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Health and Human Services Interim Committee
MINUTES OF THE
HEALTH AND HUMAN SERVICES INTERIM COMMITTEE
Wednesday, June 18, 1997 - 9:00 a.m. _ Room 405 State Capitol
Members Present:
Sen. Nathan C. Tanner, Senate Chair
Rep. Nora B. Stephens, House Chair
Sen. Robert F. Montgomery
Sen. Millie M. Peterson
Sen. Pete Suazo
Rep. Loretta Baca
Rep. Mary Carlson
Rep. Gene Davis
Rep. J. W. "Bill" Hickman
Rep. Bryan D. Holladay
Rep. Robert H.M. Killpack
Rep. Carl R. Saunders
Rep. Raymond W. Short
Members Excused:
Rep. Margaret Dayton
Members Absent:
Sen. Craig Taylor
Staff Present:
Mr. Mark D. Andrews
Research Analyst
Ms. Janetha W. Hancock
Associate General Counsel
Mr. R. Chet Loftis
Associate General Counsel
Ms. Karen E. Mecham
Secretary
Note: A list of others present and a copy of materials distributed in the meeting are on file in the Office of Legislative Research and General Counsel.
1. Call to Order and Approval of Minutes _ Chair Stephens called the meeting to order at 9:10 a.m. and welcomed members of the committee.
MOTION: Rep. Saunders moved to approve the minutes of the
May 21, 1997
meeting. The motion passed unanimously. Sen. Montgomery and Reps. Baca, Davis, Hickman, Short, and
Stephens were absent for the vote.
2. Reducing Disease Rates in Day-care Centers _ Mr. Andrews introduced the topic and outlined the regulatory authority given to the agency. He distributed two pieces of legislation
from the 1997 General Session, H.B. 113, Child Care Licensing Amendments, and H.B. 124,
Licensing of Day Care Facilities, and noted changes in the licensing process. He said that
licensing of child care facilities in the past has been under the Office of Licensing in the
Department of Human Services, but as a result of H.B. 113 this function will be transferred to the
Department of Health beginning July 1, 1997. He added the Department of Health is presently
developing rules to carry out their new duties. H.B. 124 requires that the department prepare
language for the 1998 General Session that will codify as much as possible the rules that the
Department of Health develops.
Dr. Richard Melton, director, Department of Health, explained that the department has
prepared rules for the transfer of licensing of day-care facilities from Human Services to the
Department of Health. He said that the emphasis of the department is the health and safety of the
children and that the department will retain responsibility for disease control as well. He also
said that regulation of day care centers will remain largely with the department, at least for now.
Ms. Debra Wynkoop-Green, director, Health Facility Licensure, Department of Health,
distributed a handout titled "Transition Child Care Licensing Moves to Health!" She said that
the emphasis of the department is on the enforcement of administrative rules governing the
operation of child day-care facilities. She outlined the changes in the new administrative rules:
1) combine the Family Day Care and Center rules into one rule; 2) add specific language for
infection control, hand washing, and sanitation; 3) complete annual "no-notice" inspections; 4)
complete training for all employees during July to ensure department protocols are followed; 5)
add new penalties permitting the department to apply civil money penalties for violations and
place monitors in facilities to ensure compliance; 6) adopt rules which comply with the Utah
School Immunization Law; and 7) require new facilities to have a separate food preparation sink
for infant areas. She added that the department will ensure that violations of law are entered into
a database which can then be produced as a written report card annually which will be available
to the public.
Committee members expressed concern about reporting issues, immunization, and
inspection costs. Dr. Melton said that the rules will, as far as possible, track diseases,
immunization compliance, and adhere to the budget appropriated for the department. Sen.
Tanner said he felt that to have quality day-care is expensive but careful monitoring will reduce
costs in the long run through prevention. Rep. Killpack asked for information on the total costs
incurred by the state for child care (e.g., the costs of subsidies, oversight, and rules).
Dr. Charles Brokopp, director, Epidemiology and Laboratory Services, Department of
Health, distributed a handout outlining the role of public health in communicable disease control.
He noted the child care environment is very important to the spread or reduction of
communicable diseases. He said that children less than five years of age have little resistance to
disease since they generally have had little exposure. He outlined the main modes of
transmission of disease including direct contact, respiratory spread, fecal-oral spread, and blood
borne.
