Title 18. Health, Safety, Housing, Human Rights, and Public Defender.
Chapter 05. Administration of Public Health and Related Laws.
Sec. 18.05.010. Administration of laws by department.
 (a) The department shall administer the statutes and regulations relating to the promotion and protection of the public health as provided by law.

 (b) In performing its duties under this chapter, AS 18.09, and AS 18.15.355 18.15.395, the department may
     (1) flexibly use the broad range of powers set out in this title assigned to the department to protect and promote the public health;

     (2) provide public health information programs or messages to the public that promote healthy behaviors or lifestyles or educate individuals about health issues;

     (3) promote efforts among public and private sector partners to develop and finance programs or initiatives that identify and ameliorate health problems;

     (4) establish, finance, provide, or endorse performance management standards for the public health system;

     (5) develop, adopt, and implement
          (A) a statewide health plan under AS 18.09 based on recommendations of the Alaska Health Care Commission established in AS 18.09.010; and

          (B) public health plans and formal policies through regulations adopted under AS 44.62 or collaborative recommendations that guide or support individual and community public health efforts;

     (6) establish formal or informal relationships with public or private sector partners within the public health system;

     (7) identify, assess, prevent, and ameliorate conditions of public health importance through surveillance; epidemiological tracking, program evaluation, and monitoring; testing and screening programs; treatment; administrative inspections; or other techniques;

     (8) promote the availability and accessibility of quality health care services through health care facilities or providers;

     (9) promote availability of and access to preventive and primary health care when not otherwise available through the private sector, including acute and episodic care, prenatal and postpartum care, child health, family planning, school health, chronic disease prevention, child and adult immunization, testing and screening services, dental health, nutrition, and health education and promotion services;

     (10) systematically and regularly review the public health system and recommend modifications in its structure or other features to improve public health outcomes; and

     (11) collaborate with public and private sector partners, including municipalities, Alaska Native organizations, health care providers, and health insurers, within the public health system to achieve the mission of public health.




Sec. 18.05.020. Department to report activities.
The department shall prepare an annual report of its activities and notify the legislature not later than 10 days after it convenes that the report is available.


Sec. 18.05.030. Cooperation with federal government.
The department shall
     (1) cooperate with the federal government in matters of mutual concern pertaining to public health, the control of communicable diseases, maternal and child health and crippled children, and other matters within the scope of this title;

     (2) make reports, in the form and containing the information the federal government requires;

     (3) cooperate with the federal government, its agencies or instrumentalities in establishing, extending, and strengthening services for the protection of the public health, and receive and expend funds and receive, utilize, and maintain equipment and facilities made available to the department by a department or agency of the federal government, the government of the state or its political subdivisions, and a person or nonofficial agency.




Sec. 18.05.031. Program planning for developmental disability. [Repealed, 5 ch 165 SLA 1978. For current law, see AS 47.80.]
Sec. 18.05.032. Information relating to pregnancy and pregnancy alternatives.
 (a) The department shall maintain on the Internet, in printable form, standard information that
     (1) contains geographically indexed material designed to inform a person of public and private agencies, services, clinics, and facilities that are available to assist a woman with the woman's reproductive choices; the department shall include information about at least the following types of agencies, services, clinics, and facilities:
          (A) agencies, services, clinics, and facilities designed to assist a woman through pregnancy, including adoption agencies, and counseling services;

          (B) agencies, services, clinics, and facilities that provide abortion options and counseling and post-abortion counseling and services; and

          (C) agencies, services, clinics, and facilities designed to assist with or provide contraceptive options and counseling for appropriate family planning;

     (2) includes a comprehensive regional directory of the agencies, services, clinics, and facilities that request to be identified by the department under (1) of this subsection, a description of the services they offer, and the manner in which the agencies, services, clinics, and facilities may be contacted, including telephone numbers;

     (3) provides information concerning the eligibility for medical assistance benefits for prenatal care, childbirth, neonatal care, abortion services, women's health care, and contraception;

     (4) states that informed and voluntary consent is required under AS 18.16.060 for an abortion;

     (5) provides information concerning the process by which a mother of a child may establish a child support order to assist in the support of a child;

