On a voice vote, the
motion carried.
RS 12761C1: Bill Roden , representing the Pharmaceutical Manufacturers Association,
presented this RS to the Committee. He explained that the purpose of the
proposed legislation is to provide a process for future rule making by the
Department of Health and Welfare relating to the Medicaid pharmacy benefit
program. The proposal provides a negotiated rule making process that will
include pharmacists, the medical profession and representatives of Medicaid
patients. The proposed legislation confirms that prior-authorization or
preferred drug lists should be based on a clinical foundation consistent with
quality patient care. It further provides that response to prior-authorization
requests will be made in a reasonable time. The proposed legislation
assures that rules adopted by the Department will affirm the right of the
prescribing physician to prescribe medicines for their patients that the
physician determines, in the physician’s best medical judgment, are the most
effective drugs to treat the patient’s health condition. Mr. Roden explained
the RS proposes that new drugs would get six months of use before being
put on the prior-authorization list.
MOTION: Rep. Nielsen made a motion to print RS 12761C1. There was Committee
discussion on the fiscal impact of the RS which states there would be no
impact to the State’s General Fund. Chairman Sali requested a full
description of how this proposed legislation would change the current rule
making process by the Department of Health and Welfare, the kinds and
numbers of prescriptions that would be approved under the proposal and the
increase in funding that would result. On a voice vote, the motion carried.
ADJOURN: As there was no further business to be brought before the Committee, Vice-Chairman Block adjourned the meeting at 3:55 P.M.






DATE: February 12, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

None
GUESTS: See attached list
Chairman Sali called the meeting to order at 1:35 P.M.
MOTION: Rep. Kulczyk made a motion to approve the minutes of the February 10,
2003 meeting as submitted. On a voice vote, the motion carried.
Rep. Garrett discussed with the Committee a letter to the Department of
Health and Welfare outlining the Committee’s concerns regarding Docket
16-0309-0214
dealing with prior-authorization for Medicaid payments for
prescriptions. (See attached letter). Rep. Garrett made an Unanimous
Consent Request
to send a copy of this letter to the Department of Health
and Welfare to be a part of the public record in today’s public hearing
regarding this docket. There were no objections.
Director Karl Kurtz of the Department of Health and Welfare addressed the
Committee. He discussed the hold backs made by the Department in 2002
and 2003. He provided a handout to Committee members outlining
reductions taken in each division. Chairman Sali asked Director Kurtz to
supply Committee members with information for each fiscal year regarding
the specific actions taken within each division to arrive at the hold back
figures given. Director Kurtz stated that he would provide that information
at the next meeting of the Committee on February 14th. In response to
questions, he clarified that there have been 192 reductions in services, but
24 services have been added back to Medicaid.
Rep. McGeachin discussed with the Committee several cost savings ideas
within the Department of Health and Welfare that she has researched. She
thanked the Department for their cooperation in this research. She provided
handouts to Committee members outlining three projects she has been
working on. These include; reduction in personnel and costs, analysis of
administrative costs within each division, and appropriation costs for
Department vehicles. A copy of her report is attached.



Rep. McGeachin explained that the number of dollars that the Department
of Health and Welfare has claimed to have saved in reduction of personnel
cannot be substantiated by the Department of Human Resources. She
further explained that it appears that the average salary in Medicaid is higher
than the average salary in the other divisions, and that overall administrative
costs could be reduced to be more in line with the other divisions. Lastly,
she explained that she recommends that the appropriation for vehicles
should not be approved until the Department has increased the average
mileage of vehicle use as recommended by the Office of Performance
Evaluations, and has reached the recommended 75,000 to 100,000 miles for
vehicle disposal.

Director Kurtz responded to the questions raised by Rep. McGeachin. He
explained that Medicaid administrative costs were 5.9 percent in 2002 which
puts Idaho in the middle of the national average.
Gary Broker, from the Department of Health and Welfare, responded to
questions raised in Rep. McGeachin’s report. He explained that the
Department’s vehicles are purchased with General Funds, then after the car
has depreciated, the cost to the state is only 50 percent for the vehicle.
Chairman Sali thanked Rep. McGeachin for her hard work in researching
these cost-saving ideas. He announced that his presentation to the Joint
Finance and Appropriation Committee has been changed to Wednesday,
February 19th and would like ideas from Committee members on additional
ways to save money within the Department.
H 22: Rayola Jacobsen, director of the Bureau of Occupational Licensing,
presented this bill to the Committee. She explained that this legislation was
requested by the Board of Barbers. This bill allows the Barber Board to
expand exemption to include all licensed nurses, persons practicing in their
own homes on family members without compensation, and allows services
for those unable by ill health, medical confinement or involuntary
incarceration to go to the barber shop. The bill would also require barber
schools or colleges approved by the board to deliver to the board a $20,000
bond.
Roger Hales, an attorney representing the Bureau of Occupational
Licensing, addressed the Committee in response to Committee questions.
He explained that he was not aware of anyone who has been charged or
convicted of barbering without a license.
MOTION: Rep. Mitchell made a motion to send H 22 to the Floor with a DO PASS
recommendation. On a voice vote, the motion carried. Rep. Mitchell will
sponsor the bill on the House Floor.
H 23: Ms. Jacobsen presented this bill to the Committee. This bill strikes
language designating levels of nursing experience, adding barber-styling as
a designation and allows cosmetologists to provide services for those unable
to go to a cosmetological establishment.
MOTION: Rep. Mitchell made a motion to send H 23 to the Floor with a DO PASS
recommendation. On a voice vote, the motion carried. Rep. McGeachin will
sponsor the bill on the House Floor.
H 24: Ms Jacobsen presented this bill to the Committee. This bill adds language
for disciplinary proceedings of the Board of Counselors and Marriage and
Family Therapists and provides the Board additional disciplinary alternatives.
The bill also contains language that allows a registration fee for interns.
MOTION: Rep. Henbest made a motion to send H 24 to the Floor with a DO PASS
recommendation. On a voice vote, the motion carried. Rep. Eberle will
sponsor the bill on the House Floor.
H 25: Roger Hales, an attorney representing the Bureau of Occupational
Licensing, presented this bill to the Committee. This bill allows the Nursing
Home Administrator Board to set objective standards when reviewing
applications for licensure from applicants from other states. Mr. Hales
explained that rules would be promulgated regarding these standards and
will be brought before the Legislature for review next session.
MOTION: Rep. Mitchell made a motion to send H 25 to the Floor with a DO PASS
recommendation. On a voice vote, the motion carried. Rep. Nielsen will
sponsor the bill on the House Floor.
H 26: Michael Graham, representing the Blind Commission, presented this bill to
the Committee. He explained that this bill is necessary to remove from Idaho
Code the requirement of a medically documented opinion in determining
whether an individual is functionally blind. The Idaho Commission for the
Blind and Visually Impaired believes that a medical opinion should only be
one of the factors used in determining whether an individual is functionally
blind and this amendment would allow Commission counselors the ability to
consider additional factors in making a final decision as to whether an
individual is functionally blind. Mr. Graham explained that if this bill passes,
40 to 75 individuals will have one less step to go through to receive services
from the Commission.
MOTION: Rep. Ring made a motion to send H 26 to the Floor with a DO PASS
recommendation. On a voice vote, the motion carried. Rep. Ring will
sponsor the bill on the House Floor.
Chairman Sali announced that the next meeting of the Committee will be
1:00 P.M. on February 14th.
ADJOURN: As there was no further business to come before the Committee,
Chairman Sali adjourned the meeting at 3:00 P.M.






DATE: February 14, 2003
TIME: 1:00 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

Rep. Eberle, Rep. Mitchell
GUESTS: See attached list.
Chairman Sali called the meeting to order at 1:05 P.M.
MOTION: Rep. Ring made a motion to approve the minutes of February 12, 2003
as submitted. On a voice vote, the motion carried.
Chairman Sali discussed with Committee members a copy of his letter to
the Speaker explaining the Committee’s action regarding administrative rule
review. The letter will be forwarded to the Speaker and a copy will be placed
in the member’s minute books.
Director Karl Kurtz of the Department of Health and Welfare addressed the
Committee. He provided to Committee members a handout detailing hold
backs in Fiscal Year 2002, 2003 and Base Reductions in Fiscal Year 2003.
(See attached). Hold backs were detailed within the following divisions,
Division of Health, Division of Welfare, Division of Medicaid, Division of
Family and Community Services, and Indirect Support. Director Kurtz
explained that the independent councils; including the Developmentally
Disabled, Domestic Violence, and Deaf and Hard of Hearing, were not
included in the handout, but the hold backs in these councils totaled
approximately $70,000. He further explained that there were three hold
backs implemented, 3 percent in Fiscal Year 2002, 1 percent in Fiscal Year
2003 base reduction, and 1 percent in Fiscal Year 2003. He also discussed
the additional positions hired by the Division of Medicaid. He explained that
the positions were needed to implement the cost-saving reductions within the
Division and to manage Medicaid services. Director Kurtz further explained
that the Division of Family and Community Services has eliminated 194
positions, 140 of which were administrative positions. He emphasized that
the Department has tried to minimize the hold backs in services to impact the
least amount of people and cause the least harm, but people have been
impacted. He commended the outstanding professionals that work at the
Department and the support they have received during this difficult time from
members of the Legislature. Director Kurtz stated that if the Department is
asked to implement another two percent in hold backs, $7 million would
come out of the Division of Medicaid.






In response to questions from Committee members, he explained that the
Division of Welfare has been designated to be the state’s agency for the
receiving and the collection of child support payments. He stated that
between $140 million and $150 million is collected per year in child support.
Also in response to questions, Director Kurtz stated that the Department
would welcome the ability to return unused medications and will visit with the
Board of Pharmacy for possible implementation. In response to questions,
he also explained that the Department has received about 20 responses
from employees giving ideas for cost-savings within the Department. He
stated that these ideas have been forwarded to the Joint Finance and
Appropriation Committee, and employees have been encouraged to share
ideas.

Chairman Sali asked that Director Kurtz further detail how much was
saved under each division’s hold back.
Chairman Sali put the Committee at ease at 2:35 P.M.
Chairman Sali called the meeting back to order at 2:45 P.M.
H 19: Due to the absence of Rayola Jacobsen, Bud Hetrick, Deputy
Administrator of the Bureau of Occupational Licensing, presented this bill to
the Committee. This bill clarifies the manner of payment to the national
examination entity for psychologist examiners, clarifies the processing fee
of $25.00 and strikes unnecessary language.
MOTION: Rep. Garrett made a motion to send H 19 to the Floor with a DO PASS
recommendation. On a voice vote, the motion carried. Rep. Garrett will
sponsor the bill on the House Floor.
H 20: Mr. Hetrick presented this bill to the Committee. This bill strikes language
removing the sanitary supervision of barber shops, hairdressing parlors, and
retail cosmetics dealers from the jurisdiction of the Director of Health and
Welfare. He explained that these establishments are currently being
inspected by the Bureau of Occupational Licensing.
MOTION: Rep. Martinez made a motion to send H 20 to the Floor with a DO PASS
recommendation. On a voice vote, the motion carried. Rep. Martinez will
sponsor the bill on the House Floor.
H 21: Mr. Hetrick continued his presentation. This bill relates to the Board of
Podiatry and strikes the reference to a national examination entity and sets
a cap on the examination fee. In response to questions from Committee
members, Mr. Hetrick explained that the Board cannot raise the examination
fee without a rule change which would have to come before the Legislature
for review. He further explained that the Board has been giving this exam
for the past three years, and the proposed cap is comparable to those in
other states.
MOTION: Rep. Ring made a motion to send H 21 to the Floor with a DO PASS
recommendation. On a voice vote, the motion carried. Rep. McGeachin
will sponsor the bill on the House Floor.
Lengthy Committee discussion followed in which members discussed
various ways to further save money with the Department of Health and
Welfare. The following points were made; multi-state buying pools for
pharmaceuticals should be investigated, the proposed appropriation for
vehicles for the Department of Health and Welfare should be cut in half, and
the needs of the Department should be prioritized. Chairman Sali
expressed his concern that the Committee needs direction from leadership
whether or not a tax increase will be considered before members consider
additional cost-savings ideas for the Department and asked for the backing
of Committee members in going to leadership for that direction. The
Committee members present expressed their support. Vice-Chairman
Block
stated that she did not want to take any action that would cause an
increase in sales taxes.
MOTION: Rep. Kulczyk made a motion to adjourn. On a voice vote, the motion
carried.
ADJOURN: Chairman Sali adjourned the meeting at 4:15 P.M.






DATE: February 18, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

None
GUESTS: See attached list.
Chairman Sali called the meeting to order at 1:35 P.M.
MOTION: Rep. Kulczyk made a motion to approve the minutes of the February 14,
2003 minutes as submitted. On a voice vote, the motion carried.
M.C. Niland, director of WITCO (Western Idaho Training Company) and
representing the Idaho Association of Community Rehabilitation Programs,
addressed the Committee. (See attached testimony) She gave a brief
history of the programs and explained that the none of the CEOs of these
companies have interest or partnership in any private for profit businesses
which provide other services to people with disabilities. She further
explained that the primary focus of the Association is work and employment
for people with disabilities. She stated that vocational services have always
been a managed care system in Idaho. She further stated that when the
Governor ordered a 3 and one half percent reduction in General Funds, the
Department of Health and Welfare cut the General Funds appropriated for
vocational services by 27 and one half percent. Ms. Niland asked the
Committee for their support of the Association in their efforts to reduce the
amount of their Fiscal Year 2003 budget cuts and support their intent in the
Fiscal Year 2004 budget which prevents this from happening again.
MOTION: Rep. McGeachin made a motion to recommend to the Joint Finance and
Appropriation Committee to consider restoring the money cut from these
programs through the savings found by the Medicaid Task Force.
Committee discussion followed in which the following point was clarified; Ms.
Niland
explained that the current hold back is $753,000 and that the
Association is not asking for an exemption, just some relief. Committee
members discussed that this disproportionate cut for these programs should
be restored this year, then next year should be looked at in a different light.
SUBSTITUTE
MOTION:
Rep. Nielsen made a Substitute Motion that the Chairman will advise the
Joint Finance and Appropriation Committee that the Committee has
concerns about the disproportionate cuts for these programs, that work
services have been impacted disporportionately and that the consequences
to the Medicaid budget could be lessened by leveraging Medicaid funds to
pay for these services.
In response to questions from Committee members, Randy May, from the
Department of Health and Welfare, clarified that Medicaid funds cannot be
transferred into a Federally non-compliant program. He further explained he
does not have a high degree of confidence in the numbers suggested for
cost-savings and the expansion of waivered Medicaid services could be a six
month process. He stated that he would study how this expansion could be
implemented and would report back to the Committee.
After Committee discussion, the Substitute Motion carried on a voice vote.
Chairman Sali introduced the new page for the Committee, Kristina
Uhlenkott, from Cottonwood, Idaho.
H 12: Nancy Kerr, executive director of the Board of Medicine, presented this bill
to the Committee. She explained that the purpose of this legislation is to
amend existing law to add language to comply with the FBI requirement that
Idaho’s state statute establishing guidelines for issuance of a license must
require fingerprinting and authorize the licensing agency to exchange
fingerprint data with the FBI to allow access to criminal history record
information maintained by the FBI.
MOTION: Rep. Ring made a motion to send H 12 to the Floor with a DO PASS
recommendation. On a voice vote, the motion carried. Rep. Ring will
sponsor the bill on the House Floor.
H 238: Skip Smyser, representing the Idaho State Dental Association, presented
this bill to the Committee. He explained that this legislation would provide
for a civil penalty that would eliminate the financial incentive in practicing
dentistry without a license in the state of Idaho. Mr. Smyser explained that
after discussion with interested parties, the Association requests that H 238
be sent to General Orders to delete section 2 of the bill that deals with the
injunctive process for recovering attorney’s fees.
PRO: The following people stood and expressed their support of sending H 238 to
General Orders to delete section 2; Woody Richards, Jack Klure, and Mike
Sheeley
, executive director of the Board of Dentistry.
MOTION: Rep. Mitchell made a motion to send H 238 to General Orders with
Committee amendments attached
. On a voice vote the motion carried.
Rep. Sali will sponsor the bill on the House Floor.
HCR 17: Michelle Glasgow, representing the Idaho Assisted Living Association,
presented this resolution to the Committee. She explained that this
resolution would curtail the wasteful practice of destroying unused and
unopened medications by allowing Assisted Living facilities to return
medications just as hospitals and nursing homes presently do.



She further explained that this will help reduce costs of healthcare,
especially as it relates to prescription medications for the elderly and
disabled. She stated that $3 to $4 million in medications are destroyed each
year, about $1.7 to $2 million in Medicaid. She further stated that this
resolution would allow providers, the Idaho Board of Pharmacy and the
Health and Welfare Bureau of Facility Standards to work together to develop
simple, enforceable changes to regulations to allow drugs distributed in
blister packs to be returned to pharmacies. It would also provide adequate
compensation to pharmacies accepting unused blister packaged drugs and
with private payers, allow consumer demand to control the amount of drugs
being returned and reused. Ms. Glasgow clarified that consumers will be
able to choose a pharmacy that would allow returns and the dispensing
pharmacist would have the final say if the medication is returned. She
further clarified that Assisted Living Facilities are currently required to
destroy medications every 30 days.

