2004 Health & Welfare

Health/child care, welfare

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January 14, 2004
January 20, 2004
January 22, 2004
January 26, 2004
January 26, 2004 – Subcommittee
January 28, 2004
January 29, 2004 – Subcommittee
January 30, 2004 – Subcommittee

February 2, 2004
February 2, 2004 – Subcommittee
February 4, 2004
February 4, 2004 – Subcommittee
February 6, 2004
February 10, 2004
February 10, 2004 – Subcommittee
February 12, 2004
February 16, 2004
February 16, 2004 – Subcommittee
February 18, 2004
February 19, 2004 – Subcommittee
February 20, 2004
February 24, 2004
February 26, 2004

March 2, 2004
March 4, 2004
March 10, 2004
March 12, 2004
March 16, 2004
March 18, 2004
March 20, 2004

DATE:
January 14, 2004
TIME:
1:30 pm
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 sign-in sheet
Chairman Sali called the first meeting of the Health and Welfare
Committee to order at 2:40 P.M. He addressed the committee on
administration of issues from the 2003 session. A few members had
approached the Speaker last year regarding issues before the committee.
Chairman Sali asked that all members seek to resolve committee
business within the committee first. He asked that they contact him first to
try to resolve any issues. If he is unavailable or if a member would feel
more comfortable, Vice Chairman Block will field any questions as well.
If there is ever a problem that requires involving the Speaker, the
Chairman requests that he be allowed the courtesy of being present for
such discussion. The Speaker has agreed that he will ask members to
see the Chairman first to try to bring resolve within the committee before
he entertains comments from members. The Chairman urged the
committee that each member is responsible to act quickly to resolve any
issues so that the business of the committee can be handled effectively
and expediently. Chairman Sali then invited committee discussion.



Regarding length of meetings, the Chairman remarked that last year, time
was taken to educate new members and was a necessary factor that
resulted in some very long meetings. This year the Chairman will be taking
less committee time for education though he is sensitive to the fact that
educating the members on issues that come before the committee will at
times be necessary. The Chairman stated that in an effort to reduce their
length, if a meeting has not ended by 5:30 p.m., he will let the committee
decide whether or not they wish to continue further or adjourn to a later
time. He stated that the issues before the committee do not seem to be as
numerous or as difficult this year. The Chairman then opened up the
meeting for discussion and questions from the members.



Some of the members commented on the length of time allowed for
testimony. The Chairman shared that he believes those who come before
the committee ­ particularly citizens wanting to testify – should be able to
take the time that they need to make their point, but he will always
consider requests from members to establish a time limit. He suggested
that the members be sensitive to the fact that it is difficult for the public to
take time to appear at meetings and they are often very intimidated by the
process and the members. If no time limit has been imposed, it will be up
to each member to speak up if they feel one is needed.






Representative Henbest brought before the committee the consideration
of scheduling informational meetings, whether the best time would be
before or after the regular meetings or at another time altogether. She
shared the concern of having individuals who take time away from work,
especially professionals, who attend a meeting pertaining to a particular
legislation and that legislation ends up being carried over to the next day
due to lack of time. The Chairman asked that when members know that
people with difficult schedules will be appearing to testify on a bill that they
please bring this kind of situation to his attention so that he will have an
opportunity to plan ahead and schedule accordingly.



The Chairman urged the members to take the responsibility to be
knowledgeable regarding parliamentary procedure. He reminded the
members that the proper working of every legislative body, whether the full
House or its Committees, requires the proper use of parliamentary
procedure. It is each member’s responsibility to make sure they are
knowledgeable regarding that procedure and also willing to use it to make
their voice heard. He asked that any time a member has a question
regarding the procedure, even if this occurs during a vote, that he/she
bring it to the attention of the Chair immediately, allowing the Chair to
make proper rulings at the time and assist in education or explanation.



The Chairman opened for discussion and welcomed questions from the
committee. After time for discussion, the Chairman requested of the
committee that whenever they have questions or concerns that they
“speak up” and bring the issues at hand to his attention so that he can
take steps to assist in a resolution.



The Chairman addressed the committee regarding the challenge before
them concerning the growing health care crisis. The increases in the cost
of health care cannot be sustained and more and more people are faced
with going without health insurance.



Chairman Sali referred to a conference that had been sponsored by the
Idaho Assisted Living Association. Speaker Newt Gingrich had been
featured and had discussed many of the points raised in his book Saving
Lives, Saving Money.
The members were urged to read the book and
contemplate Speaker Gingrich’s points and suggestions. Chairman Sali
remarked that he had concluded, following the conference, that health
care as it is known in the United States will not exist in ten years because
the increases in costs cannot be sustained and because the growth in the
long-term care population will cause further increases, resulting in greater
overall consumption of health care and also resulting in a provider
shortage.



He pointed out that each member has been elected to lead in this area
and he encouraged each member to rise to the challenge that lies ahead
and participate in every way possible. He commented that this committee
shares a great responsibility in the future outcome for healthcare for the
state of Idaho.



Representative Garrett commented that she is serving on the Healthcare
Task Force. She asked that the Chairman seek to have more committee
members appointed to that task force as she believes there is a greater
opportunity for improvement and change if the group has a stronger voice.
Chairman Sali asked Representative Garrett to approach the Speaker
with her request. He will be happy to join her.



The Chairman will be dividing the Rules into two groups. Rules that
appear to be more complicated or controversial will be heard in front of the
full committee. The sub-committee will be assigned the remainder. He
appointed Representative Garrett to chair the sub-committee.
Representative Kulczyk, Representative Mitchell and Vice-Chairman
Block
will also serve on the sub-committee. Other members are
encouraged to attend the sub-committee as time allows. The committee
will report back to the full committee. Chairman Sali asked the members
to advise him if they hear of any rule dockets that may require the time of
the full committee.



There being no further business brought before the committee, Chairman
Sali
adjourned the meeting at 2:20 P.M.






DATE:
January 20, 2004
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 were absent
GUESTS:
Please see attached sign-in sheet.
Chairman Sali called the meeting to order at 1:35 P.M.



Dr. Erik Olsen, a member of AARP Board of Directors, gave a brief
presentation on the Medicare prescription drug bill that was passed last
year. He stated that the passage of this bill has created opportunities and
challenges for AARP, its members and volunteers, but they believe this
has opened a new era of opportunity for Medicare beneficiaries throughout
the country. Dr. Olsen elaborated on the following points: The $400
billion benefit is to be spent in the following areas — those at the lowest
end of the income scale, those with very high drug costs, employers who
might be forced to drop retiree coverage, and a basic benefit applying to
everyone. A drug discount card will be available this year which will allow
about a 15 percent savings off the retail price of prescription drugs. He
summarized by saying that AARP thinks this benefit was well worth
supporting and their goal is to make prescription drugs more affordable for
seniors and they will continue to strive for this goal. (See attached for
more detail of his presentation). Chairman Sali invited questions from the
committee.

MOTION:
Rep. Kulczyk
made a motion to approve the minutes of the January 14,
2004 meeting as submitted. On a voice vote, the motion carried.


Chariman Sali informed the Committee that they had each been given a
copy of the Catastrophic Health Care Cost Program report prepared by
Blake Hall, contract administrator for the Catastrophic Health Care Cost
Program. He encouraged the members to look through the report as it
presents some very interesting health trends.


Docket 16-0309-0215



Leslie Clement
, bureau chief of Medicaid policy, presented this docket to
the Committee. This amended docket includes amendments to the
Medicaid Case Management changes resulting from last year’s budget
holdback. The Department met with legislators and provider
representatives in order to address crisis coverage. As a result of these
meetings, this docket was amended to allow up to four hours per month of
crisis case management without department authorization, retain the four
hours of ongoing crisis management, and include another four hours for
crises if more restrictive criteria have been met. A key outcome of this
work was the development of criteria that reflects a “crisis” and clarification
of crisis case management services.



Crisis case management means “linking, coordinating, and advocacy” and
does not include crisis counseling, transportation, or skills building
provided through other channels. These rules require providers to
document crisis services and submit written justification when crisis hours
fall into the more restrictive category. This docket lengthens the interval
for service plan reviews from 120 days to 180 days. It also allows licensed
clinical professional counselors without private practice licensors and
marriage and family therapists to provide case management services.



By Unanimous Consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 16-0309-0215.



Docket 16-0309-0306



Leslie Clement
continued her presentation with this docket. This docket
restores some mental health case management hours as a result of
additional funding. This rule change reflects benefits added for mental
health case management as a result of a special Medicaid budget
appropriation for State Fiscal year 2004. With this year’s appropriation,
Medicaid has been able to restore some of the on-going case
management services that had been reduced.



With the allocation of about $148,000, the Department increased on-going
case management hours (those not requiring meeting “crisis” criteria) from
four to five hours per month. This current benefit package allows for five
hours of on-going case management, three hours of crisis case
management that doesn’t require prior authorization, and four hours of
crisis case management that requires justification and prior approval.



By Unanimous Consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 16-0309-0306.





David Rogers, administrator, Division of Medicaid, presented the
remaining dockets to the Committee. He explained that the next five
dockets all related to the implementation of the Department’s Adult
Developmental Disabilities (DD) Care Management program including
Prior Authorization of Behavioral Health Services.



Mr. Rogers asked for the permission to give the Committee a brief
summary on the remaining dockets since they are all related, and then
address each docket separately. There was no objection.



He explained that the purpose of these rules is to promote a sustainable,
integrated health care system that ensures adults with developmental
disabilities receive the right outcomes by accessing the care, in the right
place, at the right price.



Managing care improves the quality of care, controls growth in costs and
promotes consumer satisfaction through an objective assessment process
that focuses on the individuals’ needs.



The primary elements of these rules include: the use of an Independent
Assessment Provider; Improved Quality Assurance and Quality
Improvement; increased participant choice and engagement in the
development and delivery of their services.



Chairman Sali clarified to the Committee that the Behavioral Health Care
Management program as it is now called, was formerly known as the
Utilization Management Program. The House Committee had urged last
year that the Utilization Management program be postponed until
projected savings could be more clearly identified. Funding was not
explicitly provided by appropriation, but rather was to come from projected
savings. Last year the Committee had serious concerns regarding those
projections. At the urging of the Senate Health and Welfare Committee,
Utilization Management was implicitly approved by JFAC with approval of
the Department’s appropriation and the program is now in place.



Docket 16-0313-0301



Mr. Rogers
continued with his presentation by addressing Docket 16-0313-0301. This new chapter outlines the process for prior authorization
of Developmental Disability (DD) services for eligible adults. The rules
require an independent assessment of adults seeking DD services. Based
on all assessment information for the client, as well as the past three years
of Medicaid expenditures (when available), an appropriate, individualized
participant budget is negotiated for the participant that will support the
participant’s identified needs. Based on the individualized budget, and
building on the person-centered planning process, all needed services and
supports are identified. The participant may develop their own plan, or
they may choose a paid or non-paid person to serve as the plan
developer. A direct service provider cannot be a paid plan developer.



If requested services fall outside the individualized participant budget, it
can be referred to a Department care manger for additional evaluation,
review and approval as appropriate. Medicaid funded services will not be
reimbursed unless authorized by the Department.



The new chapter also outlines quality assurance and quality improvement
activities. The development of these measures will be critical as Idaho
moves toward greater self-determination for participants and the service
system is transformed into a more consumer-directed model.



During discussion of this rule, Chairman Sali put the Committee at ease.



Chairman Sali called the meeting to order at 2:50 P.M. Representative McGeachin distributed a copy of a Consumer Budget Distribution report
that she received from a constituent. This report reflects the Level of
Support linked to SIB-R scores with their corresponding budget ranges
(See attached). Questions and discussion followed relating to this report.



Committee discussion continued with the following points covered:
concern regarding budget distributions to participants based on the level of
need, the need to better monitor funds that are allotted to participants,
criteria used for assessing qualifications of independent assessment
providers, the extent the SIB-R is used as an assessment tool.



In response to questions from members, Mr Rogers commented that the
Department has worked diligently to match the participants’ needs with the
level of support received. Reports from the recent Pilot Project have been
an effective tool in monitoring the level of support compared with the level
of need. The Department tries to determine on an individual-by-individual
basis whether or not these services parallel with what was intended. He
said he would be happy to provide additional information regarding budget
distributions and any other information the Committee would desire.



Docket 16-0309-0307



Mr. Rogers
continued with his presentation. He explained that these rule
changes support the implementation of the adult Developmental Disability
(DD) care management program. These changes also clarify that the
participant’s may choose to receive or not to receive Target Service
Coordination. A participant may elect to select a non-paid plan developer
or plan monitor.

Committee discussion and questions followed. One of the main concerns
from the Committee was the language as it is currently written in Section
143.06.b.iii of the Rules Governing Medical Assistance Program is not
clear.

Jim Baugh, executive director of CO-AD (Comprehensive Advocacy,
Inc.), addressed the Committee with his concern with the interpretation of
the language to be a factor in determining eligibility versus a factor for
establishing a budget for care management. He is concerned the
participants’ eligibility would be more restrictive.

After further discussion the Committee agreed with Chairman Sali’s
proposal that the Department write a letter stating that the intent of the
changes made in this section would not affect eligibility criteria for
participants. Kathleen Allyn, deputy administrator for the Division of
Medicaid agreed to prepare the letter with an explanation that would serve
as a record, to be given to the Committee at the January 22, 2004
meeting. The letter is attached to these minutes.

Bill Benkula, president of the Idaho Association of Developmental
Disability Agencies presented his testimony regarding Docket 16-0313-0301. His agency continues to support the concept of utilization
management plan, however they maintain that it can be done more cost
effectively by professionals in the field performing the assessment process
in collaboration with the Health and Welfare personnel who authorize
services. The $2 Million expense of an independent assessment provider
is unnecessary.

Mr. Benkula remarked that the Care Management program shifts the
service authorization process from physicians to the Department and its
contracted Independent Assessment Provider. He also stated that under
the current program, the client’s access to appropriate services and
supports will change from choices, flexibility, and self-direction to simply
eligibility and the resulting program cost. Appropriate therapeutic services
and the quality of services available to the clients will be severely
challenged under this new system. He is concerned as the rules are
presently written, that too much weight is given to the SIB-R as the unit for
measuring the participant’s need with the level of support they should
receive. He gives the Department credit for their efforts in trying to come
up with a workable, effective system.

Kelly Hall, an owner and plan developer with Dunstan Hall & Associates,
addressed the Committee. She explained that the support plans they
implement are based on projected use. They may have a client who was
budgeted for a certain amount for services in a given year, but due to
vacation, illness, etc., not all of the services were used. Consequently the
budget for the next year may be less. This situation makes it very difficult
in making their projections.



Committee discussion followed with reservations regarding accepting
either of the two dockets before them, Docket 16-0313-0301 and Docket
16-0309-0307
.



Chairman Sali asked if it would be the pleasure of the Committee to
withhold action on Docket 16-0313-0301 subject to the call of the Chair.
There was no objection.



Chairman Sali asked if it would be the pleasure of the Committee to
withhold action on Docket 16-0309-0307 subject to the call of the Chair.
There was no objection.



Docket 16-0323-0301



Mr. Rogers
explained that this rule provides that the Uniform Assessment
Instrument (UAI) is not used for prior authorization of behavioral health
services. This rule change specifies that the assessment used under the
Developmental Disability (DD) program meets the requirement for a
uniform assessment necessary as condition of state payment of supported
living services.



By Unanimous Consent, the Committees’s report will reflect there was no
basis found upon which to reject Docket 16-0323-0301.



Docket 16-0411-0301



Mr. Rogers
explained that this rule aligns language with the existing rules
for Developmental Disabilities Agencies (DDA’s) with the new chapter.



By Unanimous Consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 16-0411-0301.



Docket 16-0417-0301



Mr. Rogers
explained that this rule aligns the language with existing rules

for Residential Habilitation Agencies with the new chapter.



By Unanimous Consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 16-0417-0301.





As there was no further business to be brought before the Committee,
Chairman Sali adjourned the meeting at 4:45 P.M.






DATE: January 22, 2004
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:

None
GUESTS: Please see attached sign-in sheet.
Chairman Sali called the meeting to order at 1:05 P.M.



The Chairman presented to the Committee the official letter from the
Department, previously requested by the Committee at the January 20th
meeting regarding the criteria of eligibility determination. The letter will
serve as record of clarification of the changes made in Docket 16-0309-0307, Section 143.06.b.iii of the Rules Governing Medical Assistance
Program. (The letter is attached.)



The Chairman explained to the Committee that on the Internet, a list of all
of the rules for the Health and Welfare Committee for this current year
were attached to the minutes from the January 14, 2004 meeting as an
Exhibit A. This attachment includes the web address for anyone who is
interested in seeking further information about a specific rule/rules. The
Chairman asked for consent for the Exhibit to be attached to those
minutes on the Internet, though they had already been approved by the
Committee. There was no objection.



The Chairman asked that those who wish to testify please be considerate
of the Committee by not duplicating testimony that has already been
heard.

Docket 16-0309-0311 Leslie Clement, bureau chief of Medicaid policy, presented this
temporary rule docket to the Committee. The purpose of these

rule changes was twofold: a) There was a need to reflect changes in
provider and department responsibilities as a result of staff reductions in
the Regional Mental Health Authority; and b) There was a need to clarify
service expectations and provide service definitions in response to health
& safety concerns, particularly for services provided in Partial Care
settings.

The first part of the docket identifies changes to the Pycho-Social
Rehabilitation (PSR) rules, reflecting the reduction in Regional Mental
Health staffing and resulting changes in roles and responsibilities of
Private PSR providers. The functions of assessment and service planning
have been transferred to the private PSR providers.

PSR Provider Agency personnel coming into direct contact with
participants must comply with existing statutes governing criminal history
check requirements; and, PSR agencies provide 24-hour crisis response
services for their participants or make contractual arrangements for the
provision of those services.



The changes to the mental health clinic rules and related partial care rules
were made primarily due to safety issues. Prior to these rules, “partial
care”, a –Mental Health Clinic Service– could be applied to a number of
programs. Some, including babysitting, television watching, and/or boot
camp type services. For lack of clearly articulating service expectations,
many of the safety issues have arisen in this setting.



This rule does not introduce any new federal or state requirements for
clinic except for the inclusion of building standards, which were added as
a direct result of documented cases of child endangerment due to
substandard buildings that were being used as clinics.



Ms. Clement further explained that there were a number of concerns
expressed by providers and other stakeholders after three separate public
hearings were conducted regarding the changes made in the Mental
Health Clinic section which includes Partial Care. The Department staff
have been drafting amendments that attempt to clarify requirements,
however, they have not been finalized. A meeting of interested
stakeholders will take place on February 5, 2004.



She concluded the presentation by stating that the Department is
committed to continued negotiations with stakeholders in order to produce
resulting rules that will be in compliance with applicable state and federal
laws, protect the health & safety of the recipients, be cost effective, and
will recognize resource limitations.



The Department requests that the Committee extend these temporary
rules with the Department’s assurance they will continue to work with
stakeholders on amendments that will address areas of concern.



Kelly Keele, social worker with the Mental Health Providers Association
of Idaho addressed the Committee. He briefly touched on the following
three issues: The definition of Partial Care needs to be more clearly
defined. For example, in one part of the rules the term socialization is
included for one of the services and in another area it is excluded. The
changes to the building standards are good changes and are supported
by those he represents. He proposes the current 56 hours of treatment
required per week is not necessary and should be lowered to 36 hours
per week.



April Crandall, president of Mental Health (MH) Provider’s Association of
Idaho addressed the Committee. She acknowledged that the Department
met with the Mental Health Provider Association and she complimented
them on their commitment and willingness to continue to have open,
monthly meetings with concerned groups and to continue to work on
amendments. The MH Provider’s Association recommends that this
proposed temporary rule be extended with the expectation they will be
amended following further negotiation.



Steve Myers M.D., a pediatrician in Idaho Falls spoke passionately to the
Committee regarding the need for change within Partial Care services
program. He shared several concerns that he has with PSR. Children
are in partial care programs for years without parent interventions in
place; lack of qualified PSR oversight and assessment after working with
a client for over a year; utilizing programs that are not designed to treat
the severity of the problems of children; lack of communication with the
doctor who is designated the “Team Leader”.



He further explained that policy and procedures should not be created
from the top down, but from the bottom up. Those responsible need to be
able to explain why outcome goals are not being met. He stated that the
system is fragmented.



He recommends the following; develop a state oversight system to review
treatment plans and account for outcomes not being met; make parent
participation a MUST and give parents mental health access services if
needed; provide day care if needed but do not squander limited partial
care resources for day care activities.



Tammie Bradley, a social worker from Blackfoot, Idaho, addressed the
Committee. She stated that she is in favor of the proposed rules but
believes that several changes need to occur within the scope of the
language in order for mental health services to be effective.



Matthew Smith, program director Mental Health Clinic in Idaho Falls
addressed the Committee. He stated that this is generally a good rule,
but changes still need to be made. He recommends that there be
additional stringent outcome and accountability measures for private
providers. This will allow the state to expend its resources more
effectively. He also recommends that a licensure system be set up for
partial care programs.



Ms. Clement was asked to yield to the Committee’s question regarding
the issue of allowing paraprofessionals to perform therapeutic services,
even with the recommended professional supervision. The Department is
not in favor of taking this approach. They believe it loosens the
qualifications. The Department’s philosophy has been to increase the
qualifications and standards.



Committee discussion continued regarding options of acting on this rule.

MOTION: Representative McGeachin made a Motion that the Committee delay
action on this Docket 16-0309-0311 subject to the pleasure of the Chair
to a time after the February 5, 2004 meeting. There was discussion on
the motion.
SUBSTITUTE
MOTION:
Representative Mitchell made a Substitute Motion that the Committee
vote to accept Docket 16-0309-0311. There was discussion on the
Motion.
AMENDED
SUBSTITUTE
MOTION:
Representative Kulczyk made an Amended Substitute Motion that the
Committee’s report to the Speaker will reflect that no reason was found to
reject Docket 16-0309-0311. There was discussion on the Motion.



Michelle McMullen from the Office of Administrative Rules yielded to
questions and explained that a temporary rule cannot be amended. The
Committee can find no reason to reject the rule, or the Committee can
reject the rule, but the Committee cannot make changes to the text of the
rule. If a temporary rule is held, the Committee should act on it before the
end of the legislative session.



Discussion continued on the Motions before them.

ROLL CALL
VOTE:
On a roll call vote, the AMENDED SUBSTITUTE MOTION failed.
Representatives Kulczyk, Henbest, Martinez, Mitchell
voted AYE.
Representatives Block, Garrett, Eberle
, Ring, McGeachin, Nielsen
voted NAY.



After discussion, Representative Mitchell withdrew his SUBSTITUTE
MOTION.

ROLL CALL
VOTE:
On a roll call vote the Original MOTION by Representative McGeachin
for the Committee to delay action on this Docket 16-0309-0311 subject to
the pleasure of the Chair to a time after the meeting February 5, 2004.
The Motion passed by a unanimous vote.
Docket 16-0309-0303 Shawna Kittridge, pharmacy services supervisor for the Division of
Medicaid, presented this pending rule to the Committee. She explained
that the goal of the Medicaid Pharmacy program is to provide quality care
to Medicaid participants with the most effective drug at the right price.
This rule change promotes the health and safety of Medicaid participants
by assuring that objective research plays a primary role in our prescription
drug program. This rule supports evidence-based information which
allows the Department to make prior authorization and other program
related decisions based on good science. Idaho Medicaid has joined with
other states and countries to obtain current evidence-based drug class
reviews from the Center of Evidence-based Policy at OHSU.



The Therapeutics Committee and the Medicaid Pharmacy work together.
The Committee makes recommendations to the Department regarding the
Enhanced Prior Authorization Program.



Additionally, in an effort to obtain the right price for medications paid for
by Idaho Medicaid, this rule adds guidelines for a supplemental rebate
program which allows the Department to purchase prescription drugs in a
cost-effective manner. Supplemental rebates will be received in addition
to rebates Medicaid currently receives. Supplemental rebates allow for
price competition to occur after a thorough scientific (evidence-based)
review.



John Santa, M.D., Assistant professor, Oregon Health and Sciences
University who supports the Evidence-Based approach addressed the
Committee about the Drug Effectiveness Review Project in Oregon (see
attached materials). This project provides Idaho and other participating
organizations with the most current, comprehensive, rigorous review of
evidence regarding the comparative effectiveness and safety of selected
prescription drugs. It does so in a way that is independent, scientific, and
objective enabling local decision makers to evaluate all of their decision
options.



This project is a collaboration of private and public purchasers, like Idaho,
who think it best to do this information gathering step together. Each
participant, including Idaho, has a vote in selecting the drugs to be
reviewed and identifying the key questions regarding these drugs. The
project will be guided throughout by local decision makers with input from
stakeholders in their state or organization.



The Center for Evidence-based Policy (described in the attached
materials) provides support to the project by facilitating the collaboration,
including contracting with Evidence-based practice centers to review and
report on the drugs and key questions identified. He shared an example
in support of this process regarding the effectiveness of different drugs
(see ACP Journal Club, Jan. ’04 attached).



Dr. Santa provided a more detailed paper summarizing the key elements
of systematic reviews (see attached). He invited questions from the
Committee.



Ted Epperle, M.D., physician and physicians’ trainer, addressed the
Committee in support of the rule. Dr. Epperle believes that this program is
cost-effective and provides a mechanism to insure safety and
effectiveness for patients. He explained that the program is data-driven,
evidence-based, and chooses the best practice. This is a system that
educates and also provides feedback for physicians. He said that this
does not take away from the primacy of the doctor/patient relationship. If
the decision by the Department is not in agreement with the patient or
doctor, then they have the option of choosing another alternative at their
cost. He invited questions from the Committee.



Jim Alexander, pharmacist, spoke in support of this rule. He explained
that this program is cost-effective because it creates the opportunity to
derive information from scientific data instead of relying on advertisers
and prescription drug salesmen. He invited questions from the
Committee.



Bill Roden, representing PHRMA –the trade association for research
based pharmaceutical companies in the U.S. addressed the Committee.

He explained that since last year, the Department has made significant
strides to open the process of communication for all stakeholders,
particularly through the efforts of the new Medicaid director, David
Rogers. He confirmed that the industry still believes that the Department
is headed in the wrong direction through the implementation of a Prior
Authorization system linked to Supplemental Rebates. He does
appreciate that there has been a significant improvement in
communication through the efforts of Mr. Rogers.



Mr. Roden summarized the problems as follows: a) there is no statutory
authority for implementation of supplemental rebate programs in Idaho;

b) cost effectiveness of such a program may not be great, because the
rebates will offset against state expenditures, with a resulting loss of
federal funds since the rebates will not qualify for federal fund match;

c) the rule authorizes the Department to utilize the services of a third party
to negotiate supplemental rebates. The designated third party is also a
commercial provider of health insurance containing drug benefits. He
believes this is a conflict of interest; d) Because of the definition of
“therapeutic interchangeability” in another portion of the rule, cost is not a
factor that can be considered by the P&T Committee in making its
recommendations to the Department for PDL purposes. He said that
PHRMA believes that any rule that allows the Department rather than the
prescribing physician to make the final decision as to the medication to be
prescribed is not in the best interests of the patient. He invited questions
from the Committee.



Rick Sutton, pharmacist for Shopko, Boise, addressed the Committee in
support of the rule and stated that he always has been in support of the
Prior Authorization program. He explained the process undertaken
during Pharmacy & Therapeutic Committee meetings is extensive and
thorough. The members are comprised of physicians, professionals,
pharmaceutical representation and the public. He shared that the Smart
System (computer program/Medicaid) is very effective in retrieving
necessary patient information for the pharmacists and provides data in
seconds. He invited questions from the Committee.



Clyde Dailey, State director for AARP of Idaho spoke on behalf of AARP.
He briefly stated that AARP endorses the invaluable work the P&T
Committee has accomplished and feels the promise of future work of the
P&T Committee can only strengthen the analysis of the drugs in the
market place.



Representative Garrett addressed the Committee with her remarks
regarding this rule. She believes that the P&T Committee is appropriate
for the purpose of obtaining and reviewing the best possible evidence and
making sound, clinical decisions about the effectiveness of medications
for patients. She stated she still has concerns on Evidence-Based
research for very new drugs. She also stated that this is a very new
process but believes that this is what needs to happen to move to the next
level.



Rep. Garrett distributed a copy of letter dated January 8, 2004,
addressed to Governor Kempthorne from Karl Kurtz, Director, Health and
Welfare, which provides an update on the Medicaid Enhanced Prior
Authorization Program for prescription medications (see attachment a);
Also attached is memo dated January 22, 2004, from Jeanne
Goodenough, Chief, Human Resources, Office of the Attorney General to
the Department of Health and Welfare (see attachment b); Also attached
is a chart illustrating the route that a pharmaceutical drug takes from the
initial response of the pharmacy through approval/disapproval and on to
the patient (see attachment c).



Committee discussion followed.



Chairman Sali suggested the Committee could vote to approve Docket
16-0309-0303
and allow the process to continue to improve the program.
The Committee continued with discussion.



By Unanimous Consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 16-0309-0303.




Docket 16-0501-0301


Gary Payne, Department of Health and Welfare, addressed the
Committee. He gave an overview of the remaining two dockets: Docket
16-0501-0301
and Docket 16-0501-0302. He said that these rules
replace a lengthy, confusing and outdated set of confidentiality rules.
With the advent of the Health Insurance Portability and Accountability
ACT, HIPPA, they took the opportunity to simplify and shorten the
Department’s rules. He explained the following concepts related to the
rules: 1) confidential information can be used within the Department
across programs on a need-to-know and minimally necessary basis. 2) if
information is requested to be provided to someone outside the
Department, an authorization is required from the individual who is the
subject of the record; 3) the rules clearly define the rights of the individual
to access his own records, restrict their disclosure, and the limited
circumstances when the individual may not have access to them.



By Unanimous Consent, the Committee’s report will reflect there was no
basis to object Docket 16-0501-0301.

Docket 16-0501-0302 Gary Payne included testimony for this docket within the scope of the
previous Docket 16-0501-0301.



By Unanimous Consent, the Committee’s report will reflect there was no
basis found upon which to object Docket 16-0501-0302.

ADJOURN: As there was no further business to be brought before the Committee,
Chairman Sali adjourned the meeting at 5:15 P.M.






DATE: January 26, 2004
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. Nielsen
GUESTS: See attached list
Chairman Sali called the meeting to order at 1:35 P.M.



There was discussion on the minutes. The Chairman put the Committee
at ease.



Chairman Sali announced that due to computer difficulties, the prepared
minutes were not correct and corrected minutes for meetings of January
20, and 22 will be brought before the Committee for approval at the next
meeting on January 28.

RS 13452 Rayola Jacobsen, Bureau Chief of the Occupational License Bureau
presented this RS to the Committee. This bill adds language that will
make a violation of the rules of the Board of Psychologist Examiners
grounds for a disciplinary action against a licensee.
MOTION: Rep. Ring moved to send RS 13452 to Print. On a voice vote the motion
carried.
RS 13483 Rayola Jacobsen presented this RS to the Committee. She explained
that the intent of this RS is to correct terminology, provide references to
pastoral counselors, and allow the Idaho State Licensing Board to adopt
rules requiring annual continuing education as a condition for renewal of
licenses; amend Idaho Code to delete certain continuing education
requirements for pastoral counselors; to delete language referring to the
meaning of “licensed pastoral counselor” and “licensed professional
counselor” make a grammatical change; and amend Idaho Code to
revise terminology and delete certain continuing education requirements
for marriage and family therapists. There were a number of questions
from the members.
MOTION: Rep. Martinez made a motion to send RS 13483 to Print. On a voice
vote the motion carried.
RS 13467 Rayola Jacobsen presented this RS to the Committee. This bill
increases the number of members of the Board of Social Work
Examiners by one lay member and revises the nomination process.