     (6) describes the fetal development of a typical unborn child at two-week gestational increments from fertilization to full-term, including links to photographs of a typical unborn child at four-week gestational increments, and relevant information about the possibility of an unborn child's survival at the various gestational ages; the information must be objective, nonjudgmental information that is reviewed and approved for medical accuracy by recognized obstetrical and gynecological specialists designated by the State Medical Board and designed to convey only accurate scientific information about unborn children at various gestational ages;

     (7) contains objective, unbiased information that is reviewed and approved for medical accuracy by recognized obstetrical and gynecological specialists designated by the State Medical Board and that describes the methods of abortion procedures and treatments commonly employed and the medical risks and possible complications commonly associated with each procedure and treatment, as well as the possible physical and psychological effects that have been associated with having an abortion;

     (8) contains objective, unbiased information that is reviewed and approved for medical accuracy by recognized obstetrical and gynecological specialists designated by the State Medical Board and that describes the possible medical risks and complications commonly associated with pregnancy and childbirth, as well as the possible physical and psychological effects that have been associated with carrying a child to term;

     (9) contains objective, unbiased information that is reviewed and approved for medical accuracy by recognized obstetrical and gynecological specialists designated by the State Medical Board and that concerns the harmful effects on an unborn child when a woman consumes alcohol, tobacco, or illegal drugs during pregnancy;

     (10) contains objective, unbiased, and comprehensive information that is reviewed and approved for medical accuracy by recognized obstetrical and gynecological specialists designated by the State Medical Board and that describes the different types of available contraceptive choices, including abstinence and natural family planning, that describes the methods of contraception that are intended to prevent fertilization and the methods that are intended to prevent implantation of a fertilized egg, and that describes the reliability, psychological effects, medical risks, and complications commonly associated with each method;

     (11) contains a disclaimer on the website home page concerning the graphic or sensitive nature of the information contained on the website;

     (12) contains a signature form by which a person may indicate the person has reviewed the information.

 (b) The department shall adopt regulations establishing procedures for establishing and maintaining the information under this section.

 (c) In this section,
     (1) "abortion" has the meaning given in AS 18.16.090;

     (2) "fertilization" means the fusion of a human spermatozoon with a human ovum;

     (3) "gestational age" means the age of the unborn child as calculated from the first day of the last menstrual period of a pregnant woman;

     (4) "unborn child" means the offspring of a human being in utero at various stages of biological development.




Sec. 18.05.035. Planned parenthood information.
The department shall prepare information regarding planned parenthood. The department shall place the information in public hospitals, clinics, or other health facilities throughout the state, and upon request of its administrator, in a private hospital, clinic, or health facility, so that members of the public may obtain the information voluntarily, without request. The department shall also advertise the availability of the information and distribute it to any person upon written request.


Sec. 18.05.037. Fetal health effects information.
The department shall prepare or obtain distributable information on fetal alcohol effects and the fetal health effects of chemical abuse and battering during pregnancy. The department shall make this information available to public hospitals, clinics, and other health facilities in the state for distribution to their patients.


Sec. 18.05.040. Regulations.
 (a) The commissioner shall adopt regulations consistent with existing law for
     (1) the time, manner, information to be reported, and persons responsible for reporting for each disease or other condition of public health importance on the list developed under AS 18.15.370;

     (2) cooperation with local boards of health and health officers;

     (3) protection and promotion of the public health and prevention of disability and mortality;

     (4) the transportation of dead bodies, except that the commissioner may not require that a dead body be embalmed unless the body is known to carry a communicable disease or embalmment is otherwise required for the protection of the public health or for compliance with federal law;

     (5) carrying out the purposes of this chapter;

     (6) the conduct of its business and for carrying out the provisions of laws of the United States and the state relating to public health;

     (7) establishing the divisions and local offices and advisory groups necessary or considered expedient to carry out or assist in carrying out a duty or power assigned to it;

     (8) the voluntary certification of laboratories to perform diagnostic, quality control, or enforcement analyses or examinations based on recognized or tentative standards of performance relating to analysis and examination of food, including seafood, milk, water, and specimens from human beings submitted by licensed physicians and nurses for analysis;

     (9) the regulation of quality and purity of commercially compressed oxygen sold for human respiration;

     (10) establishing confidentiality and security standards for information and records received under AS 18.15.355 18.15.395;

     (11) implementation of AS 13.55 (Voluntary Nonopioid Directive Act).