CON: Mick Markuson, executive director of the Idaho State Board of Pharmacy,
testified in opposition to HCR 17. He discussed the issue of inspections that
would have to be done in Assisted Living Facilities to ensure the proper
return of these medications. He stated that the Board only has three
inspectors to cover the entire state. He further stated that lot numbers are
not currently on blister packs and that would cause a problem if the
medication were to be recalled. He explained that if there is a recall, that all
lots of each product name will be recalled.
Committee discussion followed with the following points clarified; inspections
can be done monthly by a registered nurse of record, and consultant
pharmacists work with long-term care facilities who have oversight over the
dispensing of medications, and nursing homes are currently required to
return medications for their Medicaid patients only.
PRO: Rick Halloway, president of the Western Health Care Association and
owner of an assisted living facility, spoke in support of HCR 17. He stated
that the last inspection by the Board of Pharmacy in his facility took place
before 1997. He further stated that $1,500 worth of medications were
recently destroyed by his facility last month.
PRO: Kelly Buckland, executive director of the Idaho State Independent Living
Council, spoke in support of HCR 17. He stated that he is a member of the
Long-Term Solutions Committee, and this idea of returning unused and
unopened medications was one of the recommendations of this Committee.
He further stated that all this resolution is asking is for a committee to be put
together and study this issue and come back before the legislature for
review. He also stated that the Council supports HCR 17.
PRO: Robert VandeMerwe, executive director of the Idaho Health Care
Association, spoke in support of HCR 17. He explained that all this
resolution is trying to do is make sure all interested parties stay together and
further study this issue. He further explained that without this legislation,
unopened and unused medications cannot be returned in assisted living
facilities.
Chairman Sali asked that Committee members read a letter from Jo An
Condie, CEO of the Idaho State Pharmacy Association, expressing the
Association’s concerns with HCR 17. She stated that while returns are
allowed from Skilled Nursing Homes, Assisted Living Homes are not
regulated by the Board of Pharmacy and currently do not handle medications
in the same manner, and that is a concern to pharmacists that provide
medications to Assisted Living Facilities. She asked that the legislature be
patient in allowing the parties to work through the unique issues surrounding
return of medications from Assisted Living facilities.
MOTION: Rep. Henbest made a motion to send HCR 17 to the Floor with a DO PASS
recommendation. On a voice vote, the motion carried. Rep. Kulczyk will
sponsor the bill on the House Floor.
UTILIZATION
MANAGEMENT
Alisa Axtmann, from the Department of Health and Welfare, discussed with
the Committee the Department’s recent efforts regarding Utilization
Management of Medicaid services in the Department of Health and Welfare.
(See attached report). She gave a brief history of the Developmental
Disability/Mental Health Service Delivery Project. She explained that pilot
project was initiated in October of 2001 in Region II headquartered in
Lewiston. The pilot addressed only developmentally disabled adults. A
Quality Improvement Council and three subcommittees were established to
advise the project team that was charged with developing the pilot. She
further explained that a key component to the pilot was an Independent
Assessment Provider (IAP), a proposal suggested by the Lewin Report, a
study that made recommendations on ways to slow the growth of Medicaid
expenditures. She stated that The Lewin Report suggested an independent
statewide system to assure consistent assessments and service plans for
developmentally disabled consumers. She claimed that the report
emphasized the importance of keeping the client assessment separate from
direct service providers. The report suggested there is a potential conflict of
interest when the same provider assesses a client’s level of disability,
develops a service plan to meet those needs and then provides the services.
She explained that the pilot program was to conclude April 30, 2002, but at
the direction of the legislature, the pilot was later extended to June 30, the
end of the state fiscal year. Ms. Axtmann stated that the project used three
general measurements to track the progress of the pilot. These include;
consumer and service provider surveys to determine satisfaction with the
pilot, expenditures for clients tracked, and a survey was conducted of the
Quality Improvement Council and its subcommittees. She further explained
that the project’s aim was not to control enrollment, but to better manage
services by establishing an Independent Assessment Provider. She stated
that there were 64 consumers in the pilot who had four years of continuous
service history. She further stated that the total authorized cost was $2.3
million and the growth rate was 6 percent over the previous year. She
explained that the independent research firm found that 69 percent of the
consumers said the service plan was fair, 76 percent of the consumers said
service plan staff provided quality service, and 78 percent of consumers said
they are satisfied with the freedom to choose. Ms. Axtmann explained that
the Department concluded from the pilot program that the IAP was critical to
the success of the pilot, the UM business model demonstrated an
opportunity to avoid high growth rate, consumers were satisfied, QI
participants voiced strong support for the stakeholder process, and the
Governor’s 2020 Talk Force recommends statewide implementation.
In response to questions from Committee members, Ms. Axtmann stated
that the Independent Assessment Provider would be a licensed social worker
and that it would depend on the number of contracts as to how many IAP’s
would have to be hired.
HCR 21: Rep. Gagner presented this resolution to the Committee. He explained that
the purpose of this resolution is to further establish a cost-effective Utilization
Management Program for the Developmentally Disabled within the
Department of Health and Welfare. He explained that the Department’s
proposal has been held for the past two years because of the cost, but that
the Department found $2.8 million to implement their Utilization Management
program. He discussed the Medicaid Funding History(see attached) of the
General Fund comparison of Medicaid to the State Budget. He also
discussed the annual per person cost and institutions versus waivers costs.
He concluded that waivers are the best bargain. He also provided to
Committee members a copy of the Lewin Report which states that there
needs to be a separation between the providers of services and the person
assessing the services. Rep. Gagner also discussed a handout provided
to Committee members entitled “Idaho’s Medicaid Program: Comparisons
with other States”. He explained that Idaho spent less on vendor payments
than any other neighboring states. He also discussed the removal of caps
in 1999 of the waiver programs for the developmentally disabled and the
explosion of costs associated with that removal. He also shared with
Committee members a report on the Department’s Pilot plan written by Dr.
Julie Fodor. He quoted the sentence from the report which states, “The
notion that an Independent Contractor could effectively conduct the
independent assessment portion of the project without extensive training and
carefully planned communication systems in place appeared illogical.” He
pointed out that the resolution calls for an annual review of the plan by the
provider, consumer and support team in consultation with the Healthy
Connections physician to evaluate outcomes from the services provided. He
added that the Healthy Connections physician has the history and
knowledge of the patient.
In response to questions from Committee members, Bill Benkula stated that
the goal of Healthy Connections is to have every Medicaid patient have a
primary care physician and currently 68 percent of the Medicaid patients
have primary care physicians.
Also in response to questions, Randy May, from the Department of Health
and Welfare, stated that the Healthy Connections physicians would not have
the expertise to administer long-term health care plans.
Rep. Gagner also discussed with the Committee a report from the
Comprehensive Advocacy, Inc. prepared by Jim Baugh. The report analyzes
the Department’s UM pilot project from the perspective of Idahoans with
Disabilities and their families. He made the following points; the only date
made available from the pilot was for 64 participants who had been receiving
services since 1998 and this data shows that there is no correlation between
SIB-R scores and costs of plans, even under the conditions of the pilot, and
the individual’s circumstances are far more significant than skill level in
determining the types, amounts and costs of services a person needs to stay
in a community setting.
PRO: Katherine Hansen, executive director of Community Partnerships of
Idaho, spoke in support of HCR 21. She explained that due to the
economic conditions and rising costs of Medicaid, it is imperative that the
state develops an effective Utilization Management Plan. She further
explained that the lessons learned in the pilot project in Region II should
be applied to create a UM Plan that utilizes all that worked well in the pilot
as well as all that works in the current system. The goal must be to create
the most effective plan assuring that people get the right services at the
right time in the right amount. She discussed with the Committee what
the plan would accomplish which includes; utilizing several cost control
mechanisms, supporting choice for consumers and including the Regional
Health and Welfare staff in the Planning Meetings, development of service
plans and the prior authorization of all services. The success of the plan
requires that the Department work with providers, consumers, advocates
and families to rewrite applicable rules and to define the objective
standards. She then discussed each step in the resolution to achieve
these results. (See attached).
CON: Randy May, from the Department of Health and Welfare, spoke in opposition
to HCR 21. He outlined for Committee members specific concerns by the
Department. He made following points: The Department has budgeted $1.5
million for client assessment, plan review, and plan authorization activities.
He explained that the Department will spend this sum regardless of whether
the pilot is implemented or the Resolution proposal is implemented. He
further explained that the Department has not asked for additional FTE to
support the Region II pilot expansion and the computer upgrades will be
required to support several Department programs, not just the Adult DD
Program. He further stated that the Department does not have sufficient
staffing to allow the Department to attend planning meetings for all 3500 DD
clients. To meet this requirement, the Department would require an
additional 12 to 15 full time employees. He asked the Committee the
following four questions; should the Department turn their back on advice of
experts?, Who speaks for the taxpayers in the resolution?, Are we setting a
precedent or opening a door that we don’t want to open?, and Will this
resolution help strengthen the DD programs across the state? Mr. May
stated that the objective assessments need to be uniformly applied across
the state.
In response to questions, Ms. Axtmann stated that it might take about
two years for a Uniform Assessment Provider to understand and assess
all services.
PRO: Bill Benkula, president of the Idaho Association of Developmental
Disabilities Agencies, spoke in support of HCR 21. He explained that the
Association supports the resolutions proposal to assure that multiple
assessments will allow for all of the various aspects of a person’s life health
and safety. He stated that successful utilization management requires prior
authorization. He further stated that the concept of an independent
assessment provider to assure eligibility has no bearing on the Department’s
ability to prior authorize.
PRO: Jim Whitaker, an operations manager for a provider that participated in the
pilot program in Region II, spoke in support of HCR 21. He stated that he
found no successes in the pilot program. One problem encountered was
that there were lost or missing plans.



He spoke of his personal experience with his brother who is developmentally
disabled. He pointed out that the cost-savings in region II with the pilot
program were no different than the savings in Region IV without the pilot.

PRO: Debra Johnson, the Legislative Chairperson for the Board of Directors of
Idaho Parents Unlimited, Inc., spoke in support of HCR 21. She made the
following points; IPUL supports the resolution because it proposes a
utilization management system that only uses the SIB-R or other
standardized assessment to determine eligibility for services, it requires that
the consumer’s budget of services be based on his/her individual support
plan, it supports a more standardized process for service authorization, it
includes the regional Department staff in the planning process, it utilizes
existing providers to conduct the eligibility assessments, and it maximizes
the Healthy Connections physicians referral and authorization process.
PRO: Kris Ellis, representing the Idaho Association of Developmentally Disabilities
Agencies, spoke in support of HCR 21. She clarified the following points; the
Lewin report discourages the Department from doing assessments, the goal
is to have objective standards, there are administrative costs that cannot be
determined with the Departments UM plan, and the rules would state how
the objective standards would work.
Tracy Warren, representing the Idaho Council on Developmental
Disabilities, addressed the Committee. She stated that the Council does not
have a position on HCR 21. She further stated that the Council supports a
utilization management system in which the consumers’ services and budget
are based on person-centered planning and not principally determined by
their scores on the SIB-R; and the Council supports a utilization
management system in which the consumer is protected from coercion and
undue influence in assessment, plan development, and plan implementation.
Rep. Gagner summarized and made the following points; the Department
originally asked for 80 full time employees to implement the UM plan and
was turned down because of the cost involved, the legislature speaks for the
taxpayers, consumer costs for the Developmentally Disabled have gone
down, and interested parties can objectively sit down together to create an
improved Utilization Management system as HCR 21 suggests.
MOTION: Rep. Kulczyk made a motion to send HCR 21 to General Orders with
Committee amendments attached. The advocates for the developmentally
disabled wished to be included in the language of the resolution and
requested the amendments(see attached).
SUBSTITUTE
MOTION:
Rep. Henbest made a Substitute Motion to HOLD HCR 21 until time certain
at the pleasure of the Chairman. She explained that there needs to be time
for the interested parties to get together to take a serious look at Utilization
Management. She further explained that this resolution still has not
achieved the separation of services and there is no cost-containment in the
resolution.
After Committee discussion, the SUBSTITUTE MOTION failed on a voice
vote.
ORIGINAL
MOTION:
The ORIGINAL MOTION to send HCR 21 to General Orders with Committee
amendments passed on a voice vote. Rep. Henbest voted NAY.
Chairman Sali provided to Committee members a copy of a letter from
Sen. Brandt concerning the adult dental rule. He asked that the
Committee review the options outlined in the letter.
ADJOURN: As there was no further business to be brought before the Committee,
Chairman Sali adjourned the meeting at 7:55 P.M.






DATE: February 20, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

None
GUESTS: See attached list
Chairman Sali called the meeting to order at 2:45 P.M.
MOTION: Rep. Kulczyk made a motion to approve the minutes of the February 18,
2003 meeting as submitted. On a voice vote, the motion carried.
Chairman Sali discussed with the members a copy of a letter from Sen.
Brandt
regarding the Senate Health and Welfare Committee’s action on
Medicaid’s adult dental rule. He explained that both the House and the
Senate Committees approved the rule, but agrees with the Senate Health
and Welfare Committee’s suggestion to direct the Department of Health and
Welfare to reduce coverage for non-essential services in the children’s
dental program in the area of orthodonture and to provide coverage for
emergency dental services to adults with high risk conditions. Chairman
Sali
requested that Rep. Ring follow up with the Idaho Dental Association
in providing to the public information regarding this issue.
Bill Southerland, president of ALMSA (Assisted Living Management
Services of America), addressed the Committee. He explained that ALMSA
provides both consultative services and software systems to owners and
operators of residential and assisted living care facilities. He further
explained that this management system uses the Internet as the medium for
wide area networking, building a support network for owners, staff and
residents and raising the level of accountability and communication. He
stated that this system is cost effective and easy to use. He further stated
that this system has been tested for about two years and is currently in use
in 16 facilities.
H 203: Rep. Henbest presented this bill to the Committee. She explained that
the purpose of this legislation is to preserve the title of nurse. The title of
“nurse” may only be used by a duly licensed person. She further
explained that this legislation protects the title of nurse and helps to give
more professionalism to the profession. She stated that the Board of
Nursing was involved in the drafting of this bill.
Kay Mannweiler, from the Attorney General’s Office, responded to
questions from Committee members regarding the language in the bill
stating the law does “prohibit unqualified and dishonest persons from
practicing nursing.” She explained that this is existing language in Idaho
Code and the Board of Nursing does not have any problem with it.
MOTION: Rep. Ring made a motion to send H 203 to the Floor with a DO PASS
recommendation. On a voice vote, the motion carried. Rep. Henbest will
sponsor the bill on the House Floor.
H 160: Kelly Buckland, president of the Idaho State Independent Living Council,
presented this bill to the Committee. He explained that the purpose of this
bill is to amend language that was not amended last legislative session
regarding termination of parental rights for parents with disabilities. He
further explained that the word “failure” is inserted in the language regarding
discharging parental rights replacing the language “unable to discharge
parental responsibilities because of mental illness or mental deficiency”. He
explained that this legislation is supported by many organizations making up
the group, Fathers and Mothers Independently Living with their Youth. The
proposed amended language is supported by this group.
MOTION: Rep. Mitchell made a motion to send H 160 to the Floor with a DO PASS
recommendation.
CON: Heather Reilly, Ada County deputy prosecutor, and representing the Idaho
Prosecuting Attorney Association, spoke in opposition to H 160. She
explained that parental rights should not be terminated because of mental
illness or disability and these individuals should not be discriminated against.
She further explained that the proposed amended language in the bill makes
the section too broad and could give the state the right to terminate the
parental rights of parents of latch key children or divorced parents. She
stated that the prosecuting attorneys were invited to the meetings held by the
FAMILY group drafting this legislation, but were unable to attend. She
further stated that the prosecutors are willing to meet with Mr. Buckland to
work out their concerns with this legislation. She also stated that each
parental rights termination case should be treated individually and
prosecutors think that the current statute is sufficient.
Mr. Buckland responded to the concerns raised by Ms. Reilly. He stated
that he is concerned with making any additional language changes when so
many of other organizations have approved the specific language of this
legislation.
Committee discussion followed in which the following points were made;
there is concern that violations arising under subsection (d) of the bill would
also be violations of the language in subsection (b), and the language
amended in subsection (d) may actually lower the standard when the state
will terminate parental rights.
SUBSTITUTE
MOTION:
Rep. Block made a Substitute Motion to HOLD H 160 to time certain,
Friday, February 28th.
PRO: Leslie Goddard, director of the Human Rights Commission, spoke in
support of H 160.



She stated that this legislation supports the efforts to remove discrimination
of those with mental illness or disability and focuses on the relationship of
the parent and child.

CON: Cathleen MacGregor-Irby, Ada County deputy prosecutor who handles all
of the county’s child termination cases, spoke in opposition to H 160. She
explained that the present statute provides for the disabled and the proposed
language change would take the teeth out of the prosecuting laws. She
further explained that “failure” is less than “neglect” and the proposed
legislation gives no standard by which to measure failure.
PRO: Ron Enright, representing the Idaho Council on Developmental Disabilities,
spoke in support of H 160. He stated that the group that drafted this
legislation did have attorney representation.
PRO: Cathy Sherman, an advocate for the disabled, spoke in support of H 160.
She stated that this legislation would equal the playing field for those with
disabilities and protects families and children.
PRO: Brenda Kotewa, a parent with disabilities, spoke in support of H 160. She
stated that disabled parents should be held accountable for their parenting
and treated equally.
After Committee discussion, Ms. Reilly stated that if the bill is held for a
week, she would commit to working with Mr. Buckland to work out concerns
with H 160.
Mr. Buckland responded that he would do whatever needs to be done to
work out the concerns raised. He stated that he is concerned about the
support of the other groups that have signed on to this legislation and this bill
already has compromise language.
SUBSTITUTE
MOTION:
On a voice vote, the Substitute Motion by Rep. Block to HOLD H 160
until time certain, Friday, February 28th, passed.
Chairman Sali announced that H 201 and H 202 will considered together
and the Committee will only send one of the bills out of Committee. He
explained that the bills cover the same area and the Committee must choose
which policy should be sent for consideration by the full House. He stated
that both bills will be presented and no repeat testimony will be taken.
H 201: Rep. Henbest presented this bill to the Committee. She explained that the
purpose of this legislation is to direct the director of the Department of Health
and Welfare to apply for a waiver of federal regulations to allow coverage
under the Children’s Health Insurance Program to be expanded to include
prenatal coverage for pregnant women who meet the program’s income
qualifiers. She further explained that Medicaid is a health insurance benefit
programs and Congress decides who gets what benefits and the rules can
be bent if a waiver is applied for. Currently, three other states have received
a waiver for this coverage. Pregnant women over the age of 19 and
between 133 percent and 150 percent of the federal poverty level would be
covered by this waiver. The benefits are similar to those of the Pregnant
Women and Children coverage and the child born would be CHIP eligible.