Roger Hales, attorney for the Bureau of Occupational Licenses, stated
that the intent of this bill is to give a good representation by having a
public member and the legislation is not an effort to broaden the
spectrum of input.

MOTION: Rep. Ring made a motion to send RS 13467 to Print. On a voice vote
the motion carried.
RS 13468C1 Rayola Jacobsen presented the RS to the Committee. This bill clarifies
that the application fee includes the original license fee. It is not a new
fee. Questions from the Committee followed with concern that the
language is still not clear as to the real intent of the bill.



Chairman Sali asked for unanimous consent to return RS 13468C1 to
the sponsor for further clarification. There was no objection.

Docket 27-0101-0205 Richard Markuson, Executive Director of the Idaho Board of Pharmacy
presented this pending rule. He explained that this rule recognizes
revised controlled substance prescription forms authorized by House Bill
No. 331 in the 2001 legislative session, as well as Senate Bill No. 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.



Mr. Markuson responded to a question from the Committee regarding
filing prescriptions electronically. He said that there are electronic
systems already in place in some health care facilities. Chairman Sali
asked that he share with the Pharmacy Board the interest this Committee
has in establishing electronic prescription filing process.



By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 27-0101-0205.

Docket 27-0101-0302 Richard Markuson presented this pending fee rule. Mr. Markuson
explained that the FDA is in the process of working on legislation that will
ban all use of ephedrine products in the next three to four months.
However, he believes passage of this rule is necessary as a safeguard in
the interim. He explained that this rule treats “preparations containing
ephedrine or salts of ephedrine” as prescription drugs. The proposed
rule sets out specific criteria for ephedrine products that can be sold
without prescription. These criteria include maximum dosage
requirements and label disclosure and warnings. 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. The fee charged under this rule is necessary to
fund testing of these products to ensure compliance with the
requirements of the rule.



By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 27-0101-0302.

Docket 27-0101-0303 Richard Markuson presented this pending rule. He explained that this
rule allows the return and use of unopened and unused drugs and makes
a technical correction. This change responds to House Concurrent
Resolution No. 17 directing the Board of Pharmacy and the Department
to develop necessary statutory and rule changes to allow the return and
use of unopened and unused drugs. He further explained that the
integrity of the product is left up to the pharmacy. The product travels
from the pharmacy to the facility and the unchanged product (unopened,
in its original packaging) is returned back to the pharmacy.



Michelle Glascow, Director of the Idaho Assisted Living Association,
spoke in support of this rule. She explained work is being done with the
help of the Department, in developing a reimbursement plan which will
provide the incentive for participation that will allow dollars to be returned
to the state.



By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 27-0101-0303.

Docket 27-0101-0304 Richard Markuson presented this rule to the Committee. Mr. Markuson
explained that this rule change expands the list of acceptable pharmacy
references which are part of the required library in each pharmacy. This
change is necessary to implement an expanded list of acceptable
pharmacy references and electronic data sources now recognized by the
Board of Pharmacy. This is a ‘housekeeping’ bill.



By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 27-0101-0304.

Docket 16-0309-0309 Paul Leary, Program Manager for Medicaid Policy addressed the
Committee. He explained that the purpose of this rule is to support the
Department’s commitment to providing both the right price for services
and the right services for participants. Additionally, the Department
wants the rules that govern their services to be clear to all stakeholders.
This docket includes two different Sections of the Medical Assistance
rules, Section 121 and Section 146.



Within the first section, Idaho Medicaid has used the same
reimbursement methodology as Medicare for Ambulatory Surgical
Center. Medicare has recently changed their methodology for
reimbursing these facilities and this change is not compatible with Idaho
Medicaid’s automated system. The Department will continue to use the
historic reimbursement methodology instead of the new Medicare
methodology.



The second section of the rule deals with Personal Care Services.
Section 146 of the Medical Assistance rules, was deleted completely and
the entire section was reorganized and rewritten in plain language based
on ongoing input of staff and providers. In response to public comment a
new subsection was added to permit agencies to use a software system
allowing personal assistants to register their start and stop times and
maintain a list of services they provide by placing a telephone call to the
agency system from the participant’s home. This does not replace the
documentation requirements of these rules. Mr. Leary asked the
Committee to adopt this pending rule as final.



By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 16-0309-0309.

Docket 16-0612-0301 Terri Meyer, Deputy Administer of the Division of Welfare addressed the
Committee. She explained that access to affordable child care is a
critically needed support for families transitioning to and maintaining
employment. The Child Care program provides assistance for about
10,000 children of low income working families. This change allows us to
meet last year’s budgetary reduction, without reducing the coverage
group. It results in a 6% per child increase in the family’s co-payment, or
an average of $23 per child per month.



Geni Weppner, Program Manager for the Division of Welfare yielded to
a question from Rep. Martinez who asked her about a constituent’s
concern regarding late payments made by the Department to providers
of the Idaho Child Care Program. Mrs. Weppner responded by stating
that the Department has acknowledged that there is a problem.



By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 16-0612-0301.

Docket 16-0311-0101 Debby Ransom, Bureau Chief of Facility Standards, presented this
temporary rule. She explained that this rule sets a cap on beds in
community intermediate care facilities for persons with mental retardation
at 486 beds. Of that 486, with 12 beds reserved for time-limited
emergency use. She stated that the Department is before the
Committee requesting extension of the ICF/MR bed cap for another year.



She further explained that the Department consulted with the Idaho
Association of Community Options and Resources, the ICF/MR
association, and there is no objection to this request from the
association, and she is not aware of concerns from any other group.



By unanimous consent, the Committee’s report will reflect there was
no basis found upon which to reject Docket 16-0311-0101.

ADJOURN: As there was no further business to be brought before the Committee,
Chairman Sali adjourned the meeting at 3:40 P.M.






DATE: January 26, 2004
TIME: 8:30 a.m.
PLACE: Room 406
MEMBERS: Chairman Garrett, Representatives Kulczyk, Block, and Martinez
GUESTS: See attached list

The Chairman called the meeting to order at 8:37 a.m. with a quorum present.



15-0230-0301 Business Enterprise Program – Retirement

Ms. Lisa Van Ry spoke to the Committee regarding this rule. A copy of her testimony is
attached. She noted that the provisions of the previous rule was unenforceable. This rule will
rectify that problem. In addition, this rule allows vendors for the Business Enterprise Program
the option of choosing their own investment broker.



MOTION: Rep. KULCZYK moved that the Sub-Committee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.



15-0230-0302 Business Enterprise Program – Allowable cost
manual

Ms. Lisa Van Ry spoke to the Committee regarding this rule. A copy of her testimony is
attached. She said that it provides clearer guidelines which will be fairer to all concerned.



MOTION: Rep. MARTINEZ moved that the Sub-Committee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.



16-0203-0401 Emergency Medical Services – Added new EMT-I
designation

Ms. Dia Gainor, Emergency Medical Services Bureau Chief, Division of Health, spoke to the
Committee about this rule. A copy of her testimony is attached. She said that two separate
entities had been given the opportunity to comment on this rule: a state advisory Committee
which was already wrestling with the issues included in this rule, and an EMT task force.



Mr. Dick Schultz also spoke to the Committee regarding this rule. He said that it arose because
of a dispute between a city and a county in the state regarding an EMS application. One entity
approved, the other did not. The state really had no say in the matter. This rule allows the local
authority the ultimate decision-making ability.



MOTION: Rep. KULCZYK moved that the Sub-Committee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.









16-0210-0401 Idaho Reportable Diseases – SARS and West Nile
Virus added to list

Dr. Chris Carter, speaking on behalf of Dr. Christine Hahn, spoke to the Committee regarding
this rule. She said that it includes the SARS and West Nile viruses in the list of diseases which
are to be reported and it lists measures to be taken if and when those diseases are found to be
present. It enhances prevention and control of the spread of these diseases in Idaho.



MOTION: Rep. KULCZYK moved that the Sub-Committee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.



16-0214-0301 Public Swimming Pools – Permit fees & authority code -Repeals
chapter and moves swimming pool rules into 16.05.05
16-0505-0301 Fees for Operation Permits, Licenses & Inspection Services – repeal
of chapter

Ms. Elke Shaw-Tulloch, Bureau Chief of the Department of Health and Welfare, spoke to the
Committee regarding these rules. She explained there is no new language; it is simply a
housekeeping measure. There is no new policy proposed; language is simply moved from one
section to another for the sake of clarity. Any fees included in this rule are the same as before.



MOTION: Rep. MARTINEZ moved that the Sub-Committee inform the full Committee
that they have found no reason to reject 16-0214-0301. Motion carried by
voice vote.



MOTION: Rep. KULCZYK moved that the Sub-Committee inform the full Committee
that they have found no reason to reject 16-0505-0301. Motion carried by
voice vote.



16-0301-0201 Medicaid Eligibility/Provision to count TAFI income consistently
when determining Medicaid eligibility

Ms. Terri Meyer, deputy Administrator, Department of Health and Welfare, spoke to the
Committee regarding this rule. She said that small increases in previous allowances had
caused some families to lose their eligibility for Medicaid. This rule remedies that situation.
Many families are so close to the cutoff amounts that even these very small increases cause
great hardship. There are some technical clarifications to ease understanding and
communication.



In answer to a question from the Committee regarding “disqualified parents”, she noted that in
certain cases where a parent refuses to cooperate with the Department, they can be disqualified
for Medicaid eligibility. The parent is disqualified, but not the child.



She reiterated that there are no new standards being imposed. There is new language which
clarifies the Department’s position. There is no change in policy.



Ms. Joyce McRoberts, Deputy Director of the Department of Health and Welfare, said that the
Department had begun a serious attempt to phrase the rules in plain language to make it easier
to use by administrators and clients.



Ms. Beverly Barr, an employee with the Department, said that the overall guideline for the
Department was to make the language clear and understandable. In many cases, employees
had been following certain procedures to improve efficiency and clarity, and this rule simply
employs those existing standards.






MOTION: Rep. KULCZYK moved that the Sub-Committee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.



16-0301-0301 Medicaid Eligibility/Aligns citizenship requirements with federal
regulations

Ms. Terri Meyer, deputy Administrator, Department of Health and Welfare, spoke to the
Committee regarding this rule. She said that previous federal legislation had severely restricted
access to Medicaid by legal immigrants. Another set of federal legislation removed these
restrictions. This rule simply implements these last requirements into practice. She noted that
legal immigrants must qualify for Medicaid eligibility according to existing requirements. She
noted that there are a very small number of people who will be affected by this rule change.



MOTION: Rep. KULCZYK moved that the Sub-Committee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.



16-0301-0302 Medicaid Eligibility/Aligns SSN with federal regulations; clarifies
countable income for eligibility

Ms. Terri Meyer, deputy Administrator, Department of Health and Welfare, spoke to the
Committee regarding this rule. She explained that part of the rule was written so that certain
information could be transferred electronically, and thereby produce a cost savings by the
Department. However, she noted that part of the rule adversely impacts over 200 children in
the CHIPS program, and she recommended that the Committee reject this portion of the rule
(sections 346-349).



She noted that annual reviews of client cases save the Department time and money. However,
the Department feels that a 6-month review is adequate to accurately determine eligibility of all
its participants in the Medicaid program. She believes that a six-month review period will
address the seasonal workers better. She noted that these reviews are done locally, rather
than at the state level. She also believes that tracking by social security numbers will help
ensure accuracy.



Greg Kunz, acting division administrator of the Department of Health and Welfare, said that the
Department has a good system of verifying eligibility. The Department is doing its very best to
streamline the entire process, including the language in the rule. He noted that using
technology to help this process will cut down on time and will produce savings.



MOTION: Rep. BLOCK moved that the Sub-Committee inform the full Committee
that they have found no reason to reject section 214 of this rule, but they
urge that sections 346-349 of this rule be rejected. Motion carried by voice
vote.



16-0303-0301 Child Support Services

Ms. Terri Meyer, deputy Administrator, Department of Health and Welfare, spoke to the
Committee regarding this rule. She said that this rule will help children obtain coverage under a
parent’s insurance as a part of child support.



MOTION: Rep. MARTINEZ moved that the Sub-Committee inform the full
Committee that they have found no reason to reject this rule. Motion
carried by voice vote.



16-0304-0202 Food Stamps-Aligns rules with federal regulations & with
provisions in Title IV of the federal Farm Bill

Ms. Terri Meyer, deputy Administrator, Department of Health and Welfare, spoke to the
Committee regarding this rule. She noted that it deals with recipients of food stamps, most of
whom are the elderly or are children. She noted that the number of people seeking food stamp
assistance in the state had exploded in recent years as a result of changes in the economy.
This rule was written to follow federal guidelines. She noted that it particularly dealt with
changes to benefits for the disabled and for large families.



Mr. John Wheeler, acting food stamp manager, spoke in support of the rule.



A member of the Committee noted that the huge increase in people seeking assistance should
be a sobering reminder that Idaho’s citizens have been severely hurt by the latest downturn in
the economy.



MOTION: Rep. KULCZYK moved that the Sub-Committee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.



16-0304-0301 Food Stamps-Aligns rules with federal regulations with
provisions in Title IV of the federal Farm Bill

Ms. Terri Meyer, deputy Administrator, Department of Health and Welfare, spoke to the
Committee regarding this rule. She noted that it deals with online verification of eligibility by use
of the social security number. It also includes language which abolishes the stricter
requirements on legal immigrants, and streamlines overall language for clarity. She said that it
is a prelude to legislation to be introduced next year which will provide some internal
housekeeping.



A member of the Committee commended the Department in its attempt to simplify very complex
requirements and regulations.



MOTION: Rep. BLOCK moved that the Sub-Committee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.



The meeting adjourned at 10:04 a.m.






DATE: January 28, 2004
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 were absent
GUESTS: See attached sign-in sheet
Chairman Sali called the meeting to order at 1:35 P.M.



The Chairman reminded the Committee that three sets of minutes were
before them for approval. The minutes were for the meetings of January
20, 22 and 26.



Rep. Henbest questioned testimony as it was recorded for Dr. Meyer in
the minutes prepared for January 22nd. Rep. Garrett requested that the
letter to Governor Dirk Kempthorne from Health and Welfare Department
Director, Karl Kurtz, supporting Docket 16-0309-0303 (establishing P&T
committees) be entered in the minutes as an attachment. She also
asked that hand-outs she had prepared for the prior authorization
process be attached as well.



Rep. Martinez inquired about the meeting of the Psycho-Social Rehab
work group that the Department is planning to hold on February 5, 2004
in reference to Docket 16-0309-0311. Chairman Sali asked Kathleen
Allyn, Administrator, Medicaid Division, if she would ask Leslie Clement
to send a letter indicating the groups who do attend that meeting. She
agreed.

MOTION: Rep. Nielsen moved that the minutes of January 20, 2004 be approved
as written.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
MOTION: Rep. Ring moved that the minutes of January 26, 2004 be approved as
written.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Teri Ottens, Director of Community Action Partnership Association of
Idaho, addressed the Committee. She gave an overview of the program.
She explained that the Community Action Partnership Association of
Idaho is an association of Idaho’s six Community Action Partnerships,
the Idaho Migrant Council and Canyon County Organization on Aging,
Weatherization and Human Services, all dedicated to promoting self-sufficiency through removing the causes and conditions of poverty in
Idaho’s communities. In Idaho 11.8% of our population lives at or below
poverty levels and an additional 11% are what are called the working
poor – working but not making enough money to pay even the most basic
of their living expenses.



Programs provided by CAPs include: employment preparation and
dispatch, education assistance, child care, emergency food, senior
independence and support, clothing, home weatherization, affordable
housing, health care access, and much more. The existence of local
boards allows CAP’s to identify and develop programs to address the
needs of the low income in each community. It also allows them to
respond quickly to abrupt changes in those needs.



Community Action also mobilizes its partnerships into increased funding
for its programs. For every one Community Service Block Grant dollar,
another $7 are mobilized in monetary and in-kind resources through
private and public resources. Total state Community Service Block
Grant monies total $3.3 Million.

Chairman Sali yielded the gavel to Vice Chairman Block.
RS 13668 Rep. Garrett addressed the Committee. She explained that this bill
would add language to the Idaho Code which would give patients who
are subject to involuntary commitment the right to contact and
communicate with representatives of the state protection and advocacy
(P&A) system. This agency is designated by the governor under federal
law to receive federal funds for the purpose of protecting the rights of
people with disabilities. The P&A system must have authority to
communicate with people who reside in treatment facilities to investigate
allegations of abuse, neglect, and other rights violations. This bill
clarifies in state law the rights that people involuntarily committed to the
custody of the state have to communicate with representatives of the
Idaho P&A. This bill also clarifies that the person’s right to communicate
with their attorney includes the right to communicate with employees of
their attorney’s firm. There is no Fiscal Impact to this legislation.



Jim Baugh, Executive Director of Co-Ad, Inc, responded to a question
from the Committee regarding how his agency was funded.



Vice Chairman Block yielded the gavel to Chairman Sali.

MOTION: Rep. Martinez moved to send RS 13688 to Print.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Docket 22-0103-0301 Nancy Kerr, Executive Director of the Idaho State Board of Medicine,
addressed the Committee regarding this pending fee rule. A public
hearing was held in November 2003 and changes were made to the
proposed rule. She explained that following three points of the rule: a.)
the rule revises and updates the scope of practice definitions and
provides clear requirements for the delegation of patient services by a
supervising physician and provides method for requesting the approval of
special procedures; b.) the rule provides for patient safety by limiting the
numbers of physician extenders that a physician may safely supervise
and provides for required review of education, training, and experience of
each physician assistant assigned; c.) this rule provides housekeeping
and grammar changes.



By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 22-0103-0301.

Docket 22-0104-0301 Nancy Kerr addressed the Committee regarding this pending fee rule.
Notification had been provided to every licensee of the Board of Medicine
newsletter in the summer of 2003. Negotiated rule processes for the
Athletic Trainers and Physician’s Assistants had highlighted needed
changes to these rules.



Ms. Kerr explained that the purpose of the rule is for the following: a.) to
update the rules for supervising physicians as required by changes to the
PA rules and to add the requirement for directing physicians as required
by the changes to athletic trainer’s act and rules. b.) to provide for
patient safety by limiting the numbers of physician extenders that a
physician may safely supervise and provide for required review of
education, training, and experience of each physician assistant assigned;
c.) to define the fee range for the registration of directing physicians; d.)
to clarify the responsibility of supervising and directing physicians, direct
complaints to the appropriate licensing board and limit scope of practice
to that of supervising physicians.



By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 22-0104-0301.

Docket 22-0110-0301 Nancy Kerr addressed the Committee. She explained that the pending
rules before the House are the result of negotiated rule-making process
with the chiropractic physicians association, athletic trainers association
and physical therapist association representatives. Licensees of the
Board were notified of the rule making process in the summer 2003
newsletter.



The purpose of this rule is to update the rules for athletic trainers to
reflect changes of House Bill No. 199 from the 2003 session. The rule
provides for a more formal relationship with the directing physician to be
defined by the Athletics Trainers’ service plan and protocol. It also
defines the duties and responsibilities of the directing physician, clarifies
the licensing types, allows for two-year renewal, and clarifies the renewal
process including continuing education requirements. This rule clarifies
appointment and responsibilities of the Board of athletic trainers, and
designates that a contact person for the Board of chiropractic physicians
be assigned; and clarifies the complaint process as it relates to the
directing physician and the athletic trainer.



By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 22-0110-0301.

Docket 22-0111-0301 Nancy Kerr addressed the Committee regarding this pending fee rule.
She explained that these rules are the result of negotiated rule-making
process with the Polysomnographer’s Association and Respiratory
Therapist Association representatives. Licenses of the Board were
notified of the rule making process in the summer 2003 newsletter.



Ms. Kerr further explained the purpose of the rules as follows: a.) to
update the rules for respiratory therapists to reflect changes of Senate
Bill No. 1165 from the 2003 session; b.) to provide addition of
polysomnographer permit types and related terminology definitions; c.)
to permit requirements and grounds for discipline for permitted
polysomnographers; d.) to clarify appointment and responsibilities for the
Board of respiratory therapists; e.) to provide for two-year licensure
renewal process; f.) to provide a uniform ground for refusal to issue or
renew a license or permit and suspension and revocation of license or
permit.



By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 22-0111-0301.

Docket-0309-0213 Kathleen Allyn, Deputy Administrator for the Division of Medicaid,
addressed the Committee. She explained that this rule implements a
previous state statutory change and subsequent court ruling on state-funded abortions for low-income women. This same rule was presented
last year as a temporary rule and the Committee voted to extend it.



Ms. Allyn 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 and ruled that the state law requirement to have
two physicians certify the necessity of an abortion violated federal law
and could not be enforced by the state (effective July 1, 2002).



Ms. Allyn further explained that this rule implements both the statutory
amendment and court decision by: 1) removing state payment for
abortions to save the health of the mother; 2) changing the two physician
certification requirements to certification by one physician. Questions
from the Committee followed.



By unanimous consent, the Committee’s report will reflect there was no
basis found upon which to reject Docket 16-0309-0213.

Docket 16-0219-0301 Dick Shultz, Administrator, Division of Health, addressed the
Committee. He explained that this Docket contains the current food
regulations, therefore, he would like to consider the new regulations in
Docket 16-0219-0302 before reviewing the old rules.
Docket 16-0219-0302 Mr. Shultz proceeded to present this rule to the Committee. He began
by stating that the last time these rules were updated in the state of
Idaho was 1998. Our Attorney General recommended that the
“interpretations” of the Food Protection Program be incorporated into
rule. A Food Advisor Committee met last year and adopted the federal
Food Code as referenced in these rules. He further explained that three
public hearings were held in Boise, Pocatello and Coeur d’ Alene and out
of those hearings, there were three areas of concern that have already
been addressed. (See Attachment A).



Mr. Shultz listed the ten substantive changes in the proposed new Idaho
Food Code and how they are distinguished from the existing Unicode.
He responded to Chairman Sali’s request that he would provide this
same list to the Committee. (See Attachment B).



Mr. Shultz further explained that Senate Bill 1215 has passed the
Senate House and Welfare Committee which exempts jails and
correctional facilities from the food rules. The Idaho Assisted Living
Association has expressed concern over certain aspects of the rules.

Questions and discussion followed. Among some of the points of
concern shared was the requirement placed on churches, bed and
breakfasts, mom and pop grocery stores, and day care facilities.

Patrick Guzzle yielded to the Committee for clarification of how these
particular facilities will be affected.



A member from the Committee questioned the language under Section
001, .04, f. Title, Scope and Applicability
, pg. 27 regarding the usage
of the words or/no. The Committee and Department believed it
reasonable to assume that the error in the wording was a typographical
error.



Chairman Sali yielded to Dennis Stevenson, Administrator, Office of
Rules Administration for his opinion of how to correct the typographical
error. After further discussion, Mr. Stevenson stated that he would
research proper procedures for this kind of correction and report back to
the Committee.



Michelle Glascow, Executive Director Idaho Assisted Living Association,
addressed the Committee. She stated that the Idaho Assisted Living
Association would like to express its concerns with the replacement of
the Idaho Unicode with the FDA 2001 Food Safety Code. She explained
that as with the correctional facilities, through an oversight, her industry
was not involved in the development and they are scrambling to come to
an agreement with Health and Welfare on ways to adapt these rules to
the Assisted Living Industry needs.



She further explained that smaller assisted living residences have unique
needs compared to larger industry food entities with large kitchens, chefs
and dieticians on staff. She said that they are convinced that they need
more time and she and her association are concerned that during the
interim, facilities may be exposed to unfair survey deficiencies, unfair
suspensions and litigation because of the facilities’ inability to meet the
requirement of this rule that really do not apply easily to some assisted
living providers. (Please see Attachment C for more detail of testimony).



Committee discussion followed. One of the main points of discussion
was the consideration of holding this rule until some of the problem
issues can be worked out.



Mr. Shultz yielded to this question by saying that since the Senate
approved this rule and if the House were to hold it until next year, then
those groups that have already gone forward with the program will be put
in jeopardy. He answered a question by saying that this rule will go into
effect upon adjournment of this legislative session.



Michael Kane, attorney, representing the County Sheriffs Association,
addressed the Committee regarding the concerns he has pertaining to
this rule. He commented that in order to meet the requirements, most
food groups will have the financial burden of increasing staff, and that the
added cost of these changes will be too burdensome on the correctional
institutions and the agency he represents. He explained that there is
legislation coming forth that will exempt the county jails as well as the
Department of Corrections and Juvenile Corrections. He does not
oppose this rule, as long as the forth coming legislation is passed.



Mr. Kane yielded to a question from Rep. Kulczyk by saying that the
county jails are overseen by the Health Districts.



Rep. Kulczyk commented that he does not think that the same rules
should apply to restaurants and public food service establishments as

apply to nursing homes and jails.



Chairman Sali expressed his concern regarding staffing issues, the
fiscal impact to the Medicaid budget as well as private business.



Rep. Garrett recommended that a task force be put together for further
discussion and return to the full Committee with a recommendation of
how to proceed.



Chairman Sali directed Vice Chairman Block to chair a subcommittee
regarding this Docket 16-0219-0302. Rep. Nielsen, Rep. McGeachin,
Rep. Kulczyk, and Rep. Henbest will serve on that subcommittee.

ADJOURN: As there was no further business to be brought before the Committee,
Chairman Sali adjourned the meeting at 4:40 P.M.






DATE: January 29, 2004
TIME: 3:30 p.m.
PLACE: Room 406
MEMBERS: Chairman Garrett, Representatives Block, Kulczyk, Martinez, and Mitchell
ABSENT/

EXCUSED:

Representative Martinez
GUESTS: See attached list
Chairman Garrett called the meeting to order at 3:37 p.m. with a quorum
present
MINUTES: Rep. Kulczyk moved that the minutes of January 26, 2004 be approved.
Motion carried by voice vote.
RULE:

15-0120-0301

Operation & Services Provided by Area on Aging

Ms. Sarah Scott spoke to the Committee regarding this rule. She stated
that this rule has only one change. These rules apply to agencies, not
contractors. Area agencies will follow the Federal rules. The intent is to
clean up the rules, get rid of excess and avoid duplication of The Older
Americans Act. The rules have been reorganized to read more clearly.
There will be more choices and flexibility for consumers.

MOTION: Rep. Mitchell moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

16-0322-0301

Licensed Residential and Assisted Living Facilities in Idaho
MOTION: Rep. Kulczyk moved that this rule be held for review of full Committee.
Motion carried by voice vote.
RULE:

16-0309-0308

The Medical Assistance Program
MOTION: Rep. Kulczyk moved that this rule be held for review of full Committee.
Motion carried by voice vote.
RULE:

16-0305-0203

Aid to the Aged, Blind and Disabled

Ms. Terry Meyer, Deputy Administrator, Division of Welfare, spoke to the
Committee regarding this rule. This rule serves a fragile population, those
over 65, blind or disabled. The change makes it physically easier to apply
for the program. The requirements go from a face to face interview to a
telephone interview. This also clarifies dates, and income guidelines to
be internally consistent. The cost saving is $45,000.00 a year.

MOTION: Rep. Mitchell moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

16-0305-0301

Aid to the Aged, Blind and Disabled

Ms. Terri Meyer spoke to the Committee regarding this rule. The
language in this rule has been updated due to Welfare Reform mandates.
All recipients must meet the established requirements. This aligns
citizenship requirements with federal regulations. There is an estimated
30 people affected with a saving of $160,000.00 a year.

MOTION: Rep. Block moved that the Subcommittee inform the full Committee that
they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

16-0305-0302

Aid to the Aged, Blind and Disabled

Ms. Terri Meyer spoke to the Committee regarding this rule. This rule
accomplishes safeguards and supports for Social Security Number
verification. This can be done when the person is there. This closes a
loophole and allows the Department to consider real estate holdings in
determining benefits. Rule clarifies services offered to ages 15-19. There
is no fiscal impact and adds no new participants.



Mr. W. Corey Cartwright, Deputy Attorney General, spoke regarding
section 841. This has technical corrections only- no real changes. There
is no intent to change the meaning.

MOTION: Rep. Kulczyk moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

16-0308-0301

Temporary Assistance for Families in Idaho

Ms. Terri Meyer spoke to the Committee regarding this rule. This rule
aligns citizenship requirements with federal regulations for assistance.
This rule will affect two people and cost $7,500.00 annually. The funds
come from the Federal government.

MOTION: Rep. Block moved that the Subcommittee inform the full Committee that
they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

16-0308-0302

Temporary Assistance for Families in Idaho

Ms. Terri Meyer spoke to the Committee regarding this rule. This rule
aligns social security numbers with federal regulations. This allows for
SSN verification to be done on line.

MOTION: Rep. Kulczyk moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

16-0320-0301

Electronic Payments of Public Assistance, Food Stamps and Child
Support

Ms. Terry Meyer spoke to the Committee regarding this rule. This rule is
required by the Federal Government and meets the Federal standards.
The Department is required to correct errors. No fiscal impact.

MOTION: Rep. Block moved that the Subcommittee inform the full Committee that
they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

16-0414-0301

Low Income Home Energy Assistance Program (LIHEAP)

Ms. Terri Meyer spoke to the Committee regarding this rule. This rule
helps low income families pay their utility bills. There are approximately
30,000 people with an average income of $11,000.00 a year in the
program. Variables to program moved from rules to procedures. No
fiscal impact.

MOTION: Rep. Kulczyk moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

16-0309-0212

The Medical Assistance Program

Ms. Leslie Clement spoke to the Committee regarding this rule. The
purpose of this rule is to update the terminology used to describe the
department’s Traumatic Brain Injury Waiver program in order to improve
understanding and clearly describe services. These are technical
changes and do not introduce any new services.

MOTION: Rep. Block moved that the Subcommittee inform the full Committee that
they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

16-0309-0217

The Medical Assistance Program

Ms. Leslie Clement spoke to the Committee regarding this rule. This rule
updates terminology regarding the department’s peer review organization
and provides for the consistent application of penalties for late submission
of a review docket. The clarification was made to ensure that all
procedures are submitted in a timely manner for medical necessity review
to protect the public health and safety.

MOTION: Rep. Block moved that the Subcommittee inform the full Committee that
they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

16-0309-0218

The Medical Assistance Program

Ms. Leslie Clement spoke to the Committee regarding this rule. This rule
removes an extra Medicaid payment for sending information to a national
registry. It removes the Medicaid payment for the entry of laboratory
results into the Clozapine National Registry for participants who require
Clozapine to treat mental illness. In October 2001, the department
reduced its payment for this service from $29.07 to $5.00 to bring
payment into line with what other states were paying. After additional
research they found that Utah, Wyoming, Montana, and Nevada were not
paying for his service at all under their Medicaid programs. Last year,
Idaho Medicaid followed suit and elected not to continue the $5.00
administrative processing payment. This is consistent with other
reimbursement policies which do not establish an additional
reimbursement rate for administrative activities.