 (b) A regulation may not be adopted under (a) of this section that duplicates, conflicts with, or is inconsistent with AS 18.60.705 18.60.740.




Sec. 18.05.042. Access to health care records.
 (a) The department may, during reasonable business hours, inspect health care records maintained by physicians and other health care professionals, hospitals, out-patient clinics, nursing homes, and other facilities or agencies providing health care services to patients that would identify patients or establish characteristics of an identified patient with cancer required to be reported under 42 U.S.C. 280e 280e-4, or a birth defect or infectious disease required to be reported to protect the public health under this chapter and regulations adopted under this chapter. Disclosure of these health care records to the department does not constitute a breach of patient confidentiality.

 (b) The department may conduct research using health care data reported under (a) of this section. The department may provide data obtained under (a) of this section to other persons for clinical, epidemiological, or other public health research.

 (c) Data obtained or a record inspected under this section that identifies a particular individual
     (1) is confidential;

     (2) may not be further disclosed to other persons except by the department under (b) of this section; and

     (3) is not subject to inspection or copying under AS 40.25.110 40.25.125.




Secs. 18.05.044 , 18.05.046. Registry of persons with impairments; Use of the registry of persons with impairments. [Repealed, 12 ch 54 SLA 2005.]
Sec. 18.05.050. Hospital advisory council. [Repealed, 3 ch 89 SLA 1964.]
Secs. 18.05.051 18.05.055. Comprehensive Health Advisory Council; powers and duties; definitions. [Repealed, 2 ch 78 SLA 1973.]
Secs. 18.05.056 18.05.060. Practice of lay midwifery. [Repealed, 8 ch 130 SLA 1992. For current law, see AS 08.65.]
Sec. 18.05.061. Penalty for violation.
A person who violates a provision of AS 18.05.040 or 18.05.042 or a regulation adopted under AS 18.05.040 or 18.05.042 is guilty of a misdemeanor and, upon conviction, is punishable by a fine of not more than $500, or by imprisonment for not more than one year. Each day that a person continues a violation is a separate offense.


Sec. 18.05.065. Dental radiological equipment.
This chapter does not authorize the department to register, inspect, test, or otherwise regulate dental radiological equipment or records relating to dental radiological equipment regulated by the Board of Dental Examiners under AS 08.36.075.


Sec. 18.05.070. Definitions.
In this chapter,
     (1) "commissioner" means the commissioner of health and social services;

     (2) "condition of public health importance" means a disease, syndrome, symptom, injury, or other threat to health that is identifiable on an individual or community level and can reasonably be expected to lead to adverse health effects in the community;

     (3) "department" means the Department of Health and Social Services.




Chapter 06. Rights of Blind and Otherwise Physically Disabled Persons.
[Repealed, 16 ch 69 SLA 1987. For current law, see AS 09.20.010; AS 09.65.150; AS 11.76.130; AS 18.80.]

Chapter 07. Certificate of Need Program.
Sec. 18.07.010. [Repealed, 1 ch 275 SLA 1976.]
Sec. 18.07.011. Statewide Health Coordinating Council. [Repealed, 21 ch 6 SLA 1993.]
Sec. 18.07.020. [Repealed, 1 ch 275 SLA 1976.]
Sec. 18.07.021. Administration.
The department shall administer the certificate of need program under this chapter and perform other functions prescribed in this chapter.


Sec. 18.07.030. [Repealed, 1 ch 275 SLA 1976.]
Sec. 18.07.031. Certificate of need required; relocations.
 (a) Except as provided in (c) and (d) of this section, a person may not make an expenditure of $1,000,000 or more for any of the following unless authorized under the terms of a certificate of need issued by the department:
     (1) construction of a health care facility;

     (2) alteration of the bed capacity of a health care facility; or

     (3) addition of a category of health services provided by a health care facility.

 (b) Notwithstanding the expenditure threshold in (a) of this section, a person may not convert a building or part of a building to a nursing home that requires licensure as a nursing facility under AS 47.32 unless authorized under the terms of a certificate of need issued by the department.