The Department of Health and Welfare estimates that there are
approximately 1,000 women who would qualify for this benefit. Rep.
Henbest
explained that there would be no negative fiscal impact because
for every dollar the state spends on prenatal care, delivery services and post
partum care, the state will save two dollars in neonatal intensive care costs.

Rep. Ring also presented this bill to the Committee. He provided a handout
to Committee members outlining the differences between H 201 and H 202.
(See attached). He explained the importance of post-partum care that would
be covered for those eligible women in H 201. He stated that he felt H 201
is a far better bill than H 202.
In response to questions from Committee members, Kathleen Allyn, from
the Department of Health and Welfare, clarified that the Pregnant Women
and Children program could be expanded, but would have a different match
rate than that of the CHIP program.
Committee discussion followed and the following points were clarified;
ineligible aliens would be covered under H 202, it is difficult to determine the
savings from post-partum care, a low-income pregnant woman with no
prenatal care usually results in high-risk pregnancies, and it is difficult to
separate care for the mother and the fetus. Rep. Henbest clarified that H
201
is not an attempt to raise the cap of the CHIP program and that the state
will have to spend $1.3 million to expand the coverage.
Ms. Allyn stated that the cap of the CHIP program may have to be raised if
either H 201 or H 202 passes. She was not sure what would happen if the
$3.8 Million cap is exceeded, since that has not happened in the past. It was
further clarified that H 201 covers fewer children than H 202.
Dr. Kevin Rich, representing the Family Practice Residency of Idaho,
testified in support of H 201 and in opposition to H 202. (See attached
testimony). He explained the importance of prenatal care, postpartum care
and the adverse effects of not providing care for the low income pregnant
women.
H 202: David Ripley, executive director of Idaho Chooses Life, presented this bill
to the Committee. He explained that the proposed legislation is brought
before the Committee in order to strengthen the position of pre-born children
in our state. He further explained that his organization believes that the
legislation will enhance the depth and breadth of pre-natal care in the state.
He stated that H 202 is sponsored by the Chairmen of both the Senate and
House Health and Welfare Committees as well as Rep. McKague. He
further stated that this legislation comes as a result of President Bush’s offer
to expand federal CHIP benefits to unborn children. H 202 amends the
powers of the Department of Health and Welfare to make it clear that the
Department shall use the amended definition of “child” contained in the
federal regulations to qualify pre-born children as eligible for benefits for the
state’s CHIP program. The bill also directs the Department to amend the
CHIP program so that the state can begin to offer extended services to
children. He explained that the expansion of prenatal care will mean more
healthy children. He stated that other states, after enacting legislation like
H 201, had used CHIP monies to pay for abortions. He further explained
that by offering this proposed legislation in H 202, more people would
choose to give babies life instead of choosing abortion.
Rep. Henbest stated that abortion is not the primary reason for H 201 and
felt that Mr. Ripley’s comment was insulting, misleading and grossly
inaccurate.
Mr. Ripley stated that H 201 would allow for the CHIP program to pay for
abortions in some cases and cited examples from other states in which CHIP
money was used for abortions. He also discussed the illegal alien issue and
stated that when the baby is born, it would become a U.S. citizen.
Dr. Stacy Seyb testified PRO H 201 and CON H 202. (See written
testimony). He explained that by extending the CHIP program to include the
unborn child as the primary beneficiary, it would fail to provide adequate
prenatal care to those babies who need and deserve it. He stated that it is
his medical opinion that maternal health must be optimized for all babies.
Finally, he cautioned against interpreting H202 as limiting benefits to the
unborn baby because the health and welfare of a mother and her baby is so
closely tied.
Mia Crosthwaite, representing the Roman Catholic Diocese of Boise,
testified PRO H 202. (See written testimony). She stated that the Diocese
is encouraged by the language in the bill that legally defines a child to
include that time from conception to birth.
Dr. Angela Devitt, a family physician caring for both pregnant women and
children, spoke in support of H 201 and in opposition to H 202. (See written
testimony). She stated that she is opposed to H 202 because the manner
in which it proposes to improve access to prenatal care sends the message
that the pregnant woman is not vital to this process.
Kerry Uhlenkott, legislative coordinator for Right to Life of Idaho, testified
in support of H 202. (See written testimony). She stated that H 202 will
equally serve unborn children and their mothers, in the most immediate and
straightforward way possible.
A letter was read from Dr. Suzanne Allen who was in support of H 201
and in opposition to H 202. (See attached letter).
Elizabeth Hickson spoke in support of H 202. She stated that the bill
would cover immigrants and give dignity to women as well as the unborn
child.
Dr. Lynn Kammermeyer, director of Program Services for the March of
Dimes, spoke in support of H 201. (See written testimony). She stated that
H 201 will allow the state to cover more income eligible pregnant women at
less cost to the state than under Medicaid and will begin to address the need
to cover prenatal care for those 56,000 women of childbearing age who are
in need.
Bryan Fischer, senior pastor of Community Church of the Valley, spoke in
support of H 202. (See written testimony). He explained that the pre-born
is described as a baby with an already developed capacity to experience
emotion.
Judy Cross, a nurse, testified in support of H 201 and in opposition to H
202
. (See written testimony). She stated that H 201 will provide the
mechanism to use CHIP directly to cover the care for the mother and infant,
prenatally and during the crucial first two transitional months after delivery.
Kristen Uhlenkott, on the board of Hope Pregnancy Centers, spoke in
support of H 202. She stated that the life of the child is crucial.
Daniel Rice, president of the United Brotherhood of Carpenters Union,
spoke in support of H 201 and in opposition to H 202. He stated that H 201
supports family more and respects all life.
Linda Burch, a licensed clinical social worker, and president of the Idaho
Chapter of the National Association of Social Workers, spoke in support of
H 201 and in opposition to H 202. (See written testimony). She stated that
a mother without coverage for postpartum medical care as proposed under
H 202 may be forced to seek funding through the county welfare system.
Toni Lawson, from St. Alphonsus Hospital, spoke in support of H 201.
Mark Meuser, a law student, spoke in support of H 202 and in opposition to
H 201. He explained that currently five other states have applied for a
waiver to expand CHIP services, three of which have received the waiver.
He stated that he is in opposition to H 201 because of the length of time it
takes to obtain a waiver, which could be up to a year and a half.
Janet Satterwhite, a registered nurse and an associate professor in the
Department of Nursing at Boise State University, testified in support of H 201
and in opposition to H 202. (See written testimony). She stated that acute
or chronic disease or infection left untreated in the mother will result in infant
death or morbidity in the form of severely premature or low birth weight
infants.
Kathleen Allyn, deputy administrator for the Division of Medicaid for the
Department of Health and Welfare, addressed the Committee. She stated
that the Department has taken no position on either bill and that either bill
may require an increase in State Fiscal Year 2004 of the General Fund
appropriation of CHIP. Either bill will cause the state to max the funding of
federal allotment for CHIP within the next five years. Ms. Allyn clarified that
with the existing program, CHIP funding is within one-half million of the cap.
MOTION: Rep. Mitchell made a motion to send H 201 to the Floor with a DO PASS
recommendation.
SUBSTITUTE
MOTION:
Rep. McGeachin made a Substitute Motion to send H 202 to the Floor
with a DO PASS recommendation and to HOLD H 201 in Committee.
Committee discussion followed with the following points made; it may take
time to implement H 201, H 202 would support prenatal care for illegal
aliens, H 201 provides postpartum care, and H 202 does not.
CALL FOR
QUESTION:
Rep. Mitchell called for the question to cut off debate and vote on the
Substitute Motion. On a roll call vote, the call for the question failed by a
vote of 6 AYES to 5 NAYS. Representatives Sali, Kulczyk, Garret, Eberle,
McGeachin, and Nielsen voted AYE; Representatives Block, Ring
Henbest, Martinez, and Mitchell voted NAY.
Chairman Sali stated that if the motion passed, the fiscal impact statement
of H 202 would need to be examined to make sure the impact is correctly
stated.
CALL FOR
QUESTION:
Rep. Kulczyk called for the question to cut off debate and vote on the
Substitute Motion. On a roll call vote, the call for the question passed by
a vote of 10 AYES to 1 NAY. Representatives Sali, Block, Kulczyk,
Garrett, Eberle, Ring, McGeachin, Nielsen, Henbest, and Mitchell
voted AYE; Representative Martinez voted NAY.
SUBSTITUTE
MOTION:
On a roll call vote, the Substitute Motion to send H 202 to the Floor with a
DO PASS recommendation and to HOLD H 201 passed on a vote of 7
AYES and 4 NAYS. Representatives Sali, Block, Kulczyk, Garret,
Eberle, McGeachin, Nielsen voted AYE; and Representatives Ring,
Henbest, Martinez, and Mitchell voted NAY. Rep. Sali will sponsor the
bill on the House Floor with Rep. McKague.
ADJOURN: There being no further business to be brought before the Committee,
Chairman Sali adjourned the meeting at 7:05 P.M.






DATE: February 24, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

Rep. Mitchell
GUESTS: See attached list.
Chairman Sali called the meeting to order at 2:20 P.M. He announced that
the minutes of the February 20, 2003 meeting will be approved at the next
Committee meeting.
H 213: Jim Baugh, executive director of Comprehensive Advocacy, Inc., an
advocacy group for people with disabilities, presented this bill to the
Committee. He explained that this bill is designed to rewrite the portion of
Idaho Code regarding involuntary sterilization for people with developmental
disabilities. The current statute has been found unconstitutional by Idaho
District Courts. He further explained that this bill would require courts to use
criteria which meets constitutional standards for substantive and procedural
due process. It also establishes a uniform procedure for the evaluation of the
capacity of a person to give informed consent. For people who lack such
capacity, this bill will give them an opportunity to access information about
the procedure, it’s risks and benefits and to express their preferences. This
bill would also give physicians and health care workers a clear legal authority
for such procedures and protection from liability when they perform a surgery
that meets the guidelines of the statute. Mr. Baugh gave a brief history of
why the state has an involuntary sterilization law and the problems with the
current law. (See attached). He also stated that he knows of no opposition
to this bill and the bill is supported by various groups including the Idaho
Medical Association, the Idaho Council on Developmental Disabilities, and
the State Independent Living Council.
MOTION: Rep. Ring made a motion to send H 213 to the Floor with a DO PASS
recommendation.
Rep. Henbest discussed with the Committee a fax she had received from
Mr. Allen Derr regarding concerns with the language dealing with petitions
filed by the court outlined in H 213. She suggested a trailer bill could be
written to address these concerns.
PRO: Marty Durand, representing the Idaho Civil Liberties Union, testified in
support of H 213. She stated that the ACLU supports reproductive freedom
and protection of the rights of those with disabilities.
PRO: Kelly Buckland, executive director of the State Independent Living Council,
stated that his council supports H 213.
ORIGINAL
MOTION:
On a voice vote, the Original Motion by Rep. Ring to send H 213 to the Floor
with a DO PASS recommendation, passed. Rep. Henbest will sponsor the
bill on the House Floor.
H 237: Rep. Frances Field presented this bill to the Committee. She explained that
this bill is necessary to adjust the schedule of controlled substances in Idaho
to match schedule adjustments by the federal Drug Enforcement
Administration. She further explained that the Board of Pharmacy currently
has temporary rules in place implementing this change, and this bill would
make those changes in statute.
PRO: Debbie Bennett testified in support of H 237. She explained to the
Committee that she has cataplexy,a rare but debilitating complication
stemming from the sleep disorder, narcolepsy. She further explained that
Gamma hydroxybutyric acid, known commonly as GHB, has been approved
by the FDA to be prescribed for her condition and has helped her 100
percent. She stated that when GHB was abused and used as a “date rape”
drug, the schedule was increased and she could not obtain it for medical
purposes. This bill would allow one pharmacy to dispense this medication
under severe prescription restrictions and patient surveillance.
MOTION: Rep. Ring made a motion to send H 237 to the Floor with a DO PASS
recommendation. On a voice vote, the motion carried. Rep. Frances Field
will sponsor the bill on the House Floor.
H 199: Ron Williams, representing the Idaho Athletic Trainers, presented this bill
to the Committee. He explained that the purpose of this bill is to substitute
“licensure” for “registration” regarding athletic trainers. It also contains much
more specific definitions of an “athlete” and “athletic injury” and what the
practice of “athletic training” means. He further explained that the board of
Medicine drafted many of the key definitions in the bill, with substantial imput
from other health provider organizations. He also stated that the Board of
Medicine also drafted extensive provisions dealing with how the practice of
“athletic training” can only occur under the watchful eye of a “directing
physician” and only as allowed within a new “scope of practice” section. He
further stated that the Board of Medicine drafted into this legislation and
approved a provision prohibiting athletic trainers from operating an
independent practice, thus insuring that athletic training will occur only under
the watchful eye of a directing physician. He explained that this bill also
streamlines and simplifies the licensing requirements for athletic trainers
meeting the statutory qualifications. He further explained that Idaho athletic
trainers now must take a national certification examination approved by the
Board of Medicine, rather than a separate examination administered by the
Board of Athletic Trainers. Educational standards are also raised from
simply having a college degree, to having a four year degree that meets the
“minimum athletic training curriculum” established by the Board of Medicine.
PRO: Tom Koto, an athletic trainer representing the Idaho Athletic Trainer
Association, testified in support of H 199. He gave a brief history of the bill
and explained that the original language of the statute regarding athletic
trainers was established in 1989. He further explained that the Board of
Medicine was recruited to help draft language to update the current statutes
and the legislative intent language was written to ensure public safety and
welfare. Mr. Koto then discussed the definition section of the bill, which
defines “athlete”, “athletic injury” “athletic training”, and “directing physician”.
He explained that the definition of “athlete” has been changed to more
correctly identify the types of recreational athletes currently seen by athletic
trainers. He further explained that this bill has been approved by the Board
of Medicine. He also stated that 41 other states are currently regulating
athletic trainers and most of the other states have similar education
standards as proposed in the bill.
In response to questions from Committee members, Mr. Williams explained
that he would support trailer legislation to address the language that was
deleted in the bill; “nothing herein shall be construed to require registration
of elementary or secondary school teachers, coaches or authorized
volunteers who do not hold themselves out the public as athletic trainers”.
Chairman Sali explained that a trailer bill would have to be printed in a
privileged committee and is subject to the passage of H 199.
CON: James Kranz, a chiropractor, testified in opposition to H 199. He explained
that his concern was that if this bill were to pass, he could not employ an
athletic trainer in his office because chiropractors are not licensed by the
Board of Medicine. He proposed amendments to the bill which would strike
“registered by the board” in sentences in the bill outlining that athletic training
would be under the direction of a designated Idaho licensed physician. Mr.
Kranz
stated that he had no problems with any other part of the bill.
PRO: Tamara Pascoe, president of the Idaho Athletic Trainers Association and an
athletic trainer at Boise State University, spoke in support of H 199. She
stated that this bill would ensure that the profession of athletic trainers would
be protected and that the public would be protected. She further stated that
standards need to be higher and need to be addressed in statute.
CON: Lynn Johnson, a physical therapist and an athletic trainer, spoke in
opposition to H 199. (See attached testimony). He stated that he is opposed
to specific sections of the bill but does support the intent. He explained that
he is concerned that the definition of “athlete” in the bill is too broad and
could be construed to include any living person that decides to get up and
move for fun. He further explained that the term “designated Idaho licensed
physician” is also too broad and gives a blanket license to compete directly
with other health care providers. He is also concerned about the definition
of “directing physician” is also too broad and could include any living, Idaho
licensed medical physician.
PRO: Dr. Ron Pfeiffer, a professor of kinesiology at BSU and a registered athletic
trainer, testified in support of H 199. He explained that he has no personal
interest in the passage of this bill. He clarified the educational criteria for
athletic trainers.

He further explained that there is only one way to become an athletic trainer
and that the internship program will no longer exist after this year. A
baccalaureate degree is required to become an athletic trainer.

CON: Jeremy Pisca, an attorney representing the Idaho Physical Therapy
Association, spoke in opposition to H 199. He made the following points; a
better definition is needed for “athlete”, a better definition is needed for
“athletic injury”, no direction is given under the statute for the directing
physician, and “independent practice” needs a better definition. He further
explained that he is concerned that the legislation does not state what the
four year degree should be in for qualification of licensure. Mr. Pisca stated
that his Association was not able to reach a compromise with the Board of
Medicine in the drafting of this bill.
PRO: Steve Gueber testified in support of H 199. He explained that his daughter
is currently studying for a doctorate in kinesiology and recognizes that there
has been a tremendous transition in this field. He further explained that this
bill recognizes the professionalism of athletic trainers and not everyone can
be happy with every legislation. He stated that the national licensing exam
is very stringent and would be very difficult to pass without accredited
education.
CON: Lorna Brown, a physical therapist representing the Idaho Physical Therapy
Association, testified in opposition to H 199. She stated that she supports
many aspects of the bill and also supports the professionalism of athletic
trainers. He explained that her main concern is the broad definitions of
“athlete” and “athletic injury” in the bill. She further explained that the athletic
trainer does not have the training for the broad scope of injuries that could
be incurred by those defined in the bill as athletes. She stated that current
educational standards do not support the broader scope of practice.
PRO: Nancy Kerr, executive director of the Idaho State Board of Medicine, spoke
in support of H 199. She explained that the Board has oversight of athletic
trainers and that the Board would, by rule, more clearly define the scope of
practice for athletic trainers.
CON: Brad Hoaglun, representing the Idaho Association of Chiropractic
Physicians, testified in opposition to H 199. He stated that his Association
is concerned about the language in the bill that states that athletic trainers
can only be supervised by physicians who are licensed by the Board of
Medicine. He explained that chiropractors are licensed by the Board of
Occupational Licensing and would not be able to employ athletic trainers if
this bill were to pass.
PRO: Linda Hammond, a physical therapist and athletic trainer, spoke in support
of H 199. She stated that athletic trainers have better on-field skills and can
better minimize damage than physical therapists. Physical therapists are
better trained in diseases. She further stated that the physical therapist and
athletic trainer can work well together and know when to refer back to the
physician and rely on the physician’s expertise.
CON: Lynn Darrington, representing the Idaho Association of Health Plans, spoke
in opposition to H 199.