Dr. Brokopp added that the most prevalent communicable diseases in children include
Shigellosis, Salmonellosis, and Hepatitis A. The Utah rates for these diseases are higher than the
national average in children below age five. Shigellosis rates in Utah are three times the national
average. Salmonellosis is a food borne disease with the Utah rate at one third of the national
average. Utah's Hepatitis A rate is the highest in the nation. The state Hepatitis A rate is four
and one-half times the national rate. Last year only 7 percent of Hepatitis A cases were linked to
food handlers with the disease. The reservoir for the disease is with asymptomatic children who
pass the disease to others.
Dr. Brokopp said that the department has adequate authority to deal with the outbreaks
but has not been able to control them. He added that additional resources are needed to make
progress in control. He felt that because asymptomatic children are major carriers of Hepatitis A,
concentrated efforts are needed to reduce the incidence of this disease. He said that
comprehensive child care licensing, more emphasis on proper hand washing, vaccination, and
better training of child care providers and parents is necessary.
Sen. Tanner spoke in favor of passing on the costs of ensuring compliance with health
regulations to delinquent child care providers.
Mr. Lewis Garrett, director, Family Health Services, Salt Lake City/County Health
Department, said that doctors report communicable diseases to the county and the county health
department tries to stop the spread. He explained that the rates of Hepatitis A are probably a
result of the high numbers of children in Utah. He said that there is a study of the worst areas of
infection to determine if vaccination would be appropriate. He added that there has been a task
force convened by the county to review the incidence of communicable disease in day care.
Mr. Garrett said that the local health department would like more specific authority to
deal with child care centers, but that the authority should come from the Utah Department of
Health rather than statute. He indicated that he was disappointed to hear that the Utah
Department of Health does not want to include the local health departments at first in the
regulation of child care centers. He also said that he did not want the rules codified too much.
3. Health Insurance Coverage for Children in the Care of Non-custodial Grandparents _ Mr. Loftis distributed a handout, "Health Care Coverage for Grandchildren." He noted that Primary Children's Hospital is sponsoring a seminar on this issue in July.
Mr. Loftis outlined the problem grandparents face in obtaining health insurance for grandchildren who live with but are not in the legal custody of the grandparents and how medicaid
may be the only plausible option for coverage under current law and practice.
The problem, according to Mr. Loftis, raises a number of policy issues, for example: (1)
Should medicaid be the only real option for covering grandchildren? (2) Should a parent only be
required to provide coverage for a child if it is available from the parent's employer? (3) Should the
existence of child-only coverage be encouraged in the private health insurance industry for purchase
by parents and grandparents?
Rep. Pat Larsen distributed a handout, "Non-custodial grandparents," and invited Ms.
Karmen Sanone, Salt Lake County Aging, to assist in the presentation. Rep. Larsen suggested that
the process needs to be simplified for grandparents. She noted that while many grandparents are
willing to pay the extra insurance, the insurance companies will not accept the grandchildren as
dependents unless the grandparents have legal custody.
Ms. Sanone said that some states are establishing "kinship" status for grandparents to
provide primary caregiver status so the child will be recognized as a dependent by the insurance
companies. Sen. Tanner asked that any bill written to establish kinship status be submitted to the
committee for consideration. Sen. Tanner suggested that Rep. Larsen work with insurance providers
to develop a bill.
Rep. Saunders raised the possibility of providing catastrophic coverage rather than primary
coverage for children.
4. Diseases With High Rates of Incidence _ Dr. Brokopp distributed a newsletter outlining significant public health problems, including AIDS, the third leading cause of death among men ages
25-44 in Utah. He supports the HIV testing discussed earlier in the year by the committee and
changes to the statute to reflect the new technologies available for anonymous testing.
Dr. Brokopp said that tuberculosis is still a threat, especially to minorities and the homeless,
and that he would like legislation for methods less expensive than quarantine to deal with the
disease. Some drug resistance is being found and quarantine is not as effective as possible. New
strains of Salmonella are being found and new methods of detection and control are needed as are
additional resources. The rise of E coli 0157 cases needs investigation and additional resources.
Other diseases include Hepatitis A, chlamydia, and diseases that have been traditionally confined
to third-world countries. Food imports from around the world are bringing new diseases to Utah.
5. Other Business _ Mr. Loftis distributed an update on the tobacco suit prepared by the attorney general for her June 17, 1997 press conference. The next meeting of the committee will be
held July 16.
6. Adjournment _
MOTION: Sen. Peterson moved to adjourn the meeting at 11:40 a.m. Reps. Davis, Hickman, Holladay were absent for the vote.
MINUTE06.WPD
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