 (c) Notwithstanding (a) of this section, a person who is lawfully operating a health care facility that is an ambulatory surgical facility at a site may make an expenditure of any amount in order to relocate the services of that facility to a new site in the same community without obtaining a certificate of need as long as neither the bed capacity nor the number of categories of health services provided at the new site is greater.

 (d) Beginning July 1, 2005, the $1,000,000 expenditure threshold in (a) of this section is increased by $50,000 annually on July 1 of each year up to and including July 1, 2014.

 (e) In (a) of this section, "expenditure" includes the purchase of property occupied by or the equipment required for the health care facility and the net present value of a lease for space occupied by or the equipment required for the health care facility; "expenditure" does not include costs associated with routine maintenance and replacement of equipment at an existing health care facility.




Sec. 18.07.035. Application and fees.
 (a) Application for a certificate of need shall be made to the department upon a form provided by the department and must contain the information the department requires to reach a decision under this chapter. Each application for a certificate of need must be accompanied by an application fee established by the department by regulation.

 (b) The department may require a person who intends to submit an application under (a) of this section to submit a letter of intent to the department, except in the case of an application for an emergency or temporary certificate of need authorized under AS 18.07.071.

 (c) The department shall notify the applicant in writing when the application is complete under this chapter.




Sec. 18.07.040. [Repealed, 1 ch 275 SLA 1976.]
Sec. 18.07.041. Standard of review for applications for certificates of need relating to non-nursing home beds and services.
The department shall grant a sponsor a certificate of need or modify a certificate of need that authorizes beds other than nursing home beds or that is for a health care facility other than a nursing home if the availability and quality of existing health care resources or the accessibility to those resources is less than the current or projected requirement for health services required to maintain the good health of citizens of this state.


Sec. 18.07.043. Standard of review for applications for certificates of need relating to nursing homes, nursing home beds, and residential psychiatric treatment centers.
 (a) The department shall develop review standards for an application for a certificate of need, or for a modification of a certificate of need, issued under this chapter for a health care facility that is a nursing home or residential psychiatric treatment center, or that has nursing home beds.

 (b) In developing the review standards under (a) of this section, the department shall consider whether
     (1) a public process and existing appropriate statewide, regional, and local plans were included in planning and designing the residential psychiatric treatment center, the additional nursing home beds, or the nursing home;

     (2) the residential psychiatric treatment center, the additional nursing home beds, or the nursing home meets minimum required use rates for, as applicable, the residential psychiatric treatment center or new nursing beds, and the effect on use rates for existing nursing home beds;

     (3) the residential psychiatric treatment center, the facility proposing additional nursing home beds, or the nursing home demonstrates consideration of the community, regional, and statewide needs for, as applicable, the residential psychiatric treatment center or the new nursing home beds;

     (4) the residential psychiatric treatment center, the additional nursing home beds, or the nursing home meets the minimum number of, as applicable, residential psychiatric treatment beds or new nursing beds that should be required in a facility to ensure efficiency and economies of scale;

     (5) the residential psychiatric treatment center, the facility proposing additional nursing home beds, or the nursing home demonstrates the proposed service will provide a quality of care equivalent to existing community, regional, or statewide services;

     (6) the residential psychiatric treatment center, the facility proposing additional nursing home beds, or the nursing home demonstrates financial feasibility, including long-term viability, and what the financial effect will be on consumers and the state; and

     (7) the sponsor has demonstrated cost effectiveness through considering the availability of appropriate, less costly alternatives of providing the services planned.

 (c) The department shall grant a sponsor a certificate of need or modify a certificate of need that authorizes a residential psychiatric treatment center or nursing home beds, or that is for a health care facility that is a nursing home, if the department finds that the sponsor meets the standards established in or under this chapter.




Sec. 18.07.045. Time standards for review of applications for certificates of need.
 (a) The following time standards apply for a review by the department of an application for a certificate of need under this chapter:
     (1) the department may defer commencement of the review process under this chapter for an application for a period not to exceed 60 days after the determination that the application is complete in order to allow the department to receive and consider concurrent applications from each person who has submitted a letter of intent to submit an application proposing an activity that is similar to the activity proposed by the application in the geographic area;

     (2) the department shall review the application made under this chapter and submit an analysis and recommendation to the commissioner within 60 days after the date that notification under AS 18.07.035(c) is sent to the applicant stating that the application is complete.