MOTION: Rep. Mitchell moved that the subcommittee inform the full committee that
they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

16-0309-0301

The Medical Assistance Program

Ms. Leslie Clement spoke to the Committee regarding this rule. This rule
describes the payment methodology used to reimburse out-of-state
nursing homes for care provided to Medicaid eligible persons. Medicaid
payment for out of state nursing home care is very limited and generally is
only allowed if the care the person needs is not available in an Idaho
facility. Because of the complexity of the 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 process.

MOTION: Rep. Block moved that the Subcommittee inform the full Committee that
they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

16-0309-0304

The Medical Assistance Program

Ms. Leslie Clement spoke to the Committee regarding this rule. This rule
restores routine and preventive coverage for adults effective July 1, 2003.
Medicaid was able to restore these benefits as a result of a special
appropriation at the conclusion of last year’s legislative session. This rule
also includes technical changes that reflect new HIPAA coding
requirements. Access to dental care has improved, but there are still
issues. The Board of Dentistry will pursue legislation to improve services
regarding Dental Hygienists.

MOTION: Rep. Kulczyk moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

16-0309-0310

The Medical Assistance Program

Ms. Leslie Clement spoke to the Committee regarding this rule. The
purpose of this rule change is to reduce the administrative barriers that
have created reluctance among school districts to become Medicaid
providers. Over the past year, department staff has been working in
collaboration with the department of education and school representatives
to streamline procedures that will improve access to care for Medicaid
eligible children. By encouraging increased school participation in
Medicaid, more children may be served in a familiar environment with
services coordinated and managed under a single roof. There are
already positive affects of this rule change. In January 2003, there were
just 44 school districts enrolled as Medicaid providers. By June 2003, this
number increased to 71 districts. The number of eligible children
receiving service also jumped during this time frame, up from 3,300 to
6,400.



School district providers are unique in that they fund the Medicaid state
match – there are no costs to the state Medicaid program when services
are billed by a school-based provider. This is an attractive service
arrangement that the department wants to further develop and support.
The department has begun working with some private providers and
school district representatives to develop protocols and templates for
coordinating services. Private providers can play a key role by providing
an additional resource during the school hours. Children can be better
served by having most of their needed services provided during the day
rather than after a long school day. Schools are encouraged to contract
with providers and bill Medicaid for all services whether provided directly
or through a contract. Many school districts have already established this
arrangement in their communities. The department will continue to work
with schools and private providers to support the cost-effective
collaborative effort to providing services to school aged children.

MOTION: Rep. Block moved that the Subcommittee inform the full Committee that
they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

16-0309-0305

The Medical Assistance Program

Mr. Paul Leary, Program Manager, Division of Medicaid, spoke to the
Committee regarding this rule. The Uniform Assessment Instrument is
the tool used by the Department to assess whether or not a participant
requires Nursing Facility level of care. The scoring system for the Uniform
Assessment Instrument was quantified for scoring levels of care for
supervision. The rules are being amended to reflect current practice and
to assure services on the UAI are consistent.

MOTION: Rep. Kulczyk moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

16-0317-0301

Service Coordination

Ms. Pamela Mason, spoke to the Committee regarding this rule. This
rule is a total rewrite of the current four sections. It combines all four sets
of rules into one chapter. It is more consistent and understandable to
providers. Many interested groups provided input.



Mr. Ken Mordan, Rules Specialist, stated that they will be putting forth
dockets to remove these four sets of rules next Legislative session.



Ms. Kelly Hall, Dunstan, Hall & Assoc., objected to these changes. Their
firm provides service coordination for disabled people. She had two
issues: The 30 day time line is too rigid with all that needs to be done; 60
days would be more realistic, and there is no reimbursement for time
spent developing plans for the participants.

MOTION: Rep. Kulczyk moved that this rule be held for review of full Committee.
Motion carried by voice vote.
RULE:

16-0309-0214

The Medical Assistance Program
MOTION: Rep. Kulczyk moved that this rule be held for review of full Committee.
Motion carried by voice vote.
ADJOURN: 5:25 p.m.






DATE: January 30, 2004
TIME: 10:00 a.m.
PLACE: Room 412
MEMBERS: Chairman Garrett, Representatives Block, Kulczyk, Martinez, and Mitchell
ABSENT/

EXCUSED:

Representative Mitchell
GUESTS: See attached
Chairman Garrett called the meeting to order at 10:07 a.m. with a
quorum present.
RULE:

16-0601-0301

Family and Children’s Services

Mr. Ken Deibert, Division Administrator for Family and Community
Services with the Dept. of Health & Welfare, spoke to the Committee
regarding this rule. The intent of this rule will make it more consistent and
understandable, in particular by adding clarification around the word
“parent” and the word “certified adoption professional.” The term “certified
adoption professional” was added and clarifications of the sections related
to that term were edited.

MOTION: Rep. Kulczyk moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

16-0601-0401

Family and Children’s Services

Mr. Ken Deibert spoke to the Committee regarding this rule. This rule is
to increase the rate that foster parents are reimbursed for the care they
provide to the state’s most vulnerable children. Although financial
incentives are not the most important factor in recruiting and retaining
foster parents, and Idaho’s rates are still below the national average,
efforts to increase the reimbursement rates are appreciated by Idaho’s
foster parents.

MOTION: Rep. Block moved that the Subcommittee inform the full Committee that
they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

16-0614-0201

Prevention of Minor’s Access to Tobacco Products

Ms. Terry Pappin, Program Specialist, Division of Family and Community
Services, Dept. of Health & Welfare spoke to the Committee regarding
this rule. The first change in this rule is to require permittees to pay
outstanding fines prior to the renewal of their annual permit. The state
Auditor’s Office recommended this change be made to improve the rate
and timeliness of fine payments. The change has increased permittee
awareness of the law and the need to comply with the law. In addition,
one technical and several insignificant word changes were also made to
the rule. The technical change moved the date on which the number of
permittees is established. This is used in the formula determining the
number of inspections to be conducted during the following calendar year.
Word changes were made to conform with the Department of Health and
Welfare’s “plain-speaking” rules.

MOTION: Rep. Martinez moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

19-0101-0301

Code of Professional Conduct and Advertising

Mr. Mike Sheeley, Executive Director, Idaho State Board of Dentistry
spoke to the Committee regarding this rule. These rules are intended to
incorporate the American Dental Association’s Principles of Ethics, Code
of Professional Conduct and Advisory Opinions (Principles of Ethics) by
reference into the Idaho Board of Dentistry’s professional standards. The
ADA’s Principles of Ethics address such areas of dental practice as
patient self determination, patient confidentiality, standards of care and
dentist veracity. The ADA’s Principles of Ethics are currently applicable to
all Idaho dentists who are members of the Idaho State Dental Association
or the American Dental Association. A violation of the Idaho Board of
Dentistry’s professional standards can result in disciplinary action against
a dental licensee.

This rule will also specify those dental specialities which are recognized
and licensed by the Idaho Board of Dentistry. The Idaho Board of
Dentistry currently licenses six dental specialities and the Board members
determined that those specialities should be expressly identified in the
administrative rules.

This rule will also define advertising terms and delineate what conduct
constitutes false, misleading or deceptive advertising. Enforcement of the
advertising provisions in the Idaho Dental Practice Act requires the Idaho
Board of Dentistry to specify those matters that constitute impermissible
advertising conduct.

MOTION: Rep. Martinez moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

24-0601-0301

Hearing Aid Dealers and Fitters

Ms. Rayola Jacobsen, Bureau Chief, Bureau of Occupational Licenses,
Dept. of Health & Welfare spoke to the Committee regarding this rule.

This rule adds required sections; clarifies application fees and license
fees currently being assessed; clarifies continuing education requirements
and amends sound field testing requirements. All license renewals are for
12 months and will be due on the applicant’s birthday. There will be
random audits for continuing education requirements.

MOTION: Rep. Kulczyk moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

24-1001-0301

Optometry

Ms. Rayola Jacobsen spoke to the Committee regarding this rule. This
rule is to clarify required examination and acceptable requirements, and
clarify the continuing education requirements and the record keeping
required for continuing education. In 1986 the National Board of
Optometry established standards for all states for the “Treatment and
Management of Ocular Disease Examination.” For those licensed in
another state before that time, they must submit documentation that they
have the education, training and exam for therapeutic privileges in that
other state.

MOTION: Rep. Block moved that the Subcommittee inform the full Committee that
they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

24-1201-0301

Psychologist Examiners

Ms. Rayola Jacobsen spoke to the Committee regarding this rule. This
rule changes the date on articles incorporated by reference; corrects e-mail addresses; clarifies application procedure; amends exam section to
comply with national testing; amends service extender section to clarify
documentation required and amends educational curriculum
requirements. The way the tests are scored has been changed. A
passing score on the test shall be a raw score of 140 or for examinations
after April 1, 2001 a scaled score of 500 for liscensure.

MOTION: Rep. Kulczyk moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion carried by voice
vote.
RULE:

241401-0301

Social Work Examiners

Mr. Roger Hales, Attorney, Idaho Bureau of Occupational License, spoke
to the Committee regarding this rule. This rule adds definition for
psychotherapy, clarifies practice of social work at each level, clarifies
examination procedure and endorsement requirements, amends
continuing education in cases involving illness, clarifies continuing
education ethics requirement, allows continuing education from social
services agencies, and defines competent practice for social workers.
The rule also includes the definition for supportive counseling. Revisions
were made in practice of social work; the word endorsement was added
to section 350 ; and competent practice for social workers is defined.



Ms. Linda Burch, President, National Association of Social Workers,
State of Idaho spoke in support of this rule.



Mr. Ray Millar, Central Office Program Manager, Adult Mental Health,
Division of Family and Community Services, Department of Health and
Welfare spoke to the Committee regarding this rule. He supports the
Board’s continuing efforts to improve the standard of practice for social
workers and asked the Committee to approve the rules.



Mr. Robert Payne, Chairman, Idaho Board of Social Work Examiners
stated that nothing proposed runs counter to the rules. He recommended
adoption.



Mr. Greg Dickerson, Mental Health Providers Association of Idaho,
stated that he fully supports this rule.

MOTION: Rep. Martinez moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion passed on voice
vote with Rep. Kulczyk voting nay. He was not comfortable with the
flexibility this rule affords.
RULE:

24-1501-0301

Marriage and Family Therapists

Ms. Rayola Jacobsen spoke to the Committee regarding this rule. This
rule makes provision for supervision guidelines and definitions for both
counselors and marriage and family therapists; deletes grandfather
provision as the grandfather period has passed; requires ethics as part of
continuing education. Items in the rule have been renumbered.

MOTION: Rep. Kulczyk moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion passed on voice
vote.
RULE:

24-1701-0301

Acupuncture

Ms. Rayola Jacobsen spoke to the Committee regarding this rule. This
rule corrects the Board address and changes the effective date for
continuing education requirements for renewal.

MOTION: Rep. Martinez moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion passed on voice
vote.
RULE:

24-1901-0301

Residential Care Facility Administrators

Ms. Rayola Jacobsen spoke to the Committee regarding this rule. This
rule incorporates by reference the American College of Health Care
Administrators (ACHCA) Code of Ethics; adds facility language to conform
with Idaho Code; strikes temporary permit, as law does not allow for
extension or emergency permits; adds violation of Code of Ethics as
discipline.

MOTION: Rep. Kulczyk moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion passed on voice
vote.
Chairman Garrett did recuse herself from discussion regarding the
following five (5) rules. The gavel was turned over to Vice-Chairman
Block.
RULE:

16-0310-0203

Medicaid Provider Reimbursement

Ms. Sheila Pugatch, Senior Financial Specialist, Division of Medicaid
spoke to the Committee regarding this rule. This rule addresses hospital
reimbursement. As a result of the Governor’s 3.5% hold back, the
Department is paying hospitals 3.5% less each month.

MOTION: Rep. Martinez moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion passed on voice
vote.
RULE:

16-0310-0204

Medicaid Provider Reimbursement

Ms. Sheila Pugatch, spoke to the Committee regarding this rule. This
rule changes how Medicaid pays for wheelchairs for residents of
Intermediate Care Facilities for the Mentally Retarded, also known as
ICFs. Under these rules, Medicaid directly pays Durable Medical
Equipment Supplies instead of paying the ICFs. This change has three
positive affects. It eliminates the cash flow problem experienced by small
ICF’s when a resident requires a highly specialized and expensive
wheelchair. Since Medicaid purchases wheelchairs directly from the
suppliers, costs are reduced because Medicaid reimbursement is less
than the retail prices that ICFs pay. 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.

MOTION: Rep. Kulczyk moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion passed on voice
vote.
RULE:

16-0310-0301

Medicaid Provider Reimbursement

Ms. Sheila Pugatch spoke to the Committee regarding this rule. This
rule explains that out-of-state nursing homes are reimbursed using the
same rate they receive from the Medicaid program in their home state.
Other minor clarifying language has been added to improve
understanding of this reimbursement section. In addition, this rule
incorporates Title 42 of the Code of Federal Regulations, Part 447,
entitled “Payment for Services,” and the Medicare Provider
Reimbursement Manual into these rules.

MOTION: Rep. Martinez moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion passed on voice
vote.
RULE:

16-0310-0302

Medicaid Provider Reimbursement

Ms. Sheila Pugatch spoke to the Committee regarding this rule. This
rule changes how monthly Medicaid payments are paid to hospitals in
order to lessen the effect of overpayments and under payments. The
change will improve the accuracy of payments during the course of the
year rather than waiting until cost settlement which often occurs two years
after the interim payments are made. The change will improve cash flow
for the Department. The change only affects those hospitals where
payments vary by more than $100,000.00 on their most recent cost
report. No hospital receives a 100% reimbursement. Hospitals under 40
beds receive 96.5% maximum reimbursement.

MOTION: Rep. Kulczyk moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion passed on voice
vote.
RULE:

16-0310-0303

Medicaid Provider Reimbursement

Ms. Sheila Pugatch spoke to the Committee regarding this rule. This
rule clarifies four sections in Chapter 16.03.10. The first section clarifies
the occupancy adjustment factor. The clarification is to specify that the
property rental rates are not included in the total property costs for the
occupancy level calculation. The second section clarifies the extension of
the effective date for a special rate. The third section clarifies that all
financial reports are subject to audit. The last section clarifies the process
regarding amending Disproportionate Share Hospital surveys, otherwise
known as DSH.

MOTION: Rep. Kulczyk moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion passed on voice
vote.
Rep. Garrett again took up the role as Chairman of this Committee.
The gavel was handed to Chairman Garrett from Rep. Block.
RULE:

16-0603-0301

Minimum Standards governing Alcohol/Drug Abuse Prevention &
Treatment Programs

Mr. Pharis Stanger, Substance Abuse Program Manager, Department of
Health and Welfare, Division of Family and Community Services spoke to
the Committee regarding this rule. This rule standardizes treatment for
Drug Court participants. The new language corresponds with other drug
treatment programs. This rule was approved as temporary one year ago.

MOTION: Rep. Martinez moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion passed on voice
vote.
RULE:

16-0613-0301

Emergency Assistance for Families and Children

Ms. Mardell Nelson, Program Manager, Division of Family and
Community Services, Department of Health and Welfare spoke to the
Committee regarding this rule. This rule repeals the entire chapter.

MOTION: Rep. Block moved that the Subcommittee inform the full Committee that
they have found no reason to reject this rule. Motion passed on voice
vote.
RULE:

16-0613-0302

Emergency Assistance for Families and Children

Ms. Mardell Nelson spoke to the Committee regarding this rule. This
rule standardized the use of Emergency Assistance funds to help families
address any immediate crises that puts children at risk. The rules will
allow direct service providers in all Department programs, not just
licensed social workers in Children and Family Services, to authorize
these one-time funds on behalf of families. This expedites the
responsiveness of the Department to resolve the families’ emergency
conditions, precisely when timeliness is critical to child safety and well-being. These rules also specify the types of Emergency Assistance
services that are to be available statewide. This clarification assures that
children at risk and their families receive individualized services, based on
their presenting needs and it assures that this array of emergency
services are consistently available, regardless of where the family lives in
the state. These rules comply with Welfare Reform Legislation.

MOTION: Rep. Martinez moved that the Subcommittee inform the full Committee
that they have found no reason to reject this rule. Motion passed on voice
vote.
Chairman Garrett stated that there were four Rules from the meeting on
January 29, 2004 that did not meet requirements of non-confrontational
rules:

RULE: 16-0322-0301

RULE: 16-0309-0308

RULE: 16-0317-0301

RULE: 16-0309-0214

Additionally: on one rule from the January 26, 2004 meeting, the
Committee found to have no reason to reject section 214 of the rule, but
the Committee urged that sections 346-349 be rejected.

RULE: 16-0301-0302

MOTION: Rep. Block moved that the list of Rules that appear without conflict be
recommended to the full Committee and that the five (5) rules referenced
above be referred to the full Committee for consideration. Motion carried
by voice vote.
Rep. Martinez stated that his name should be included in the list of
Subcommittee members.

Chairman Garrett agreed to talk to Chairman Sali.



Chairman Garrett thanked the Committee members for their hard work
on this Subcommittee.

Meeting adjourned: 12:03 p.m.






DATE: February 2, 2004
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.
The Chairman asked the Committee to review the minutes of January 22,
2004 for approval.
MOTION: Rep. Garrett moved that the minutes of January 22, 2004 be approved as
written.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
The minutes of January 28, 2004 will be presented for review and
approval at the next meeting.



Chairman Sali announced to the Committee that he has been asked by
the Joint Finance Appropriations Committee (JFAC) to give a presentation
on February 11, 2004 at 9:45 A.M. JFAC would like to hear
recommendations for this year. He asked that if any member has any
concerns (programs, spending, other issues) they would like included in
the presentation, please bring them to his attention so that they can be
discussed in the full Committee before next week’s appointment on the
11th.



Rep. Garrett suggested that Karl Kurtz, Director of the Health and
Welfare Department be invited to present an overview of their budget to
the Committee. The secretary will arrange scheduling.



Rep. Mitchell shared that there are some excellent printed materials
available regarding JFAC budget information. The secretary will arrange
to make these available.



Chairman Sali shared with the Committee that guardianship issues have
been contentious over the years and he feels that the time is appropriate
to address these issues. He asked for members who would desire to be
on the Committee. Rep. Eberle, Rep. Block, and Rep. Kulczyk
volunteered to serve. Chairman Sali will chair. Rep. Henbest will report
back with a member who will serve on this committee.

Jim Hardenbrook, representing Healthy Families Nampa presented to
the Committee this Faith-Based initiative. He stated that this organization
is comprised of religious, civic and business leaders in the Nampa
community. The program is focused on improving the well-being of
children by promoting healthy marriages and responsible fatherhood. In
2000, there were 6,874 divorces in Idaho which cost the state and the
U.S. government an estimated $206 million.



Mr. Hardenbrook explained that their goal is to make Nampa a
community where families thrive; their objectives are to help children by
strengthening marriages and parents by increasing knowledge and skills
as parents. He further explained their “Bottom-Line” objectives are: a. to
reduce the number of divorces by 25%; b. to reduce the number of out-of-wedlock pregnancies and births by 30%; c. to provide all that marriages
performed by Healthy Families-Nampa coalition members will include
professional premarital instruction. A film was shown which is available to
the public.



Father Doug Yarbrough,

Rector of Grace Episcopal Church in Nampa, addressed the Committee
by giving an account of the events and accomplishments of the coalition
in 2003-2004.



Keith Fletcher, member of Church of Jesus Christ of Latter Day Saints,
addressed the Committee by giving a summary of the reasons why they
are using this faith-based approach to address this prevailing crisis in our
country. He shared that the family is the basic unit of all society and
healthy families lead to strong societies. Without the family, man and
society will fail. They believe that using a faith-based approach brings a
philosophy of love and hope which builds stability in people’s lives.



Terry Smith, Executive Director, distributed to the members a handout
with facts and data relating to the presentation.



Mr. Hardenbrook responded to a question of the Committee by
answering that the federal government is very supportive of this program
and has set very few limitations on this endeavor.

RS 13468C2 Rayola Jacobsen, Occupational License Bureau, addressed the
Committee regarding this bill. Rayola explained that the purpose of this
bill is to incorporate the necessary language changes to clarify intent. This
bill clarifies that each person submitting an application for licensure to
practice social work shall pay an application fee, determined by the
Board’s rules which shall not exceed $75.00 and will include the original
license fee.
MOTION: Rep. Kulczyk moved to send RS 13468C2 to Print
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
HB 551 Rayola Jacobsen addressed the Committee explaining that this bill adds
language that clarifies the conditions that would qualify for non-issuance
and/or revocation of licenses. This will allow the Board to take action
against anyone violating the rules as promulgated by the Board and
approved by this legislative body.
MOTION: Rep. Ring moved to send HB 551 to the Floor with a DO PASS
recommendation.
VOTE: ON A VOICE VOTE THE MOTION CARRIED. Rep. Ring will sponsor
the bill.
HB 553 Rayola Jacobsen addressed the Committee explaining that this bill is in
response to the request from the public. This bill increases the Board
membership by the addition of a lay member which broadens the
representation of the Board. She explained that this also broadens the list
of nominees the Governor may choose from and enables a nomination
process to go forth smoothly.
MOTION: Rep. Henbest moved to send HB 553 to the Floor with a DO PASS
recommendation.
VOTE: ON A VOICE VOTE THE MOTION CARRIED. Rep. Henbest will
sponsor the bill.
Docket 16-0301-0302 Greg Kunz, Department of Health and Welfare addressed the Committee
regarding this rule. He explained that Section 214 clarifies that SSN’s
must be verified before eligibility is determined for benefits for Medicaid.
He said that there is minimal effect on the Fiscal Impact. Mr. Kunz stated
that the way the language in Section 346-349 is currently written, 200
children from the CHIP program would be removed. He asked that the
Committee reject these sections but accept Section 214.



Rep. Garrett commented that the Subcommittee concluded that the way
Section 214 has been re-written allows for electronic verification which is
more efficient in qualifying applicants and ascertaining necessary
information.

MOTION: Rep. McGeachin moved that the Committee accept the recommendation
made by the Subcommittee to approve Section 214 of Docket 16-0301-0302 and reject sections 346-349. There was discussion on the motion.
Chairman Sali explained that in approving Section 214, the Committee
will be affirmatively stating that the Docket meets with legislative intent.



Dennis Stevenson yielded to the Committee by confirming that Section
214 of the rule will be approved if Sections 346-349 are rejected.

MOTION: ON A VOICE VOTE THE MOTION CARRIED.
ADJOURN: The meeting was adjourned at 2:50 P.M.






DATE: February 2, 2004
TIME: 3:05 P.M.
PLACE: Room 404
MEMBERS: Chairman Block, Representatives Kulczyk, McGeachin, Nielsen,
Henbest
ABSENT/

EXCUSED:

Rep. McGeachin
GUESTS: None
Chairman Block called the meeting to order at 3:05 P.M.



The Chairman announced to the Committee that the purpose of the
Subcommittee meeting is to obtain additional testimony on the rule
Dockets 16-0219-0302 and 16-0219-0301. She explained that their job is
to acquire research. She directed the members specifically to the Health
and Welfare rule book, Tab 6, Text Tab 1 and 2, page 25 under the
descriptive summary wherein lies the text of the food safety rules.



The members were given a handout listing six areas of research to be
assigned to the Subcommittee. The six areas are:

1. The circumstances that prompted the promulgation of the rule
dockets.

2. A complete account of the facilities, organizations, businesses
or other entities affected by the rules contained in the dockets.

3. A complete account of the difference between the standards in
existing rules and those contained in these dockets.

4. An accurate estimate of the fiscal impact to governments as
well as the financial impacts to private businesses.

5. The training available to those whom the rules impact to assist
them with compliance.

6. Issues that may arise with the transition from the old standards
to the new rules.



Chairman Block assigned Rep. Henbest to research areas No’s. 1, 5, 6;
Rep. Nielsen
to research area No. 2; Rep. McGeachin to research area
No. 3; Rep. Kulczyk to research area No. 4.



Chairman Block asked the Committee to report their findings at the next
Subcommittee meeting Upon Adjournment of the full Committee meeting,
February 4.



The Chairman made the following announcements:

  • Time Line for the Subcommittee work is two weeks or nine
    working days.
  • The hearing date is tentatively scheduled for Thursday, February
    12.
  • The date to report Subcommittee findings to the full Committee is
    Monday, February 16.


Rep. Henbest commented by making a suggestion that some of the
burden of finding a resolution be placed on those representing the
assisted living associations. Chairman Block asked the Committee to
please include the assisted living associations in their area of research.



Chairman Block stated that the scope of this effort is to find additional
information about the these two dockets concerning food safety rules.

ADJOURN: Chairman Block adjourned the meeting at 3:20 P.M.






DATE: February 4, 2004
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.
The Chairman asked the Committee to review the minutes of January 28
and February 2.
MOTION: Rep. Nielsen moved that the minutes of January 28, 2004 be approved
as written.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
MOTION: Rep. Nielsen moved that the minutes of February 2, 2004 be approved
as written.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Chairman Sali asked that Committee that if there was no objection he
would like to change the status of the subcommittee on guardianship
issues to a workgroup. The members who are Democrats are having
difficulty rearranging their workload to have representation for a
subcommittee. This workgroup will include Rep. Nielsen, advisors from
the Department, and other interested parties. The Committee did not
object.



Chairman Sali announced that his presentation originally scheduled
February 11 to JFAC has been postponed for a couple of weeks at his
request. He explained that he wanted the Committee to have more time
to gather information and discuss issues to be included in the
presentation.

Chairman Sali announced that he would like to hold a meeting on Friday,
February 6 to dispatch further Committee business in reviewing rules.
The target date for the report to the Speaker is Friday February 6.
Karl Kurtz, Director of the Department of Health and Welfare addressed
the Committee. He gave a summary of the presentation on the budget he
had given to JFAC. He explained three decision units that were used in
determining the amount of supplemental funds they would be requesting
over and above the base appropriation. First is – the Infant and Toddler
Program ($250,000); second – the Foster Care Program ($161,000); third
the Medicaid Program. He explained that 80% of Medicaid goes to
providers and 70% of Health and Welfare is for Medicaid. He explained
that the CHIP B/Access Card program, which is part of the supplemental
fund request, provides insurance opportunities for the working poor to buy
into an employer group or insurance program. There will be 5600
children enrolled by July 1, 2004 and another 11,000 who will be eligible
that arise from the “wood work” effect. In addition there is an anticipated
12,000 coming in under Medicaid. He further explained that the
Department is asking for a total of 39 million for trustee benefits. Mr.
Kurtz invited questions from the Committee.



Some of the concerns considered were: constituents as well as
colleagues are putting pressure on members about how programs can be
cut; cutting the budget in areas without cutting programs and/or affecting
the efficiency of the program; losing the federal match by cutting
programs; shifting the cost to counties if programs are cut; reviewing
possible cuts in the administrative areas without cutting services.

Richard Burns, Analyst for Legislative Services, began his presentation
by directing the attention of the Committee to the bottom chart on the front
page of the handout they had been given (see attached). He explained
that this chart shows the change in full-time equivalent positions (FTP) for
the state as a whole and for the Department of Health and Welfare. He
further noted that since 1994 through 2004, FTP grew by 812 or 5%
statewide, but declined by 438 in the Department of Health and Welfare
for an overall decrease of about 11%. This was after adjusting for
programs and FTP’s transferred out of the Department over this same
period of time.



On pages 2 and 3, Mr. Burns further explained the changes in authorized
position levels in the Department for the period 2003 and 2004, noting
that the Governor had authorized 77 additional staff above what had been
authorized by the Legislature.



Mr. Burns then turned to page 4 and walked the Committee through
changes in funding for the Medicaid budget from 2003 through 2006. He
noted a structural deficit of some $50 million that occurred during 2003
that continues to this day. Mr. Burns further noted that increased drug
rebates, third-party recoveries, audit settlements, and enhanced federal
match were the only reasons keeping the Department from requesting a
supplemental appropriation to deal with this shortfall. Instead, he
indicated the real impact will be felt in fiscal year 2006, where he
estimates that about $55 million in new state dollars will be needed to
maintain current levels of services.



Turning to page 6, Mr. Burns informed the Committee that the Legislature
had implemented a series of cost reduction initiatives to help reign in the
spiraling costs of Medicaid during fiscal years 2002 and 2003. He
reported however, that only 82% percent of the savings expected from
these cost saving measures had been realized to date.



In addition, Mr. Burns also noted, in referring to page 7 of the handout,
that federal mandates, or requirements, were not the driving force behind
these escalating costs. He pointed out that the cost of federally required
services went from 75% of the total in 1993 down to 44% in 2003.
Conversely, the cost of optional services climbed from 25% in 1993 up to
56% of the total in 2003.



Mr. Burns then briefly reviewed page 8 of his presentation that showed
those services required by the federal government, those enacted into law
at the state level, and those put into place through administrative rule.
Page 9 was a similar report that was sorted by type of service from high to
low, where he indicated the top five categories of expense were in
inpatient hospital, prescription drugs, nursing home care, waivered
services, and mental health.



Finally, Mr. Burns turned to page 10 of his handout reviewing for the
committee the 2003 federal poverty guidelines as published in the Federal
Register, February 2003. He indicated that individuals making up to
100% of the federal poverty level typically qualified for Medicaid, those
earning between 100% to 133% qualified under the Pregnant Women and
Children’s Program (PWC), those earning between 133% to 150%
qualified for the Children’s Health Insurance Program (CHIP), and those
earning between 150% up to 185% of federal poverty would qualify for
services under the newly expanded CHIP B/ Idaho Acces program. Mr.
Burns invited questions from the Committee.

Presentation by
Providers
Chris Johnson, representing Case Managers Association of Idaho,
addressed the Committee. She referenced a handout the members had
been given illustrating a historical comparison of state employee pay
increases versus medicaid provider cost of living adjustments to case
management rates. She stated that private providers can no longer bear
the brunt of the effects of inflation on their ability to deliver the best
service and have fallen far behind in their ability to keep up with Idaho’s
ever-increasing cost of living. She explained that her association and
members have approached the past three governors, JFAC, and the
Department many times with no resolution. She explained that private
providers are requesting that the Department establish a methodology for
periodic review of rates.
Shelley Holmes, Idaho Association of DD Agencies (IADDA), addressed
the Committee. She distributed a handout of her testimony and one of
Cynthia Dunagan of the ID Association of Residential Habilitation
Agencies. Ms. Holmes noted in her handout a comparison of the rising
costs of operating expenses from July 1999 to the present. She
explained that IADDA is asking for support from this Committee to ensure
the Department establishes a consistent methodology to adjust
reimbursement rates on a regular basis. (see attachment).
Laura Scuri, Vice President, Mental Health Association of Idaho,
addressed the Committee. She explained that employee turnover for
providers is a huge problem. Many leave a private provider association to
gain employment with the Department because salary and benefits are
greater. Ms. Scuri asked that the Committee urge the Department to
establish a method of working cooperatively with providers to provide
ongoing dialogue between the groups on reimbursement rates.



Chairman Sali asked David Rogers, Department administrator to yield,
who explained that currently there is not a concrete system in place that
will measure performance. He explained that the Department needs to
review the process of determining the standard of rate increases for
providers who deserve to be compensated for their quality of service.



Chairman Sali asked if Mr. Rogers would provide a letter from the
Department indicating how the Department would provide a process for
such review of rates.



Rep. Garrett commented that she believes a mechanism is needed that
would allow providers the opportunity to setup a procedure for regular,
consistent dialogue with the Department.