She explained that she is concerned with the definition of “directing
physician” in the bill. She stated that with this definition, it would allow for a
referral process that an athletic trainer can refer to a directing physician and
a referring physician can make a referral to an athletic trainer under a
different referring physician. She further explained that she is concerned
with patient care and the need for clarification for these referrals.

Mr. Williams clarified the following points; it is possible for an athletic trainer
to have more than one directing physician, the athletic trainer is doing what
the physician directs them to do, and the directing physician is directly liable
for the athletic trainer and oversees that practice. He further explained that
his organization has negotiated in good faith with the physical therapists
association and that this bill has generated a turf war between the two
associations. He stated that the issue of the chiropractors needs to be
addressed in possible trailer legislation.
MOTION: Rep. McGeachin made a motion to send H 199 to the Floor with a DO
PASS
recommendation.
SUBSTITUTE
MOTION:
Rep. Ring made a Substitute Motion to HOLD H 199 in Committee.
Committee discussion followed and the following points were made; there is
a niche for both physical therapists and athletic trainers, there is a turf war
between the two professions, and there is confidence that the Board of
Medicine will write the appropriate rules to define the scope of practice.
AMENDED
SUBSTITUTE
MOTION:
Rep. Nielsen made an Amended Substitute Motion to HOLD H 199 until
time certain at the pleasure of the Chair. Committee discussion followed and
the following points were discussed; language needs to be cleaned up in the
bill, a trailer bill may need to be drafted, both the athletic trainers and the
physical therapists have had time to work things out, but need more time.
ROLL CALL
VOTE:
On a roll call vote, the Amended Substitute Motion passed by a vote of 5
to 4. Representatives Kulczyk, Garrett, Eberle, Nielsen, and Henbest
voted AYE. Representatives Block, Ring, McGeachin, and Martinez voted
NAY. Rep. Mitchell was absent.
ADJOURN: As there was no further business to be brought before the Committee,
Chairman Sali adjourned the meeting at 5:45 P.M.






DATE: February 26, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

None
GUESTS: See attached sheet.
Chairman Sali called the meeting to order at 2:25 P.M.
MOTION: Rep. Eberle made a motion to approve the minutes of February 20, 2003 as
submitted. On a voice vote, the motion carried. Rep. Henbest made a
motion to approve the minutes of February 24, 2003 as submitted. On a
voice vote, the motion carried.
Rep. Eberle explained that he had received a request from one of his
constituents to present their views on Idaho’s current vaccination law.
Ingri Cassel, president of the Vaccination Liberation group from northern
Idaho, addressed the Committee. She explained that Idaho’s current
immunization statutes allow for medical, religious and personal conviction
exemptions from recommended vaccinations, although many people are
unaware of this fact. She further explained that the other problem is that
there are no penalties for violating this law, as well as no provisions for
enforcing it. She stated that the Idaho Chapter of Vaccination Liberation
receives personal testimonies weekly from Idaho residents who have been
denied employment, threatened to be terminated, or have had their children
refused at a daycare or school for refusal to vaccinate. She further stated
that due to an increased awareness of the dangers inherent in vaccinations,
many have opted to deal with the risk of getting the disease, which is
treatable, rather than risk the possibility of dealing with a vaccine injury that
is not treatable. Ms. Cassel requested that Committee members reexamine
the current Idaho immunization statute.
Rep. Henbest stated that she felt it was unusual for the Committee to hear
such a controversial view and asked that another side could be given an
opportunity to speak to the Committee. Chairman Sali stated that any
Committee member could request a presentation to be brought before the
Committee and would invite them to do so. Rep. Eberle had requested that
this presentation be given and Chairman Sali stated he had agreed to make
time on the agenda.
Angie Vasquez, representing the Vaccination Liberation group in Burley,
addressed the Committee. She explained that her infant daughter died
because of a reaction to a vaccine.



She further explained that parents should be told of the risks of vaccines
before they are administered and felt that there should be a fine for those
who break the current immunization law.

H 240: Because he was the sponsor of the proposed legislation, Chairman Sali
turned the meeting over to Vice-Chairman Block to chair the remainder
of the meeting.
Chairman Sali introduced Corissa Mueller who told of her experience that
prompted him to offer changes to the current statute dealing with
abandonment and neglect of children. Ms. Mueller explained that last
August she pro-actively sought medical care for her infant daughter, Taige
Mueller
. Because the physician thought that there was a 5 percent chance
that the baby could have spinal meningitis, he felt that the infant should be
given antibiotics and a spinal tap. Ms. Mueller explained that she refused
the treatment and as a result, police officers were called and her daughter
was taken away from her and the procedures were performed without her
permission. At a shelter care hearing, the judge dismissed the case. Ms.
Mueller
further explained that as a result of this incident, she has suffered
tremendous emotional trauma.
Chairman Sali presented H 240 to the Committee. He explained that this
proposed legislation revises the manner in which and the grounds on which
a child may be removed for shelter care on an emergency basis. It also
amends the language regarding how a court may order medical treatment
against the wishes of a parent. It adds an objective standard for review,
promotes protection of parental rights wherever possible and adds
recognition of non-medical health care as a consideration by the judge. He
further explained that the current Emergency Removal statute is vague and
needs to be better clarified. He also explained that the proposed language
change in the statute regarding the Authorization of Emergency Medical
Treatment relates to three possible situations; when the parent is present,
refuses treatment and has taken some action to injure the child, when the
parent refuses medical treatment, but any reasonable person would agree
that the child is at risk, and when the parent is not present and the child is
at risk. Chairman Sali explained that the proposed language “all readily
available evidence” should be taken into account by the judge when ordering
treatment. H 240 would also have the judge take into consideration the
grounds on which the parent is refusing treatment and the rights of the child.
Definitions are clarified in the proposed legislation for “neglected” and
“abused.” Chairman Sali explained that parental rights are intrinsic
fundamental rights which pre-date the U.S. Constitution and must be
protected.
CON: Dr. Gary Walsh, an emergency physician from Caldwell, spoke in opposition
to H 240. He explained that the onset of spinal meningitis could be rapid
and in his view the standard of care is a spinal tap and antibiotics. He
further explained that not doing the spinal tap and risking the possibility of
the infant contracting the disease could create lifelong consequences. In
response to questions from Committee members, Dr. Walsh explained that
he would contact a hospital administrator if a parent refuses treatment for
their child and that he has seen no adverse reactions to spinal taps in his 25
years of practice.
PRO: Eric Mueller, the father of Taige Mueller, the child described in the above
incident, spoke in support of H 240. He stated that he did not feel that the
law was followed in the situation with his daughter. He further stated that
there are no checks and balances in the current law. He also stated that
physicians are human and make mistakes. He referred to statistics
regarding deaths that occur as a result of medical errors.
CON: Jean Fisher, deputy prosecutor for Ada County and representing the Idaho
Prosecuting Attorney Association, spoke in opposition to H 240. She
explained that the current law is not broken and parents rights are protected
because a hearing will occur within 48 hours of a child being removed. She
further explained that last year there was 300 cases of imminent danger in
Ada County and due process was followed. She stated that the proposed
legislation sets an impossible standard and that law enforcement officers
have to make split second decisions and sometimes cannot know all of the
relevant facts. She stated she was concerned that the police will be subject
to too much liability with the proposed legislation. Ms. Fisher stated that the
proposed legislation is complicated and would require a tremendous amount
of interpretation. She further stated that if the proposed legislation were to
pass, law enforcement will be told not to declare imminent danger. In
response to questions from Committee members, Ms. Fisher clarified that
since 2001 there have been 138 imminent danger cases filed and out of
those cases, there have been 10 dismissals.
CON: Dr. Randy Cordle, representing the Idaho Medical Association, spoke in
opposition to H 240. He explained that the first and foremost duty of the
physician should be to the child and that sometimes that duty supersedes
the rights of parents. He further explained that he talks to parents about the
risks of procedures to parents. He stated that sometimes procedures cannot
wait and the primary reason is to protect the child. In response to questions
from the Committee, Dr. Cordle clarified that there are different standards
followed in emergency rooms than in physician’s offices. He stated that
there are both sides to every issue and felt that physicians have been
attacked with no rebuttal and health care workers have been attacked with
no rebuttal in the today’s Committee meeting.
CON: Patrick Calley, a lieutenant from the Ada County Sheriff’s Office, spoke in
opposition to H 240. He stated that he felt that the incident discussed is an
isolated incident and his concern that the proposed language change would
alter the foundation upon which law enforcement bases their judgements for
declaring imminent danger. He further stated that the bill would create
confusion with the police to carry out emergency removal. Mr. Calley stated
that he would sit at any table to see if improvements could be made to the
proposed legislation.
MOTION: After Committee discussion, Rep. Eberle made a motion to adjourn the
meeting. The motion failed on a roll call vote of 6 NAYS and 4 AYES.
Representatives Kulczyk, Eberle, Ring and Henbest voted AYE.
Representatives Block, Garrett, McGeachin, Nielsen, Martinez and Sali
voted NAY. Rep. Mitchell was absent.
CON: Susan Hazelton, executive director of the Family Advocate Program, spoke
in opposition to H 240. (See attached testimony). She stated that she is
concerned with the proposed language stating that “all relevant information”
is needed to determine imminent danger. She further felt that the proposed
language “any reasonable person aware of all relevant facts” would restrict
police in removing a child when abuse or neglect is suspected.
CON: Shirley Alexander, representing the Department of Health and Welfare,
spoke in opposition to H 240. She explained that in 1997 it was determined
that the rights of the parents were looked at before the rights of the child.
She provided to Committee members a pamphlet entitled, “Care Enough to
Call” which outlines when to call and report suspected cases of child abuse
and neglect. She explained that if H 240 were to pass, it may reduce the
number of abuse cases reported. She further explained that her main
concern was that the proposed legislation may cause individuals to conduct
preliminary investigations before contacting Child Protective Services. She
stated that the parts of the statute should not be taken out of context and the
whole statute should be looked at in its entirety. She further stated that the
current statute works 99 percent of the time and focuses on the child. She
explained that federal funds may be jeopardized if the state government says
that parental rights are above the child’s rights.
CON: Tony Wallace, representing the Boise Police Department, testified in
opposition to H 240. He stated that last year there were 2,400 cases of child
abuse in Ada County and only 80 were cases of imminent danger. He
further stated that if the proposed legislation were to pass, more children
would be put at risk and police officers would be asked to meet impossible
standards.
CON: Dr. Jerry Hirschfeld, representing the Idaho Chapter of Pediatricians and
the Idaho Hospital Association, spoke in opposition to H 240. He explained
that this statute was established to protect the rights of children and the
proposed changes would change that focus to the rights of the parents. He
further explained that hospitals have rigid guidelines to treat minor without
the consent of the parents. He stated that approximately 20,000 children are
seen annually in St. Luke’s emergency room and that only 2 or 3 times a
year is imminent danger declared. He further stated that the primary
responsibility of the physician is the care of the child and that consensus for
treatment is reached 99 percent of the time with the parents. Dr. Hirschfeld
stated that there are multiple facets to the incident discussed today and
there is another side of the story. He further stated that the proposed
language would put barriers for children to receive proper care. In response
to questions from Committee members, Dr. Hirschfeld stated that not all
customers are satisfied all the time and many factors are involved in any
case in which a child is removed.
CON: Steve Millard, president of the Idaho Hospital Association, spoke in
opposition to H 240. He stated that his association is opposed to this
legislation for many of the same reasons already stated by other testifiers.
He stated that every problem cannot be fixed and that the current statute
seems to work well.
CON: Ken Diebert, administrator of the Division of Family and Community
Services for the Department of Health and Welfare, spoke in opposition to
H 240. He stated that his job is to protect the children of the state and the
proposed legislation would not allow him to carry out his duties.
PRO: Angie Vasquez spoke in support of H 240. She stated that this bill is
needed to protect those parents fighting for their kids and there is no current
program designed for accountability.
Chairman Sali thanked all of the participants in today’s meeting and stated
that everyone is concerned about children. He stated that after hearing the
testimony, it is clear that the current statute does not reflect what happens
in real life.
Chairman Sali made an UNANIMOUS CONSENT REQUEST to HOLD H
240
in Committee to a time certain at the pleasure of the Chair. There were
no objections.
ADJOURN: There being no further business to be brought before the Committee, the
Committee was adjourned at 7:10 P.M.






DATE: February 28, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

None
GUESTS: See attached list
Chairman Sali called the meeting to order at 1:45 P.M. He announced that
the minutes of the February 26, 2003 will be approved at the next Committee
meeting.
Chairman Sali discussed with the Committee a letter written by four
members of the Committee to the Speaker concerning their concerns
regarding the hearing on February 20, 2003 on the debate between HB 201
and HB 202. (See attached letter). He explained that originally the Chief
Clerk had indicated that she could not find anything in Mason’s Manual
prohibiting the Committee’s action, however shortly before the Committee
meeting she had given him a copy of Section 56 which states, “An important
practical principle is that only one proposition can be considered at a time.
It is the responsibility of the presiding officer to promote efficient
consideration of business by permitting only one proposition to be
considered at a time and to limit discussion to that one proposition.” While
this section does not strictly prohibit the Committee’s action, It clearly
indicates that the better way to deal with such matters is to handle bills and
Motions on them one at a time. Chairman Sali explained that it was his
intent from this time forward to consider bills one at a time. He further
explained that it is inappropriate for the chair to make motions or debate,
however the chair may ask questions of anyone testifying.
Rep. Henbest stated that she had never been on a Committee that has
considered two bills at the same time and explained that she would not raise
any procedural questions when H 202 is debated on the House Floor.
MOTION: Rep. Mitchell made a motion to reconsider Committee action on HB 201.
The motion failed by a show of hands. Chairman Sali then ruled that the
failure of the motion will result in final action on HB 201 which will be that it
will remain HELD in Committee.
H 160: Kelly Buckland, director of the State Independent Living Council, presented
this bill to the Committee. He explained that the purpose of this legislation
is to amend language that was not amended last legislative session
regarding the law relating to termination of parental rights for parents with
disabilities. Mr. Buckland further explained that he had held productive
meetings with the prosecuting attorneys since the last Committee meeting
regarding their concerns with the language in the bill.






He stated that a compromise has been reached and offered proposed
language changes. The compromise language includes; under the section
dealing with conditions under which termination may be granted, (d) “The
parent is unable to discharge parental responsibilities and there are
reasonable grounds to believe such inability will continue for a prolonged
indeterminate period and will be injurious to the health, morals or well-being
of the child.”

MOTION: Rep. Henbest made a motion to send H 160 to General Orders with
Committee amendments attached.
Committee discussion followed and Rep. Nielsen expressed his concern
that the language in (d) is not needed because of the language in (b) which
states, “The parent has neglected or abused the child.” He explained that
by striking the words “because of mental illness or mental deficiency” in (d)
it would allow for too much supposition. Rep. Henbest stated that she has
seen how the system works and felt that the language would deal with the
situation when a child is repeatedly placed in harm’s way.
CALL FOR THE
QUESTION:
Rep. Mitchell called for the question to cut off debate and vote on the
Motion. On a roll call vote, the call for the question passed on a vote of 9 to
1. Representatives Kulczyk, Garrett, Eberle, Ring, McGeachin, Nielsen,
Henbest, Martinez and Mitchell voted AYE. Rep. Block voted NAY.
ORIGINAL
MOTION:
The Original Motion to send H 160 to General Orders with Committee
amendments attached passed on a voice vote. Representatives Sali and
Nielsen voted NAY. Rep. Henbest will sponsor the bill on the House Floor.
H 15: Roger Hales, representing the Bureau of Occupational Licensing, presented
this bill to the Committee. He explained that the purpose of this bill is to
strike the term “assisted living” and replace it with “care facility” throughout
the act relating to residential care facility administrators. He further
explained that it is a housekeeping bill and would cost approximately $3,000
to make the name change. He stated that this bill is an attempt to clean up
old language and also allows for a provisional permit for residential care
facility administrators for up to three months to make sure the facility has an
administrator. He further stated that the Bureau of Occupational Licensing
will promulgate rules for legislative review regarding this issue. Mr. Hales
clarified that he had contacted the assisted living facilities association and
that they were not opposed to the name change.
MOTION: Rep. Martinez made a motion to send H 15 to the Floor with a DO PASS
recommendation. On a voice vote, the motion carried. Rep. Mitchell will
sponsor the bill on the House Floor.
Rayola Jacobsen, bureau chief of the Bureau of Occupational Licensing,
requested that the Committee HOLD H 10 and H 16. She explained that
there have been many comments received regarding these bills and that the
Bureau would like the opportunity to work with the interested parties. She
further explained that H 10 was sent by the Business Committee to the
House Floor, then was referred back to the Health and Welfare Committee
because of concerns. She explained that H 16 deals with pastoral
counseling.