 (b) The commissioner may extend the time periods set out in (a) of this section for not more than 30 days for any of the following reasons:
     (1) the applicant amends the application under this chapter;

     (2) the department requests an extension of time within which to prepare its findings and recommendations on the application; the commissioner may grant only one extension under this paragraph.




Sec. 18.07.050. [Repealed, 1 ch 275 SLA 1976.]
Sec. 18.07.051. Terms of issuance of the certificate.
Each certificate issued must specify terms of issuance describing the nature and extent of the activities authorized by the certificate.


Sec. 18.07.060. [Repealed, 1 ch 275 SLA 1976.]
Sec. 18.07.061. Modification and termination of activities.
The certificate holder shall apply to the department for a modification of the certificate before terminating part of the activities authorized by the terms of issuance, but the certificate holder is not required to obtain the acquiescence of the department before terminating all the activities authorized by the certificate. If a certificate holder terminates all of the activities authorized by a certificate, the certificate holder is required to notify the department 60 days before termination and to surrender the certificate to the department within 30 days of termination.


Sec. 18.07.070. [Repealed, 1 ch 275 SLA 1976.]
Sec. 18.07.071. Temporary and emergency certificates.
 (a) The department shall grant a sponsor an emergency certificate for the construction of a health care facility for which a certificate is required under AS 18.07.031 if the sponsor shows, by affidavit or formal hearing, that the act of construction consists of effecting emergency repairs.

 (b) The department may grant a sponsor a temporary certificate for the temporary operation of a category of health service if the sponsor shows by affidavit or formal hearing
     (1) the necessity for early, immediate, or temporary relief; and

     (2) adverse effect to the public interest by reason of delay occasioned by compliance with the requirements of AS 18.07.041, 18.07.043, and application procedures prescribed by regulations under this chapter.

 (c) A temporary certificate granted under (b) of this section does not confer vested rights on behalf of the applicant. The department shall impose those special limitations and restrictions concerning duration and right of extension that the department considers appropriate. A temporary certificate may not be granted for a period longer than necessary for the sponsor to obtain review of the action certified by the temporary certificate under AS 18.07.051. Application for a certificate of need under AS 18.07.041 or 18.07.043 must commence within 60 days of the date of issuance of the temporary certificate.




Sec. 18.07.080. [Repealed, 1 ch 275 SLA 1976.]
Sec. 18.07.081. Proceedings for modification, suspension, and revocation.
 (a) The department, a member of the public who is substantially affected by activities authorized by the certificate, or another applicant for a certificate of need may initiate a hearing conducted by the office of administrative hearings (AS 44.64.010) to obtain modification, suspension, or revocation of an existing certificate of need by filing an accusation with the commissioner as prescribed under AS 44.62.360. A revocation, modification, or suspension of an outstanding certificate may not be undertaken unless it is in accordance with AS 44.62.330 44.62.630.

 (b) The certificate holder may obtain modification of an existing certificate by utilizing the application procedure enumerated in regulations adopted under this chapter.

 (c) A certificate of need shall be suspended if an accusation is filed before the commencement of activities authorized under AS 18.07.041 or 18.07.043 that charges that factors upon which the certificate of need was issued have changed or new factors have been discovered that significantly alter the need for the activity authorized. A suspension of a certificate may not exceed 60 days. At the end of this period or sooner, the department shall revoke or reinstate the certificate.

 (d) A certificate of need may be revoked if
     (1) the sponsor has not shown continuing progress toward commencement of the activities authorized under AS 18.07.041 or 18.07.043 after six months of issuance;

     (2) the applicant fails, without good cause, to complete activities authorized by the certificate;

     (3) the sponsor fails to comply with the provisions of this chapter or regulations adopted under this chapter;

     (4) the sponsor knowingly misrepresents a material fact in obtaining the certificate;

     (5) the facts charged in an accusation filed under (c) of this section are established; or

     (6) the sponsor fails to provide services authorized by the terms of the certificate.