HB 605 Rayola Jacobsen, Bureau Chief of the Department, addressed the
Committee. She stated that the purpose of the bill is to clarify the
language in the statutes making it clear that the application fee for initial
licensure includes the original license fee.
MOTION: Rep. Ring moved to send HB 605 to the Floor with a Do Pass
recommendation.
VOTE: ON A VOICE VOTE THE MOTION CARRIED. Rep. Block will sponsor
the bill.
SCR 120 Rep. Garrett addressed the Committee regarding this concurrent
resolution. She explained that the Subcommittee heard the
corresponding rule Docket 16-0301-0302 and recommended to the full
Committee to retain Section 214 relating to verifying SSN’s. The
Department requested that Section 346-349 be rejected because this part
of the rule adversely impacts over 200 children in the CHIP program.
MOTION: Rep. McGeachin moved to send SCR 120 to the Floor with a Do Pass
recommendation. There was discussion on the motion.
SUBSTITUTE
MOTION:
Rep. Kulczyk moved to hold SCR 120 in Committee. He commented
that he is not in favor of this bill.
VOTE: ON A VOICE VOTE THE SUBSTITUTE MOTION FAILED.
VOTE ON
ORIGINAL
MOTION:
ON A VOICE VOTE THE ORIGINAL MOTION CARRIED. Rep. Kulczyk
voted nay. Rep. Garrett will sponsor the Resolution.
Chairman Sali yielded the gavel to Vice Chairman Block.
RS 13888 Chairman Sali addressed the Committee on this bill. The intent of the bill
is to afford the people of Idaho a legal right to receive copies of their
health care records.
MOTION: Rep. Mitchell moved to send RS 13888 to Print. There was discussion
on the motion.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Vice Chairman Block yielded the gavel back to Chairman Sali.
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 4, 2004
TIME: Upon Adjournment
PLACE: Room 404
MEMBERS: Chairman Block, Representatives Kulczyk, McGeachin, Nielsen, Henbest
ABSENT/

EXCUSED:

None
Chairman Block called the meeting to order at 5:20 P.M.



She explained that the purpose of the meeting was to hear reports from
members on their research to-date.

MOTION: Rep. Nielsen moved to approve the minutes of February 2 as written.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Rep. Henbest reported on Area #1 (circumstances that prompted the
promulgation of the rule dockets). She provided materials she had been
given from the Department explaining reasons for updating the food rules,
available training options, and some of the obstacles that the new food
rules are likely to present to the industry (see attached).



Rep. Nielsen reported on Area #2 (complete account of the facilities,
organizations, businesses or other entities affected by the rules contained
in the dockets). He reported that he had acquired a list of all of the
facilities that are affected by these rule changes (see attached).



Rep. McGeachin reported in Area #3 (complete account of the difference
between the standards in existing rules and those contained in these
dockets)
. She reported that she had acquired information from the
Department which compares the provisions in the current code with the
proposed code. She reported she had learned that the a primary focus
has to do with food temperature. She also reported that the Department
is considering exempting assisted living facilities under ten beds.



Rep. Kulczyk reported on Area #4 (an accurate estimate of the fiscal
impact to governments as well as the financial impacts to private
business). He reported that he had spoken with the correctional
institutions who have expressed that in order to meet the requirements of
the new food code, an additional three full-time employees would have to
be hired. He reported that restaurants and nursing homes are not
affected by this, consequently, the issue is narrowing down to facilities of
eight beds and under. He noted that our own kitchen for the House of
Representatives would not be in compliance.



Rep. Henbest reported on Area #5 (training available to those whom the
rules impact to assist them with compliance). She reported that she has
acquired information explaining training options. She commented that
she believes them to be reasonable (see attached).



Rep. Henbest reported on Area #6 (issues that may arise with the
transition
from the old standards to the new rules). She reported on three
concerns: (1) storage of refrigerated medications in food establishments;
(2) additional expense if additional manpower is necessary; (3) Definition
of critical violation that was changed within the code (see attached).



Chairman Block thanked the Committee for their work and announced
there would be another meeting to finalize their findings.

ADJOURN: Chairman Block adjourned the meeting at 5:45 P.M.






DATE: February 6, 2004
TIME: Upon Adjournment
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 sign-in sheet.
Chairman Sali called the meeting to order at 8:40 P.M.
RS 13647 Rep. Donna Boe addressed the Committee. She explained that this bill
is designed to continue a program that has already been in effect since
the year 2000. This legislature made it possible to provide food stamps
and temporary cash assistance to persons convicted of a drug related
felony occurring after August 22, 1996 provided they are in compliance
with probation and parole. She explained that all this legislation does is
strike the sunset provision to let the present methods continue. She
responded to a question from a Committee member that there is no fiscal
impact.
MOTION: Rep. Henbest moved to send RS 13647 to Print.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
RS 13904 Michelle Glasgow, Executive Director of Idaho Assisted Living Facilities
Association addressed the Committee. She explained that the purpose of
this bill is to require that for all purposes relevant to the survey process of
assisted living facilities, that Medicaid accept staffing ratios that were
previously determined sufficient to meet the needs of the residents
through the Uniform Assessment Instrument required for every individual
in assisted living facilities. She further explained that UAI and the
Facilities Standards Survey reports are often in conflict. The
recommendations of number of staff needed through the UAI will differ
from the number of staff deemed necessary when Facility Standards
performs a survey of the facility. She commented that the burden falls on
the facility to try to provide staff for which they are not given any
reimbursement. There were questions and discussion from the
Committee.
MOTION: Rep. Kulczyk moved to send RS 13904 to Print. There was discussion
on the motion. The Committee brought to the attention of the Chair that
the word “unfounded” in the Statement of Purpose should be correctly
written as “unfunded.”
SUBSTITUTE
MOTION:
Rep. McGeachin moved to send RS 13904 to Print with the correction of
replacing the word “unfounded” with the word “unfunded” in the
Statement of Purpose.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
RS 13905 Michelle Glasgow, addressed the Committee. She explained that the
purpose of this bill is to allow for the use of electronic signatures in
documentation management systems in assisted living residences.
Electronic signatures may be used for both documentation maintenance,
and where applicable, for transfer of information from the residences to
the Department of Health and Welfare for documentation verification and
the documentation verification portion of the survey process. This
process increases efficiencies and provides increased accountability,
security and documentation verification. This procedure provides a
signature and an indelible electronic paper trail of the time, date and
location of the signature. There were questions and discussion from the
Committee.



Rep. Sali pointed out the language Line 17, Section 1 suggesting that the
word “of” be stricken and the words “regarding the identity of the person”
be inserted for more clarity. The Committee was in agreement.

MOTION: Rep. Ring moved to send RS 13905 to Print with the change in the
language in Line 17, Section 1 of striking the word “of” and inserting the
words “regarding the identity of the person.”
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
DOCKET 16-0317-0301 Paul Leary, Program Manager for the Department of Health and Welfare
addressed the Committee regarding this rule docket. He explained that
this pending rule is a re-write of the current four sections of Medical
Assistance rules pertaining to case management services for individuals
with developmental disabilities (DD), individuals receiving personal care
services, individuals with mental illness, and children meeting certain
medical criteria. The Chapter defines the requirements for eligibility, case
management functions, availability and access to services, provider
qualifications, agency responsibilities, and required documentation and
payment for service limitations.



Mr. Leary explained that a provider had expressed concern during the
Subcommittee meeting with Section 400 with regard to the 30 day time
limit stated. The Department agreed that 60 days is more appropriate
especially for the DD population. He stated that the Department proposes
to promulgate a new docket that addresses this concern of time limit for
service plan development as soon as possible.



Chairman Sali requested that Mr. Leary provide a letter to the Committee
indicating intent by the Department. He agreed. Rep. Nielsen requested
that there be a specific time frame included. Mr. Leary agreed to have the
letter state that the Department will propose to have a temporary rule in
place by the end of this session.



The report to the Speaker will reflect that the Committee found no basis
upon which to reject Docket 16-0317-0301.

DOCKET 16-0322-0301 Debbie Ransom Bureau of Facility Services of the Department of Health
and Welfare addressed the Committee. She explained that Section 428
was amended to cite the Board of Nursing rules without referencing
specific sections due to changes made to those rules. This rule was also
amended to delete a statement that is in conflict with the Board of
Pharmacy rules. This rule removes language that allowed a licensed
nurse to fill Medi-sets for patients. This amendment only allows the
pharmacist to fill Medi-sets.



Michelle Glasgow spoke in opposition to this rule change. She shared
that assisted living facilities receive many of their patients’ medications in
bulk from other entities such as the Railroad Retirement Fund, Veterans
Administration, insurance companies, family, etc., who will bear the cost
as a result of this rule. She also shared her concern for error if nurses are
not allowed to repackage medications and this process is left for the non-licensed care givers. There were questions and discussion by the
Committee.



Ms. Ransom answered a question by giving the two options of packaging
that are eligible for return which are the “true unit dose” and the ‘blister’ or
‘bubble’ pack.



Another concern considered was the increase in cost for the facility due to
removing the ability of nurses and allowing only pharmacists to fill Medi-sets.



Chairman Sali asked the Committee to consider the options for accepting
or rejecting this rule. He commented that the Department is concerned
about errors if the Medi-sets are packaged by nurses, and the Facility is
concerned about errors if they are not allowed to package Medi-sets.

MOTION: Rep Kulczyk moved to hold Docket 16-0322-0301 in Committee to a
time certain until the pleasure of the Chair.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.












April Crandall, Director Mental Health Provider’s Association, addressed
the Committee. She shared that the meeting with providers and the
Department on February 5, 2004 was successful. She commented that
there had been positive, open dialogue and she believes the Department
is committed to participating in ongoing meetings. Ms. Crandall
distributed a handout to the members illustrating a pathway of services for
the mental health consumer.
ADJOURN: There being no further business, Chairman Sali adjourned the meeting at
10:30 A.M.






DATE: February 10, 2004
TIME: 3:00 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 sign-in sheet
Vice Chairman Block called the meeting to order at 3:00 P.M.
Vice Chairman Block asked the Committee to review the minutes from
February 4 and February 6.
MOTION: Rep. Kulczyk moved that the minutes of February 4 be accepted as
written.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
MOTION: Rep. Henbest moved that the minutes of February 6 be accepted as
written.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Vice Chairman Block yielded the gavel back to Chairman Sali.



Chairman Sali addressed the Committee regarding SCR 120 concurrent
resolution. There was discussion of whether to bring the resolution back
to Committee or let it remain on the Floor Calendar. Several members
expressed their desire to first and foremost serve the people in need.
However, at the same time look for efficiencies in the health care system.

MOTION: Rep. Garrett moved to bring SCR 120 back to the Committee for further
discussion and testimony. There was discussion on the motion.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Chairman Sali asked the Committee to review the report from the
Garrett Subcommittee that was in their folders. Chairman Sali asked
the Committee to decide whether or not they would like the report to the
Speaker to reflect that the Committee has accepted the
recommendations as indicated in the report of the Garrett Subcommittee
as written. There was no objection.



Presentation:


Kelly Buckland, Director, Idaho Independent Living Association,
addressed the Committee on the Medicaid Buy-In Program for Idahoans
with disabilities and provided handouts for the members (see
attachments). He explained that this program would allow recipients to
continue working or return to work without the risk of losing vital Medicaid
benefits. Currently if a person’s income is below a certain level, he or
she receives full Medicaid benefits; if a person makes one dollar more,
he or she receives nothing. He expressed that a Medicaid buy-in
program would enable Idahoans with disabilities to: achieve self-sufficiency and independence; integrate skilled recipients into the work
force and transition off of Medicaid; contribute to society as they pay
taxes and reduce or eliminate their need for public assistance. Mr.
Buckland stated that in 2003 Governor Kempthorne’s Blue Ribbon 2020
Task Force recommended that the state implement a Medicaid Buy-In
Program. He also stated that Idaho was awarded a 2.1 million dollar
grant from the Health Care Financing Administration (HCFA) to analyze
and design a Medicaid buy-in initiative for legislative consideration in
2002.



Mr. Buckland replied to a question by a Committee member by saying
that there would be a $400,000 fiscal impact. Committee questions and
discussion followed, the majority of the questions were regarding the
impact of the cost of the program to the general fund.



Steven Rodoletz, E.D., Idaho Benefits Planning Assistance and
Outreach Program addressed the Committee in support of this program.
He stated that the Medicaid Buy-In Program puts the monies back into
Idaho and lets people work without penalizing them. The program allows
Idahoans with disabilities to become more independent.

HB 627 Rep. Donna Boe addressed the Committee. She explained that this
legislation allows for a program to continue by removing the sunset
provision that provides food stamps and temporary cash assistance to
persons convicted of a drug related felony provided they are in
compliance with probation and parole. She further explained the struggle
these offenders face to reconnect to their families, stay off of drugs, and
be able to support and provide for their families economically. She noted
from one of two handouts distributed to the members a chart depicting
the number of families on the program and the costs associated with
services provided. She noted the second handout a letter from a prison
warden expressing that at least 50% of female offenders paroled will
return to their dependant children upon their release (handouts
attached).
MOTION: Rep. Martinez moved to send HB 627 to the Floor with a Do Pass
recommendation. There was discussion on the motion.
SUBSTITUTE
MOTION:
Rep. Kulczyk moved to sent HB 627 to General Orders with an
amendment to remove the words “cash assistance” from Line 35. There
was discussion on the motion.



Chairman Sali asked Jenie Sue Weppner, Department of Health and
Welfare, to yield to questions from the Committee regarding the cash
assistance services. Rep. Kulczyk withdrew the Substitute Motion.

VOTE: ON A VOICE VOTE THE ORIGINAL MOTION CARRIED. Rep. Kulczyk
is recorded as voting nay. Rep. Boe will sponsor the bill.
RS 13879 and
RS 13895
Rep. McGeachin addressed the Committee. She explained that the
purpose of this memorial is to encourage the U.S. Congress to amend
Section 1917 (b) (1) (C) of the Social Security Act by deleting May 14,
1993 as the deadline for approval by states of long-term care partnership
plans. This will allow all states the right to participate in long-term care
partnership plans.



Rep. McGeachin believes this bill will save the tax payers of Idaho a
substantial amount of money in the Medicaid budget. She explained that
both RS 13879 and RS 13895 go hand in hand. RS 13895 compliments
RS 13879 and RS 13879 must be past before RS 13895 can go into
effect. She further explained that the memorial will be sent to the U.S.
Congress as a statement of support from the State of Idaho and will align
with the long term care initiative Senator Larry Craig is introducing and
Governor Kempthorne’s long term care initiative with the National
Governors’ Association. She explained that long term care services
(personal care homes, assisted living facilities, nursing homes) cost

$143 million annually, $43.7 million is the state’s share. This bill would
provide people with an incentive to acquire private long term health care
insurance.

MOTION: Rep. Block moved to send RS 13879 and RS 13895 to Print.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
RS 13959 Rep. McGeachin addressed the Committee. She explained that the
purpose of this resolution is to give legislative direction to the Department
of Health and Welfare in relation to Medicaid private providers. During
times when money is tight and more demands are being placed on
Medicaid private providers, it is important for good communication to be
maintained between the two parties. This legislation encourages the
Department to meet with providers on an annual basis in a “good faith”
effort to work out the challenges they are being faced with.
MOTION: Rep. Block moved to send RS 13959 to print. There was discussion on
the motion.
VOTE: ON A VOICE VOTE THE MOTION CARRIED. Rep. Mitchell is
recorded as voting nay.
RS 13994 Randy Hudspeth, Nurse Practitioner, addressed the Committee. He
explained that this legislation clarifies the current relationship between
advanced practice professional nurses (APPNs and physicians. He
further explained that this bill will amend the Nursing Practitioners Act
definitions for advanced practice professional nursing by deleting
language that states the requirement of physician supervision.
MOTION: Rep. Nielsen moved to send RS 13994 to print.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Chairman Sali yielded the gavel to Vice Chairman Block.
RS 13971 Jim Jones, attorney with Jim Jones And Associates, addressed the
Committee. He explained that this bill amends Chapter 46, Title 54,
Idaho Code, to include licensed professional nurses in the category of
providers that are required to furnish certain job-related information to
professional licensing boards. The information is designed to put the
public on notice of certain background information pertaining to the
professionals, including criminal convictions, disciplinary action,
malpractice information, and the like. The reporting requirements for all
providers are expanded to include instances where providers who are
authorized to handle controlled substances have been disciplined or
convicted for abuse of such substances. The legislation also imposes
certain reporting requirements on employers of such providers.
MOTION: Rep. Kulczyk moved to send RS 13971 to print. There was discussion
on the Motion.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
ADJOURN: Vice Chairman Block adjourned the meeting at 5:00 P.M.






DATE: February 10, 2004
TIME: Upon Adjournment of full Committee.
PLACE: Room 404
MEMBERS: Chairman Block, Representatives Kulczyk, McGeachin, Nielsen, Henbest
ABSENT/

EXCUSED:

None
Docket

16-0219-0302

Vice Chairman Block called the meeting to order at 5:10 P.M.
MOTION: Rep. Kulczyk moved to approve the minutes of February 4, 2004.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Dick Schultz addressed the Committee. He provided the members with
a bound copy of the new, proposed safety rules as well as a copy of the
existing safety rules. He also provided the Committee with a list of
persons who have been involved in the preparation of these rules.
Chairman Block made the following announcements:

  • Monday, February 16 – hearing date on the Docket.


  • Wednesday, February 18 – Subcommittee members to make
    research report to the Subcommittee and give written report to
    Committee Chair, providing both hard copy and disk, listing
    research results including information gained at hearing.
    Subcommittee will debate and vote on their recommendation to
    the full Committee.


  • Friday, February 20 – Subcommittee recommendation report to full
    Committee.

ADJOURN:

Chairman Block adjourned the meeting at 5:22 P.M.






DATE: February 12, 2004
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. Kulczyk
GUESTS: See attached list.
Vice Chairman Block brought the meeting to order at 1:35 P.M. She
invited Brent Reinke, Director of Idaho Department of Juvenile
Corrections to address the Committee.
Brent Reinke gave an overview of the department and referred to a
handout he provided to the Committee. He explained that the Department
provides services to adjudicated youth committed to its custody and has
developed active partnerships with agencies, courts, counties, and others
to prevent and reduce juvenile crime. He noted on page 2 of the handout
that there are 170,936 10 to 17 year-olds in the state of Idaho as of
August, 2003. Of that population, 8.4% are juvenile arrests, 5.1% are
juvenile petitions, and .2% end up in prison.

Ryan Hulbert, PhD of Clinical Services, addressed the Committee. He
noted on page 4 of the handout the average age of juvenile offenders is
15.7 years old. He further noted in the handout on page 5 the 48.9%
figure representing the area of Significant Aftercare Challenges. He
demonstrated three approaches used in the aftercare program by using a
stool with three legs as a model. The first step is the protection of the
community. The goal is for the offender to be less likely to use drugs. The
second approach is competency development where the goal is to
educate the offender on healthy kinds of behavior. The third is an
accountability factor, where the offender takes part in paying restitution to
the victim. (See attached handout.)

Dr. Stan Weed, PhD, representing the Institute for Research and
Evaluation, SLC, Utah, gave an overview of the serious health and social
problems associated with adolescent sexual activity. Unwed teen
pregnancy and birth rates in the U.S. have shown some recent decline,
but remain at unacceptable high levels – one in 11 girls becomes pregnant
by the 12th grade; the percentage of teen births occurring outside of
marriage continues to increase. Rates of STDs have reached epidemic
levels and continue to increase. There are more than twenty-five different
types of STDs many of which cause lasting and permanent damage and
sometimes death. He explained that years of research and rigorous
studies of the best ways to develop programs aimed at decreasing
adolescent sexual risk-taking behaviors are showing that the paradigm is
shifting from the traditional approach of risk reduction strategy to a risk
prevention approach. He shared the failure rates of various contraceptive
devices.

Dr. Weed concludes that the emergence of abstinence education is
becoming more evident as a primary factor in risk prevention. He cited a
study conducted in Virginia where the Department of Health developed
and piloted an abstinence education strategy. The purpose was to
determine the impact of an abstinence education program on teenage
sexual initiation over a one year period and to understand how this impact
occurred. The conclusion to the study was that an abstinence education
program could influence students to abstain from sexual intercourse in
significantly greater numbers than their counterparts who did not receive
this education. The presentation was followed with questions and
discussion from the Committee. (See attached handouts for greater detail
of the presentation.”)

Vice Chairman Block yielded the gavel back to Chairman Sali.
Chairman Sali asked the Committee to review the minutes of

February 10.

MOTION: Rep. Eberle moved to accept the minutes of February 10, 2004.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
HB 579 Jim Baugh, Director Co-Ad, Inc., addressed the Committee explaining
that this bill includes an amendment with the correction on page 2 of the
printed bill, line 36, deleting the section number “6042” and inserting the
correct number “15043.” He explained that this bill would give patients
who are subject to involuntary commitment the right to contact and
communicate with representatives of the state protection and advocacy
system (P&A). The P&A system must have authority to communicate with
people who reside in treatment facilities, to investigate allegations of
abuse, neglect, and other rights of people who are involuntarily committed
to the custody of the state to communicate with representatives of the
Idaho P&A. This bill also allows the person’s right to communicate with
employees of their attorney’s firm. (See attached handouts – “Consortium
for Idahoans with Disabilities”, “Comprehensive Advocacy, Inc.”)
MOTION: Rep. Eberle moved to send HB 579 to General Orders with Committee
amendments attached.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
RS 13454C1 Sandra Evans, Director, Idaho State Board of Nursing addressed the
Committee. She explained that this bill amends the Idaho Code to
authorize regulation of nursing assistants by the Board of Nursing, to
include establishing requirements, including education and training, for
licensure for persons practicing as nursing assistants and to establish
fees for initial licensure and renewal. (See attachment for more detail of
testimony.) Committee discussion followed. Some of the considerations
were the cost of this effort and the language as currently written in the bill,
primarily having to do with the definition of “nursing assistant.”
MOTION: Rep. Ring moved to send RS 13454C1 to Print. Committee discussion
followed.
SUBSTITUTE
MOTION:
Rep. Eberle moved to return RS 13454C1 to the sponsor. Committee
discussion followed.
AMENDED
SUBSTITUTE
MOTION:
Rep. Henbest moved to send RS 13454C1 to Print with the following
change made on Page 3, Line 18 and 19 deleting the words “or is
employed to perform or provide nursing care functions.”
Michelle Glasgow, Executor Director, Idaho Assisted Living Association,
addressed the Committee in opposition to this bill. She explained that this
bill will affect unlicenced care givers as well as CNA’s who are the
backbone of these facilities. Assisted Living Facilities are more and more
hiring CNA’s to fill these positions. She is also concerned with how this
will affect Certified Family Homes, ICFMR’s day services, care givers of
disabled living independently, individual school personnel in rural areas
assisting children with routine medications, and day care workers. She is
concerned about the definition of “nursing care functions” currently written
in the language.



Keith Holloway, CEO Western Health Care Corporation, addressed the
Committee in opposition of this bill. He explained that the bill is not
needed because the licensure act duplicates criteria to screen nursing
aides that is already in place. He explained that the nursing home industry
is the second most regulated industry in America. The process of
certification of nursing assistants is done on a regular basis and includes
reviewing qualifications, checking references and background checks. He
explained that he takes exception to the affect on the fiscal impact.



Rick Holloway, President, Western Health Care Corporation addressed
the committee in opposition of this bill. He expressed his concern with the
words currently written in the language: “engages in the practice of
nursing.” He further expressed that this language is extremely vague as it
is written.

Chairman Sali put the Committee at ease.



Robert VandeMeure, addressed the Committee in opposition of this bill.
He stated that he has problems with the language of the bill as it is
currently written. Federal law states that family members and volunteers
can help with feeding patients, but their own employees cannot assist in
feeding patients. He further explained the concern he has for the
shortage of nursing aides. They rely on family members because there is
not an adequate supply of nursing assistants.

VOTE: On a Roll Call Vote the Amended Substitute Motion passed.
Representatives Eberle, McGeachin, Nielsen voted Nay.
RS 13455C1 Sandra Evans addressed the Committee. She explained that this bill
proposes amendments to the Idaho Nursing Practice Act to authorize the
Board of Nursing to require applicants for initial licensure and
reinstatement of licensure to submit to criminal background checks. She
further explained that this legislation is necessary to comply with federal
laws which requires that state agencies implementing criminal
background checks must have authority to do so set out in state statute.
(See attachment for further testimony.)
MOTION: Rep. Henbest moved to send RS 13455C1 to Print
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Chairman Sali yielded the gavel to Vice Chairman Block.
RS 14007 Rep. Sali addressed the Committee. He explained that he had been
asked to introduce this bill regarding the regulation of naturapathic
practitioners. This bill deals with three different levels, registration,
certification and licensure and a naturapathic counsel. He further
explained that this bill sets out qualifications of these three levels.
MOTION: Rep. Henbest moved to send RS 14007 to Print with the request that if
there is another bill regarding the same legislation that it be presented to
this body.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
RS 14050 Chairman Sali addressed the Committee explaining that this RS would
not be taken up at this time. He further explained that this RS had been
inadvertently printed as a bill.
Vice Chairman Block yielded the gavel back to Chairman Sali.
RS 14029C1 Rep. Henbest addressed the Committee. She explained that this bill
directs the department of Health and Welfare to apply for a waiver from
the Center for Medicare and Medicaid Services to conduct a pilot project
to determine the effectiveness and projected cost savings which may
result from providing reimbursement for weight control therapies, including
anorexic drugs, and nutritional, diet and exercise counseling. She further
explained that in situations where a physician tries to assist a patient with
getting their weight control, there is no reimbursement by the insurance
companies.
MOTION: Rep. Eberle moved to send RS 14029C1 to Print.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
RS 14038 Rep. Henbest addressed the Committee. She explained that this
legislation will amend Section 56-1017, Idaho Code to provide for the
adoption of rules and standards concerning criteria for the use of air
medical services by certified EMS personnel at emergency scenes. She is
concerned with a potential problem of the triage for life flight services.
This bill will provide guidelines for EMS personnel when making the
decision to call air medical services. She believes that this effort will be a
potential cost savings measure.
MOTION: Rep. Martinez moved to send RS 14038 to Print.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Chairman Sali yielded the gavel to Vice Chairman Block.
RS 14092 Rep. Sali addressed the Committee explaining the purpose of this
legislation is to delay the effective date for CHIP B and Access Card
programs for two years. There is a projected savings of over $4 million for
fiscal year 2005. He explained that due to the concern for the rising costs
of Medicaid, he wanted to provide opportunity for the Committee to
discuss and explore the benefits and drawbacks in the implementation of
the CHIP B/Access Card program. The purpose of this legislation is to
begin the discussion process. He explained that CHIP A will still move
forward.
MOTION: Rep. McGeachin moved to send RS 14092 to Print.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Vice Chairman Block yielded the gavel back to Chairman Sali.
ADJOURN: There being no further business Chairman Sali adjourned the meeting at
4:35 P.M.






DATE: February 16, 2004
TIME: Upon Adjournment of Afternoon Session
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 sign-in sheet.
Chairman Sali called the meeting to order at 3:55 P.M.



Chairman Sali asked the Committee to review the minutes of February
12, 2004.

MOTION: Rep. Nielsen moved to accept the minutes of February 12, 2004 as
written. There was discussion on the motion.
SUBSTITUTE
MOTION:
Rep. Henbest moved that the minutes reflect the unanimous consent by
the Committee regarding taking further testimony on RS1345C1 or to
continue with the next RS on the agenda due to the time factor.

Chairman Sali explained that noting the unanimous consent request was
not required because the ruling from the Chair had been that those who
had signed up to testify would be recognized to offer testimony only on
the changes that Rep. Henbest had suggested for the RS. Chairman
Sali
also explained that the specific language that Rep. Henbest wanted
to include would have to be spelled out for the Substitute Motion.



Rep. Henbest withdrew the Substitute Motion.

VOTE: ON A VOICE VOTE THE ORIGINAL MOTION CARRIED. Rep. Henbest
voted Nay.
Chairman Sali yielded the gavel to Vice Chairman Block.
HB 656 Rep. Sali addressed the Committee regarding this bill. He explained that
the purpose of this bill is to repeal licensing of pastoral counselors to
eliminate licensed pastoral counselors from Idaho Code. He explained
that there has only been one licensed pastoral counselor in the state of
Idaho.



Rayola Jacobsen, Occupational License Bureau, addressed the
Committee supporting the bill by stating that it deletes pastoral counselors
from licensure. A pastoral counselor may still practice pastoral
counseling, however, he/she may no longer retain the word “licensed”
within the scope of a title. Ms. Jacobsen in response to a Committee
member’s question stated that a person could apply for a license in
another category as long as they have met all of the licensure
requirements including required education, examinations, etc.

MOTION: Rep. Kulczyk moved to send HB 656 to the Floor with a Do Pass
recommendation.
VOTE: ON A VOICE VOTE THE MOTION CARRIED. Rep. Sali will sponsor the
bill.
Vice Chairman Block yielded the gavel back to Chairman Sali.
HB 552 Rayola Jacobsen addressed the Committee. She explained that this bill
includes an amendment to authorize the Board to adopt rules requiring
annual continuing education as a condition for the renewal of licenses.
She also presented an amendment to strike all references to pastoral
counselors.
MOTION: Rep. Henbest moved to send HB 552 to General Orders with amendment
attached. Rep. Henbest will sponsor the bill.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
HB 626 Michelle Glasgow, Director of Assisted Living Association of Idaho
addressed the Committee by explaining that this bill is for the purpose of
establishing the maximum staffing level requirements of a facility. She
further explained that there are two approaches to determining the needs
of residents, the assessment generated by the Uniform Assessment
Instrument (UAI) and assessment of the resident’s needs made by
Bureau of Facility Standards during a survey. These are sometimes in
conflict with each other. The Bureau of Facility Standards determines if
there is appropriate staffing and may choose to give the residence a
deficiency for inadequate staffing that may have no correlation with the
needs determined in the UAI. She further explained that Facility
Standards determines appropriate staffing required and UAI determines a
daily reimbursement rate by translating resident needs into hours
required. There were questions and discussion from the Committee.

Bill Sutherland, President of Idaho Assisted Living, commented that this
bill will more clearly identify the criteria for determining the appropriate
number of additional staff that would be necessary.

MOTION: Rep. Block moved to send HB 626 to General Orders with Committee
amendments attached changing the language in line 13 by deleting the
words “Existing admission agreements” and inserting the words “The
most recent negotiated service agreement
.”
Jim Shadduck, Operations Director of Ashley Manor LLC, addressed the
Committee with some of his concerns regarding this bill. He explained
that there is no uniformity between Uniform Assessment Instrument (UAI)
as used for Medicaid residents versus the assessment made for private
pay residents. UAI assessments are only implemented on Medicaid



clients. He asked the question: How can we set a staffing guideline that
can only apply to a portion of the residents? He commented that the UAI
was originally set as a reimbursement tool not a staffing tool.



Mr. Shadduck continued by stating that the term “Negotiated” needs to
be put back into the equation. The Regional Medicaid Unit (RMU)
typically does not want to negotiate the rate and thus the provider is left
with a resident with inadequate reimbursement. He also stated he would
like the consideration of retroactive reimbursement back to date of
request.

.
Debbie Ransom, yielded to a Committee member’s question by
explaining how the two survey groups interface with each other. She
explained that a random sampling is taken of individuals in the residence
and in turn are then included in the overall evaluation of the facility.