MOTION:
Rep. Kulczyk made a motion to HOLD H 10 in Committee. On a voice vote,
the motion carried.
MOTION: Rep. Block made a motion to HOLD H 16 in Committee. On a voice vote,
the motion carried.
HCR 13: Marilyn Sword, representing the Idaho Council on Developmental
Disabilities, presented this resolution to the Committee. She explained that
this resolution directs the Council of Developmental Disabilities to convene
a task force to develop a Medicaid waiver that would permit up to 200 adults
with developmental disabilities to choose a different way of receiving
services. The services would be based on need as determined by a
consumer-centered plan and would cost no more, on average, than the
services for these 200 people cost now. Implementation of this model
requires the Department of Health and Welfare to submit a waiver
application to the federal Centers on Medicaid and Medicare. Ms. Sword
explained that passage of this resolution is a statement of public policy by
Idaho lawmakers that they support people with developmental disabilities by
giving them the option of choosing the services and supports they need
without increasing costs for services. She outlined the key elements of self-determination which include; individualized budgets, personal broker, fiscal
intermediary, and choice of service providers. Ms. Sword explained that
after meeting with the Department of Health and Welfare, compromise
language has been drafted in the resolution. The language changes include
inserting the words “following a legislative review” in the sentence, “..the
Department of Health and welfare will submit such a waiver to the federal
Centers on Medicaid and Medicare for approval”. Other changes include,
striking “non-Medicaid” and replacing it with “traditional and non-traditional”
providers; and inserting the words, “including cost analysis” shall be reported
to the Legislature by January 15, 2004.
MOTION: Rep. Ring made a motion to send HCR 13 to General Orders with
Committee amendments attached.
PRO: Kristan Cherbert spoke in support of HCR 13. She explained that she has
used a waiver for the past six years and that a self-determination waiver
would give her more dignity, more control over her services, and would allow
her to set goals.
PRO: Katherine Hansen, executive director of community Partnerships of Idaho,
spoke in support of HCR 13. (See attached testimony). She explained that
she participated on the Idaho Task Force on Self-Determination. She stated
that the ideas of choice, control and flexibility are taken to a new level in this
waiver option.
PRO: Debra Johnson, representing Idaho Parents Unlimited, Inc., spoke in
support of HCR 13. (See attached testimony). She explained that IPUL has
long supported the concept of self-determination; individual and family
choice; and the necessity of an effective array of service options and waivers
to meet the needs of Idahoans with disabilities. She further stated that IPUL
is ready to actively participate and provide input to the proposed task force.
PRO: Jim Baugh, executive director of CO-AD, an advocacy group for those with
disabilities, testified in support of HCR 13.
ORIGINAL
MOTION:
On a voice vote, the Original Motion to send HCR 13 to General Orders with
Committee amendments attached, carried. Representatives Garrett and
Sali will sponsor the resolution on the House Floor.
Due to the absence of one of the self-advocates and supporter of HCR 13,
Noll Garcia, Chairman Sali requested that Rep. Henbest send a letter to
him informing him of the Committee’s action on HCR 13.
ADJOURN: As there was no further business to be brought before the Committee,
Chairman Sali adjourned the meeting at 2:45 P.M.






DATE: March 4, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

Rep. Garrett
GUESTS: See attached list
Chairman Sali called the meeting to order at 1:40 P.M.
MOTION: Rep. Ring made a motion to approve the minutes of the February 26, 2003
meeting as submitted. On a voice vote, the motion carried. Rep. Henbest
voted NAY.
MOTION: Rep. Henbest made a motion to approve the minutes of February 28, 2003
as submitted. On a voice vote, the motion carried.
H 199: Ron Williams, representing the Athletic Trainers Association, presented this
bill to the Committee. He explained that after meeting with Jeremy Pisca,
who represents the Idaho Physical Therapy Association, amendments were
agreed to by both organizations. These amendments include; a more narrow
definition of “athlete”, an amendment to the section of the bill that answers
the concerns of the Committee regarding athletic trainers in the school
settings and adds the language “this act shall not be construed as to require
licensure by persons assisting in an emergency or in providing aid or service
for which no fee for service is contemplated, charged or received, provided
that the person providing the service or assisting in the emergency does not
hold himself out as an athletic trainer.” Mr. Williams further explained that
these proposed amendments have resulted in a level of peace with the
physical therapists, but that there still are some concerns from that
organization. He discussed the proposed amendments offered by the
Chiropractor’s Association which would strike “registered by the board” to
allow chiropractic physicians to continue to employ athletic trainers. Mr.
Williams
stated that he was concerned that if the amendment proposed by
the Chiropractor’s were to pass, that the Board of Medicine would withdraw
their support of the bill. He further stated that the athletic trainer’s would
continue to work with the chiropractors and would possibly work on a trailer
bill to address their concerns if H 199 passes.
Jeremy Pisca, representing the Idaho Physical Therapy Association,
addressed the Committee. He stated that he had met yesterday with Mr.
Williams
and the proposed amendment is language that his association
could live with.
Brad Hoaglun, representing the Idaho Association of Chiropractic
Physicians, addressed the Committee. He explained that his organization
supports the licensure of athletic trainers, but proposed an additional
amendment to the bill to strike “registered by the board” in the bill. He stated
that adoption of these amendments will allow athletic trainers to work under
the direction of any “designated Idaho licensed physician.” He further stated
that if H 199 is signed into law with these amendments, the Board of
Chiropractic Physicians and the Board of Medicine will be asked to develop
a Memorandum of Understanding or other protocol to ensure consistent
oversight by both boards on the work of athletic trainers. He also added that
the Board of Medicine would retain jurisdiction over the rulemaking authority
of athletic trainers. Mr. Hoaglun stated that the Board of Medicine required
the language in the bill that states “registered by the board” and that if his
organization’s amendment is not approved he felt that the Board of Medicine
would not negotiate with the Board of Chiropractic Physicians.
Nancy Kerr, executive director of the Board of Medicine, addressed the
Committee. She stated that the Board may not support H 199 with the
proposed amendment by the Chiropractic Physicians. She stated that she
felt that the proposed amendment was brought at the eleventh hour and was
not sure of the span of authority. In response to questions from Committee
members, Ms. Kerr stated that the Board of Medicine meets quarterly and
is meeting this weekend and would discuss the proposed amendment by the
Chiropractic Physicians. She further stated that she was not sure what stand
the Board would take on the proposed amendment. Ms. Kerr also stated
that the Board of Medicine has no control over Chiropractic Physicians and
was not aware of any athletic trainers who are currently working with
chiropractors.
Dr. James Kranz, a chiropractic physician, addressed the Committee. He
explained that his association proposed an amendment to H 199 as soon as
they reviewed the bill. He further explained that if there was a complaint
about a chiropractic physician the Chiropractic Board would review the case.
He stated that athletic trainers would still be governed by the Board of
Medicine and that Chiropractic physicians can hire other health care
professionals that are governed by different boards. Dr. Kranz explained
that under the current law, chiropractic physicians can employ or direct
assistants in their offices, but if H 199 were to pass, chiropractic physicians
would not be able to employ athletic trainers in their offices.
In response to questions by Committee members, Mr. Pisca clarified that he
was not sure if the physical therapists would object to the proposed
amendment offered by the chiropractic physicians, some would care, some
would not.
Also in response to questions from Committee members, Mr. Williams
stated that the athletic trainers would like to work with chiropractic
physicians, but suggested that the proposed amendment could be debated
in the Senate Health and Welfare Committee.
Committee discussion followed and the following points were discussed; the
Board of Medicine meets this weekend and could discuss the proposed
amendment offered by the chiropractic physicians and if both amendments
are attached to the bill, the Board of Medicine may not be supportive.
MOTION: Rep. Ring made a motion to send H 199 to General Orders with the
amendment proposed by the athletic trainers and physical therapy
associations.
SUBSTITUTE
MOTION:
Rep. Kulczyk made a Substitute Motion to send H 199 to General Orders
with both sets of proposed amendments attached.
AMENDED
SUBSTITUTE
MOTION:
After Committee discussion, Rep. Nielsen made an Amended Substitute
Motion to HOLD H 199 to time certain of Wednesday, March 12th. He
explained that this would give the Board of Medicine time to meet and
discuss the proposed amendment by the chiropractic physicians.
Rep. Henbest stated that she has been licensed under two boards and that
it is a complicated issue. She further stated that the Committee should go
forward with the bill and that it may take some time to resolve the issue of
the chiropractic physicians and the Board of Medicine.
CALL FOR THE
QUESTION:
Rep. Mitchell Called for the Question to cut off debate and vote on the
Amended Substitute Motion. A roll call vote was taken, and the Call for the
Question failed by a vote of 6 AYES, 4 NAYS, and 1 absent. A two-thirds
majority is required for the question to pass. Representatives Kulczyk,
Eberle, Ring, Henbest, Martinez, and Mitchell voted AYE.
Representatives Block, McGeachin, Nielsen, and Sali voted NAY.
AMENDED
SUBSTITUTE
MOTION:
After further Committee discussion, on a voice vote the Amended Substitute
Motion to HOLD H 199 to time certain of Wednesday, March 12th failed.
SUBSTITUTE
MOTION:
On a voice vote, the Substitute Motion to send H 199 to General Orders with
both sets of proposed amendments failed.
ORIGINAL
MOTION:
On a voice vote, the Original Motion to send H 199 to General Orders with
the amendment proposed by the athletic trainers and physical therapy
associations carried. Rep. Kulczyk voted NAY. Rep. Ring will sponsor the
bill on the House Floor.
ADJOURN: As there was no further business to be brought before the Committee,
Chairman Sali adjourned the meeting at 2:55 P.M.






DATE: March 6, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, and Mitchell
ABSENT/

EXCUSED:

None
GUESTS: See attached list
Meeting was called to order by Chairman Sali at 1:40 p.m. Rep. Eberle
made a motion to approve the minutes of the March 4, 2003 meeting;
motion passed on voice vote.
H 167 Chairman Sali called upon Kelly Buckland, Executive Director of the Idaho
State Independent Living Council, (SILC), to provide an overview of H167.
Mr. Buckland distributed a handout listing the numerous members of the
FAMILY Coalition (Fathers and Mothers Independently Living with their
Youth) who met numerous times over the past five years to work on this
legislation. Included with this handout, was a letter of support from former
Ada County Commissioner, Sharon Ullman. Also included was a letter from
Patricia Tobias, Administrative Director for Idaho’s Supreme Court who
indicated that the Supreme Court’s Children in Foster Care Committee had
reviewed this legislation and suggested certain changes to alleviate
concerns raised by committee members. The court cannot take a position on
proposed legislation but their recommended changes have been
incorporated into this bill. They do want to go on record stating that in 16-1602(24)(b) a list of causes for the failure of a parent or guardian to
discharge their responsibilities, i.e. incarceration, hospitalization, or other
physical or mental incapacity, has been stricken in favor of any failure on
account of which the child lacks parental care.



Chairman Sali called upon Jim Baugh to elaborate on FAMILY’s
recommended amendments. Mr. Baugh distributed a blue sheet displaying
FAMILY’s proposed bill with their recommended amendments. The
difference between the blue sheet and the original bill was done to reach a
compromise between FAMILY members and the Prosecuting Attorney’s
Association. Blue sheet gets rid of discriminatory language, replacing with
language that protects the rights of parents with disabilities, and defines
supportive services.



Mr. Baugh provided an overview of definitions in Section 2, 16-1602.
Adaptive equipment means any piece of equipment or an item that is used
to increase, maintain or improve the parenting capabilities of a parent with
a disability. Disability definition is that used by the American’s with
Disabilities Act, which has 10 years of interpretation behind it, plus the courts
recognize this definition. The bill also excludes certain conditions that clearly
state what is not a disability (i.e. pedaphilia, exhibitionism, pyromania, ect).
Definition of “homelessness” was worked out with Prosecuting Attorney
Association – statutory definition – means that the child is without adequate
shelter or other living facilities, and the lack of such shelter or other living
facilities poses a threat to the health, safety, and well being of the child.
H&W has the power to make rules under the Child Protective Act and could
further define the term homeless. Definition of “neglected” was decided
upon agreement with Ms. Irby and Reilly form the Prosecuting Attorney’s
Association. Time constraints did not allow the association to endorse the
verbage as a whole.



In original language “failing” was used, but they prefer “demonstrating” that
inability to discharge.



Prosecuting Attorney Assn felt that the word “failing” requires you to actually
have control of the child and have failed exercising responsibility. The use
of “demonstrating the inability” to parent other than the behavior toward the
particular child



FAMILY Coalition would support original bill.

CON Ken Deibert, H&W Administrator for Division of Family and Community
Services presented testimony opposing H16. Mr. Deibert has worked with
the FAMILY Coalition and believes in the attributes of the bill. However, he
has not seen the current language proposed until a few minutes before the
Committee meeting. H&W’s concern is with the unfunded mandate. The
fiscal impact of one million dollars is not included in the Governor’s
maintenance budget and there is no latitude in current budget to accomplish
this increase in services.



H&W would not oppose this legislation if the fiscal impact was eliminated
from H167.

Mr. Buckland stated that it is not fair to the department nor to parents with
disabilities to put into place a program that is not funded. It puts the
department in a bad position and creates a hollow promise for parents.
Discriminatory language could be eliminated with some protections for
parents built in; service provisions / assessments could be stricken to leave
zero fiscal impact.
PRO Diane Strunk, parent with a disability, spoke in favor of H167. She feels
current language is discriminatory; the burden should be on the state to
prove a parent is not providing for their children, rather than stating the
parent is incapable because they have a disability.
PRO Jeanne Coyl testified in support of H167. She feels this is good legislation
and recommends that the Committee send it to the floor.
PRO Andrea Leads, NASW, testified in support of H167. She has been a
Guardian Ad Litem and has advocated for children in foster care. In her
experiences, this legislation is warranted.
CON Shirley Alexander, H&W Child Welfare Program Manager, provided
testimony opposed to H167 primarily due to unfunded mandate. Her other
concern is in the language requiring additional “expertise” when deciding
these cases. She stated that the department in currently making reasonable
efforts; what is the time frame for when supportive services are concluded?
PRO Marilyn Sword, Executive Director for Developmental Disabilities Council
provided testimony in support of H167. This is “pro-family” legislation. It
maintains the highest regard for the welfare of the child. It does not exempt
a neglectful or abusive parent from the law, but it does give them equal
footing with other parents in consideration before the court. It gives them the
opportunity to present evidence as to their ability to parent and the supports
or equipment that they need to do so. These changes do not allow a child to
remain in an unsafe setting if the parent is not able (with assistance) or
willing to adequately fulfill their parenting responsibilities.
CON Michael Crawford, Deputy Prosecuting Attorney for Elmore County provided
testimony opposing H167. He has worked with child protection issues for five
years; 3 ½ as a Public Defender in Canyon County representing parents and
children as a Guardian Ad-Litum Attorney in child protection cases. The last
year and a half has prosecuted these cases thus seeing both sides of this
issue. He is opposed to the definition of “neglect” in 16-1602 subsection b
on blue sheet. He would like to eliminate this section in its entirety. In 16-1608 subsection c is not necessary. Subsection f is his biggest concern.
There is no provision in the proposed statute for how determination of
disability is made. Is there to be a separate hearing? If that is not plead in
original petition by Prosecuting Attorney or Deputy Attorney General then
how is that determination to come to attention of the court? The
determination in section 6 seems to require the court or department to micro-manage these cases. The eight Magistrates that Mr. Crawford has worked
under feel they are not there to micro-manage these cases. That’s what
social workers are there for. Mr. Crawford proposed that language under
Sub-section 6 be transferred to 16-1609, Investigation by Multi-disciplinary
Teams. Copies of his proposed text was distributed to committee members.
PRO Mike Keithly, Chair, State Independent Living Council, spoke in favor of
H167. As a member of FAMILY, Mr. Keithly feels this legislation removes
discriminatory language and secures the rights of parents with a disability to
keep their children.
PRO Kim Steinberg, representing herself as a parent with a disability spoke in
favor of H167. Ms Steinberg had her children taken after a diagnosis of a
disability but through resources has been able to care for her family. Other
parents don’t have the resources she had available. In all the FAMILY
meetings she has attended, she never heard H&W raise concerns about the
definition of a disability and that parents with disabilities were receiving a
higher standard. This is important legislation. Please pass H167.
PRO Camaron Ball, a 16 year-old child of a parent with a disability spoke in favor
of H167. At age 3, Mr. Ball found out that his mother had broken her neck
and would be in a wheel chair the rest of her life. Through adaptive means,
she was able to raise her two children and be active in their lives. Mr. Ball
read a poem to the committee regarding his appreciation of his mother.
PRO Brenda Kotewa, who represents parents with disabilities and is also a
parent with a disability herself, spoke in favor of H167. She went through
many struggles when she became a parent, but with supportive and adaptive
services, she was and continues to parent her child safely. Ms. Kotewa
described to the Committee the adaptive equipment and services she used.
PRO Bobby Ball, parent with a disability, spoke in favor of H167. She feels the
department can find the funding and has the responsibility and ability to do
so. This legislation is important.
PRO Kim Kane, Executive Director United Cerebral Palsy, spoke on behalf of
Ron Seiler who is in favor of H167.Mr. Seiler is the Project Director for the
Idaho Assistive Technology Project at the Center on Disabilities and Human
Development at the University of Idaho. Ms Kane read a letter from Mr.
Seiler describing assistive technology devices, parenting devices, and
technology purchased by the disabled. There are over 20,000 devices
currently in the marketplace designed to help persons with disabilities. Ms
Kane distributed copies of Mr. Seiler’s power point presentation.
PRO Roger Howard, Director Living Independent Network, spoke in favor of
H167. LINC has three centers in the state, Pocatello/Idaho Falls and the
Panhandle. The centers are private non-profit centers. They provide a wide
variety of services which enable parents to maintain their independence.
They currently help to organize and coordinate existing resources; a lot of
these services already exist. These centers have the expertise and possible
resources to assist families.
PRO Bob Aldridge, a Member of the Committee representing Taxation &
Probate Trust Section of the Idaho State Bar spoke in favor of H167. Mr.
Aldridge was their legislative chairman for 14 years and has practiced law in
Idaho for 33 years. He has written hundreds of bills and laws and is always
concerned if bills can be carried out in the real world. Feels this committee
needs to get this legislation out; we are currently pulling families apart. We
owe the duty to at least get fundamental due process protection for parents
with disabilities. There is money from outside resources that can flow in to
assist the state; the state just has to show reasonable effort.
CON Heather Riley, Id Prosecuting Attorney’s Association representative spoke
against the current proposed blue sheet amendments from the FAMILY
Coalition. The association supports removing discriminatory language, but
has concerns with amendments in the blue sheet. Has concerns about the
definition of neglect. ” demonstrating” is better than “failing”, but is still not
the right language. How do you prove what is “demonstrated”? This may put
children at risk. She takes issue with definition of neglect.; prefers
custodian is “unable” language as it relates to neglect.
PRO Marty Durand, representing the American Civil Liberties Union of Idaho
spoke in favor of H167. Ms Durand, who is a former Prosecuting Attorney
and Public Defender, has represented children, parents and the state in child
protection cases. This legislation takes a big step in confronting the
discriminatory treatment of parents with disabilities. The state cannot
interfere without compelling reasons. Protecting children from abuse and
neglect is a compelling reason, but discrimination of a parent with a disability
in and of itself, is not a compelling reason. This legislation carefully requires
the disability to be considered in context of available support. The goal of
the state should be to keep families intact. Removing discrimination
language is not easy, and might increase the work load for prosectors but it
is important legislation. Please pass this legislation.
Committee discussion took place regarding the million dollar fiscal impact.
Mr. Buckland indicated that his figures showed less than this amount but
consensus from committee members was that with the current budget
problems there would be no way to get the bill passed unless FAMILY was
willing to take out the fiscal
MOTION: Rep. Mitchell made a motion to send H 167 (as originally printed) to
General Orders with his attached amendments.
SUBSTITUTE
MOTION:
Rep. Henbest made a Substitute Motion to send H 167 to General Orders
with Rep Mitchell’s amendments with the change in “Amendment to Section
2, page 4, line 12 of his amendments” where the verbiage should read
“unable” instead of “demonstrating the inability”; deleting “because of
incarceration, hospitalization, or other physical or mental incapacity” as in
original bill; and in line 15 strike out “such failure” and insert “inability”.
AMENDED
SUBSTITUTE
MOTION:
Rep Sali made an Amended Substitute Motion to send H167 to General
Orders with Rep Mitchells amendments with the exception on page 4, line
12 leaving the existing statute language – which would read “Whose parents,
guardian or other custodian are unable to discharge their responsibilities to
and for the child because of incarceration, hospitalization, or other physical
or mental incapacity.” Delete remaining part of line 14, 15 and 16.
Rep McGeachin questioned in SOP and fiscal impact would need to change
as a result of the motion. Rep Sali indicated there was no need to change
the SOP until amendments are approved by the Committee of the Whole.
At that time it is the obligation of the Committee to make sure that an
appropriate SOP and fiscal statement accompanies the bill.
ROLL CALL
VOTE ON
AMENDED
SUBSTITUTE
MOTION
On a roll call vote, the Amended Substitute Motion failed by a vote of 4 to
7.
Representatives Block, Kulczyk, Garrett, Ring, Henbest, Martinez and
Mitchell, voted NAY. Representatives Eberle, McGeachin, Nielsen and Sali,
voted AYE.
ROLL CALL
VOTE ON
SUBSTITUTE
MOTION
On a roll call vote, the Substitute Motion passed by a vote of 9 to 2.
Representatives Block, Kulczyk, Garrett, Eberle, Ring, McGeachin, Henbest,
Martinez and Mitchell, voted AYE. Representatives Nielsen and Sali voted
NAY.
H 160