SUBSTITUTE
MOTION:
Rep. Kulczyk moved to hold HB 626 to Time Certain, Friday, February
20. Committee discussion continued. One point of consideration was the
idea of including private payers along with Medicaid payers when
determining needs assessment.
AMENDED
SUBSTITUTE
MOTION:
Rep. Nielsen moved to send HB 626 to General Orders with Committee
Amendments attached with further changes in the language. There was
discussion on the motion. Rep. Nielsen withdrew the Amended
Substitute Motion.



Rep. Block withdrew the original Motion commenting that she thinks
more time for discussion needs to take place. The Substitute Motion
then became the Main Motion.

VOTE: A VOTE WAS TAKEN ON THE MAIN MOTION AND WAS CARRIED BY
A VOICE VOTE
.
HB 628 Michelle Glasgow addressed the Committee. She explained that the
purpose of this bill is to allow for the use of electronic signatures in
documentation management systems in assisted living residences.
Electronic signatures may be used for both documentation maintenance,
and where applicable, for transfer of Welfare for documentation
verification and the documentation verification portion of the survey
process. She explained some of the advantages of using electronic
signatures: (1) Reduced time in submitting and returning documents
needing signatures and/or approval; (2) More document storage capability
in electronic storage i.e. paperless documentation; (3) Better security and
authenticity than with hand\written signatures as time, date and place is
always recorded in addition to the signature; (4) Easier documentation
retrieval in an electronic data management system; (5) Option to use
electronic documentation in the oversight process.

Bill Sutherland addressed the Committee in support of this legislation.
He stated that he thinks this method would make the process much
easier, more efficient, and less costly. He also added the efficiency of the
survey process by encouraging other providers to adopt this system
would be increased as well.

The issue of the secured password was considered by the Committee.
Mr. Sutherland explained that the method of tracing a signature through a
secured log-in password is a far more secure and reliable means than
trying to trace a written signature.

MOTION: Rep. Nielsen moved to send HB 628 to the Floor with a Do Pass. There
was discussion on the motion.



David Rogers, Medicaid Division of Department of Health and Welfare,
addressed the Committee. He stated that the Department has taken the
position that a system that would support electronic signatures is not in
place and not possible to implement at this time.

SUBSTITUTE
MOTION:
Rep. Henbest moved to send HB 628 to General Orders with Committee
amendments attached with the change made on line 13 to strike the word
shall” and replace it with the word “may“. There was discussion on the
motion.



Some of the following points considered were: the potential cost to the
general fund, other agencies in the state using this kind of system, time-line required for the Department to have electronic technology in place.
This legislation requires the Department to have eight criteria in place by
July 1, 2004.

MOTION: Rep. Martinez called for the question.
VOTE: ON A ROLL CALL VOTE THE MOTION TO CALL FOR THE QUESTION
PASSED
UNANIMOUSLY.
VOTE: ON A ROLL CALL VOTE THE SUBSTITUTE MOTION TO SEND

HB 628 TO GENERAL ORDERS PASSED.

Voting Nay – Representatives Kulczyk, McGeachin, Nielsen

Voting Aye – Representatives Block, Eberle, Garrett,

Ring, Henbest, Martinez, Mitchell

Rep. Sali announced his presentation before JFAC would be Thursday,
February 19 at 11:00 A.M. He stated that Committee discussion on the
presentation would be held at the next meeting on February 18.
ADJOURN: There being no further business, Chairman Sali adjourned the meeting at
5:50 P.M.






DATE: February 16, 2004
TIME: Upon Adjournment of Full Committee
PLACE: Room 404
MEMBERS: Chairman Block, Representatives Kulczyk, McGeachin, Nielsen,
Henbest
ABSENT/

EXCUSED:

None
GUESTS: See attached sign-in sheet.
Chairman Block called the meeting to order at 6:00 P.M.
MOTION: Rep. Nielsen moved to approve the minutes of February 10, 2004.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Dockets

16-0209-0302

16-0209-0301

Dick Schultz, Health Division, Department of Health and Welfare
addressed the Committee in support of the rules. He referred the
Committee to Subsection 001.04.f in Docket 16-0219-0302 explaining
the response he had received from Dennis Stevenson regarding the
typographical error: The word “or” in this subsection should be “on” as it is
written in Idaho Code. Mr. Stevenson recommended two options for
correcting the error. In either case a rule making will have to be done to
correct the typo. (See attachment.)



Mike Kane, Attorney representing Idaho Sheriff’s Association, spoke in
support of the bill. He explained that the county jails (total of 42) in the
state of Idaho will have to add additional staff to meet the requirements
set out in this rule, which will be an additional cost of approximately
$75,000 to $100,000 per jail.

Al Lance, attorney, addressed the Committee in opposition of the rule.
He explained he was before the Committee as a volunteer representing
the American Legion, VA, Elks, VFW, Shiners, etc. He explained that with
the passage of this rule, these service clubs run the risk of curtailing many
of the events that are held throughout the year involving food service.
Committee questions followed.



Lisa Wright, Corporate Manager for Jack in the Box restaurants,
addressed the Committee in support of the bill. She explained they are
already in compliance and have food supervisors in place during all shifts.
She stated that the acceptance of these rules would align Idaho with the
majority of states that have adopted the federal food code.



Michelle Glasgow, Director Assisted Living Facilities, addressed the
Committee in opposition of these rules. She expressed her concern of
the additional cost to facilities of 15 beds or less.
Another concern she expressed is the lack of clarity in the extensive
descriptive information contained within the scope of the 15 questions,
and critical violations.



Eric Mundell, surveyor for the Department of Health and Welfare,
addressed the Committee. He stated that he is in favor of adopting the
food code in its entirety. He also stated that the only change to the code
is the new requirement of a training course in food handling and
recognition of temperature of food. Committee discussion and questions
followed.



Some of the considerations were: why some entities are exempt and
others are not; critical violations are not easily identified; lack of
clarification of the “person in charge” and their responsibilities.



Dick Schultz yielded to a question explaining the report ability of food
borne disease.



Dick Schultz yielded to a question explaining that the District Health
Department will perform the enforcement of these rules.



Dick Schultz yielded to a question by explaining the following three
categories of compliance: (1) Avoid critical violation; (2) Take the
accredited course; (3) Be able to answer the fifteen questions relating to
food handling, temperature of food, etc. A facility will be in compliance if
they meet any one of the three categories.



Kathy Holley, Director Central District Health Department, yielded to a
question by stating that no additional cost is expected.



Tom Turco, Director Environmental Health-Central District Health
Department, addressed the Committee in support of this rule. He
explained that presently there are about 2200 licensed food
establishments that they will be regulating under these new rules. He
believes that these rules represent the best science and knowledge
concerning assuring that the Committees’ constituents receive safe food.

(See attachment for further detail of testimony.)



Dick Schultz yielded to a question by Chairman Block by agreeing to
provide her with information regarding where the exemptions are listed in
the federal code.

Chairman Block announced the next meeting would be on February 18,
2004 upon adjournment of the full Committee.
ADJOURN: There being no further business, Chairman Block adjourned the meeting
at 7:35 P.M.






DATE: February 18, 2004
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 sign-in sheet.
Chairman Sali called the meeting to order at 1:35 P.M.
Chairman Sali brought before the Committee HB 628 and HB 626,
already heard by the Committee February 16, 2004 and asked for their
consideration.



Chairman Sali asked if the Committee would like to reconsider the action
taken on HB 628, which had been to send the bill to general orders.
There was Committee discussion.

MOTION: HB 628 Rep. Garrett moved to reconsider action taken on HB 628.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.

At the request of Chairman Sali HB 628 will be returned to the
Committee for further discussion.

Chairman Sali presented the Committee with HB 626 explaining that the
action taken on the bill had been to hold to a time certain on Friday,
February 18. The sponsor has requested additional time to complete
work on proposed amendments.
MOTION: HB 626Rep. Eberle moved to postpone further action on HB 626 until
Tuesday, February 24, 2004.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
HB 657 Chairman Sali explained that there were several people who wanted to
testify on HB 657 but who could not be available today. He asked that the
bill be taken off of the agenda for consideration at a later date. The
Committee agreed.
Chairman Sali welcomed the new page, Cassie Beck who is from
Blackfoot, Idaho. Ms. Beck’s predecessor, Heather Callen had planned
to stay until the end of the week, but had to leave early for school.






Docket No.

16-0309-0308






Mond Warren, Bureau Chief, Audits and Investigations, Department of
Health and Welfare, addressed the Committee. He explained that these
rules govern the Department’s activities relating to investigation of
Medicaid fraud and abuse and have been amended to help the
Department protect the program funds and clients from fraud and abuse.

He explained the following changes/amendments to clarify and restructure
the rules: In the changes the Department has clarified their ability to
access and copy records of services provided to Medicaid clients. He
stated that these changes do not add authority but clarify existing
authority and practices. Changes have been made to clarify the
Department’s ability to deny payments or suspend provider agreements
for failing to provide access to records. This language is consistent with
federal regulations and clarifies existing authority. Changes have been
made to clarify and standardize the appeal process for Department
actions. The Department is attempting to consolidate rules, and appeals
are defined in the Rules Governing Contested Case Proceedings.
Clarifications have been made on Department actions to mirror the federal
regulations when suspending payments to providers for fraud which
makes the Department more accountable.



Mr. Warren stated that after publication, the Department did not receive
any public comment or opposition to the pending rules. He further stated
that he had presented these rules to the Senate Committee a few weeks
ago and heard opposition/testimony from two groups. One did not oppose
the rules, however, opposed the organizational structure of the fraud unit.
He explained that he has met with the second group, the Mental Health
Providers Association who understand the need to address fraud and
abuse in order to stop those providers who will drain program resources,
and cast distrust on their profession and the services they perform. He
stated he has committed to the association to further define the process
for decision making when suspending payments to providers. With this
commitment, the association has agreed to support these rules to allow
the Department to stop unnecessary waste and abuse, provided sections
210 is restored. The Senate Committee approved the amendments as
final except for section 204 and 210 which they recommended be restored
and not changed. This would provide in rule, a hearing within 30 days for
an immediate action, and would give the Department a mechanism to
refer issues to a committee to review. Mr. Warren noted in a handout
provided to the Committee a pie chart illustrating eight levels of case
resolutions of provider investigations from 2001 to 2003 (See attachment
for further testimony and handout).

CON Jeff Hough, representing Cooperative Action, spoke in opposition of the
bill. He thanked the Department for their efforts and decision to remove
Sections 204 and 210. He explained the two areas he takes issue with:
HIPPA Compliance and Due Process. Cooperative Action believes that
the concerns over privacy and the lack of due process for the provider is
enough to warrant the rejection of the temporary rule. (Copy of testimony
is attached). Committee discussion followed.



Mr. Warren yielded to the various concerns raised by the Committee
regarding the language used in Section 202.01 pertaining to the
Department’s ability to access records. He explained that this section
describes documentation of services as “Documentation to support claims
for services includes, but is not limited to, medical records, treatment
plans, medical necessity justification, assessments…..”



Mr. Warren yielded to questions regarding the intent and the potentially
broad language as to what documentation a provider was required to
provide the Department access to since this rule indicates “to include, but
not limited to”. He explained that this rule identifies the documentation
that is required by rule, statue, or contract, and each program may have
different types of documentation requirements such as pharmacy, durable
medical equipment, nursing services. The intent of this rule is not to list
all of the documentation.



Rep. Sali asked Mr. Warren if he would provide a letter verifying that the
intent of this rule was not to list the documentation but require providers to
maintain documentation which is already required by rule, statute or
contract for the individual program under which the provider provides
services. He agreed to provide such a letter.



Kathleen Allyn, Medicaid, Health and Welfare Department answered a
question regarding the appeal process for providers under investigation.
She explained three categories of action the department can take when
dealing with fraud and abuse issues: (1) Administrative (suspension of
payments, pending investigation, opinion of hearing officer etc.); (2)
Education (opinion of Director); (3) Criminal (grand jury indictments, state
or federal court, prosecutor).



Jeff Hough stated his concerns regarding suspension of payments for
providers while undergoing investigations without an automatic stay on
appeal. It will put providers out of business whether they have committed
fraud or not.



Mr. Warren yielded to Chairman Sali by explaining that the intention of
the Department is to suspend the payments and stop the money from
being disbursed.



Chairman Sali stated to the Committee that the Senate has provided a
concurrent resolution rejecting Sections 204 and 210. He stated that the
Committee will take up that concurrent resolution.



By Unanimous Consent the report to the Speaker will reflect that the
Committee found no basis upon which to reject Docket No. 16-0309-0308
with the exception of Section 204 and Section 210.

Docket No.

16-0309-0214

Shawna Kittridge, Pharmacy Supervisor, Division of Medicaid,
addressed the Committee. She explained that these rules will allow
Medicaid to provide participants with the most effective drug at the right
price through a variety of pharmacy management tools. Medicaid and
pharmacy programs have implemented strategies including generic
substitution requirements, prior authorization of drugs and coverage
limitations such as limits on quantities per prescription and early refills.
She further explained that these rule changes allow Medicaid to make
decisions based on objective scientific information (evidence-based
reviews) which provides clinical foundation and support for pharmacy
management processes. (See attachment for further testimony).



CON



Bill Roden, representing PhRMA, spoke in opposition of this bill. One of
his concerns is allowing the state to make the decisions for provisions for
these patients, not the doctor. He is also concerned with the underlying
cost to the state and urges the Committee and others to consider the cost.
He asked the question: “Are we saving money or just avoiding cost.”
PRO JoAn Condie, CEO, Idaho State Pharmacy Association, addressed the
Committee. She asked that the Committee accept this rule, making it a
permanent rule. She shared written testimonies in support of the rule
(see attachments).
PRO Clyde Daily, Director AARP, addressed the Committee in support of this
bill and has advocated for quality medical care. He explained that
prescription drugs are an integral factor in the effective treatment and
prevention of disease and there is a wide range of drugs available which
purport to treat the same condition. He believes that the scientific
approach identifies the most effective drugs in today’s health care market
PRO Jim Alexander, pharmacy owner in Mountain Home and member of Blue
Cross Pharmacy and Therapeutics Committee, addressed the Committee
in support of the rule. He is a member of the Utilization Review
Committee for the Department. He explained that if they have questions
regarding specific medications that cannot be addressed by their review
committee, they will look to other sources for necessary answers. He
answered a question from the Committee by stating that if a patient is
resistant to a particular medication, he/she may receive a waiver.



Ms. Kittridge yielded to a question by explaining that technology is in
place and advancing the Smart PA program and the Physician Dial Up
Box is very successful and useful in providing information to physicians.



By Unanimous Consent, the report to the Speaker will reflect that the
Committee found no basis upon which to reject Docket 16-0309-0214.

HJM 17

and

HB 658

Rep. McGeachin addressed the Committee and asked the permission of
the Chair to give presentation on both HJM 17 and HB 658. She referred
to the handout (see attached) given to the Committee noting findings from
the Congressional Budget Office in the year 2000 of total expenditures for
long term care at $123 billion, $5 billion for private insurance carriers; for
the year 2020 total expenditures estimated at $207 billion and private
insurance $36 billion. The concept is an effort to contain the rising cost to
the state for long term care which is one of the highest expenditures in our
state Medicaid budget. This program advances the concept that private
payers pay first and government pays last. She explained that long term
care partnerships are not intended for the wealthy, but for people with
$100,000 to $500,000 in assets. She further explained that every
partnership policy sold is a potential savings of more than $50,000 per
year to taxpayers. She noted page No. 7 of the handout the number of
approximately 140,000 policies in force in four states and out of that
number, only about 70 people have qualified for Medicaid.



Rep. McGeachin explained that Senator Craig’s bill to amend the portion
of the Social Security Act which will allow all of the states to participate in
the partnership care program has been introduced and will be heard by
Congress this year. (See attached handouts: The Robert Wood Johnson
Foundation “Partnership for Long-Term Care; National Association of
Health Underwriters in support of this bill).



Rep. McGeachin yielded to a question by explaining that the policies do
have to conform to state approved policies.

MOTION: Rep. Eberly moved to send HJM 17 to the Floor with a Do Pass
recommendation.
SUBSTITUTE
MOTION:
Rep. Ring moved to send both HJM 17 and HB 658 to the Floor with a
Do Pass recommendation. There was discussion on the Substitute
Motion.
Ms. Allyn yielded to questions from the Committee regarding the fiscal
impact by explaining that there will be start up and ongoing costs to
implement this program that will require additional state general fund
dollars. The amount will depend on when the program is implemented
and what existing resources can be used.



Rep. Henbest recommended that the Statement of Purpose (SOP) be
rewritten before it is placed on the Third Reading Calendar. Rep. Garrett
asked Rep. McGeachin if she would work with the Department to arrive
at an agreement on the fiscal impact for the SOP. She agreed.

PRO April Howard, insurance agency owner, addressed the Committee. She
expressed that this bill encourages people to take responsibility for saving
the state from bankruptcy.
PRO Gordon Lawton, Financial Advisor who writes for Farm Bureau,
encouraged this program to be available for the more affluent sector of
society, for the purpose of preventing the Medicaid program to be taken
advantage of. He also recommends the living death benefit be offered in
the long term care program and offering this benefit to the wealthy.
PRO Pete Chesney, insurance agency owner, addressed the Committee. He
explained that this bill would serve as an asset preservation tool that
would provide an opportunity for the elderly to avoid selling their homes in
order to pay for their long term care, which would allow them to leave an
estate to their loved ones.
PRO Scott Levitt, insurance agent, addressed the Committee expressed that
this program makes private insurance the payer of first resort and
Medicaid the payer of last resort. He stated that this program will give
dignity to individuals as it allows choice in facilities.
PRO Clyde Dailey, addressed the Committee in support of this bill explaining
that this program has been working in other states. He mentioned the
factor of the “baby boomer” crisis is fast approaching and the thought that
we need to do all we can to alleviate the eventual cost to the state.
Rep. Ring withdrew the Substitute Motion.
VOTE: ON A VOICE VOTE THE MAIN MOTION TO SEND HJM 17 TO THE
FLOOR WITH A DO PASS RECOMMENDATION PASSED.
MOTION: Rep. Ring moved to send HB 658 to the Floor with a Do Pass
recommendation.
VOTE: ON A VOICE VOTE THE MOTION CARRIED. Rep. Kulczyk voted Nay.
Chairman Sali put the Committee at ease at 5:30 P.M.

Chairman Sali called the meeting to order at 5:40 P.M.

HB 659 Rep. Henbest addressed the Committee. She explained that she is a
nurse practitioner and stated that this legislation will not change the
financial relationship with her employer or the physicians she works with.
Present time education standard has evolved over the past thirty years to
the standard requirement of a post graduate masters degree.

An advisory committee to the board of nursing is made up of physicians,
advanced nurses and pharmacists, a balanced committee of peers that
regulate advanced practice nursing. She explained that this bill removes
physician supervision requirements applicable to nurse midwives, clinical
nurse specialists, nurse practitioners, and registered nurse anesthetists.
Currently there are only six states that still require supervision by
physicians. This legislation aligns Idaho more closely with other states. A
handout from Dr. Neeraj Soni, a supervising physician in support of bill
was distributed to the Committee (see attached handout).



Rep. Henbest explained that she has met with Idaho Medical Association
resulting in an understanding that this legislation would be more
acceptable if there was reference to a collaboration relationship and peer
review process included in the language, which would provide additional
assurance that nurse practitioners were functioning in a safe manor. She
proposed an amendment to HB 659 reflecting the concerns brought up by
the Medical Association. The amendment inserts collaboration language,
returns original language for nurse anesthetists, and provides for peer
review process. Committee questions and discussion followed.

MOTION: Rep. Eberle moved to send HB 659 to General Orders with Committee
amendments attached.
CON James Scheel, M.D., Idaho Medical Association, addressed the
Committee. He explained that he is concerned with the education
standard for nurse practitioners as compared to physicians and how this
would impact quality of care. Nurse practitioner requirements – 4 years
college, 2 additional years; physicians requirements – 4 years college, 4
years medical school, 3 to 7 years residency. He also explained that
within the scope of collaboration language in the bill, the term “health care
professionals” is not clearly defined.
PRO Sandra Evans, Director, Idaho Board of Nursing, addressed the
Committee in support of the bill explaining that since the 1970’s the
definition of advanced practice nursing and the regulation of the nearly
700 licenses advanced practice nurses in our state has been evolving to
best meet the needs of Idaho’s citizens. She further explained that these
advanced practice registered nurses are regulated by the Board of
Nursing and provide primary health care services throughout Idaho in
group and independent practices and in both large and small
communities, but always in concert with other health care providers,
including physicians, pharmacists, social workers, dietitians, physical
therapists and others. (See attachment for further detail of testimony)
SUBSTITUTE
MOTION:
Rep. Nielsen moved to hold HB 659 in Committee to a Time Certain
subject to the discretion of the Chair.
Larry Benton, Benton and Associates, addressed the Committee by
explaining that his representation originally opposed the bill, however,
now is in support if the proposed amendments are made as it applies to
the nurse anesthetist portion.
PRO Debra Casdorf, Nurse Practioner, Emmett, explained that she has a sole
practice and already collaborates with many physicians. She expressed
that her patients trust her in making appropriate decisions and seeking
advice for their care.
PRO Lynn Kulahara, Nurse Practioner, Idaho City, explained that she has a
solo practice in Idaho City and collaborates with many physicians,
chiropractors, social workers.
PRO Dave Foss, Nurse Practitioner, Parma, explained that he has a
successful practice and collaborates regularly with many physicians and
he operates within the scope of the knowledge and education of nurse
practitioners.



Rep. Nielsen withdrew the Substitute Motion.



Myrna Olson, Idaho Nurses Association, yielded to a question by stating
that Blue Cross will reimburse moneys directly to Nurse Practitioners if
physician supervision is removed from the equation. This will save her
patients and Blue Cross money.

SUBSTITUTE
MOTION:
Rep. Block moved to hold HB 659 until a Time Certain subject to the call
of the Chair. She commented that she would like the parties involved to
work together to arrive at a clear and agreeable definition of the language
of collaboration and supervision.
SUBSTITUTE
MOTION:
ON A VOICE VOTE THE SUBSTITUTE MOTION TO HOLD HB 659
UNTIL A TIME CERTAIN FAILED.
VOTE: ON A VOICE VOTE THE MAIN MOTION TO SEND HB 659 TO
GENERAL ORDERS WITH COMMITTEE AMENDMENTS ATTACHED
PASSED.
Chairman Sali announced to the Committee that his presentation to
JFAC would be tomorrow, February 19 at 10:00 A.M. He listed the main
points he would cover: (1) The factors causing increases in health care
costs as discussed at the Committee’s first meeting this session. (2) The
coming crisis when Baby Boomers reach Nursing Home age, (3) The
need to set out savings which the Department proposes will arise from
their various initiatives, (4) The need to put limitations on the CHIP B and
ACCESS Card programs, (5) The need to ensure that all bills which will
cause a Medicaid expansion have gone through the germane Committee
prior to being funded by an appropriation bill, and (6) The factors that
drive Medicaid increases.



Rep. Garrett also provided a letter to Chairman Sali regarding the need to
have the Department report on the total cost of the Prescription Drug
Management as well as savings actually experienced from that initiative.
Chairman Sali will include that information in the presentation. (See
attached letter.)

ADJOURN: There being no further business Chairman Sali adjourned the meeting at
6:35 P.M.






DATE: February 19, 2004
TIME: 8:00 A.M.
PLACE: Room 408
MEMBERS: Chairman Block, Representatives Kulczyk, McGeachin, Nielsen,
Henbest
ABSENT/

EXCUSED:

None
GUESTS: See attached sign-in sheet.
Chairman Block called the meeting to order at 8:15 A.M.
The Subcommittee members presented their findings from their research
of their designated areas to Chairman Block and submitted copies of
their reports.
Chairman Block reminded the Committee that the intent of this meeting
is to explore the impact on the food safety rules from the research
reported on by the Subcommittee members. She presented the
Committee with several options to consider during the process of deciding
the action to take on the rules.

  • (1) To accept both dockets
  • (2) Reject both dockets – a concurrent resolution to be sent
    through both Houses would be required; a portion of the rules as
    they exist may be rejected.
  • (3) Reject the first docket and plan to amend S 1215 to exempt
    other entities, including public schools, assisted living facilities,
    veterans, administrations, churches, soup kitchens, etc.
Dick Schultz, Administrator, Department of Health and Welfare
addressed the Committee. He announced that his recommendation to the
Committee is to reject the entire set of rules. This action will provide the
Department and those involved to be working on changes that will be
better for all concerned. Committee discussion followed.
By Unanimous Consent the recommendation of the Subcommittee to the
full Committee will be to reject Docket 16-0219-0301 and Docket 16-0219-0302.
ADJOURN: There being no further business, Chairman Block adjourned the meeting
at 8:45 A. M.






DATE: February 20, 2004
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:

Chairman Sali
GUESTS: See attached list.
Vice Chairman Block called the meeting to order at 1:35 P.M.



The Vice Chairman announced that the minutes of February 18 had not
been reviewed and would be approved at the next meeting on February
24. She asked the Committee to review minutes of February 16.

MOTION: Rep. Ring moved to approve the minutes of February 16, 2004 as written.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Rep. Ring asked permission of the Chair to move the Medicaid
presentation by David Rogers to the end of the agenda to allow enough
time for the bills to be heard since some may have to leave early. The
Committee and Mr. Rogers agreed.
Docket No.

16-0309-0311

Leslie Clement, Medicaid Division, Department of Health and Welfare
addressed the Committee explaining that when the docket was first
presented to the Committee, the Committee was informed that
department staff met with stakeholders to review some areas of concern
and that the department had committed to having monthly meetings with
an established work group to resolve issues. She explained that there
was a need to reflect changes in provider and department responsibilities
as a result of staff reductions in the Regional Mental Health Authority; and
there was a need to clarify service expectations and provide service
definitions in response to health and safety concerns, particularly for
services provided in Partial Care settings.



Ms. Clement further explained that the rule changes relate to two distinct
mental health benefits: 1) Psycho-Social Rehabilitation (PSR) and 2)
Mental Health Clinic services. The first part of the docket identifies
changes to the PSR services, reflecting the reduction in Regional Mental
Health staffing and the resulting changes in the roles and responsibilities
of private PSR providers. The functions of assessment and service
planning have been transferred to the private PSR providers.
Additionally, these rules incorporate service definitions, clarify provider
qualifications, and spell out service expectations. Significant clarifications
include the requirements that: PSR Provider Agency personnel coming
into direct contact with participants must follow the criminal history check
process identified in existing rules and, PSR agencies provide 24-hour
crisis response services for their participants or make contractual
arrangements for the provision of those services.



Ms. Clement explained that the changes to the mental health clinic rules
and related partial care rules were made primarily due to safety issues.
Over the past year, the department was alerted to situations where
individuals appeared to be at risk when receiving care under this benefit.
Without these rules, there is limited ability to stop providers from providing
poor quality services. This rule docket does not introduce any new
federal or state requirements for clinics except for the inclusion of building
standards, which were added as a direct result of documented cases of
child endangerment due to substandard buildings that were being used as
clinics.



Ms. Clement explained that since her previous testimony before this
Committee, the Senate Health & Welfare committee was provided an
update on our work group’s progress and voted to extend these
temporary rules. On February 5 including members of the MH Provider’s
Association, individual provider representatives, advocates, consumers
and department representatives sat down to review these rules and
discuss the primary areas of concern. She explained that all groups were
able to come to agreement on many issues. She explained that although
the work group met for almost five hours, all the rule changes were not
addressed. There were assignments made that included researching
utilization of partial care and clarifying rule promulgation procedures and
schedules. The work group has scheduled its next meeting for early
March and anticipates that amendments can successfully be completed
for publication. This is just the first step in the work group’s long term
commitment to addressing mental health system issues. The group will
be developing recommendations for outcome measurements in addition
to reviewing different approaches in service delivery.

Gregory Dickerson, Mental Health Providers Association and member of
the work group working on these rules, addressed the Committee
explaining that the association agrees with the recommendation to extend
these rules with the understanding that both providers and the
Department are going to meet and develop amendments to meet the
needs with all of the stakeholders participating in this process. He
commended the Department for being sensitive to the providers’ needs
and the expectations contained in these rules. He explained that if these
assessment and planning functions can be administratively combined,
then cost savings may be generated without denying anyone’s care.



Laura Scurri, Vice President, Mental Health Provider’s Association
addressed the Committee thanking them for participating in the
promulgation of these rules. The negotiation has been very positive. She
explained that their mutual goal is to provide quality of services in a cost-effective manner.



Vice Chairman Block noted a letter from April Crandall, President of
Mental Health Provider’s Association regarding this docket and
agreements made with the Department of Health and Welfare in reference
to these rules and the mental health system. (See attached copy of
letter.)



By Unanimous Consent, the report to the Speaker will reflect that the
Committee found no basis upon which to reject Docket 16-0309-0311.

HB 697 Rep. Henbest addressed the Committee. She explained that this
legislation will provide for the adoption of rules and standards concerning
criteria for the use of air medical services by certified EMS personnel at
emergency scenes. She explained that this bill opens the door to
negotiated rule making and looking at improving the system in place
today. She stated that it is her assurance that the Department will enter
into a negotiated rule making encompassing the entire geography of the
state of Idaho that would not be limited to the urban centers and would go
beyond the current state EMS advisory committee and include everyone
who feels that they need to have a place at the table. She stated that she
will transmit this in writing to the Bureau of EMS.



Michael McGrane, RN, MSN, Director of Air St. Luke’s Hospital
addressed the Committee. He explained that 70% of Idaho’s emergency
medical services are provided by volunteer basis life support personnel,
the majority residing in Idaho’s rural and frontier areas with remote access
to emergency services. EMS services in Idaho depend upon air medical
services to provide advanced life support backup, additional personnel
and equipment, rapid patient transport, and allows the local EMS service
to remain available. He explained that there are mechanisms already in
place to address concerns with air medical services or utilization by EMS
personnel by medical directors. (See attachment for further detail of
testimony and handout entitled, “Recommended Elements of a Pre
hospital Air Medical Dispatch Protocol”).

Jim Alter, Department of Health and Welfare, EMS Bureau, addressed
the Committee. He explained that the EMS focuses on the care of
patients at emergency scenes and transportation to the hospital. The
EMS Bureau provides both reasonable regulation and support of local
EMS agencies throughout Idaho. He believes that the most pressing
problem in the EMS system in Idaho is getting rural EMS providers to
make appropriate choices about when to call for a helicopter for their
most severe patients, but acknowledged that many agencies do make
good decisions regarding patient transportation. He further explained that
this legislation will create an organized method to set criteria through
negotiated rule making which will allow the air medical services, local
EMS agencies, hospitals and physician communities throughout the state
to craft a common standard of care about patient transportation from
emergency scenes. (See attached testimony.)