MOTION Rep Nielsen made a Motion to hold H160 in Committee.
SUBSTITUTE
MOTION
Rep Henbest made a Substitute Motion to send H160 to General Orders
with amendments. The amendments are on page 1, in line 24, section d, to
put back the word “unable”, and delete “failing” and in line 26 take out “such
a failure” and put in “inability”.
MOTION TO
CLOSE DEBATE
Rep Martinez made a Motion to Call for the Question.
ROLL CALL
VOTE TO
CLOSE DEBATE
Roll Call vote to Close Debate on H160 passed by a vote of 7 to 3.
Representatives Block, Kulczyk, Garrett, Ring, McGeachin, Henbest, and
Martinez, voted AYE. Representatives Eberle, Nielsen and Sali voted NAY.
Representative Mitchell was absent.
SUBSTITUTE
MOTION
On a roll call vote, the Substitute Motion passed by a vote of 6 to 4.
Representatives Block, Garrett, Eberle, Ring, Henbest, and Martinez voted
AYE. Representatives Kulczyk, McGeachin, Nielsen and Sali voted NAY.
Representative Mitchell was absent.
ADJOURN There being no further business to come before the committee, the meeting
was adjourned at 5:20 p.m.






DATE: March 10, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

None
GUESTS: See attached sheet.
Chairman Sali called the meeting to order at 2:30 P.M. He announced that
the minutes of the March 6, 2003 meeting will be approved at the next
Committee meeting.
SB 168: Mike Sheeley, executive director of the Idaho Board of Dentistry, presented
this bill to the Committee. He explained that the purpose of this bill is to
bring the Board of Dentistry’s licensing examination statutes into step with
actual practice. He further explained that this is accomplished by specifically
stating that the Board of Dentistry may accept the examination results of
regional and national testing organizations for licensing purpose and that
the regional and national testing organizations will establish the standards
for passing the examinations they administer. Mr. Sheeley stated that the
proposed changes to the Board of Dentistry’s examination statute do not
place any additional costs or examination requirements upon an applicant
for licensure. He further stated that the proposed legislation would not cause
any additional fiscal impact upon an applicant or the Board of Dentistry. The
examinations currently required of an applicant by the Board will not change.
He explained that the Board of Dentistry’s ability to administer the
examination requirements of the Idaho Dental Practice Act will be greatly
enhanced by the proposed legislation.
MOTION: Rep. Mitchell made a motion to send SB 168 to the Floor with a DO PASS
recommendation. On a voice vote, the motion passed. Rep. Block will
sponsor the bill on the House Floor.
SB 1073: Terri Meyer, Chief of the Bureau of Child Support Operations with the
Department of Health and Welfare, presented this bill to the Committee. She
explained that federal law requires that the state of Idaho begin using the
National Medical Support Notice (NMSN). The NMSN is a standardized
federal form that will provide information and a standardized procedure to
employers and administrators of group health plans in obtaining medical
support for Idaho’s children. She stated that last year the child support
program administered over 76,000 cases and collected and distributed over
$100 million. She further stated that getting and keeping health care
coverage for children, as the Department is currently doing it, is complicated
and resource-intensive for everyone involved.

There are no consistent procedures to follow, and the process can be
frustrating. Ms. Meyer explained that the proposed legislation would
eliminate barriers to enrollment and coverage in either parent’s private health
insurance and ensure that coverage is obtained in the easiest and most
cost-effective manner possible for both parents. She further explained that
the Department has been working with the Department of Insurance, Blue
Cross, Blue Shield, and the local chapters of the American Payroll
Association. She then explained the specifics of the proposed legislation
which include the following; definitions for “medical child support order”,
“obligor” and “party”, sets forth the standardized requirements and
procedures to be used, lists for employers and plan administrators, the
exceptions to immediate enrollment, makes it clear that a child shall not be
denied enrollment in medical insurance for various reasons, requires that all
support orders and divorce decrees issued after 7/1/2003 include notice to
obligated parents that they must proceed to enroll the child in a health
insurance plan, and that failure to do so will result in the Department or the
other parent working directly with the employer to enroll the child, gives the
Department the authority to promulgate rules to support the implementation
and day-to-day business governed by these new laws, a safety net providing
a way to start the process over again, prohibits employers from dis-enrolling
or eliminating coverage with specific exemptions, and requires that the
employer notify the Department or the other parent within 20 days when
coverage is not longer available. Ms. Meyer explained that after meeting
with Julie Taylor, representing Blue Cross, and Lyn Darrington,
representing Blue Shield, compromise language was worked out and
amendments are being proposed to the bill. These amendments include
adding “business” to the number of days the employer is required to provide
the National Medical Support notice to the plan administrator, adds language
in the dis-enrollment section regarding when the child is no longer eligible for
coverage under the terms of the plan, or the required premium has not been
paid by or on behalf of the child and deletes the penalties for non-compliance.

In response to questions from Committee members, Ms. Meyer stated that
currently in one- third of the child support cases the child lives in another
state.
MOTION: Rep. Nielsen made a motion to recess the Committee meeting until 5 P.M.
because several of the members had a meeting with the Governor. On a
voice vote, the motion failed.
The following points were discussed by Committee members, child support
orders are entered by a court and the proposed legislation could apply to
college students up to the age of 23.
Ms. Meyer explained that the fiscal impact on the proposed legislation needs
to be changed to reflect current numbers. The first year the estimated cost
was $60,000 now changed to $36,000 and each year thereafter is changed
from $45,000 to $20,000.
Lyn Darrington, representing Blue Shield, clarified that those who can
submit claims in the proposed legislation are identical to the current federal
language.
MOTION: Rep. Henbest made a motion to send SB 1073 to General Orders with
Committee amendments attached.
SUBSTITUTE
MOTION:
Rep. Kulczyk made a Substitute Motion to HOLD SB 1073 in Committee.
He explained that the employer is not protected in the bill.
Committee discussion followed with the following points discussed, if the
proposed legislation does not pass, more kids will be on Medicaid or CHIPS
for medical coverage and employers are currently required to provide health
coverage, but every state is different and the proposed legislation would
standardize all states.
AMENDED
SUBSTITUTE
MOTION:
Rep. Block made an Amended Substitute Motion to refer SB 1073 to the
Business Committee. She explained that because the proposed legislation
deals with insurance issues, it would be better handled by the Business
Committee. Chairman Sali explained that whatever action is taken by the
Business Committee, SB 1073 would not come back to the Health and
Welfare Committee. On a voice vote, the motion carried.
ADJOURN: As there was no further business to be brought before the Committee,
Chairman Sali adjourned the meeting at 3:25 P.M.






DATE: March 12, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

None
GUESTS: See attached list.
Vice-Chairman Block called the meeting to order at 3:10 P.M.
MOTION: Rep. Henbest made a motion to approve the minutes of March 6, 2003 as
submitted. On a voice vote, the motion carried.
MOTION: Rep. Henbest made a motion to approve the minutes of March 10, 2003 as
submitted. On a voice vote, the motion carried.
H 17: Rayola Jacobsen, chief of the Bureau of Occupational Licensing, presented
this bill to the Committee. She explained that the proposed legislation
clarifies the exemption language for chiropractic physicians and increases
the cap for renewal fees and examination fees from $100 to $150. She
further explained that amendments are being proposed to the bill to spell out
the referenced sections of the Code that deals with exemptions. She also
stated that the exemptions specifically remove the religious exemption to
address the problem of unlicenced chiropractic physicians practicing in the
state using the religious exemption. Ms. Jacobsen stated that the proposed
legislation closes the loophole in the statute that deals with this exemption.
MOTION: Rep. Ring made a motion to send H 17 to General Orders with
Committee amendments attached.
PRO: Brad Hoaglun, representing the Association of Chiropractic Physicians,
spoke in favor of H 17 and the motion by Rep. Ring. He stated that the
Association approves of the proposed amendment and does not oppose the
proposed cap on fees.
ORIGINAL
MOTION:
On a voice vote, the motion to send H 17 to General Orders with Committee
amendments attached, carried. Rep. Eberle will sponsor the bill on the
House Floor.
S 1074: Richard Schultz, administrator of the Division of Health for the Department
of Health and Welfare, presented this bill to the Committee.



He explained that when the sections of Idaho Code relating to the
Department of Health and Welfare were separated from those provisions
relating to the Idaho Department of Environmental Quality, the enforcement
provisions of the Food Establishment Act were not adjusted accordingly.
This bill corrects the references to statutory enforcement provisions in the
food establishment act to reflect current enforcement statutes applicable to
the Department of Health and Welfare.

MOTION: Rep. Henbest made a motion to send S 1074 to the Floor with a DO PASS
recommendation. On a voice vote, the motion carried. Rep. Henbest will
sponsor the bill on the House Floor.
H 202: Rep. Sali presented this bill to the Committee. He explained that since the
Committee took action on H 202, there has been a great deal of discussion
of the fiscal impact. He further explained that the projections have varied
greatly. He stated that he has proposed amendments to the bill and would
like to send H 202 to General Orders with the proposed amendments. He
provided to Committee members a handout outlining the groups that would
be affected and the kind and cost of proposed prenatal care. (See attached).
He explained that an approximate total of 1,770 mothers would be affected
by the proposed legislation and that there would be an approximate cost of
$1,480,000. He added that the following services would be provided;
vitamins, limited medications, limited ultrasounds, lab services and post
partum care. Additionally, two full-time positions would be added to the
Department of Health and Welfare to administer this program at a cost of
approximately $110,000. Rep. Sali then discussed the high costs of
Neonatal Intensive Care Units that could be avoided with proper prenatal
care. Currently, over $1.7 Million is spent for NICU care. With the proposed
legislation, there would be a net savings of approximately $114,000. He
explained that he has proposed the legislative intent language to try to avoid
runaway costs. He further explained that delivery services would not be paid
for under the proposed amendments to the legislation, and currently these
services are not being paid for by the Medicaid or CHIP program. He stated
that because the legislation would be a separate program from Medicaid,
additional restrictions could be applied.
In response to questions from Committee members, Rep. Sali clarified that
he was not sure if the Secretary of Health and Human Services would
approve of the proposed legislation, but that something needs to be done
to help avoid the high NICU costs.
Also in response to questions from Committee members, Kathleen Allyn
from the Department of Health and Welfare stated that because the
proposed legislation would be a new program, new rules could apply. She
further stated that she was not sure about the proposed manual record
keeping and added that it would be difficult to do a statistical analysis of the
program if manual record keeping was done. She explained that the state
is required to have a unique identifier assigned to individual clients before
they can receive services. She further explained that she did not know if
additional full time employees would have to be hired to administer the
proposed legislation and has not had time to do an analysis.
Rep. Sali explained that under a proposal by the Department, about 10% of
the total positions at the Department will be eliminated with the
implementation of the ’04 budget cutbacks and he felt that it may be wise to
include amounts for two additional full time employees so that the
department would not be caught short in trying to implement the proposed
legislation. In response to questions, Rep. Sali stated that the proposed
10% of medications and ultrasounds in the legislation is within the
acceptable range after talking with an OB/GYN physician who treats
Medicaid patients. He further stated that delivery services were left out of
the proposed legislation because of the high cost of between $6 and $9
million annually.
Committee discussion followed with the following points made; physicians
could be liable for law suits if ultrasounds are not done, there is concern
about the lack of delivery services offered, concern about the access
problem for Medicaid and CHIP patients, and the concern over whether or
not the Secretary of Health and Human Services will approve the plan set
out in the proposed legislation.
MOTION: Rep. Henbest made a motion to HOLD H 202 in Committee and send a
letter from the Committee to the Department of Health and Welfare to
express interest in this concept and also write a letter to Health and Human
Services to see if this program could be implemented.
Rep. Ring stated that he had talked to several physicians in the Boise area
and there was concern about a physician providing prenatal care to Medicaid
patients without also providing delivery care. He felt that it would be better
to pay for full care for as many women as the budget would allow and when
the money ran out the remaining women could just wait “until next year.”
Rep. Sali clarified that an additional appropriation of 1.8% was added in the
proposed legislation to allow for population growth.
SUBSTITUTE
MOTION:
After lengthy Committee discussion, Rep. Kulczyk made a Substitute
Motion to send H 202 to General Orders with Committee amendments
attached.
AMENDED
SUBSTITUTE
MOTION:
Rep. Sali made an Amended Substitute Motion to send H 202 to General
Orders with the specific additional Committee amendments discussed. (See
attached).
After Committee discussion, Rep. Sali amended his motion to include in his
motion adding the words “up to” in the sentences in the legislative intent
language which deals with raising the expenditure cap each year 1.8% for
population growth.
Rep. Sali stated that he had spent many hours on the proposed legislation
and had tried to address the concerns of Committee members and others.
ROLL CALL
VOTE:
The Amended Substitute Motion by Rep. Sali to send H 202 to General
Orders with specific amendments attached carried on a vote of 6 to 5.
Representatives Block, Kulczyk, Eberle, McGeachin, Nielsen, and Sali
voted AYE. Representatives Garrett, Ring, Henbest, Martinez, and
Mitchell voted NAY.
ADJOURN: There being no further business to be brought before the Committee, Vice-Chairman Block adjourned the meeting at 4:50 P.M.






DATE: March 14, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

None
GUESTS: See attached sheet.
Vice-Chairman Block called the meeting to order at 2:15 P.M. She
announced that the minutes of the March 12, 2003 meeting will be approved
at the next Committee meeting.
H 240: Chairman Sali presented this bill to the Committee. He explained that it was
his intent to propose amendments to this bill which would amend sections
16-1612 and 16-1616 dealing with emergency removal and authorization of
emergency medical treatment and delete the other sections of the proposed
legislation. He outlined the proposed amendments for the Committee
members. In section 16-1612 of the bill; the proposed amended language
includes, “In cases where endangerment of a child is claimed to arise from
refusal of medical care by a parent, legal guardian or custodian, the
provisions of section 1616 of this chapter shall apply and, prior to removal
of a child , every effort shall be made to contact a court.” In section 16-1616
of H 240 amended language includes if a parent or guardian refuses
treatment, the physician has to contact the court, a parent or guardian may
request a second opinion, and a judge can consider alternative treatments.
Chairman Sali responded to an Attorney General’s Opinion Letter from
Jody Carpenter, Deputy Attorney General regarding H 240. (See attached)
He explained that he had not had a chance to review the opinion, but
understood that H 240 does not violate federal law if the proposed
amendments are added.
PRO: Corissa Mueller parent of a child who was taken from her custody for
refusing medical treatment, spoke in support of H 240. She explained that
she was treated like a criminal and did not have custody of her child for two
days. She further explained that the physician did not treat her child for over
three hours after the initial diagnosis. She stated that it cost $1,400 in legal
fees to regain custody of her child and another $5,000 for hospital
treatments that she did not want for her child.
CON: Dr. Richard Roberge, a retired obstetrician, testified in opposition to H 240.
He discussed several diseases that left untreated for forty-eight hours can
cause death. He also shared the story of his daughter who had spinal
meningitis and was successfully treated. He stated that even with the
proposed amendments, H 240 does not allow a physician to act in
emergency situations.
PRO: Dr. Tim Dudley, a chiropractic physician, testified in support of H 240. He
explained that paradigms change and it is dangerous to make decisions on
one paradigm. He further explained that voice on both sides of a “medical”
emergency need to be heard.
CON: Ken Deibert, administrator of Family and Community Services for the
Department of Health and Welfare, spoke in opposition to H 240. He stated
that he was concerned with the proposed amendments because he did not
have an opportunity to review them. He further stated that the current child
protection law was crafted with many different agencies involved and that
any revisions to it should also include input from all interested parties.
PRO: Dr. Karen Erickson, a naturopathic physician and primary health care
provider, spoke in support of H 240. She explained that she was the
referring physician for the Mueller’s. She stated that it is frustrating that the
current child protection law is not being followed and that the current practice
of the state is an obstacle for parents who want a choice in their health care.
CON: Jean Fisher, an Ada County Prosecutor, testified in opposition to H 240.
She explained that she is not representing the Association of Ada County
Prosecutors. She stated that she has concerns with the proposed
amendments to the bill. She explained that the standards have changed
with the proposed amendments and in small counties it would be difficult to
obtain a second opinion from a physician for medical treatment. She further
explained that she was concerned about the lack of a definition of
“physician” in the proposed legislation. She state that the bad facts the
Committee has heard should not be used to make bad laws.
PRO: David Snyder, a pastor, spoke in support of H 240. He explained that no
person or state agency should encroach on parental rights. He further
explained that the proposed legislation provides for checks and balances for
hospitals, physicians, and police and makes everyone accountable for their
decisions.
CON: Jody Carpenter, deputy Attorney General for the Department of Health and
Welfare, spoke in opposition to H 240. She explained that she had not seen
the proposed amendments. She stated that she had the following concerns;
the Department of Health and Welfare’s federal funding could be put at risk
by the proposed legislation and she is concerned about the definition of
“physician”. She further stated that there is nothing wrong with the current
child protection law, but that there appears to be a problem where people did
not follow the law with the Mueller’s.
PRO: Eric Mueller, father of the child who was taken from their custody for refusal
to accept medical treatment, spoke in support of H 240. He explained that
since the incident with his daughter, he has researched the medical risks
present at hospitals. He stated that there are approximately 12,000 deaths
per year at hospitals and there is a 10% chance of being given the wrong
medication in hospital emergency rooms.



PRO:


Sarah Anderson spoke in support of H 240. She shared her experience
with her son in an emergency room. She explained that the physician
discouraged her from leaving without treatment and when she tried to leave
the police were called. She was allowed to take her son home, but received
a visit from Child Protective Service the next day.
PRO: David Anderson spoke in support of H 240. He explained that parents have
inalienable rights that cannot be taken away without due process.
PRO: Chris Melgaard, spoke in support of H 240. He explained that currently
doctors and prosecutors are not acting properly within the child protection
law and that the truth can get twisted. He further explained that he felt that
in section 1612 the word “injury” in the proposed legislation should be
changed to “abuse.”
PRO: Dr. Craig Ellison, a chiropractic physician, testified in support of H 240. He
stated that the medical profession is not perfect and that people should have
the freedom to choose what kind of health care they want.
PRO: Dr. Katherine Zigler, a chiropractic physician, testified in support of H 240.
She stated that there is an appropriate time for medical intervention.
Vice-Chairman Block asked that those who testify limit their testimony to
the proposed legislation and refrain from making statements that could be
perceived as personal attacks.
PRO: Dr. Greg Ferch, a chiropractic physician, testified in support of H 240. He
explained that he has had experience in hospital emergency rooms and has
seen the good and the bad. He further explained that health care is not a
perfect science.
In response to questions from Committee members, Ms. Carpenter stated
that the statute as it now stands, addresses parental rights. She further
stated that the proposed legislation could allow for child abuse and that the
current statute is set up to target those that abuse children. She said that
the proposed legislation does not improve the law.
In response to questions from Committee members, Ms. Fisher stated that
she would like to see the term “medical treatment” changed to “medical care”
in the proposed amendments. She further stated that the majority of child
abuse cases are abuse from a parent and the proposed legislation would
make it more difficult to take a child away.
Ms. Carpenter responded to questions from Committee members. She
stated that she did not believe the proposed amendments violate federal law.
She further stated that the police are not comfortable detaining a parent until
the court is notified.
Mr. Deibert clarified that IV-E funding as referenced in the opinion letter from
Jody Carpenter is funding from the Social Security Act and is used to pay
for therapy for families with children in the custody of the state under the
Child Protective Act, services provide under the Safe and Stable Families
Act and expenses associated with Foster Care.
Ms. Carpenter stated that parents rights are protected in the shelter care
hearings and that this is a complex issue and any changes to the current
child protection statute should involve all interested parties.
MOTION: Rep. Nielsen made a motion to HOLD H 240 in Committee to a time certain
of Thursday, March 20th so all interested parties can study the proposed
amendments.
SUBSTITUTE
MOTION:
Rep. Ring made a Substitute Motion to HOLD H 240 in Committee. He
stated that if all parents were as caring as the families that have testified
today, there would not be a need for the Child Protective Act. He felt that the
current statute is working.
AMENDED
SUBSTITUTE
MOTION:
Rep. Sali made an Amended Substitute Motion to HOLD H 240 in
Committee to time certain at the pleasure of the Chair. He stated that he
felt that the proposed legislation is an important issue and should be
further studied.
After lengthy Committee discussion, Rep. Nielsen withdrew his motion to
HOLD H 240 in Committee to a time certain of Thursday, March 20th.
ROLL CALL
VOTE:
On a roll call vote, the Amended Substitute Motion to HOLD H 240 to a time
certain at the pleasure of the Chair, passed by a vote of 6 AYES, 3 NAYS,
and 2 absent. Representatives Block, Kulczyk, Garrett, McGeachin,
Nielsen, and Sali voted AYE. Representatives Ring, Henbest, Martinez
voted NAY. Representatives Eberle and Mitchell were absent.
MOTION: Rep. Nielsen made a motion to adjourn the meeting. On a voice vote, the
motion carried.
ADJOURN: Vice-Chairman Block adjourned the meeting at 4:18 P.M.






DATE: March 20, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

None
GUESTS: See attached list
Chairman Sali called the meeting to order at 2:45 P.M.
MOTION: Rep. Henbest made a motion to approve the minutes for March 12, 2003
and March 14, 2003 as submitted. On a voice vote, the motion carried.
Chairman Sali announced that HB 376, relating to expanded CHIP
coverage is in the Committee. He explained that he thought it would be
better dealt with in the Business Committee.
MOTION: Rep. Mitchell made a motion to refer HB 376 to the Business Committee.
On a voice vote, the motion carried.
HCR 28: Senator Kennedy presented this resolution to the Committee. He explained
that this concurrent resolution would reject a pending rule of the Idaho
Commission on Aging relating to senior services program fees and client
contributions and determining income. Sen. Kennedy explained that the
Senate Health and Welfare Committee felt that the sentence should not be
stricken in the rule, “In determining income for respite clients, income means
the gross income of the client as specified above but shall not include in the
income of any other person(s) who reside in the household”. The Senate
Health and Welfare Committee felt that only the income of the client should
be considered.
CON: Sarah Scott, representing the Commission on Aging, spoke in opposition to
HCR 28. She explained that the Commission does not charge its clients for
respite care services and by leaving the sentence in the rule as referenced
above, could be misleading and confusing. She stated that whether the
sentence is removed or not, service would not be affected.
In response to questions from Committee members, Ms. Scott clarified that
the section that is proposed to be deleted has nothing to do with eligibility,
and pointed out to the Committee that respite care services has a separate
section in the rule that deals with eligibility. She further clarified that the
Commission only charges for homemaker and chore services.


Sen. Kennedy responded to questions from Committee members. He
explained that the concern was that clients might be excluded from other
services if the income of other household members was taken into account.
MOTION: Rep. Henbest made a motion to HOLD HCR 28 in Committee.
SUBSTITUTE
MOTION:
Rep. Ring made a Substitute Motion to send HCR 28 to the Floor with a
DO PASS recommendation.
ROLL CALL
VOTE:
A roll call vote on the Substitute Motion to send HCR 28 to the Floor with a
DO PASS recommendation failed on a vote of 4 AYES and 7 NAYS.
Representatives Block, Ring, Nielsen and Sali voted AYE.
Representatives Kulczyk, Garrett, Eberle, McGeachin, Henbest, Martinez
and Mitchell voted NAY.
ORIGINAL
MOTION:
On a voice vote, the Original Motion to HOLD HCR 28 in Committee
carried.
SCR 108: Senator Kennedy presented this resolution to the Committee. He explained
that this concurrent resolution would reject a pending rule of the Department
of Health and Welfare relating to eligibility for aid to the aged, blind and
disabled concerning rebuttable presumption relating to transferring money
to become Medicaid eligible. Sen. Kennedy explained that the Senate
Health and Welfare Committee felt that by striking the words, “there is a
rebuttable presumption” is contrary to legislative intent.
CON: Phil Gordon, chief of the Bureau of Benefit Programs Operations in the
Division of Welfare, testified in opposition to SCR 108. He explained that the
Department proposed the rule change in order to align their policy with Idaho
Code. He further explained that the intent was to clarify the language to
sync-up with state statue and Medicaid rules, believing that language
consistency would assist the Department in ensuring more accurate eligibility
determinations and would reduce the incidence of fraud and estate recovery
issues. He stated that the presumption is that unless the asset transfer
meets permissible criteria, the transfer was made for the purpose of
qualifying for Medicaid, and the transfer penalty would be applied. He further
stated that the client can rebut that presumption and the asset transfer
penalty would not be imposed then, if the individual proves the transfer was
made for another purpose than to qualify for Medicaid.
CON: Willard Abbott, deputy Attorney General assigned to the Department of
Health and Welfare, spoke in opposition to SCR 108. He explained that any
person can rebut a claim unless it says in statute that you cannot. He further
explained that this section in rule is crucial to carrying out legislation passed
last year concerning asset transfers. He also explained that this section in
rule is meant to address a loophole in the Federal Medical law that one
spouse can transfer assets to another when one person is in a nursing home
and one is in the community. In response to questions, Mr. Abbott clarified
that the statute would have control over the rule.
In response to questions from Committee members, Karen Gustafson, from
the Administrative Rules office, clarified that the Legislature cannot amend
a rule, either the entire section has to be kept in its entirety or sections
rejected in their entirety.
MOTION: Rep. Eberle made a motion to send SCR 108 to the Floor with a DO
PASS
recommendation.
Committee discussion followed and the following points were discussed;
the rule is an attempt to line up with the statute and rules promulgated by
agencies should be clear.
ORIGINAL
MOTION:
On a voice vote, the Motion to send SCR 108 to the Floor with a DO PASS
recommendation failed.
SB 1102a: Steve Millard, president of the Idaho Hospital Association, presented this
bill to the Committee. He explained that health care organizations maintain
a formal peer review process in order to reduce the occurrence of illness and
death and to enforce and improve standards of medical practice. He further
explained that records used in peer review are confidential and privileged.
He stated that the purpose of this legislation serves to clearly define key
terminology, to include: “peer review,” “peer review records, ” and “patient
care records.” It also delineates the circumstances upon which records
lawfully may be released by the health care organization that owns them;
and it clarifies immunity from civil liability. Further, a new section fully
delineates the health care organizations’ reporting obligations to the State
Board of Medicine and details the sanctions and content of mandatory
reports. In addition, the proposed legislation clarifies that no physician or
surgeon shall be required to report information known, learned or discovered
as a result of access to peer review records or participation in peer review.
Mr. Millard explained that the proposed legislation is co-sponsored by the
Idaho Medical Association and the Idaho State Board of Medicine and is a
result of over four months of negotiations. He further explained that there is
an amendment to the bill which was proposed by the Board of Medicine. It
inserts “shall” in place of “may” in the section dealing with requests of
records from the district court and deletes the phrase “and then only to the
extent the board of medicine is required by law to disclose such records, files
or information.”

PRO: Nancy Kerr, executive director of the Board of Medicine, and Bob
Seehusen
, CEO of the Idaho Medical Association, voiced their support
for S 1102a.
MOTION: Rep. Garrett made a motion to send S 1102a to the Floor with a DO PASS
recommendation. On a voice vote, the motion carried. Rep. Garrett will
sponsor the bill on the House Floor.
H 368: Rep. Eberle presented this bill to the Committee. He explained that the
purpose of this legislation is to amend the section of Idaho Code that relates
to immunizations, to clarify existing state law, to require notification that
immunization is voluntary, and to prohibit denial of services.
Rep. Eberle further explained that there is currently in statute, an exemption
for parents who do not choose to have their children immunized, but that
schools has chosen to ignore the exemption and prohibit un-immunized
children from registering. He clarified that everything except for section 4 of
the bill is currently in Idaho Code. Section 4 of the bill states that “no school,
medical establishment, or other facility shall deny admittance or services to
any person who is not fully immunized and who is lawfully exempt from any
immunization requirement. Any notice regarding immunization disseminated
by a school, medical, or other facility shall include the preceding sentence,
and an explanation of the legal right to refuse immunization pursuant to
Idaho Code. “
Rep. Eberle stated that the proposed legislation is not in it’s final form and
would like impute from Committee members and other interested parties.
Dick Schultz, Administrator for the Division of Health, addressed the
Committee. He provided packets of information to Committee members that
are given to parents or guardians when their children are immunized. He
stated that it is required by federal law to have signed informed consent for
immunizations. He further stated that he would be happy to work with Rep.
Eberle
to rewrite the proposed legislation to satisfy his concerns.
MOTION: Rep. Kulczyk made a motion to HOLD H 368 in Committee to a time certain
at the pleasure of the Chair.
SUBSTITUTE
MOTION:
Rep. Henbest made a Substitute Motion to HOLD H 368 in Committee.
After Committee discussion, Rep. Henbest withdrew her Substitute
Motion.
ORIGINAL
MOTION:
On a voice vote, the Original Motion to HOLD H 368 in Committee to a time
certain at the pleasure of the Chair, carried.
ADJOURN: As there was no further business to be brought before the Committee,
Chairman Sali adjourned the meeting at 4:55 P.M.






DATE: March 24, 2003
TIME: 1:30 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

Rep. Henbest
GUESTS: See attached list
Chairman Sali called the meeting to order at 3:03 P.M.
MOTION: Rep. Martinez made a motion to approve the minutes of the March 20, 2003
meeting as submitted. On a voice vote, the motion carried.
H 200: Rep. Douglas presented this bill to the Committee. She explained that the
purpose of this legislation is to require that if a child under the age of one
year dies suddenly and unexpectedly and sudden infant death syndrome
(SIDS) is suspected, an autopsy is to be performed. She further explained
that Sudden Infant Death Syndrome (SIDS) is declared to be the cause of
death of a child, generally one year of age or under, when there is not a
medical, environmental or genetic cause of death. She stated that the
number of deaths attributed to SIDS have declined in the past few years, due
in part to a program of continuing awareness and education of parents. She
further stated that in Idaho, the majority of SIDS victims already undergo an
autopsy. In 1999, there was a 93 % autopsy rate, in 2000 all 12 cases
underwent autopsy, and in 2001, 14 of the 15 cases underwent autopsy.
Rep. Douglas related her personal experience with her own child who died
of SIDS. She stated that parents deserve to know if the infant died of SIDS
and autopsies could relieve some guilt for the parents.
In response to questions from Committee members, Rep. Douglas stated
that she would like an autopsy to be performed in every case of an
unexplained death. She further stated that for a true diagnosis of SIDS, an
autopsy needs to be performed. She also stated that she would not object
if the bill were sent to General Orders to clarify language as to who can
perform autopsies.
PRO: Dr. David Christensen, a pediatrician, representing the American Academy
of Pediatrics, spoke in support of H 200. He explained that to make a
diagnosis of SIDS, an autopsy has to be performed. He further explained
that the cause of SIDS is unknown. He discussed other causes of sudden
death of infants which include, asphyxiation, metabolic disorders, congenital
abnormalities, alcohol or drug exposure, abdominal trauma and shaken baby
syndrom. He stated that many inflicted injuries could be mis-diagnosed as
SIDS, and an autopsy is the only way to rule out other causes of death.



He outlined the benefits of autopsies of SIDS victims which include the
prevention of potential genetic or metabolic disorders. He further stated that
forensic pathologists do not necessarily need to do autopsies and that any
pathologist could discern infanticides.

PRO: Karl Malott, a fire fighter and EMT representing the Professional Firefighters
Association, spoke in support of H 200. He explained that he has personally
seen approximately 10 unexplained infant deaths. He stated that it is
important for parents to know that they did not do anything wrong and an
autopsy could rule out any other cause of death. He further stated that it is
important to have autopsies done to know if the EMT was exposed to
anything.
CON: John Buck, Gem County Coroner and representing the Idaho State
Association of Coroners, spoke in opposition to H 200. He explained that
most county coroners are already doing autopsies on suspected SIDS
victims and felt that this should not be mandated by the state. He stated that
if the state mandates the autopsies, the state should pay for them also. He
further stated that the Association is currently looking at adopting a protocol
to deal with SIDS victims which would require autopsies. He explained that
coroners would like to have flexibility to decide if an autopsy should be done.
He provided to Committee members a handout outlining the current costs of
autopsies, (see attached) which cost approximately $1,000 to $1,500 rather
than $500 to $750 as outlined in the fiscal impact of the proposed legislation.
He also discussed the possible funding by the Department of Health and
Welfare for autopsies. He stated that most coroners are unaware that a
grant could be applied for and do not know how to apply.
MOTION: After Committee discussion, Rep. McGeachin made a motion to HOLD H
200
in Committee.
Rep. Douglas clarified that funding from the Department of Health and
Welfare would allow pathologists to directly bill the Department up to $475
apiece for autopsies.
SUBSTITUTE
MOTION:
Rep. Mitchell made a Substitute Motion to send H 200 to the Floor
without recommendation.
Chairman Sali yielded the gavel to Vice-Chairman Block.
AMENDED
SUBSTITUTE
MOTION:
Rep. Kulczyk made an Amended Substitute Motion to TABLE H 200.
Rep. Sali explained that if a bill is tabled, it requires a two-thirds vote to
bring it back before the Committee.
Committee discussion followed, with the following points made; the new
language on page 1 of the bill may negate the religious exemption for
autopsies, the fiscal impact needs to be corrected, and the language
describing those authorized to perform autopsies needs to be clarified.
ROLL CALL
VOTE:
On a roll call vote, the Amended Substitute Motion to TABLE H 200
carried by a vote a 6 to 5. Representatives Kulczyk, Garrett, Eberle,
McGeachin, Nielsen, and Sali voted AYE.