Roy Eiguren, attorney representing St. Al’s Hospital Regional Medical
Center, addressed the Committee. He noted a letter from Stanley Rose,
director of St. Al’s Life Flight program in support of establishing criteria for
the use of air medical resources by EMS personnel. Mr. Eiguren



explained that the director of Life Flight has indicated at times there is
utter chaos and confusion at emergency scenes particularly in rural areas,
when determining the appropriate situations for dispatching air ambulance
services

MOTION: Rep. Mitchell moved to send HB 697 to the Floor with a Do Pass
recommendation.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
HB 694 Sandra Evans, Executive Director, Idaho State Board of Nursing,
addressed the Committee. She explained that this bill amends the Idaho
Nursing Practice Act to require applicants for initial nurse licensure and
for reinstatement of licensure to submit to criminal background checks.
She explained that the Board grants initial licensure to approximately
1500 nurses a year with an additional 200-300 nurses seeking
reinstatement of lapsed licenses each year. Both a felony and/or
misdemeanor conviction should be carefully scrutinized in making the
determination to grant licenses to nurse candidates. Currently, the Board
relies on the honesty and integrity of applicants to be truthful. (See
attached testimony). Committee questions and discussion followed.



Ms. Evans yielded to the following concerns:
(1) The Board of nursing anticipates that applicants will be required to
submit their fingerprints to the FBI, which in turn reports to the Board. The
Board, after all facts, application, etc. have been reviewed decide whether
the applicant would pose a risk to the public. The cost will be included in
clerical costs of receiving, reviewing and compiling information, as well as
investigating information or to impose disciplinary action. The licensure
fee will not increase.
(2) Fingerprints are taken at the time of examination and then again at
licensure and the two sets are compared, this also applies to those
applicants applying from other states, providing a safeguard.
(3) The Board will look at first time/repeat offense, pattern of behavior,
recent offense or long history honesty and integrity in answering
questions truthfully.
(4) An additional two full-time employees are necessary to provide for
program operation and for administrative costs.

MOTION: Rep. Mitchell moved to send HB 694 to the Floor with a Do Pass
recommendation. He commented he believes that Idaho needs to take the
steps necessary to safeguard the public, especially due to mobility of
nurses among states and shortage of nurses in Idaho.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Vice Chairman Block presented to the Committee the official letter from
Paul Leary, Program Manager, Department of Health and Welfare,
previously requested by Rep. Sali at the February 6 meeting confirming
that the date the temporary rule will take effect will be upon Sine Die of
this current legislation. Vice Chairman Block asked for Unanimous
Consent
to attach this letter to today’s minutes as well as the minutes of
February 6. There was no objection. (The letter is attached.)
Presentation: David Rogers, Administrator, Medicaid Division, Department of Health
and Welfare gave the Committee an overview of Medicaid Cost
Containment. He explained that growth in state health care costs,
including Medicaid expenditures has outpaced increases in available
revenue. Medicaid expenditures are reflective of general health care
trends, including medical inflations. He explained that premiums for
private employer-sponsored health insurance have experienced double
digit increases over the last few years. Medicaid is different in relation to
caseload increases. In bad economic times, Medicaid caseloads tend to
rise, increasing demand in times when state revenues are often declining.
Idaho is not alone in facing the challenge of rising Medicaid costs; 32
states are expecting to experience a shortfall in their Medicaid budgets in
FY 2004.



Mr. Rogers explained that the state is acting to restrain Medicaid
expenditures in the categories of eligibility, benefits, provider payments
and to improve program management. He further explained that the
Department’s Enhanced Prior Authorization Program (EPAP) for
pharmacy benefits is an effort to manage care delivered to Medicaid
participants and Care Management for adults with developmental
disabilities is an effort to more effectively manage the growth of Medicaid
expenditures. The Department has made great efforts to enroll almost
80% of Medicaid participant’s in Healthy Connections, which provides
participants with a medical home. The Department is working on
development and implementation of new programs in the areas of
Disease Management and Long Term Care. (See attached copy of
presentation for references and further detail).

ADJOURN: There being no further business, Vice Chairman Block adjourned the
meeting at 3:20 P.M.






DATE: February 24, 2004
TIME: Upon Adjournment from Afternoon Session
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 sign-in sheet
Chairman Sali called the meeting to order at 3:00 P.M. He asked the
Committee to review the minutes of February 18 and 20, 2004.
MOTION: Rep. Henbest moved to approve the minutes of February 20, 2004 as
written.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
MOTION: Rep. Martinez moved to approve the minutes of February 18, 2004 as
written.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Vice Chairman Block addressed the Committee regarding the Block
Subcommittee report on the food rules. She explained that after careful
consideration and at the request of the Health and Welfare Department
the Subcommittee was unanimous in recommending to the full Committee
that both Rule Dockets 16-0219-0301 and 16-0219-0302 be rejected.
The Vice Chair commended the Subcommittee members for their very
conscientious effort and dedication to obtaining their research and
submitting excellent presentations and written reports of their findings.
She also thanked the secretaries, Jennifer O’Kief and Elfreda Higgins, for
their assistance with the Subcommittee.
Chairman Sali stated that a motion was in order to accept the report of
the Block Subcommittee that was in the member’s folders. (See attached
report/letter).
MOTION: Rep. Nielsen moved to accept the report of the Block Subcommittee.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.












The Chair asked for unanimous consent that the report to the Speaker
will be the acceptance of the Subcommittee’s recommendation to the full
Committee and that the action of the full Committee would be to reject
Docket 16-0219-0301 and Docket 16-0219-0302. There was no
objection.
RS 14184 Chairman Sali introduced this concurrent resolution and explained that
the Committee has been given the status of a privileged committee for the
purpose of introducing RS 14184 (See attached letter of permission from
the Speaker). The purpose of this RS is to implement the
recommendation of the Subcommittee to reject the food safety rules.
MOTION: Rep. Henbest moved to send RS 14184 out for printing and that it be
sent to the second reading calendar.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
HB 626 Chairman Sali stated that HB 626 would be pulled at the request of the
sponsor.
Dockets:

16-0313-0301

16-0309-0307

David Rogers, Administrator, Division of Medicaid, Department of Health
and Welfare addressed the Committee explaining that both Dockets

16-0313-0301 and 16-0309-0307 had been held in Committee for further
review and are related to the Care Management Program. He distributed
a copy of a letter, dated February 23, 2004, from the Department,
including handouts, regarding questions and concerns that had been
raised in the Department’s previous presentation of these rules. He
referred to the letter and briefly touched on the following items addressed
in the letter: (1) Number of Independent Assessment Providers (IAP) and
caseload size; (2) IAP Qualifications (12 of the 17 or 70%) have masters
degrees); (3) Individualized Budget Ranges; (4) Guardianship and
Consumer Training issues posed by Kelly Hall of Dunstan Hall &
Associates; and IAP Training, Plan Development, and Region II Reports,
concerns posed by Bill Benkula, Delta Developmental Services. (See
letter and attached charts).

By Unanimous Consent, the report to the Speaker will reflect that the
Committee found no basis upon which to reject Docket No. 16-0313-0301
and Docket 16-0309-0307.
HB 657 Jim Jones, Attorney, representing himself and Jon and Brenda Field,
addressed the Committee. He explained that the Fields’ son Caleb died
as a result of medication that was tampered with by a nurse who was later
convicted of two felonies and is serving time in prison. He further
explained that this bill amends Idaho Code to include licensed
professional nurses in the category of providers that are required to
furnish information such as certain background information, including
criminal convictions, disciplinary action and malpractice. He further
explained that this legislation imposes reporting requirements of providers
who have been disciplined by an employer or regulatory board or been
convicted for abuse of controlled substances. This reporting gives the
public knowledge of providers who have had a history of substance
abuse.
CON Sandra Evans, Executive Director, Idaho State Board of Nursing,
addressed the Committee. She stated that this bill will likely result in
unnecessarily encumbering IDACARE (data system containing
information on physicians and nurses), which is a consumer information
system that currently works well. She explained that this bill has been
presented on the premise of protecting consumers from tragic
circumstances like that of Caleb Field by making public, information
related to mishandling and abuse of controlled substances. She further
explained that regulatory boards have discovered that the best way to
protect the public against the risk posed by health providers who suffer
from the disease of addiction, is through a structured system of early
detection and intervention, appropriate treatment, and long-term
monitoring of practice and behavior. Committee discussion and questions
followed.
CON Nancy Kerr, Executive Director of the Idaho Board of Medicine,
addressed the Committee. She explained that this bill discourages
physicians from reporting concerns and voluntary participation in the
Physician Recovery Program. Currently the largest number of reports of
impaired or at risk providers to the Board is from colleagues or concerned
relatives and friends. Voluntary contracts require physicians to notify key
individuals in their hospital and practice locations by submitting a copy of
the board stipulation and provide confirmation to the Board that this was
accomplished. She stated that hospitals are required to report adverse
professional actions to the Board of Medicine as per the peer review
legislation passed by the legislature last year and this legislation appears
to be in opposition to the intent of Peer Assistance legislation. Ms. Kerr
stated that the public can view the Board of Medicine web site and print
the documents associated with board actions taken regarding any
licensee. She expressed that a physician in a monitored recovery
program is a safer provider than the one that is attempting to hide or
disguise an addiction problem. Committee discussion and questions
followed.
PRO Brenda Field, mother of Caleb Field, addressed the Committee. She
explained that she feels obligated to honor her son by not letting a tragic
situation like this happen again. She urged the Committee to protect the
public by passing this bill.
CON Steve Millard, Idaho Hospital Association addressed the Committee.
One of his concerns is the use of the word “mishandling”. He stated that
in a hospital environment there are thousand of drugs handled by
employees each day. A vial may be dropped on floor or an incorrect dose
given to a patient which might both be deemed mishandling. He further
stated that the word could either mean incidental or accidental, not
necessarily intentional. Another concern is that nursing homes, school
nurses, corporate nurses are not covered by this proposed law. He
expressed how difficult it is to receive accurate references on employees
from former employers and that they are almost impossible to get for fear
of law suit. Mr. Millard suggested that the Committee look at developing a
system that would guarantee valid and sufficient reference checks. He
stated that this bill as it is currently drafted does not accomplish much.
There were questions from the Committee.
CON Roy Eiguren, attorney, representing St. Alphonsus Hospital, addressed
the Committee. He stated that St. Alphonsus is willing to work with all
interested parties in developing a balanced bill that responds to the
concerns expressed in this legislation. He explained that he is concerned
that this legislation conflicts with other laws impacting employment
situations of individuals, specifically the Federal American with Disabilities
Act, where actions taken within the scope of this legislation could be in
violation of federal law. He further explained the liability issue is a factor,
as well, in the event an individual is hired with a history of drug abuse
problems and that history/report is overlooked.
CON Teresa Molitor, lobbyist with the Idaho Association of Commerce and
Industry, addressed the Committee. She explained that this bill is
contrary to the original intent of the Freedom of Information Act. She
further explained that the result of this legislation may place a burden on
employers to have to report a disciplinary action within thirty days.
CON Victoria Paulson, lobbyist with the Idaho Medical Association, addressed
the Committee. She invited those interested parties the opportunity to sit
down at the table for discussion and resolution of these most critical
issues.
Mr. Jones addressed the Committee by explaining that a collegial
group did meet last year but with no success. He further explained that
the participation and cooperation was not there and nothing was
accomplished.
MOTION: Rep. Kulczyk moved to send HB 657 to the Floor without
recommendation.
SUBSTITUTE
MOTION:
Rep. Nielsen moved to hold HB 657 to a Time Certain subject to the call
of the Chair. There was discussion on the motion.
VOTE: ON A ROLL CALL VOTE, THE SUBSTITUTE MOTION TO HOLD

HB 657 IN COMMITTEE TO A TIME CERTAIN PASSED.

Voting Nay – Representatives Block, Kulczyk

Voting Aye – Representatives Garrett, Ring, McGeachin, Nielsen, Henbest, Martinez, Mitchell

The Chairman put the Committee at ease at 5:05 P.M.

The Chairman called the meeting to order at 5:15 P.M.

HB 696 Rep. Henbest addressed the Committee. She explained that this bill
directs the Department to apply for a waiver from the Center for Medicare
and Medicaid to conduct a pilot project to determine the effectiveness of,
and projected cost savings which may result from providing
reimbursement for weight control therapies in the state medicaid drug
program. She further explained that this is a huge health care problem
and there are increasingly more people with diabetes and heart disease
resulting from obesity, many of whom end up becoming a financial burden
on the state.
PRO Mary MacConnell, American Heart Association Advocacy Director
addressed the Committee. She explained that there is an “explosion” of
obesity in this country and being overweight is one of the number one
factors causing heart disease.
Kathleen Allyn, Medicaid Division, Department of Health and Welfare
yielded to a question by stating that this project would not require hiring
two additional staff, but would require the same amount of work that
would be required of two full-time employees. She further explained that
possibly employees may be pulled from other agencies. She also stated
that there may be grants for this project available.



Some of the considerations from the Committee were the time-line of this
project, the estimated cost, number of participants who would qualify,
some type of reporting procedure put in place.

MOTION: Rep. Garrett moved to send HB 696 to the Floor with a recommendation
that the Department and Rep. Henbest pursue providing regular progress
reports as the project moves forward. There was discussion on the
motion.
SUBSTITUTE
MOTION:
Rep. Kulczyk moved to send HB 696 to General Orders with Committee
amendments attached. There was discussion on the motion.
AMENDED
SUBSTITUTE
MOTION:
Rep. Henbest moved to send HB 696 to General Orders with Committee
amendments attached to include: On line 18 after “gram” insert “, with the
following limitations:

(1) Participation in the pilot program shall be limited to 100 clients;

(2) The length of the pilot program shall be limited to three (3) years;

(3) Participation shall be limited to clients with a Body Mass Index over
25; and

(4) The Department shall report annually to the Senate and House
Health and Welfare Committees concerning the progress of all
programs initiated under the waiver.”

VOTE: ON A VOICE VOTE THE AMENDED SUBSTITUTE MOTION CARRIED.
HB 628 Michelle Glasgow, Director of Idaho Assisted Living Association,
addressed the Committee explaining this bill is before the Committee
again because the association believes it is important to rescind the
amendment that changed the word “shall” to “may” on line 13. The
association proposes the following amendment that should narrow the
scope of the bill and eliminate any need for additional funding to the
Department (see attached amendment). She explained that the purpose
of this bill is to allow for the use of electronic signatures in documentation
management systems in assisted living residences which would allow for
quicker response to resident needs, in turn resulting in more person
centered care. She further explained that facilities require signatures on
an immense amount of data, both current and archived. She stated that a
paper signature is no safer nor more secure than an electronic signature.
She further stated that the healthcare system needs to be more efficient
and can be if present technology would be utilized. The Committee was
given a handout listing documentation currently requiring signatures and
advantages and safeguards with electronic signatures (see attached
handouts).
CON David Rogers, Administrator, Medicaid Division, Department of Health
and Welfare, addressed the Committee. He stated that he believes that
the amendments offered are too broad. He explained that he could not
estimate the cost because the impact of the cost depends on the breadth
and type of documentation received and the scope of appropriate
validation and certification.
PRO Bill Sutherland, President, Idaho Assisted Living Association,
addressed the Committee explaining that there are safeguards already in
place and there will be no additional cost incurred to the Department. The
cost of $150 for a certificate that allows for the security process would
already be in place. This cost is incurred by the facility for using the
program which is internet based. He further explained that this procedure
is more efficient and would save up to, in some cases, two weeks or more
in lag time.
Chairman Sali was alerted by Rep. Martinez that there was not a
quorum present.
ADJOURN: Chairman Sali adjourned the meeting at 6:50 P.M. explaining that the
Committee would again take up HB 628 at the next meeting, Thursday,
February 26.






DATE: February 26, 2004
TIME: Upon Adjournment of Afternoon Session
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

Rep. McGeachin
Chairman Sali called the meeting to order at 2:15 P.M.
GUESTS: See attached sheet
HB 628 Michelle Glasgow, Director of Assisted Living Association of Idaho,
addressed the Committee. She explained that after discussions with the
Department of Health and Welfare, the groups involved are going to
implement a pilot project to allow the parties to come to the table and
resolve their issues. She stated that the Department has committed to the
project and is willing to begin immediately. She recommended that the bill
be held in Committee.
MOTION: Rep. Kulczyk moved to hold HB 628 in Committee. David Rogers,
Administrator for the Department yielded to a question by responding that
he would draft a letter of intent regarding the Department’s commitment to
work with the association on a proposed pilot project.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Docket No.

16-0322-0301

HB 748

Chairman Sali explained that HB 748 is aligned with Docket 16-0322-0301. He further explained that individuals may testify on both the docket
and the bill at the same time.



Debbie Ransom, Bureau of Facility Services, Department of Health and
Welfare, addressed the Committee. She explained that this rule
recommends three changes: (1) Amends Section 428 to cite the Board of
Nursing rules without referencing specific sections due to changes made to
those rules; (2) Deletes a statement that is in conflict with the Board of
Pharmacy rules; (3) Allows residential care facilities to return unopened
medications for credit.

CON Mick Markuson, Idaho Board of Pharmacy, addressed the Committee. He
stated that he is opposed to nurses being allowed to repackage and re-label medications for patients in licensed residential and assisted living
facilities. He explained that the chance for error increases when
repackaging and re-labeling occurs. He stated that he is concerned about
the level of expertise that nurses have. He also stated that this rule is in
conflict with federal regulations of the Food and Drug Administration and
the Idaho Board of Pharmacy statute. He distributed handouts to the
Committee from which he referenced (see attachments).
PRO Michelle Glasgow addressed the Committee. She explained that the
purpose of HB 748 is to clarify statute and rule regarding filling Medi-sets
or other unit dose delivery system from bulk medication containers or pill
bottle. She further explained that as was previously discussed in front of
this Committee earlier this year, VA and railroad employees may only take
advantage of their prescription benefits if those medications are purchased
in bulk containers/pill bottles. She explained that if an assisted living
facility has VA or railroad and some insurance retirees, the facility must
now apply for a waiver to be allowed to have care givers assist in
medication delivery directly from those pill bottles. Presently the board of
nursing and rule acknowledges that filling a medi-set comes under a
nurses scope of practice.
CON Rick Holloway, President, Western Health Care, addressed the
Committee. He explained that he is concerned with mistakes made among
nurses and unlicenced care givers administering medications.
PRO Sherry Marshall, Licensed Practical Nurse, addressed the Committee.
She demonstrated the actual steps involved with repackaging medication
by filling a medi-set container with pills (candy was used for the purpose of
the demonstration) and re-labeling the package. She responded to a
question by stating that care givers in assisted living facilities “assist” with
administering their medications as opposed to solely administering the
medications to them.
PRO Duke Van Campen, Masters Degree Nurse, owner of seven assisted living
facilities, addressed the Committee. He explained that filling medi-sets lies
within the scope of practicing as a nurse, as well as does the responsibility
of liability that might be incurred. He further explained that his staff is
educated in the proper handling of medications and instructed through the
delegation of a nurse.
Debbie Ransom yielded to a question by stating that the initial reason for
proposing this rule is because the method currently in practice is in
violation of the Board of Pharmacy statute.
PRO Jerry Mitchell, owner of four assisted living facilities, addressed the
Committee. He expressed that allowing nurses to fill medi-sets, will be a
tremendous cost savings to residents. He further expressed that
dispensing medication directly from the pill bottle leaves more opportunity
for error than does repackaging pills into blister packs/medi-sets.
PRO Jim Shaddock, Administrator, Ashley Manor, addressed the Committee.
He explained that the issue is whether to administer medications directly
from pill bottles or from medi-sets previously packaged by a nurse, the
later method being more efficient and safer.
PRO Stan Turner, Administrator of an assisted living facility, addressed the
Committee. He explained that he believes filling medi-sets is much safer
and more reliable. He also stated that re-labeling involves making a photo
copy of the original label on the bottle and applying that copied label
directly to the container.
PRO Richard Christensen, attorney representing Idaho Assisted Living
Association, addressed the Committee. He referenced from handouts
distributed to the Committee, rules within the FDA regulations and Idaho
Board of Pharmacy statute, and concluded that the current practice of
filling and labeling medi-sets is not in conflict with either one.
MOTION: Rep. Nielsen moved to reject Section 428, Subsection 01 and 02 of
Docket 16-0322-0301. There was discussion on the motion.
ON A VOICE VOTE THE MOTION FAILED.
By Unanimous Consent the report to the Speaker will reflect that the
Committee found no basis upon which to reject Docket No. 16-0322-0301.
MOTION: Rep. Nielsen moved to send HB 748 to the Floor with a Do Pass
recommendation. There was discussion on the motion.



Vice Chairman Block asked for Unanimous Consent that the action on
Docket 16-0322-0301 be reconsidered. There was no objection.

MOTION: Rep. Nielsen moved to reject Section 428, Subsection 01 and 02 of
Docket 16-0322-0301.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
MOTION: Rep. Kulczyk moved to send HB 748 to the Floor with a Do Pass
recommendation.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
HCR 49 Kris Ellis, representing the Assisted Living Association of Idaho,
addressed the Committee. She explained that this resolution proposes
development of new rules, methods, and efficiencies to aid in assuring that
facilities have appropriate and timely surveys without dramatic increases to
the state general funds.



Randy May addressed the Committee in support of the bill. He noted from
a handout given to the Committee entitled, “Residential or Assisted Living
Restructuring Task Force,” a list of the objectives and of the participant
stakeholders involved in this task force (see attached handout).

MOTION: Rep. Mitchell moved to send HCR 49 to the Floor with Do Pass
recommendation.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Chairman Sali brought SCR 122 before the Committee explaining that this
concurrent resolution rejects Section 204 and 210 of Docket 16-0209-0308 relating to the medical assistance program. He further explained that
adoption by both houses will prevent the agency rules from going into
effect.



MOTION:


Rep. Mitchell moved to send SCR 122 to the Floor with a Do Pass
recommendation.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Chairman Sali stated that due to the time factor, the sponsor of HB 731
has requested to move the bill to the next meeting, Tuesday, March 2.
Presenter: Marilyn Sword, Executive Director of the Idaho Council on Developmental
Disabilities, addressed the Committee. She distributed to the Committee
the report on Self-Determination in Idaho, which is a project in
collaboration with the Idaho Department of Health and Welfare. She noted
several key points from the report, including a brief summary about the Self
Determination Waiver Project, mention of the $500,000 grant they have
received, and information regarding the development of the waiver (see
attached report). Ms. Sword introduced Tygh Hales.



Tygh Hales, a member of the task force, addressed the Committee. He
explained that this waiver will give those with developmental disabilities
more choice in determining the types of services they feel they need as
well as choice in who they want as their provider. He expressed that this
system is participant driven by allowing them the freedom to plan their own
lives, and have the authority to have control over their own lives.



Katherine Hansen, Executive Director of Community Partnerships of
Idaho, addressed the Committee explaining that she is one of five
providers in the Waiver Task Force Group. She explained that this waiver
allows the consumer to choose to hire individual providers rather than an
agency. She further explained that consumers have the opportunity to
negotiate for their services by meeting with various providers, both
individual and agency to try to get the best deal for their dollars.



David Rogers, Administrator, Department of Health and Welfare,
addressed the Committee. He explained that the Department has been
working with the council to come up with strategies to further the
development of this project. He stated that not only has the $500,000
grant been funded, but the council has committed to $150,000 toward the
project.

ADJOURN: There being no other business, the meeting was adjourned at 5:30 P.M.






DATE: March 2, 2004
TIME: 1:30 P.M. or Upon Adjournment
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 sign-in sheet.
Chairman Sali called the meeting to order at 1:50 P.M. He asked the
Committee to review the minutes of February 24 and 26, 2004.
MOTION: Rep. Nielsen moved to approve the minutes of February 24, 2004 as
written.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
MOTION: Rep. Ring moved to approve the minutes of February 26, 2004 as written.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Chairman Sali presented to the Committee with a letter from Mond
Warren, Bureau Chief with the Department of Health and Welfare,
requested by the Chairman at the February 18, 2004 meeting. The letter
provides clarification of the types of documentation the provider is
required to create and maintain. Chairman Sali asked for Unanimous
Consent to attach this letter to today’s minutes as well as the minutes of
February 18. There was no objection (see attached letter, dated February
24, 2004).
HB 731 Rep. Naccarato addressed the Committee. He explained that this bill will
provide for a division in EMS III grant funds based on annual call volume.
Currently, agencies in urban areas are unable to qualify for funding
because of population, service area, and budget. This amendment would
provide equal access to funding for rural and urban emergency medical
service providers.



Dia Gainor, EMS Bureau Chief, Department of Health and Welfare,
addressed the Committee. She explained the dedicated grants
distribution process by referencing from a handout given to the
Committee. She noted in page 1 and 2, agencies that were awarded
vehicle funding and those that were not in 2003 and 2004. The handout
illustrates how distributions are weighted among all agencies in the state
and clearly shows the majority of grants distributed to the smaller, more
rural areas. She also explained the scoring process and the factors used
to determine the score given to each application, i.e., greater mileage of
vehicle, greater age, smaller fleet size, etc. She further noted on page 7,
which of the providers would be entitled to 50% of dedicated funds
depending on agencies’ call volume. (See attached handout).



Karl Malott, representing Professional Fire Fighters of Idaho, addressed
the Committee. He responded to a question from the Committee
regarding the total number of calls that were responded to. He explained
that at the point where the call volume breaks between call volume areas
above and below 1000, of the total of 74,460 calls statewide, 66,476 of
those are to agencies greater than1000, i.e., agencies greater than a
thousand answer to 89% of the calls. (Mr. Malott explained that these
were 2002 figures).



Mr. Malott explained that in 1999 the EMS Fund III was established by
the legislature for the purpose of acquiring vehicles and equipment for
rural emergency medical services personnel. He further explained that
the reason a fee was added to drivers’ licences is because a major
portion of calls received are for motor vehicle accidents. He stated that
the medicaid cutbacks have been a hardship. He believes that a 50%
split among all agencies is a fair split. He believes the larger agencies
should be as eligible as the smaller ones to qualify for making application
for grants. He expressed that their needs are as great as those needs of
the rural areas. He stated that he is asking to be put under the same
system as the smaller agencies in making application to receive these
funds. (See attached handout-Idaho EMS III revenues collected & 2002
Agency reported calls).



Concerns considered were: this legislation would put more of a burden on
the rural areas that do not have the tax base to support EMS services; it
would also allow urban areas to have an equal share in qualifying for
funding, even though they draw from a greater tax base, normally a taxing
district.



Scott Long, EMS Division Chief, Idaho Falls City County Ambulance,
addressed the Committee. He explained that their funding comes from
county sources and direct charges from patient transports, including
insurance. He explained that his agency is not eligible to receive funds
based on the current scoring system. He asks that they are allowed to
make legitimate requests for funds from grants. Recent changes in
Medicare rules have limited them from doing balance billing to insurance
companies and this factor alone has brought many agencies to the brink
of bankruptcy.



Mr. Long answered questions from the Committee by stating that the
Medicare assignment, the 3% cap, and general cost of doing business
have placed great hardship on these agencies. He further expressed that
the rural areas now have more of a tax base to draw funds from than they
did in past years. He also expressed that smaller/rural areas rely on the
larger/urban agencies to respond to calls by coming to their aid and using
their vehicles, equipment, and personnel which is an added burden on the
larger agency.



Some of the concerns from the Committee raised were: how the calls are
weighted through the current scoring system and the likelihood that the
smaller EMS agencies will be asking for more funding next year by
proposing another fee on drivers’ licenses if this bill passes.



Dia Gainor agreed with Chairman Sali’s question that this legislation
would divert this grant money to higher call volume areas and would
cause some of the rural areas currently receiving funds not to receive
them.

MOTION: Rep. Martinez moved to send HB 731 to the Floor with a Do Pass
recommendation.
SUBSTITUTE
MOTION:
Vice Chairman Block moved to send HB 731 to General Orders with
Committee amendments attached which would be to change “50%” on
line 20-21 to “25%” and to change “50%” to “75%” on line 22.
AMENDED
SUBSTITUTE
MOTION:
Rep. Nielsen moved to hold HB 731 in Committee. There was discussion
on the motion.
VOTE: ON A VOICE VOTE THE AMENDED SUBSTITUTE MOTION FAILED.
VOTE: ON A VOICE VOTE THE SUBSTITUTE MOTION FAILED.
VOTE: ON A ROLL CALL VOTE THE MAIN MOTION TO SEND HB 731 TO
THE FLOOR WITH A DO PASS RECOMMENDATION PASSED.

Voting Nay – Representatives Block, Kulczyk, McGeachin, Nielsen

Voting Aye – Representatives Garrett, Eberle, Ring, Martinez, Mitchell

HB 646 Patrick Collins, Attorney, Hawley Troxell Ennis & Hawley, representing
Idaho Health Facilities Authority, addressed the Committee in support of
this bill. He explained that the Idaho Health Facilities Authority was
created to lend money to, and issue bonds on behalf of, healthcare
institutions serving Idaho for the purpose of promoting health and welfare
for the people. He further explained that this bill amends the definition,
“health institution,” to make it clear that hospitals operating health facilities
in Idaho either directly, or indirectly through one or more corporate
affiliates, are entitled to borrow money from or issue bonds through the
Idaho Health Facilities Authority.
MOTION: Rep. Ring moved to send HB 646 to the Floor with a Do Pass
recommendation. Committee discussion followed.



Neil Moss, representing Idaho Health Facilities Authority, responded to a
question regarding secured vs. unsecured loans by stating that the
borrower has to meet two criteria: (1) be either a government owned or a
private, non-profit entity because the money must be exempt from federal
and state income tax; and (2) must show proof that the monies generated
will be sufficient to service the debt on the length of term that the debt is
issued. In response to questions regarding the changes, he answered
that a financial feasibility study would be required for each loan and stated
that the entity applying for a loan must show proof that they can service
the debt or they will be denied. He also stated that his company has
exceeded $1 billion in loans since 1973 and has not had one payment
default.



Mr. Collins answered a question/concern regarding giving loans to
affiliates residing outside of the state of Idaho. He stated that with the
changes in the law, monies would only be loaned to an entity to meet
local needs in Idaho demonstrated through a feasibility study. He also
stated that when the client makes application for a loan, they must be
specific as to what it will be used for, i.e., must be used for capital
expenditures only.

VOTE: ON A VOICE VOTE THE MOTION CARRIED.
HB 657 Jim Jones, Attorney, representing Jon and Brenda Field, addressed the
Committee explaining that the parties interested in House Bill 657 had met
and negotiated amendments to the bill that are more detailed and that
everyone is satisfied with. He explained that the amendments add a new
Section 37-117A, Idaho Code, to provide reporting and disclosure
requirements for certain health care providers who are terminated from
employment for adulteration or misappropriation of controlled substances.
He continued to explain that if an employer in good faith provides such
information, he/she shall not be held civilly liable for the disclosure or for
the consequences of providing the information. He also noted additional
requirements for professional licensing boards and prospective employers
of health care providers.



Steve Millard, Idaho Hospital Association, yielded to a question by
responding that all parties have come together and are in agreement with
this amendment.

MOTION: Rep. Block moved that the Committee request that the negotiated
amendments be put into RS form and that the Committee send a request
that the Ways and Means Committee print the RS and send it directly to
the Second Reading Calendar.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
MOTION: Rep. Kulczyk moved to hold HB 657 in Committee.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
SCR 120 Chairman Sali brought SCR 120 before the Committee explaining that
this concurrent resolution rejects Sections 346, 347, 348 and 349 of
Docket 16-0301-0302 of the Department of Health and Welfare relating to
eligibility for Medicaid for families and children/CHIP Program, but accepts
Section 214 pertaining to verification of social security numbers. This bill
was before the Committee February 4th. Chairman Sali explained that
the issue is that if these sections are not rejected there will be about 200
children eliminated from the Chip Program because their household has
seasonal income that exceeds the threshold amount, even though on a
yearly basis the household income may not exceed that threshold
amount.