Representatives Block, Ring, Bray(substituting for Rep. Henbest),
Martinez, and Mitchell voted NAY.

S 1075: Richard Schultz, administrator of the Division of Health, presented this bill
to the Committee. He explained that in recognition of the need to be
prepared to deal with the threats of drug-resistant and emerging diseases
and the threat of chemical or biological terrorism, this bill clarifies the
authority of the Director of Health and Welfare to impose isolation and
quarantine orders. It also provides for the possibility of immediate judicial
review of such orders as a safeguard to those who may be affected by such
orders. He explained that the proposed legislation differentiates between
isolation and quarantine and court relief is give to those in quarantine. He
further explained that if this bill passes, it will be in sync with the
Department’s rules regarding isolation and quarantine.
MOTION: Rep. Eberle made a motion to send S 1075 to the Floor with a DO PASS
recommendation. On a voice vote, the motion carried. Rep. Eberle will
sponsor the bill on the House Floor.
S 1128: Pharis Stanger, interim Adult Mental Health Program manager for the
Department of Health and Welfare, presented this bill to the Committee. He
explained that currently some courts within the state are not recognizing
licensed counselors and marriage and family counselors as qualified to be
Designated Examiners. He further explained that making Designated
Examiner definitions the same would give the Department Director authority
to designate “other mental health professionals” and will enable qualified
professionals the same opportunity to practice as Designated Examiners for
adult and child cases. The proposed legislation would amend Idaho Code to
define terms of becoming a designated examiner, add language to
strengthen the qualifications to become an examiner making it consistent
with the designated examiner definition in existing Idaho Code, and amend
the Code to define terms making it consistent with the designated examiner’s
definition found in children’s mental health services.
In response to questions from Committee members, Mr. Stanger explained
that a Designated Examiner is someone who makes recommendations to the
court of mental illness for the appropriate determination.
MOTION: Rep. Nielsen made a motion to send S 1128 to the Floor with a DO PASS
recommendation. On a voice vote, the motion carried. Rep. Garrett will
sponsor the bill on the House Floor.
ADJOURN: As there was no further business to be brought before the Committee,
Vice-Chairman Block adjourned the meeting at 5:20 P.M.






DATE: Friday, March 28, 2003
TIME: 1:00 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

Representatives Henbest and Mitchell
GUESTS: See attached list
Chairman Sali called the meeting to order at 1:03 P.M.
MOTION: Rep. Kulczyk made a motion to approve the minutes of the March 24, 2003
meeting as submitted. On a voice vote, the motion carried.
Rep. Kulczyk discussed with the Committee a copy of a letter written to the
Speaker dated March 13, 2003 and signed by Representatives Kulczyk,
McGeachin, Nielsen, and Eberle. (See attached). He explained that the
letter was written in response to a letter of complaint written by
Representatives Henbest, Mitchell, Martinez and Ring, a copy of which
was placed in the Secretary and Legislative Librarian’s minute books on
February 28, 2003. Rep. Kulczyk made a Unanimous Consent Request
that a copy of his letter be placed in the Secretary and the Legislative
Librarian’s minute books. There were no objections.
S 1165: Molly Creswell, representing the Idaho Sleep Disorders Association,
presented this bill to the Committee. She explained that the Idaho State
Board of Medicine has suggested that some sleep disorder technicians or
laboratory personnel (polysomnographers) have been practicing respiratory
therapy without a license. She further explained that the purpose of this
legislation is to provide for the issuance of limited permits to some
ploysomnographers allowing them to continue to perform their limited scope
of duties in the field of respiratory therapy without becoming fully licensed as
respiratory therapists. She stated that the legislation provides qualifications
for permits, including educational requirements, and places
polysomnographers under the direction of the respiratory therapy licensure
board, a board under the direction of the Idaho State Board of Medicine.
Rita Jo Devlin, a respiratory technician, explained what polysomnographers
do. She stated that the technicians administer sleep studies in sleep labs for
the diagnosis of sleep-related disorders. She further stated that sleep techs
do three things in the course of conducting sleep studies that overlap into the
practice of respiratory therapy; they administer oxygen, provide ventilatory
assistance to patients and maintain patient airways.
MOTION: Rep. Ring made a motion to send S 1165 to the Floor with a DO PASS
recommendation. On a voice vote, the motion carried. Rep. Kulczyk voted
NAY. Chairman Sali will sponsor the bill on the House Floor.
Chairman Sali announced that Rep. Gagner had previously requested that
the Committee review two paragraphs of intent language proposed for the
Health and Welfare appropriation. Rep. Gagner had withdrawn his request
just before the meeting began because one proposed paragraph will be
withdrawn and there are ongoing discussions regarding the other paragraph
of that intent language. On that basis Rep. Sali asked for unanimous
consent that the Committee not consider the intent language at this meeting.
He further announced that the Speaker has requested that the Committee
hold off on discussing the intent language.
ADJOURN: As there was no further business to be brought before the Committee,
Chairman Sali adjourned the meeting at 1:18 P.M.






DATE: April 4, 2003
TIME: 1:00 PM
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Garrett, Kulczyk,
McGeachin, Nielsen, Ring, Henbest, and Martinez
ABSENT/

EXCUSED:

Representatives Mitchell and Eberle
GUESTS: See attached list
Chairman Sali called the meeting to order at 1:06 pm.
MOTION Vice Chairman Block moved that the minutes of March 28, 2003 be
approved as written.
SUBSTITUTE
MOTION
Representative Henbest made a substitute motion that the minutes of
March 28 be approved with the deletion of “for Committee members” on
line one, in the last paragraph, on page one. Motion carried by voice vote.
Chairman Sali called upon Representative Gagner to present his
proposed language of intent for the H&W appropriation regarding
HCR21. The language would read “Section 9: Relating to Utilization
Management. It is the intent of the Idaho Legislature that the Department
of Health and Welfare implement a case management software program,
but not enter into an Independent Assessment Provider (IAP) contract for
the period July 1, 2003, through June 30, 2004.”



Committee discussion took place.



Chairman Sali suggested that the Committee send a letter to the Co-Chairs of JFAC including this intent language. He asked for a show of
hands from the committee. Majority approved. A draft will be written and
distributed to committee members for review.

ADJOURN: There being no further business before the committee, the meeting was
adjourned at 1:40 pm.






DATE: April 10, 2003
TIME: 1:00 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

Rep. McGeachin
GUESTS: See attached list.
Chairman Sali called the meeting to order at 1:10 P.M.
MOTION: Rep. Martinez made a motion to approve the minutes of April 4, 2003 as
submitted. On a voice vote, the motion carried.
Rep. Henbest provided to Committee members a copy of a letter she had
received from the Department of Health and Welfare addressing the
Committee’s concern about the four hour cap on mental health case
management. (See attached letter). As outlined in the letter, The Department
will, as of April 28, 2003, allow case management agencies to deliver crisis
case management services. On a monthly basis, agencies will be able to
provide up to four hours of regular case management and up to four hours
of crisis case management. The Department will also have the ability to
authorize additional hours beyond the eight hour limit based on individual
need and jointly established criteria. The Department’s letter also stated that
by May 16, 2003, statewide provider training on crisis case management will
be accomplished. Rep. Henbest asked that the letter from the Department
be included in today’s minutes. There were no objections.
Chairman Sali yielded the gavel to Vice-Chairman Block.
Rep. Sali presented to the Committee a copy of proposed intent language
regarding the use of Title X federal funds for the Department of Health and
Welfare’s fiscal year 2004 appropriation bill. He discussed the proposed
language which states, “Relating to family planning and reproductive health
care services for low-income women. It is the intent of the Idaho Legislature
that all contracts or grants awarded by the Department of Health and Welfare
from moneys received under Title X of the Public Health Services Act, go
exclusively to Idaho’s seven public health districts for the period July 1,
2003, through June 30, 2004. As a condition for receiving these contracts
or grants, Idaho’s seven public health districts must agree to retain all Title
X funding awarded to them and may not subcontract these funds to
independent agencies.” Rep. Sali explained that if the Committee votes to
support the proposed intent language, it would be a recommendation from
the Health and Welfare Committee to the Joint Finance and Appropriation
Committee.

Rep. Sali then discussed with the Committee comparisons of services
offered by Planned Parenthood of Idaho and the Central District Health
Departments. He explained that both agencies provide identical services
consistent with the Title X requirements for federal funding. Both agencies
are funded to provide access to complete medical examinations and
contraceptive supplies, and priority is given to low income, uninsured
women. Federal Title X program guidelines are comprehensive and stipulate
the methods for project planning, evaluation, financial management,
personnel, training of staff, reporting requirements, review of educational
materials, and community participation. Required services include the
following, patient education, counseling, informed consent, personal and
family medical and social history, comprehensive physical examination and
clinical procedures as indicated, laboratory testing, and follow-up and
referrals. Rep. Sali stated that Planned Parenthood of Idaho are plaintiffs
in several court cases including the suit regarding Idaho’s parental consent
statute in federal court and the state-court action regarding taxpayer funding
of “health” abortion. He also stated that Planned Parenthood of Idaho is a
private corporation and he believes it is improper for the state to provide
funding for Planned Parenthood which represents only one side of the
abortion issue. He also stated that 90% of the funds for Planned Parenthood
come from private donations. He said that it is improper for the state to give
its seal of approval by providing funding to Planned Parenthood of Idaho.

Rebecca Poedy, CEO of Planned Parenthood of Idaho, addressed the
Committee. She spoke in opposition to the proposed intent language. She
explained that the mission of Planned Parenthood is to reduce unwanted
pregnancies. She further explained that PPI serves about 7,000 patients
annually with their offices in Boise and Twin Falls. She stated that the
Department of Health and Welfare receives from the state $136,800 per year
for Title X services and that money is distributed to Planned Parenthood for
those services. She further stated that none of Title X money is used for
abortions, and that PPI cannot and will not do abortions. She also stated
that PPI does provide emergency contraceptives that do not affect
pregnancies. She said that since January of this year, PPI has already
served approximately 4,000 clients.
Pastor Bryan Fischer, senior pastor of the Community Church of the Valley,
addressed the Committee. He spoke in support of the proposed intent
language. He explained that Planned Parenthood sends a “safe sex”
message to teens that is responsible for a dramatic increase in teenage
sexual experimentation, a dramatic increase in teenage pregnancy, the
alarming spread of sexually transmitted diseases, and a dramatic increase
in the number of abortions performed on teenagers. He further explained
that Planned Parenthood is a private organization receiving taxpayer dollars
to promote a philosophy and view of human sexuality which the great
majority of parents and Idaho citizens find objectionable. He provided to
Committee members a copy of four pages from Planned Parenthood’s site
for teenage sexual advice.
Anne Pasley-Stuart, representing the Idaho Nurses Association and the
National Association of Social Workers, spoke in opposition to the proposed
intent language. She explained that the language limits access to family
planning information which is provided by Planned Parenthood. She further
explained that anything that impedes family planning is bad public policy.
Lee Flinn, executive director of the Idaho Womens’ Network, spoke in
opposition to the proposed intent language. She stated that the proposed
intent language is unnecessary and represents a threat to sound public
health policy. She further stated that family planning services are basic
reproductive health care and are necessary health care for women. She
stated that the proposed intent language is bad policy because, it is fiscally
irresponsible as it seeks to remove funding from Planned Parenthood of
Idaho, a very successful public private partnership that has received Title X
funds for 30 years and has a positive track record of providing low cost or no
cost health care; the language would likely have a negative impact on the
working poor people in Idaho, and the language seeks to solve a problem
that does not exist. She stated that no one can say for sure if the health
districts could absorb an additional 7,000 patients if Planned Parenthood
were to lose Title X funding.
Tammy Seydel spoke in support of the proposed intent language. She
explained that she opposes the funding of Planned Parenthood because it
violates decent Christian and moral codes while promoting its own statement
of beliefs. She further explained that Planned Parenthood has a tainted
reputation and has demonstrated deceptive and harmful practices. She
stated that monies spent on Planned Parenthood would be better spent on
the effective abstinence curriculums available and on providing children with
a way to stay healthy rather than encourage them to engage in unhealthy
practices.
Sabra McCreedy spoke in opposition to the proposed intent language. She
told of a personal experience with Planned Parenthood in which her
teenaged daughters received advice and services. She explained she was
grateful for Planned Parenthood and the service they provide to low income
women.
Judith Murray, representing the Idaho Nurses Association, addressed the
Committee. She spoke in opposition to the proposed intent language. She
explained that without Planned Parenthood of Idaho as a factor in the Title
X funding, the money may be lost for all health districts as well. She further
explained that with this loss of Title X funds, the State of Idaho will find
increased Medicaid expenditures due to unplanned and unexpected
pregnancies as well as an increased number of pregnancy terminations. She
stated as a past University professor, she knows that many of the students
use PPI as their only source of health care. She further stated that by having
a source for annual exams and family planning, students are able to stay in
school.
Laurie Moden spoke in support of the proposed intent language. She stated
that there are many other organizations who offer true family planning. She
felt that the methods advocated by Planned Parenthood are outdated and
have failed to keep the teenage pregnancy rates down. As a result, 33% of
births occur outside of wedlock.
Rick Schell, a father of an 18 year old daughter, spoke in support of the
proposed intent language. He stated that Planned Parenthood undermines
parental authority and Planned Parenthood’s message about promiscuous
sex creates the need for private funding.
In response to questions from the Committee, Laurie Moden stated that
Planned Parenthood does not share enough information on abstinence and
offers no guarantees against sexually transmitted diseases.
Susan Ault, manager of the reproductive health care services for the
Department of Health and Welfare responded to questions from Committee
members. She stated that she did not know if the public health districts
could handle the increase of clients if funds for Title X were not given to
Planned Parenthood. She explained that Title X is a federal grant and has
stringent guidelines and federal oversight. She stated that some of the
public health care clinics offer evening and weekend appointments and could
be encouraged to expand their hours.
In response to questions from Committee members, Ms. Poedy clarified that
the entire budget for Planned Parenthood is $900,000. She further clarified
that the state money administered by the Department of Health and Welfare
100% goes directly to client care. She stated that if Planned Parenthood
does not receive Title X funds, low income patients may have to be charged
for services.
Rep. Sali made an Unanimous Consent Request to send a letter from the
Committee to the Joint Finance and Appropriation Committee to include the
proposed intent language for the Department of Health and Welfare’s fiscal
year 2004 appropriation bill. There were objections.
MOTION: Rep. Sali made a motion to send a letter from the Committee to the Joint
Finance and Appropriation Committee to include the proposed intent
language for the Department of Health and Welfare’s fiscal year 2004
appropriation bill.
Rep. Sali provided a handout to Committee members outlining the Idaho
Reproductive Health Program and Title X and family planning. (See
attached). Rep. Sali explained that the state would get a better return on the
Title X money by directly funding the health districts.
Committee discussion followed and the following points were made; Planned
Parenthood does the best job of offering contraceptives, voting against
giving funds to Planned Parenthood would be voting for increased abortions,
and increased costs to the CHIP program and Medicaid, the requirements
are the same for Planned Parenthood and the health districts in using Title
X funds and Planned Parenthood only operates in Boise and Twin Falls so
the access to services funded by Title X are limited to Health Districts in all
other parts of the state.
Rep. Sali made a Unanimous Consent Request to cease debate and vote
on the Original Motion. There were no objections.
ROLL CALL
VOTE:
On a roll call vote, the Motion to send a letter from the Committee to the Joint
Finance and Appropriation Committee supporting the inclusion of the
proposed intent language for the Department of Health and Welfare’s fiscal
year 2004 appropriation bill, passed on a vote of 6 to 4. Representatives
Block, Kulczyk, Garrett, Eberle, Nielsen, and Sali voted AYE.
Representatives Ring, Henbest, Martinez and Mitchell voted NAY.
Representative McGeachin was absent.
Rep. Henbest asked that the letter to the Joint Finance and Appropriation
Committee reflect the vote of those opposing the Motion. The letter will be
drafted with the NAY votes recorded.
ADJOURN: There being no further business to be brought before the Committee,
Vice-Chairman Block adjourned the meeting at 2:45 P.M.






DATE: April 17, 2003
TIME: 1:00 P.M. or upon Adjournment
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring(Roberge), Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

Rep. Mitchell
GUESTS: None
Chairman Sali called the final meeting of the Committee to order at 4:00
P.M.
MOTION: Rep. Nielsen made a motion to approve the minutes of the April 10, 2003
with the following change; on page 1, the last sentence would now read,
Rep. Sali explained that if the Committee votes to support the proposed
intent language, it would be a recommendation from the Health and Welfare
Committee to the Joint Finance and Appropriation Committee.” The
underlined words were changed to better reflect the Committee’s action. On
a voice vote, the motion carried.
Chairman Sali thanked the Committee members for the flowers and cards
sent to him for the recent death of his father. He said that though this was
a difficult time, he was very proud to call Gregory Sali his father as he was
a very remarkable man.
Chairman Sali explained that there are several bills left in Committee that
have not been heard that need to be returned to the Chief Clerk’s office. He
asked for Unanimous Consent that the minutes reflect the Committee’s
official action to HOLD House Bills 10, 14, 16, 18, 161, 235, 236, 239, 240,
241, 368, 373, HCR 28, SCR 107
and SCR 108 in Committee. There was
no objection.



Chairman Sali expressed his appreciation to the members for their hard
work and dedication to the Committee this past legislative session.



Chairman Sali also recognized and praised the excellent work of the
Committee’s Secretary, Claudia Howell. The Committee joined Rep. Sali
in thanking Mrs. Howell for her hard work and excellent service to all of the
Committee members.

ADJOURN: There being no further business to be brought before the Committee,
Chairman Sali adjourned the Committee, Sine Die, at 4:20 P.M.