Chairman Sali yielded to a question by stating that there had been a
projection that an additional 17,000 enrollees would be added to Medicaid
through the CHIP B and Access Card Programs which begin July 1, 2004.
That amount has been reduced by action of the Joint Finance and
Appropriations Committee which limited the CHIP B enrollment to 1000
children.

MOTION: Rep. Garrett moved to send SCR 120 to the Floor with a Do Pass
recommendation.
VOTE: ON A VOICE VOTE THE MOTION CARRIED. Rep. Kulczyk voted No.
ADJOURN: There being no further business Chairman Sali adjourned the meeting at
4:10 P.M.






DATE: March 4, 2004
TIME: 1:30 P.M. or Upon Adjournment
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 sign-in sheet.
Chairman Sali called the meeting to order at 2.50 P.M.



Chairman Sali presented the Committee with two articles from the
Washington Post, November, 2003, relating to issues that have arisen
regarding the illegal trade of prescription drugs. One of the articles deals
with prescription medications obtained from the internet, the other deals
with the “shadow market” whereby the Food and Drug Administration has
had difficulty tracking the path drugs follow, where they are coming from
and who the buyers are. He encouraged the members to read the articles
by stating that the issues presented will be brought up in this Committee
sometime soon, probably next year.



Chairman Sali brought to the attention of the Committee an issue
regarding survey procedures for skilled nursing facilities. The Bureau of
Facility Standards of the Health and Welfare Department currently
conducts inspections of these facilities. He presented a draft of a
memorial to the members, a copy of which was in their folders, and
introduced Keith Holloway, CEO of Western Healthcare Corporation, to
present this memorial to the Committee.



Mr. Holloway stated that this memorial would provide nursing facilities
the option to be accredited by an approved national accrediting body in
place of the current survey conducted by the State of Idaho. He
estimates an approximate 20% savings in Medicaid funds dedicated to
surveys. The average savings would amount to about $6,500 a year per
survey which is about one-half of the present cost to Medicaid.



Steve Millard, Idaho Hospital Association, yielded to a question by stating
that the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO) has very high standards that are difficult to meet. He also
stated that state surveyors will monitor the JCAHO to be sure they are
conducting surveys appropriately and meeting expectations. The state
licensing agencies would follow-up with the healthcare organization if
there was a problem.



Chairman Sali asked for the Committee’s unanimous consent to have
this memorial printed by the Ways and Means Committee and sent to the
second reading calendar. There was no objection.



Chairman Sali addressed the Committee regarding the parliamentary
procedure followed during the Committee’s action on rule Docket No. 16-0322-0301 at the last meeting. He explained that the motion Rep.
Nielsen
had made to send HB 748 to the Floor with a Do Pass
Recommendation was before the Committee when Rep. Block asked for
Unanimous Consent to reconsider the action taken on the docket. He
ruled correctly that the unanimous consent request – with no objection –
had brought the rule Docket immediately before the Committee, however,
when the action on the Docket was dispensed with, HB 748 was still in
front of the Committee with Rep. Nielsen’s Main Motion still before the
Committee. The ruling by the Chair that Rep. Nielsen’s motion had been
dispensed with by the unanimous consent request was in error. Since
that Motion was still before the Committee, Rep. Kulczyk’s Motion
regarding HB748 was not required, though since it was the identical
motion Rep. Nielsen had made, the result was unchanged. The
Chairman apologized for the error.

S 1318 Senator J. Stanley Williams addressed the Committee regarding this
legislation to remove certain requirements regarding Podiatrists. He
explained that this legislation removes language in Idaho Code that
requires patients admitted to an Idaho hospital, on the recommendation of
a licensed podiatrist, to have their required history and physical performed
by a licensed M.D. He further explained that podiatrists are trained,
qualified, and licensed under Idaho Code to perform routine examination.
Podiatrists basically receive the same courses of study and undergo the
same amount of training in medical school that M.D.’s and D.O.’s do in
the area of histories/physicals.



Pro Tem Robert Geddes, addressed the Committee in support of this
legislation. He stated that the practice of podiatry is now very competitive
with the training, education, and experience that is provided to M.D.’s and
D.O.’s. He stated that there is a need to expand the capability of
podiatrists to allow them to practice and provide for the needs of their
patients. This current practice of requiring an M.D./D.O. to complete the
physical is somewhat antiquated in our current medical practices. He
expressed the need to recognize other practitioners as being capable of
providing medical services that have been prohibitive in the past.



Bob Seehusen, CEO Idaho Medical Association addressed the
Committee in opposition to the bill. He explained that the concern of the
IMA is for those high risk patients, who, because of a particular health
condition, may necessitate that surgery be performed in the hospital
rather than in the podiatrist’s office. He explained that usually these are
patients that are at high risk for heart problems, etc., or require general
anesthesia. He believes that in these cases another physician should
oversee the patient by performing an additional history/physical.



Gary Millward, Podiatrist, addressed the Committee in support of this bill.
He explained that his education, training, experience was very similar to
that of M.D.’s He stated that he had two years of surgery experience, and
performed about 100 history/physicals per month over that two-year
period. He further stated that there is an extra cost to the patient for an
additional physical which usually is not paid by insurance. He expressed
that he is asking to be allowed the same management delivery system of
history/physicals currently practiced in the office of podiatrists to be
practiced in the hospital as well.



Steve Millard, representing Idaho Hospital Association, addressed the
Committee in opposition to this bill. He explained that his concerns are
similar to previous testimony in that those patients who require an
overnight stay are put into a higher risk category and should be required
to be seen by a medical doctor prior to surgery.



Larry Benton, representing the Idaho Association of Podiatric Medicine,
addressed the Committee in support of the bill. He explained that this
requirement is outdated, inconvenient to patients and examining
physicians, and adds unnecessary costs to patients and insurers. He
further explained that the JCAHO which sets the standard for care in
hospitals throughout the U.S. ruled in December, 2000 that “it is
consistent with MS.6.2.2 for qualified, credentialed, and privileged doctors
of podiatric medicine to perform all or part of the inpatient admission
medical history and physical examination independently, subject to
applicable state law and the determination by the medical staff that high-risk patients require confirmation or endorsement of the history and
physical by a qualified physician.” JCAHO currently accredits most of the
hospitals in Idaho.

MOTION: Rep. Ring moved to send S 1318 to the Floor with a Do Pass
recommendation.
VOTE: ON A VOICE VOTE THE MOTION CARRIED. Rep. Sali will sponsor the
bill.
S 1291 Laura Rowen, Program Manager, Department of Health and Welfare,
addressed the Committee. She explained that this bill would give the
Idaho Department of Health and Welfare the authority to administer a J-1
Visa Waiver Program for Idaho and allow them to place up to thirty
foreign-trained physicians in rural communities. These physicians must
complete an American residency program and achieve a license to
practice in Idaho. Physicians must agree to practice a minimum of three
years, serve Medicaid and Medicare patients, and provide a sliding fee
scale for their services. She stated that the physician will be monitored
and will report to the Department. She explained that a qualifying facility
submits a physician’s application who holds a J-1 Visa to the Department;
if the application is accepted, the Department may then make
recommendation to the U.S. Department of State for a waiver to be
granted; the U.S. Department of State will notify the physician directly if a
waiver is granted; the physician then must seek an H1-B Visa, or work
permit for someone with non-immigration status. Ms. Rowen noted in the
handout, distributed to the members, the areas of the state that are
eligible to request primary care physicians under this proposed state
administered program. (See attached handout).
MOTION: Rep. Kulczyk moved to send S 1291 to the Floor with a Do Pass
recommendation.
VOTE: ON A VOICE VOTE THE MOTION CARRIED. Rep. McGeachin and
Rep. Ring will sponsor the bill.
S 1320 Steve Millard, president of the Idaho Hospital Association, addressed the
Committee. He explained that the purpose of this bill is to add language
that addresses Emergency Medical Services Personnel, including them
within Idaho’s peer review statutes and thereby accommodating their
participation. Currently, EMS personnel efforts to conduct peer review are
severely curtailed because they are not covered by these statutes. This
bill allows those “pre-hospital”, i.e., EMS personnel to be included for peer
review under Idaho’s peer review statutes.
MOTION: Rep. Henbest moved to send S 1320 to the Floor with a Do Pass
recommendation.
VOTE: ON A VOICE VOTE THE MOTION CARRIED. Rep. Martinez will
sponsor the bill.
S 1299 Rep. Charles Cuddy addressed the Committee. He explained that the
purpose of this legislation is to clarify that the medical professional
training defibrillator operator is released from all liability due to providing
the necessary training and prescription to the operator. This legislation
will give the training and prescribing professional the same lawful
protection now granted to the operator.
MOTION: Rep. Martinez moved to send S 1299 to the Floor with a Do Pass
recommendation.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
ADJOURN: There being no further business, Chariman Sali adjourned the meeting.






DATE: March 10, 2004
TIME: 1:30 P.M. or Upon Adjournment
PLACE: Gold Room
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives
Eberle, Garrett, Kulczyk, McGeachin, Nielsen, Ring,
Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

None
GUESTS: See attached sign-in sheets.
Chairman Sali called the meeting to order at 3:15 P.M. He
asked the Committee to review the minutes of March 2 and
March 4.
MOTION: Rep. Kulczyk moved to approve the minutes of March 2 and
March 4, 2004.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
Briefing Michael Bogert, Counsel to the Governor, and Richard
Schultz
, Administrator, Department of Health and Welfare
addressed the Committee regarding the work that has been
done in the area of informed consent for women seeking
abortions. Mr. Bogert explained that the intent of this briefing
is to discuss what has been done to rewrite Idahos informed
consent materials that must be provided to Idahoans by
current law. He has been working together with the
Department to provide concise informed consent materials.
He expressed that they are continuing to work on these
materials. He presented three draft booklets from the office
of the Governor that had been previously distributed to the
members, entitled “Fetal Development,” “Directory of
Pregnancy and Child Health Services,” and “Abortion”. He
stated that an ad hoc committee working through the
Governors office deserved thanks for their work on the
materials. Mr. Bogert introduced Mr. Schultz to address the
booklets in more detail.



Mr. Schultz explained that the booklets were a collaborative
effort of the ad hoc committee in the Governors office, his
staff and the Department. They were in agreement that many
things needed to be changed, including replacing the
American College of Obstetrics and Gynecology brochure.
The group modeled their effort after materials from the State
of Virginia. He explained that the information has been based
upon comments made by the public and interested parties.
He stated that March 19, 2004 is the deadline for receiving
input from interested parties. At that point, the process will
begin of revising and preparing a final draft of the materials,
ensuring the best and most accurate information available to
Idaho citizens. Mr. Schultz recognized Jane Smith, State
Registrar and Chief of the Bureau of Health Policy and Vital
Statistics in the audience as another key player in this effort.

S 1283 Senator Brent Hill addressed the Committee regarding this
legislation which amends Chapter 55, Title 39, regulating
smoking in public places. Senator Hill explained that this
legislation is about health. He said, “This kind of regulation is
not un-American, un-Republic, or un-Democratic.” He stated
that second hand smoke causes disease and death and
currently thousands of Idahoans are sick from heart or lung
disease, asthma, and cystic fibrosis. They are unable to go
into public places due to their intolerance to second hand
smoke. He provided a hand out from the Coalition for a
Healthy Idaho which compares current law to the changes
provided by his bill and the affect on various public and
nonpublic facilities. Senator Hill said currently, non-smokers
have no protection in public places. He said he has reports
from the United States Surgeon General, the National
Academy of Sciences, and the American Medical Association
which document the dangers of second hand smoke. He said
studies show that exposure to second hand smoke causes
thirty times the number of cases of lung cancer than all other
air pollutants. He stated that his measure would protect
children who cannot choose which public places they go to,
and adults who work in smoke-filled rooms. He explained
that his three sons worked as waiters during college and he
said, “Nineteen-year-old kids think they are invincible and
that they are never going to get sick and that they are never
going to die.” He said the opposition will suggest that this
legislation will hurt businesses. However, there have been
studies done that show no negative effect, and show that
there have been increased levels of morale and productivity.
He stated that there are volumes on government regulations
involving health and safety. He further stated that with
freedom, comes responsibility, and business owners must
accept the responsibility of providing a safe and healthy
environment for customers and employees. He said in this
bill they have tried to accommodate smokers where possible
in order to avoid denying individual rights. (See attached
handouts)
CON Russ Westerberg, representing the Stagecoach Inn
restaurant, addressed the Committee. He stated that
patrons/loyal clientele have been coming to the restaurant for
the past forty-five years for its good food and service. He
further stated that the business will suffer significant
economic loss if this bill passes. He explained that on behalf
of the Stagecoach, he does not take issue with the
contention that second hand smoke causes disease to non-smokers or that the government, in the interest of public
health, has no business attempting to prevent unintended or
unknowing exposure to second hand smoke in private
establishments. He explained that he is suggesting that there
is a way to protect the rights of non-smokers exposed to
second hand smoke while at the same time preserving the
rights of private property owners, and consumer freedom of
choice. Mr. Westerberg distributed a copy of a proposed
amendment to the Committee which strikes language in
Section 2 and adds language in Section 3. The new
language deals with posting warning signs at public
entrances to private establishments regarding the dangers of
secondhand smoke. (See attached amendment).
PRO Phil Homer, representing the Idaho Association of School
Administrators, addressed the Committee. He stated that
children should be protected from second hand smoke that
not only exacerbates childhood diseases but can cause
death. He further stated, “this will be another arrow in our
collective quivers that will help to provide a safer, healthier
environment for our children and us.”
CON Kevin Settles, owner of Bardenay Restaurants and
representing the Idaho Lodging and Restaurant Association,
addressed the Committee. He stated there is a 90% failure
rate in the restaurant business. He stated he will lose those
customers who smoke to an establishment around the corner
where food is not served. He further stated that this
legislation is poorly drafted.
PRO Phil Behm, a private citizen who suffers from a rare genetic
protein deficiency called Alpha-1 antirypsin deficiency
addressed the Committee. He explained that this disease
leaves his lungs unprotected against environmental
pollutants. He stated that he doesnt believe that he should
have to live in a bubble and he supports protection for those
unable to tolerate harmful components from smoke.
CON Mike Fitzgerald, vice president of the Idaho Lodging and
Beverage Association and owner of Table Rock Pub and Grill
addressed the Committee. He stated that he believes this is
a poorly written bill and has a problem with the way the bill
addresses restaurants on pg 2 of the bill. He further stated
that this bill will have a negative impact on his business.
PRO Dr. David McClusky, a surgeon in practice in Twin Falls,
Idaho, addressed the Committee. He stated that tobacco is
the number one cause of death and nothing is being done
about it. He further stated that 21% of his patients smoke and
account for 69% of health care costs.
PRO Liz Spear, a waitress in Boise, addressed the Committee. She
stated that the corporation she works for supports the bill.
She expressed the negative health factor for children who
dine in restaurants where smoking is allowed.
PRO MaryAnn Rosenberry, a Jefferson Junior High School freshman,
addressed the Committee. She explained that she does not like to
have to be exposed to second hand smoke while dining in
restaurants. She asked the question of the Committee: “What are
you going to do to protect me and others like me?”
CON Chris Thomas, a Boise resident and writer of college text
books involving restaurant equipment and ventilation
systems, addressed the Committee. She stated that air
conditioning and heating systems in most eating
establishments are designed for temperature control, not for
improving air quality. She further stated that the present
technology in clean air filtration does not provide the level of
efficiency by todays standards.
PRO Patrick Calley, Lieutenant from the Ada County Sheriffs
Office addressed the Committee in support of the bill.
PRO Brad Dixon, representing the American Heart Association,
addressed the Committee. He stated those he represents
believes this bill will help reduce second hand smoke
exposure and will help to reduce heart disease. Mr. Dixon
referred to an experiment in Helena, Montana where
reduction in environmental smoke resulted in a 60%
reduction in heart attacks. He stated that the rights of private
property owners are routinely restricted by government and
the Committee should not be concerned by that effect of this
bill.
CON John May, General Manager of the Owyhee Plaza Hotel in
Boise, addressed the Committee. He stated that he believes
this is an issue of choice for the restaurant and for the
customer. He stated that he takes issue with the exemption
for bars and bowling alleys, explaining that this creates an
unfair playing field. He also is concerned with his employees
who smoke. He stated that he currently has a designated
smoking area for them, but this bill will force him to send his
employees outside to smoke on the street or in front of the
building.
PRO Dr. Doug Dammrose, a physician and Vice President of Blue
Cross of Idaho, addressed the Committee. He stated that the
Surgeon Generals report forty years ago identified the
dangers of smoking. These hazards extend to non-smokers.
He stated that he believes that this is a step in the right
direction to cutting costs to health care.
PRO Lynn Kammermeyer, a Medical Geneticist with the March of
Dimes, addressed the Committee. She stated that the mission of
the March of Dimes is to improve the health of babies by
preventing birth defects and infant mortality. Studies suggest
second hand smoke during pregnancy doubles a non-smokers
risk of having a low-birth weight baby. She explained that studies
also suggest that children whose mothers were regularly exposed
to second hand smoke during pregnancy may be at increased risk
of learning and behavioral problems and babies who are exposed
to smoke suffer from more respiratory illnesses and ear infections
than other babies.
PRO Gail Baird, representing Coalition for a Healthy Idaho, addressed
the Committee. She read from a letter addressed to the
Committee by Shirley Greene, residing in Moscow, Idaho. Ms.
Greene wrote that she was a smoker for thirty-five years and
though it was very difficult to stop smoking, she now is smoke
free. She further wrote that the same laws (referring the Clean Air
Act originally passed in Idaho) that placed restrictions on where
she could smoke helped her to choose not to smoke because
there were fewer places to smoke. She stated in the letter that “it
is about the rights of every ldahoan to breath clean air.”
CON Mary Thomas, co-owner of the Stagecoach Inn in Boise,
addressed the Committee. She explained that she is very
concerned about how this bill will effect their business which
has been declining due to factors such as 911, the stock
market decline, rising operating and labor costs. She stated
that the restaurant is her livelihood as well as for many of the
employees. She also takes issue with removing the
designated smoking area for her employees. She is
concerned for their safety if they must resort to stepping
outside in the evening. She explained that this has been a
family owned business for forty-five years that will be
devastated if this bill passes.
PRO Sue Ann Reese, policy coordinator for the Coalition of a
Healthy Idaho, addressed the Committee. She stated that, as
non-smokers, the majority of the population is not being
accommodated. She further stated that banning smoking on
commercial airlines has not affected their business.
CON Terry Eastman, owner of Sargents Restaurant in Hayden
Lake, addressed the Committee. He stated that this law is
not written well and does not create a level playing field. He
stated that his business will be negatively impacted by at
least 30%. He further stated that he has already spent
around $23,000 to improve the air quality system and it is
working. He further stated that employment in his restaurant
is a primary source of income for many of his employees.
PRO Ron Williams, an attorney, addressed the Committee. He
stated that the bill will withstand scrutiny by the courts.
PRO Bob Seehusen, CEO of the Idaho Medical Association,
addressed the Committee. He stated that the main concern
of his association is the health of Idaho citizens. He further
stated that he believes that this bill will help deal with some
of the health care costs of our state.
PRO Brad Hoagland, representing the Coalition for a Healthy
Idaho, addressed the Committee. He stated that there have
been major concessions made to this bill. He referenced on
pg. 1, line 37 in the bill language that allows the facility to
become a bar with signage placed as outlined in the bill.
PRO Ferdinand Schlapper, Executive Director for BSU Health
Services, addressed the Committee. He stated that these
laws have a positive effect and the only negative effect is to
the tobacco industries. He further sited several studies that
have been done that indicate there is currently not an
allowable level of air quality from smoking. He stated that
there is already government regulation that involves levels of
carbon monoxide, temperature of meat and water, fire and
safety standards, sanitation standards, etc.
CON Rep. Roberts addressed the Committee. He takes issue with
the exemption for bowling alleys and bars and the regulation
of certain areas in private homes. He distributed to the
members a proposal for an amendment that would strike
language in the first four pages of the bill and asked the
Committee to consider allowing local counties and cities to
pass legislation more suitable to the needs of the populations
in specific areas. (See attached amendment).
CON Pam Eaton, President of the Idaho Retailers Association,
addressed the Committee. She explained three areas of
concern: the policing/enforcing of this law, especially in mall
areas; restriction of designated smoking areas for
employees, forcing them to smoke outside in front of retail
stores; and the negative impact on downtown development if
restaurants are forced out of business. Ms. Eaton presented
the Committee with a copy of a proposed amendment to the
bill changing language regarding designated employee break
room. (See attached amendment).
CON Steve Carper, beverage manager of the Stagecoach Inn,
addressed the Committee. He stated that there has been a
devastating, negative economic impact to business and
employees of those businesses in many communities fro
laws such as this. There has been a loss of jobs

and income to many individuals as a result of similar
legislation that has been passed in other states. He stated
that he believes that this is a battle between the tobacco
companies and health care advocates, and businesses such
as his are getting hurt as a result.

CON Gary Sullivan, employee of Quinns Restaurant in Boise,
addressed the Committee. He stated that market conditions
have caused him to make substantial improvements in the
ventilation system in his restaurant which has improved air
quality. Businesses are being responsible and are making
improvements as technology becomes available to help
them.
Senator Hill stated that he had no further remarks because the
case for the bill had already been made.
Upon concluding testimony, Chairman SaIi stated that the bill
was before the Committee.
MOTION: Rep. Ring moved to send S 1283 to the Floor with a Do Pass
recommendation. He commented that restaurant owners who
oppose the bill seemed to “prefer to endanger the life and
health” of their patrons. He further stated that this bill may be
the most important way this legislature can help to improve
health care in Idaho.
SUBSTITUTE

MOTION:

Rep. McGeachin moved to send S 1283 to General Orders by

incorporating a new proposed RS 14266 with the bill and the
following amendments to that RS:

Striking language on pg. 2, Line 25 and 26 of the RS,
“and within twenty (20) feet of public entrances and
exits to such facilities;”

Creating a Subsection on pg. 4 of the RS, directly
before line 43 and inserting lines 38-40 from pg. 4 of
the bill.

Creating a new Subsection 2 at line 43 of the RS,
incorporating lines 43-47 under that subsection.

There was discussion on the motion.

AMENDED

SUBSTITUTE
MOTION:

Rep. Kulczyk moved to hold S 1283 in Committee to a Time
Certain on Friday, March 12, 2004. He expressed that the
language is in conflict and more time is needed to study all
proposed amendments.
MOTION: Rep. Mitchell called for the question.
VOTE: ON A VOICE VOTE THE CALL FOR THE QUESTION CARRIED.
VOTE: THE AMENDED SUBSTITUTE MOTION TO HOLD S 1283 TO A
TIME CERTAIN, FRIDAY, FAILED.



Committee discussion continued on the motions before them.
Some of the concerns given were: the problem of
patrolling/enforcement of the bill, especially in mall areas; the
problem of restricting designated smoking areas for
employees; many constituents who support the bill may not
have read the bill in order to understand the intent.

MOTION: Rep. Mitchell called for the question.
VOTE: ON A VOICE VOTE THE CALL FOR THE QUESTION CARRIED.
VOTE: ON A ROLL CALL VOTE THE SUBSTITUTE MOTION TO SEND
S 1283 TO GENERAL ORDERS WITH ATTACHMENTS FAILED.



Voting Nay – Representatives Block, Kulczyk, Garrett, Ring, Henbest, Martinez



Voting Aye – Representatives Eberle, McGeachin, Nielsen, Mitchell

VOTE: ON A ROLL CALL VOTE THE MOTION TO SEND S 1283 TO
THE FLOOR WITH A DO PASS RECOMMENDATION PASSED.



Voting Nay – Representatives Kulczyk, Eberle, McGeachin, Nielsen



Voting Aye – Representatives Block, Garrett, Ring, Henbest, Martinez, Mitchell

ADJOURN: There being no further business, Chairman Sali adjourned the
meeting at 7:40 P.M.






DATE: March 12, 2004
TIME: 1:30 P.M. or Upon Adjournment
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

Representatives Eberle, McGeachin, Henbest
GUESTS: See attached sign in sheet.
Chairman Sali called the meeting to order at 2:20 P.M. He presented a
copy of his letter making report to the Speaker of the House advising him
of the Committee’s action on all of the pending, temporary and fee rules
that the Committee had received. (See attached letter)
S 1288 Mike Sheeley, Executive Director of the Idaho Board of Dentistry
addressed the Committee. The Idaho State board of Dentistry proposed
the following three bills for consideration by the 2004 Legislature: S1288
(extended access oral health care programs); S1289 (volunteer’s license
for retired dentists); and S1292 (change to the definition of the term
“dental assistant”).



Mr. Sheeley explained that the purpose of S1288 is to define the term
“extended access oral health care program” and to create a new dental
hygienist’s license endorsement that would provide for a dental hygienist
who satisfied the applicable qualifications to be issued an “extended
access dental hygiene endorsement” which would authorize the holder of
the endorsement to provide dental hygiene services under a dentist’s
general supervision through an extended access oral health care
program. He stated that this should not be an unsupervised setting. An
extended access oral health care program would include dental hygiene
services provided through local, state and federal programs, hospitals,
schools, community health centers and through such other non-profit or
charitable dental hygiene programs which are annually approved by the
Board of Dentistry and which provide free or low-cost dental services to
persons who are unable to receive regular dental hygiene care in a
private dental office. In order to obtain the endorsement, the hygienist
must hold an active status license in good standing and must have
practiced for a total of one thousand (1,000) hours in the two (2)
immediately prior years in order to qualify for an extended access
endorsement. Mr. Sheeley referenced the Idaho State board of Dentistry
newsletter of May, 2003 that included a draft proposal of these matters,
requesting readers’ comments. He stated that approximately seventy
dentists, dental hygienists and organizations responded overwhelmingly
in support of this proposal.



Mr. Sheeley explained that by replacing the term “institution” with
“extended access oral health care program” the scope of the area of
practice outside of a dental office is more clearly defined. He further
explained that this bill authorizes dental hygienists to go to areas they
have never been allowed to before.

Katie Barbour, representing Lucrary Dental Clinic, a non-profit clinic,
addressed the Committee in support of the bill. She explained that there
is a huge population in the state of Idaho that do not have access to
healthcare. By this new definition of extended access, a broader
population will be allowed to receive dental health care services.
Stephanie Jarvis, dental hygienist and member of the Idaho Dental
Hygienists’ Association (IDHA), addressed the Committee in support of
the bill with amendments (see attached). She explained that she has
been treating medically compromised patients and does not believe that
she should now be required to obtain the endorsement allowing her to
provide the services she has already been providing.
Brad Hoaglun, representing IDHA, addressed the Committee and
presented two proposed amendments for S1288. He explained that the
first amendment would strike the language requiring an endorsement; and
the second amendment would give the hygienists ability to practice
without supervision (see attached amendments). He explained that dental
hygienists have been practicing in areas outside of the dental office under
general supervision for twenty years and they object to the requirement of
an endorsement. He further explained that the IDHA is in agreement to
accept the endorsement requirement if the supervision requirement is
removed. He also explained that they object to the 5-day minimum for
hygienists to work in a volunteer capacity by posing the question of why 5-days was the number determined and why not more days.
Sally Kane, a dental hygienist, member of IDHA, addressed the
Committee. She explained that she has worked in alternative practice
settings under general supervision in collaboration with community
dentists for more than 17 years. She opposes the endorsement.
Jennifer Andrews-Kelly, President of IDHA, addressed the Committee in
opposition to the bill without the amendments. She explained that she
does not oppose the definition change, but does oppose the
endorsement. She further explained that dental hygienists have been
providing dental care to areas outside of the dental office for twenty years
and objects to the endorsement requirement with general supervision.
She believes this is a step backward and will inhibit dental care. They
would support un-supervised higher level of practice. She stated that the
IDHA has tried to communicate their goals of expanding access to care by
reducing the supervision requirements of dental hygienists. However,
their visions for expanded access dental hygiene care have not been fully
understood and are not part of this legislation. She stated that the two
amendments to S1288 will make a positive impact on access to dental
care in Idaho.
Jerry Davis, Executive Director of the Idaho Dental Association,
addressed the Committee in support of this legislation. He explained that
dental patients must receive the highest and safest level of care that can
possibly be provided. He also explained that dentists are totally
responsible and totally liable for any dental care services performed by
health care providers from their dental practices.
Elizabeth Criner, representing the Idaho Primary Care Association,
addressed the Committee in support of the bill. She explained that her
association bills patients on a sliding-fee scale basis. She stated that
there is a tremendous need for health care and this bill will expand access
to care and will have a positive affect in the delivery of dental care
services. She further stated that this bill will allow them to maximize the
use of dentists by allowing dental hygienists to work under general
supervision.
Julie Slee, dental hygienist, member of IDHA, addressed the Committee
in support of this bill with the amendments. She explained that in order to
do her job, she must find a dentist who is willing to take on the job of a
supervisor.
MOTION: Rep. Nielsen moved to send S1288 to General Orders with the first and
second amendments of the IDHA attached.
SUBSTITUTE
MOTION:
Rep. Kulczyk moved to send S1288 to General Orders with the first
amendment of the IDHA attached which is on pg. 2, line 21 to strike the
language beginning with the word, “holding a license with an extended
access dental hygiene endorsement”.
AMENDED
SUBSTITUTE
MOTION:
Rep. Ring moved to send S1288 to the Floor with a Do Pass
recommendation. There was discussion on the motion. Rep. Garrett

commented that the process of establishing an endorsement requirement
is a concern because of the time it may take.

VOTE: ON A VOICE VOTE THE AMENDED SUBSTITUTE MOTION FAILED.
VOTE: ON A VOICE VOTE THE SUBSTITUTE MOTION PASSED.
H 829



Rep. Jaquet addressed the Committee regarding this bill for Rep.
Henbest who is the sponsor but who was unable to attend the meeting.
She explained that this legislation will create a Healthy Idaho Advisory
Committee within the Office of the Governor that will require reporting to
the Governor and the legislation on a broad number of issues related to
diet and exercise in Idaho and in Idaho schools. This committee will
consist of up to fourteen members from various associations; the
Department of Health and Welfare, the Idaho Dietetic Association, the
Idaho Academy of Pediatrics, the Idaho Academy of Family Practice to
name a few. She explained that the objective of this committee is to
develop nutrition and physical activity recommendations and develop
recommendations for the promotion of a statewide program to address
physical inactivity and obesity.
SeAnne Safaii, a dietitian and Co-Chairman for Action For Healthy Kids,
addressed the Committee in support of this bill. She explained some of
the problems related to children in the United States regarding obesity
and lack of nutrition. She explained that the incidence of childhood
obesity has doubled over the last two decades and as many as 25% of
kids are at risk for obesity. Elementary children (45% of them) eat less
than one serving of fruit a day and 20% eat less than one serving of
vegetables (french fries were considered a vegetable). Only 18% of girls
ages 9-19 meet their calcium requirement. About 2/3 eat more fat than is
recommended. She further explained that in the last fifteen years, milk
consumption in schools has decreased by 29% and pop consumption has
increased 1100%.



Ms. Safaii explained that the health care costs associated with obesity,
poor nutrition and inactivity are staggering and the total direct and indirect
costs attributed to overweight and obesity amounted to one hundred
seventeen billion dollars in the year 2000. She stated that Idaho needs a
comprehensive plan to prevent obesity in children. Schools, parents,
students, health care providers and communities must take action in
establishing a Healthy Idaho Advisory Committee to plan and coordinate
prevention and intervention with a unified voice.

MOTION: Rep. Martinez moved to send H 829 to the Floor with a Do Pass
recommendation. He commented that coordinating this type of program is
worthwhile even if only one-hundred people are impacted and, in turn,
impact others. There was discussion on the motion.



Some of the concerns shared by the Committee were: states mandating
what kinds of foods are sold in vending machines; no representation from
the Governor’s office at this meeting; meeting monthly is a major
commitment; is this perhaps a duplication of another similar committee
already in place?; concern of whether anything will be accomplished.

SUBSTITUTE
MOTION:
Rep. Nielsen moved to hold H 829 to a Time Certain, Tuesday,

March 16.

VOTE: ON A VOICE VOTE THE SUBSTITUTE MOTION FAILED.
VOTE: ON A ROLL CALL VOTE, THE MAIN MOTION TO SEND H 829 TO THE
FLOOR WITH A DO PASS RECOMMENDATION PASSED
.

Representatives Kulczyk, Nielsen voted Nay.

Representatives Block, Garrett, Ring, Martinez voted Aye.

S 1289 Mike Sheeley addressed the Committee and explained that S 1289,
which is a bill that would provide for a volunteer licensing for retired
dentists, is a companion bill to S 1288 and because the later did not pass
without amendment, this bill has become mute. He asked to withdraw the
bill. There was no objection.
S 1292 Mike Sheeley addressed the Committee in support of this bill. He
explained that the purpose of this legislation is to amend the Idaho Dental
Practice Act (Chapter 9, Title 54, Idaho Code) by the deletion of the
restriction in the existing definition of “dental assistant” found in Idaho
Code which only authorized dental assistants to practice under the direct
supervision of a dentist and to include the term “dental assistant” in the
definitions of the terms “general supervision” and “indirect supervision”
presently found in Idaho Code. He further explained that this statute
change will provide the necessary statutory authority for the Board of
Dentistry to promulgate administrative rules authorizing dental assistants
to perform permissible functions under varying levels of supervision. This
will allow the board latitude for the future.
MOTION: Rep. Kulczyk moved to send S 1292 to the Floor with a Do Pass
recommendation.
Ms. Andrews-Kelly addressed the Committee in opposition of the bill.
She believes that this will jeopardize patient care. She stated dental
assistants are not required to have any formal education.
Kelly Campbell Burton, a dental hygienist and member of IDHA
addressed the Committee in opposition to the bill. She explained that
there are currently no regulations or standards for dental assistants. They
are not required to have CPR training, or any medical emergency training.
Brad Hoagland, representing IDHA, addressed the Committee in
opposition to the bill. He opposes dental assistants being allowed to
practice without the presence of a dentist. He is concerned with the
current practice of, in some instances, allowing dental assistants to
perform invasive procedures, when they do not have the education or
certification that would be required.
Rep. Kulczyk asked to withdraw the main motion. There was no
objection.
Katie Barbour, representing Lucrary Dental Clinic, a non-profit dental
clinic, testified in support of this bill. She stated that this is only
foundational and is necessary to make this statutory change in order to
create the opportunity for the Board of Dentistry and interested parties to
work together in developing a plan for the future status of dental
assistants.
Jerry Davis, Executive Director of the Idaho Dental Association, testified
in support of this bill. He stated that this legislation has had overwhelming
support from dentists and the only objection to the bill has come from
dental hygienists. He explained that a dentist’s liability is on the line,
consequently he/she is not going to use a dental assistant in this capacity
if they do not have a proven record for their level of ability.



Katie Barbour yielded to a question by stating that the statute needs to
be changed first, which will allow for both the opportunity to look at
possibilities and then promulgate rules, if necessary. The statute controls
the rule, i.e., one needs the statute out of the way to change the rules.

Elizabeth Criner, representing the Idaho Primary Association, addressed
the Committee in support of this bill. She stated that there are
approximately 63,000 patients served in their facilities throughout the
state and currently only six of their facilities provide dental care services.
This bill will lay the foundation that will allow the opportunity for providing
greater access to care for those who are medically under-served, as well
as, increase cost effectiveness. The rule-making process does occur,
whereby negotiations, discussion, etc. may promulgate rule changes.
MOTION: Rep. Kulczyk moved to send S 1292 to the Floor with a Do Pass
recommendation. He commented that the most important aspect is to
provide dental care to populations in need.
Chairman Sali took a point of personal privilege to express his opinion
that dental assistants are essentially apprentices in that they receive on-the-job training; dental hygienists have required education and must be
licensed/certified to practice. The need to provide dental access to
patients in need is most important. He suggested that at a lower-level of
practice a dental assistant has a lot to offer to help those who will not
otherwise get dental care. He believes dentists are normally very
responsible in trusting the ability of the dental assistants to provide the
level of health care that they would authorize.



A concern by the Committee shared was the issue of developing minimum
standard requirements for dental assistants, which are not currently in
place.

VOTE: ON A VOICE VOTE THE MOTION TO SEND S 1292 TO THE FLOOR
WITH A DO PASS RECOMMENDATION PASSED
.
MOTION: Rep. Block asked Unanimous Consent that the Committee reconsider
the action taken on S 1288.
VOTE: THERE WAS NO OBJECTION.
MOTION: Rep. Block moved to send S 1288 to the Floor with a Do Pass
recommendation. The case was not made as to why we need to have the
endorsement extended and without it why we cannot have S 1289.



Mike Sheeley yielded to a question by explaining that there needs to be
some control over the dental hygienists; some way of tracking them.



Rep. Nielsen requested the suspension of Rule 22 in order to discuss

S 1289 again. There was no objection. Rep. Nielsen asked Mike
Sheeley
to explain why S 1289 has to accompany S 1288 without
amendments in order to be acceptable. Mr. Sheeley stated that the
purpose of S 1289 is to provide for a volunteer’s license that would permit
a retired dentist to provide dental services on a voluntary basis while
practicing in an extended access oral health care program. The definition
of extended access oral health care program is included in SB 1288. He
explained that the endorsement removed by the Committee’s amendment
is proposed to be required for dental hygienists working in an extended
access oral health care program.

Rep. Block asked for Unanimous Consent that the Committee take
action on S 1289 to send it to the Floor with a Do Pass recommendation.

There was no objection.

SUBSTITUTE
MOTION:
Rep. Nielsen moved to send S 1288 to General Orders with the one
Committee amendment attached which is to strike the language on pg. 2,
line 21 that says, “holding a license with an extended access dental
hygiene endorsement”.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
ADJOURN: There being no further business, the meeting adjourned at 6:35 P.M.






DATE: March 16, 2004
TIME: 1:30 P.M. or Upon Adjournment
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Eberle, Garrett,
Kulczyk, McGeachin, Nielsen, Ring, Henbest, Martinez, Mitchell
ABSENT/

EXCUSED:

Representative Block
GUESTS: See attached sign-in sheet.
Chairman Sali called the meeting to order at 2:15 P.M. He asked the
Committee to review the minutes of March 10.
MOTION: Rep. Kulczyk moved to approve the minutes of March 10, 2004 as
written.
S 1418 Bill Von Tagen, Deputy Attorney General, representing Attorney General
Lawrence Wasden addressed the Committee. He explained that this bill
will limit Health and Welfare’s responsibility in establishing rule making
and protocols for “do not resuscitate orders” to establishing rules and
protocols for emergency services personnel. He distributed a copy of a
portion of S 1249. S 1418 is a trailer bill to S 1249. S 1249, which
passed by both houses, extended that protection of the DNR statute and
also extended the protocol and rules defining DNR protocol beyond the
threshold of the hospital door. S 1249 covers hospitals, institutional
settings, assisted living facilities, etc. The Health and Welfare
Department does not want the responsibility of establishing rules or
protocol for DNR’s in these above-mentioned settings. They’ve described
their role only as properly within the area of EMT’s. This bill leaves the
rule making authority right where it is and does not extend it to
establishing rules on DNR’s for hospitals, etc.
MOTION: Rep. Ring moved to send S 1418 to the Floor with a Do Pass
recommendation.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
S 1301a Toni Poinelli, Deputy Director of Idaho Association of Counties,
addressed the Committee. The purpose of this legislation is to provide
guidelines that clearly state when, how and who should be considered
when filing a delayed application for medically indigent assistance. Mr.
Poinelli explained that this bill will close a loophole which exists in the
current law dealing with the 180 day delayed application process.
Currently, an application to the county must be submitted within 31 days
after receiving medical services. The applicant/provider can choose to file
a delayed application – up to 180 days after the service is rendered –

if they qualify for one of the six resources listed in statute (Medicaid,
Medicare, social security, workers comp., crime victims comp., 3rd party
insurance). The problem occurs when some of those who have begun
using the delayed application process to obtain more time to file a request
for assistance have dissipated assets that could have provided
reimbursement to the property taxpayers for the assistance provided.
This bill outlines the process for filing for the other resources and what is
expected of the applicant/provider and clarifies that providers can submit
documentation anytime within the county investigatory period (45 days).
He further explained that the amendment includes two changes. The first
change adds medicaid co-payments/deductibles to the exclusions of
necessary medical services; the second change deletes “Uniform county
guidelines” which has not been used for many years.

MOTION: Rep. Mitchell moved to send S 1301a as amended to the Floor with a Do
Pass recommendation.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
S 1293 Toni Poinelli addressed the Committee. He explained that the purpose
of this bill is to provide better communication, cooperation, and
coordination dealing with mental health issues in the regions and
counties. This legislation revises the membership of the current regional
mental health advisory boards and provides for additional powers and
duties for the new boards which will increase their function beyond the
advisory level. He explained that numerous studies have been done that
indicate that this needs to be brought back to the local level. This new
advisory board will consist of fourteen members, including representatives
from counties, providers, consumers, advocates and family members, and
a representative from the regional substance abuse advisory authority
and one from the childrens’ mental health council. Their purpose is to
look at the needs within their regions. He stated that this bill changes the
membership of the existing boards and entrusts those members with the
task of identifying the gaps in services and developing a plan to meet the
needs of the community.



Mr. Poinelli referenced the proposed amendment, offered by Jim Baugh
with Co-Ad, Section 39-3130, pg. 2, line 6, inserting the language after
the word, authority. “The consumer and family representatives shall be
selected from nominations submitted by mental health consumer and
advocacy organizations.” He supports this amendment.



Jim Baugh, Executive Director of Comprehensive Advocacy, Inc.,
addressed the Committee in support of the bill with the amendment. He
explained that the bill gives Regional Mental Health Boards new powers
and prepares the way for greater local control of mental health planning.
He further explained that in order for people to have a meaningful role in
the process, they must have the right to select, or at least nominate their
own representatives. He stated that the bill with the amendment will
accomplish this.



Madeline Wyatt, registered nurse, member of the Mental Health and
Substance Abuse Committee and the Stakeholder Committee, and a
consumer of mental illness addressed the Committee. She explained that
the purpose of the bill is to encourage the management of mental health
needs at the local level. She further explained that this will require
collaboration, communication, and cooperation between regional mental
health boards and regional councils in order to increase efficiency and
avoid duplication of efforts and services. She referred the Committee to
the handout entitled, “Idaho Resident Deaths Due to Intentional Self-Harm” (suicide) graph. She noted the statistic for male suicide in 2002
was 177 as compared to the female rate of 26. She noted from the
handout the highest group of suicide was in the male age 45 to 54 and
the rate more than doubled from 20’s and 30’s to 43 in 2002. She also
noted in 2001, teen suicide climbed to 47 from 20 and 30 range. She
stated that the current system is not working. She further stated that
there is an overwhelming need for education for mental illness in the
schools and homes, helping people to learn effective ways to
communicate their situations/problems. Ms. Wyatt explained this
legislation will divert many individuals from mental institutions and the
penal system, in turn, saving the state thousands of dollars. (See
attachment).



Kelly Buckland, Executive Buckland, State Independent Living Council,
addressed the Committee in support of this bill. He explained that the
council is in support of the bill with the amendment. He stated that people
with disabilities should be able to speak for themselves and have a say in
the decision making that affects them. He further stated that this is a start
in putting the structure in place.

MOTION: Rep. Garrett moved to send S 1293 to General Orders with the following
amendments attached: Section 39-3130, pg. 2, line 6, inserting the
language after the word, authority. “The consumer and family
representatives shall be selected from nominations submitted by mental
health consumer and advocacy organizations.” Rep. Garrett referred to a
report inside the members’ folders, which is a summary entitled
“Achieving the Promise: Transforming Mental Health Care in America,”
from the President’s New Freedom Commission on Mental Health (see
attachment). She commented that the issue is about building
communities with good mental health. She commented that spending the
money on prevention is much more cost effective than waiting until a
crisis occurs with increased spending for prisons, jails, emergency rooms,
institutions, etc.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
S 1280a Kandee Yearsley, Child Support Program Manager, Department of
Health and Welfare, addressed the Committee regarding financial
institution (FIDM) data match for child support. She explained that over
$380 million is owed single parents in Idaho and FIDM is an agressive
enforcement tool that targets parents who have the financial resources to
pay but won’t. She further explained that the FIDM process includes
seizing financial assets to offset the arrears balance on cases where the
balance exceeds $2,000, or is three months in arrears and there have
been no payments. She stated that the current garnishment process has
produced no real results. With this proposed legislation, it is estimated
that potential collections would be in excess of $1 million per year to be
distributed to those families in Idaho to which child support is due, but
unpaid. (See attached testimony and H&W Department brochure on
Financial Institution Data Match)
MOTION: Rep. Henbest moved to send S 1280a to the Floor with a Do Pass
recommendation. Chairman Sali will sponsor the bill.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
ADJOURN: Chairman Sali adjourned the meeting at 3:40 P.M.






DATE: March 18, 2004
TIME: 1:30 P.M. or Upon Adjournment
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 sign in sheet.
Chairman Sali called the meeting to order at 1:40 P.M.
MOTION: Rep. Henbest moved to approve the minutes of March 16, 2004 as
written.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
MOTION: Rep. Martinez moved to approve the minutes of March 12, 2004 as
written.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
S 1317a Senator Brandt addressed the Committee. He explained that the
purpose of this legislation is to clarify jurisdiction of licensed emergency
medical service agencies to provide an exception to jurisdiction of the
sheriff. This change will provide the same clarity about chain of command
for EMS agencies as for fire agencies. Sheriffs are generally not trained
or equipped to command medical incidents, and some local EMS
agencies are frequently not affiliated with a sheriffs department. This
legislation is in the best interest of public safety in our communities.
Committee questions followed.
MOTION: Rep. Nielsen moved to send S 1317a to the Floor with a Do Pass
recommendation.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
S 1290 Kathleen Allyn, Deputy Administrator, Medicaid Division, Department of
Health and Welfare, addressed the Committee. She explained the
purpose of this legislation is to clarify the state’s responsibility in Medicaid
estate recovery and to decrease litigation costs. She explained the
following points of the bill.

Under state and federal law, the state must attempt to recover the cost of
Medicaid services from the estate of a deceased Medicaid client, which
includes property fraudulently transferred by Medicaid clients prior to
death ­ but the state’s right to recover the transferred property is only for
a limited period of time ­ four years.

This bill specifies when the time period to recover transferred property
begins; applies only to situations where property is being transferred with
the intent of making a person eligible for Medicaid, and is limited only to
transfers that take place within 36 months of when someone applies for
Medicaid eligibility. The bill results from a court decision that interpreted
current law to say the 4-year period to reverse a property giveaway begins
at the date of the transfer, even when the transfer is fraudulently
concealed from the Department of Health & Welfare. The Department
may not find out about a fraudulent transfer until 4 years or more, after the
fact, at which time they are precluded from reversing the transfer.

The bill says that the 4-year period for recovering the property starts only
when the Department discovers the transfer. This “discovery” standard
for starting the 4-year period is commonly applied by the courts in relation
to other statutory time limits and serves to place reasonable limits on the
time within which the Department can reverse a transfer of property. The
time limits in probate code for filing claims against an estate still apply.

The bill also makes a technical correction to clarify that the Department
can file a claim against community property in the estate of a spouse of a
Medicaid recipient, even if the spouse dies before the Medicaid recipient.
At the same time, the Department may not recover against the property
until both the Medicaid recipient and the spouse are dead.





Bob Aldridge, attorney representing the Department of Health and
Welfare, addressed the Committee in support of this legislation. He
explained the problem in existing law, the solution in the bill pertaining to
the order of death problem and the concealment problem, and the large
potential positive fiscal impact to Idaho. (See attached testimony)

MOTION: Rep. Mitchell moved to send S 1290 to the Floor with a Do Pass
recommendation. Rep. Nielsen will sponsor the bill.
VOTE: ON A VOICE VOTE THE MOTION CARRIED.
The Chairman put the Committee at ease at 2:08 P.M. for the purpose of
discussion regarding time constraints and allowing enough time for
testimony and Committee debate on S 1321a. By unanimous consent,
the members agreed that proponents Rep. McGeachin, Clinton Miner and
Kerry Uhlenkott would be allowed 45 minutes for presentation of the bill
and then the opponents Bruce Bistline, Ellie Merrick and Marty Durrand
would be allowed 45 minutes to make a response, though it was
recognized that there were likely 4 or more different fronts on which the
bill would be opposed. The remaining individuals would then alternate
proponent/opponent with no more than 7 minutes for any individual. Many
presenters felt they would take no more than 3 minutes.



The Chairman called the meeting to order at 2:20 P.M and repeated the
foregoing time limitations on presentation and opposition to the bill.

S 1321a Rep. McGeachin presented S 1321a. She explained the importance of
informed consent and the necessity of changing current law. She also
explained how this bill would strengthen Idaho law, and she summarized

some concerns with existing law. She concluded by explaining that the
proponents have listened to suggestions and concerns offered by others
and have implemented many of their suggestions. She further stated that
if one life is saved, the effort will be worth it. (See attached handout for
further detail of testimony and copy of draft legislation.)

PRO Clinton Minor, attorney, testified in support of this legislation. He stated
that this bill will give women the ability to have full disclosure and full
understanding. He stated that this bill provides for a required 24-hour
waiting period before an abortion procedure; required pregnancy test,
confirmed by the attending physician (test results must be signed by
patient and kept in physician’s file); an ultrasound image of the fetus
shown to the patient by the physician, if requested by the patient before
the abortion procedure; and a face to face consultation with the patient
required of the physician providing her with required information outlined
in the bill. Committee questions followed.



One of the concerns addressed was the fact that the bill will have an
effective date of July 1, 2004, but that is in conflict with the requirement
that the Department of Health and Welfare have their informed consent
materials completed and available by October 1, 2004. The 3-month gap
between the time the effective date versus the date when the department
is authorized to publish materials may make the bill unconstitutional.



Questions by Committee members followed.

The Chairman put the Committee at ease at 3:19 P.M. at the instruction
of the Speaker of the House.



The Chairman called the meeting to order at 3:21 P.M.



The Chairman explained that the Speaker had just demanded that in
spite of the action of the Committee in deciding how to arrange the
testimony on the bill, S 1321a must absolutely be voted on before 4:30
P.M., at which time the full House will be back in session on the floor.
The Committee would not be allowed to continue action until the following
legislative day. There was Committee discussion regarding how to best
accomplish this within the time constraints that had been imposed, in light
of the vast amount of information, numerous questions and large number
of people signed up to testify.

MOTION: Rep. Kulczyk moved to cut off debate of proponents and give the
opposition 45 minutes for testimony.
The Chairman put the Committee at ease at 3:28 P.M. to determine if the
course demanded of the Committee would violate Idaho Open Meeting
Law.

The Chairman yielded the gavel to Vice-Chairman Block.

Vice-Chairman Block called the meeting to order at 3:30 P.M.

VOTE: ON A VOICE VOTE THE MOTION PASSED. Vice-Chairman Block
stated the Committee would immediately begin hearing testimony from the
opposition.
CON Bruce Bistline, attorney and former lobbyist for the American Civil
Liberties Union, addressed the Committee. He explained that he was
appearing on his own behalf explaining that his particular concern has to
do with the provisions that are being added to Section 18-605, Subsection
4. He further explained that this bill dramatically and dangerously
changes the law regarding what claims can be brought in the areas of
statutory law and in the area of malpractice /negligence law. This bill
substantially expands existing rights by making it a criminal act for
abortions to not provide informed consent, creates civil penalties when it
is not done and creates a very broad cause of action that has not been
defined and which would expose abortionists to unfair liability. That may
cause doctors to choose not to do abortions.
CON Ellie Merrick, lobbyist for Planned Parenthood of Idaho addressed the
Committee. She explained that they are not opposed to informing women
about the potential risks and complications prior to their abortion
procedure. She stated that they oppose this bill because there is already
an informed consent law on the books and the Department of Health and
Welfare is currently producing the materials that will soon be available.
Physicians will continue to use fetal development materials from different
states, and references from Idaho-specific information. She further stated
that this bill makes physicians extremely vulnerable to lawsuits by third
parties, given the language in the civil liability section of the bill.
CON Marty Durand, Legal Council for the American Civil Liberty Union of
Idaho, addressed the Committee by explaining that the standards of the
medical profession, as well as current state law, ensures that health care
practitioners provide women with accurate and unbiased information
regarding the risks and benefits of their various treatment options and
obtain their informed consent. She further explained that this bill forces
doctors to provide women with information that is intended to discourage
them from having abortions. (See attached for further testimony.)
Vice Chairman Block yielded the gavel back to Chairman Sali. He
explained that according to Idaho Open Meeting Law, I.C. 67-2346, the
public may attend all meetings of the legislature, but may only testify with
the “approval of the Committee.” He explained that under the duress of
the limitations imposed upon the Committee, the remaining debate would
have to be limited to two minutes per presenter with no questions by
Committee members and while there would be time for motions, only
extremely limited time could be taken for debate in order to be able to
conclude with a vote on the bill by the time imposed for the end of the
meeting.
PRO Barry Peters, attorney in private practice representing Cornerstone
Institute addressed the Committee. He stated that he disagrees with the
suggestion previously made in testimony that the provisions of this bill
broaden liability for abortionists or increase the number of people who
would have an opportunity to make claims. He stated that this bill if
enacted into statute, contains a provision in Section 2 that would limit
liability of abortionists for their negligence. With this bill and with the
amendment, a cause of action for negligence would be limited only to the
patient or to immediate family members.
CON Dr. Gary Krouth, M.D., St. Lukes Hospital addressed the Committee. He
is concerned because section 3 of the bill repeals the reference to
immunity from civil liability for hospitals. No such limitation appears in the
new language giving hospitals new exposure to causes of action, even
when they should be against the physician. He also is concerned that
this bill includes fourteen requirements for informed consent, compared to
only four in the current statute. He believes this creates much more
opportunity for hospitals to fail, even with a good faith effort, to meet those
requirements.
PRO Mia Crosthwaite, representing the Catholic Churches, addressed the
Committee. She explained that in their counseling program for post-abortive women, many have stated that they had no idea that they would
have suffered as painfully as they have. Many did not know about the
risks. She read from a letter of a counselor who stated that some of the
post-abortive women she has counseled have undergone depression,
anxiety, guilt, emotional numbing, self-blame, and a host of other
problems. She stated that she does believe this bill will save lives.
CON Gayle B. Poorman, private citizen, addressed the Committee. She
stated that the bill is unnecessary as informed consent law is already in
statute. She urged the Committee to vote against the bill. (See attached
testimony for further detail.)
PRO Kerry Uhlenkott, Legislative Coordinator for Right to Life of Idaho,
addressed the Committee. She explained that this is pro-life legislation
which is being supported by many groups, Focus on the Family, National
Right to Life, Cornerstone, and Right to Life of Idaho, Healing the Culture
and several more. She explained the reason for the telephone counseling
provision is to allow Planned Parenthood counselors to exercise their First
Amendment rights which she feels is necessary. She believes that the
website provision is important to bring technology into play for women
seeking abortion. (See attached testimony)
CON Barbara Gough, Associate Director for Generation Life and a pre-med
student at BSU addressed the Committee. She explained that because of
the loopholes in the language of the bill, it does not give any protection to
women and it will not result in them gaining sufficient information to make
an informed decision before deciding whether to undergo an abortion.
She stated that this bill is not sound nor is it a strong bill.
CON Steve Millard, Idaho Hospital Association, addressed the Committee.
He is concerned with the immunity provision for hospitals that will be
stripped from Idaho Code, resulting in the extension of new civil liability to
doctors and hospitals. He stated that they do not have any problems with
informing patients of their rights and that hospitals operate under informed
consent for patients all of the time.
PRO Jeannette McAllister, RN, representing Right to Life, addressed the
Committee regarding the bill. She stated that many experts, including the
U.S. Supreme Court Justice Powell, have stated that the typical abortion
experience is done in an assembly-line fashion and there is no
doctor/patient relationship. (See attached for further testimony.)
CON Toni Lawson, Executive Director of Idaho Nurses Association, addressed
the Committee. She stated that they are in strong support of informed
consent regarding any medical procedure a patient is about to undergo.
She stated that this bill only adds confusion because, while existing law is
fairly clear regarding what is expected of the physician, the new language
is unclear and vague. They are deeply disturbed by the implication that
patients are not properly being counseled on medical procedures.
PRO Camille De Blasi, President of Healing the Culture addressed the
Committee in support of the bill. She noted that Father Robert Spitzer,
President of Gonzaga University, stated in his letter to the Idaho State
Legislature that S 1321a “will support our nations’s commitment to the
principle of informed consent, where such consent is necessary for free
and responsible action.” She explained that research consistently shows
that important information is frequently withheld from women seeking
abortions, on the mistaken assumption that they are either too fragile to
handle factual truths about abortion and fetal development, or that they
would not want this information. (See attached for further testimony.)
CON Lee Finn, representing Idaho Women’s Network. She stated that they
strongly support informed consent for any medical procedure, including
abortion, but does not support this bill. She stated that the informed
consent provisions of Idaho law are sufficient, including descriptions of the
fetus at two-weeks intervals and descriptions of the abortion procedure.
She further stated that the problem facing women today is that the
materials provided by the department are insufficient, but the materials the
Department of Health and Welfare is currently drafting will certainly be
sufficient and acceptable.
CON Tammy Seydel, private citizen addressed the Committee in opposition to
the bill. See expressed that “we cannot fail these vulnerable women.”
She stated that she is in opposition to some of the Planned Parenthood
testimony. She recommends that Idaho’s informed consent law is
already established and needs to be enforced. She cannot personally
endorse this bill because the language is vague and includes loopholes
that will not protect vulnerable women. (See attached testimony)
PRO Amy Lynde, sophomore in high school and daughter of Julie Lynde who
represents Cornerstone Institute of Idaho spoke on behalf of her mother
who was attending a conference out of town. She explained that currently
the abortion procedure continues to pose countless physical and
emotional risks to American women. She quoted from Fredericka
Mathews Greene of Feminists for Life who says, “No woman wants an
abortion like she wants a Porche or an ice cream cone. She wants an
abortion like an animal caught in a trap who is willing to chew off its own
leg just to break free.” True informed consent is the key to the trap that so
many women find themselves in. Information can help minimize the
damage. (See attached testimony)
CON David Ripley, representing Idaho Chooses Life, addressed the
Committee. He explained that the bill is unacceptable for many reasons,
including: The enforcement mechanism in the bill is made meaningless by
the limitation on liability to abortionists; there is no requirement for
adequate information regarding prevention – choosing life over abortion;
No requirement that accurate information regarding the after affects of
abortion be provided to women seeking abortion.
PRO Senator Brandt addressed the Committee explaining that he believes by
this bill pregnant women will receive the proper information that they need
to make a good decision. He stated that he does not believe that this is
being done in spite of the requirement of the current statute. He stated,
“Just the platform of life is better than death.” He further stated he does
not see how making good information available is bad.
MOTION: Rep. McGeachin moved to send S 1321a to the Floor with a Do Pass
recommendation. There was discussion on the motion.



Rep. Henbest commented that she is strongly in favor of strong informed
consent and a 24-hour waiting period, however is concerned with the
confidentiality factor, civil cause of action, removing the immunity clause,
and conflicting enactment dates in this bill. She also stated that she is
concerned with giving the attorney general the authority to prosecute
cases which is not in current statute. She also stated she does not
believe in setting a precedent that would allow for random prosecution by
the Attorney General’s office. She said that she has even more questions
now than she had before the hearing began, but was not able to get those
questions answered because of the time limitations imposed on the
Committee.



Rep. McGeachin commented in support of the motion by stating that this
legislation is all about saving lives and urged the Committee to vote yes.

SUBSTITUTE
MOTION:
Rep. Kulczyk moved to hold S 1321 in Committee. He commented that
his primary concern with the bill is that the effective date of the bill is July
1, but the date of authorization for the Department to publish materials
required by the language falls three months after the law would go into
effect. Consequently the bill is probably unconstitutional and could not be
defended in court. If struck down, Idaho would be left with no informed
consent law because the bill repeals the existing section. He suggests
that a new clean bill be drafted and brought back next year. He was also
concerned that the time limitations imposed by the Speaker did not give
the Committee sufficient time to listen to those testifying and ask them
questions and also prohibited a thorough debate on the motions. He has
concerns with the bill that he was unable to ask presenters about or bring
up in debate.



Rep. Garret commented that because of the time limits that had been
imposed, the Committee did not have a sufficient amount of time to gather
information and have debate. She said, “We have not had time to clarify
our questions.”



Rep. Eberle commented that he has never been a part of a committee
meeting with such time constraints as this, and without the ability to ask
questions of the presenters. He stated that he is dismayed and unable to
cast an informed considered vote. “Under duress, I will toss a coin, and
my vote will be based on that.”

MOTION: Rep. Martinez moved the previous question.
VOTE: ON A VOICE VOTE THE MOTION CARRIED. Debate ceased.
VOTE: ON A ROLL CALL VOTE, THE SUBSTITUTE MOTION TO HOLD

S 1321a IN COMMITTEE PASSED.



Representatives Sali, Kulczyk, Nielsen, Henbest, Martinez, Mitchell voted Aye.

Representatives Block Garrett, Eberle, Ring, McGeachin voted Nay.

ADJOURN: Chairman Sali adjourned the meeting at 4:45 P.M.






DATE: March 20, 2004, 2004
TIME: 5:05 P.M.
PLACE: Room 404
MEMBERS: Chairman Sali, Vice Chairman Block, Representatives Garrett, Kulczyk,
Ring, Henbest, Martinez
ABSENT/

EXCUSED:

Representatives Eberle, McGeachin, Mitchell, Nielsen
GUESTS:
Chairman Sali called the meeting to order at 5:05 p.m. Rep. Henbest
pointed out that the minutes of March 18, 2004, should be corrected on
page 5 under Dr. Krauth’s testimony changing the word “arbortionist” to
“physician.” Rep. Block made a motion to accept the minutes of March
18, 2004, as written changing the word “arbortionist” to “physician” on
page 5 under Dr. Krauth’s testimony and that the secretary, Jennifer
O’Kief, will sign the original copy. By voice vote the motion passed.



Rep. Sali asked that a committee member make a motion to hold in
committee those bills that did not receive committee action. Rep. Block
made a motion to hold House bills 572, 575, 617, 698, 701, HJM 16, HCR
41 and Senate bill S 1215 in committee. Motion passed by voice vote.

ADJOURN: Rep. Kulczyk made a motion to adjourn sine die. Motion passed by voice
vote. Chairman Sali adjourned the meeting at 5:14 p.m.