 (e) A person may not file an accusation seeking suspension or revocation of a certificate of need under this section, knowing that the charges stated in the accusation are untrue or that the charges do not constitute grounds for revocation or suspension under this chapter.




Sec. 18.07.090. [Repealed, 1 ch 275 SLA 1976.]
Sec. 18.07.091. Injunctive relief; penalties; right of action.
 (a) Injunctive relief against violations of this chapter or regulations adopted under this chapter may be obtained from a court of competent jurisdiction at the instance of the commissioner, a holder of a certificate of need who is adversely affected in the exercise of the activities conducted in violation of the certificate, or any member of the public substantially and adversely affected by the violation. Upon written request by the commissioner, the attorney general shall furnish legal services and pursue the action for injunctive relief to an appropriate conclusion.

 (b) A person who files an accusation seeking suspension or revocation of a certificate of need, knowing that the charges are untrue or that the charges do not constitute grounds for revocation or suspension under this chapter, is guilty of a misdemeanor and upon conviction is punishable by a fine of not more than $1,000. The sponsor or holder of a certificate of need injured by the violation of AS 18.07.081(e) may recover damages for loss incurred by reason of delay caused by a suspension.




Sec. 18.07.100. [Repealed, 1 ch 275 SLA 1976.]
Sec. 18.07.101. Regulations.
The commissioner shall adopt, in accordance with AS 44.62 (Administrative Procedure Act), regulations that establish procedures under which sponsors may make application for certificates of need required by this chapter and that govern the review of those applications by the department, establish requirements for a uniform statewide system of reporting financial and other operating data, and otherwise carry out the purposes of this chapter.


Sec. 18.07.111. Definitions.
In this chapter,
     (1) "category of health services" means a major type, program, unit, division, or department of care provided through a health care facility, whether inpatient or outpatient, including an outpatient department, psychiatric wing, kidney dialysis program, radiotherapy, burn unit, or newborn intensive care unit, except that "service" does not include the lawful practice of a profession or vocation conducted independently of a health care facility and in accordance with applicable licensing laws of the state;

     (2) "certificate" means a certificate of need issued by the department under AS 18.07.041, 18.07.043, or 18.07.071;

     (3) "commencement of activities" means the visible commencement of actual operations on the ground for the construction of a building, the alteration of the bed capacity of a health care facility, or the provision for a category of health services to consumers, which operations are readily recognizable as such, and which operations are done with intent to continue the work until such activities are completed;

     (4) "commissioner" means the commissioner of health and social services;

     (5) "complete activities" means the substantial performance of the work required to comply with the terms of issuance of the certificate of need to which all parties participating in those activities have obligated themselves to perform;

     (6) "construction" means the erection, building, alteration, reconstruction, improvement, extension, or modification of a health care facility under this chapter, including lease or purchase of equipment, excavation, or other necessary actions;

     (7) "department" means the Department of Health and Social Services;

     (8) "health care facility" means a private, municipal, state, or federal hospital, psychiatric hospital, independent diagnostic testing facility, residential psychiatric treatment center, tuberculosis hospital, skilled nursing facility, kidney disease treatment center (including freestanding hemodialysis units), intermediate care facility, and ambulatory surgical facility; the term excludes
          (A) the Alaska Pioneers' Home and the Alaska Veterans' Home administered by the Department of Health and Social Services under AS 47.55; and

          (B) the offices of private physicians or dentists whether in individual or group practice;

     (9) "nursing home bed" means a bed not used for acute care in which nursing care and related medical services are provided over a period of 24 hours a day to individuals admitted to the health care facility because of illness, disease, or physical infirmity;

     (10) "residential psychiatric treatment center" means a secure or semi-secure psychiatric facility or inpatient program in a psychiatric facility that is licensed by the Department of Health and Social Services and that provides therapeutically appropriate and medically necessary diagnostic, evaluation, and treatment services
          (A) 24 hours a day for children with severe emotional or behavioral disorders;

          (B) under the direction of a physician; and

          (C) under a professionally developed and supervised individual plan of care designed to achieve the recipient's discharge from inpatient status at the earliest possible time that is intensively and collaboratively delivered by an interdisciplinary team involving medical, mental health, educational, and social service components.




Chapter 08. Emergency Medical Services.
Sec. 18.08.010. Administration.
The department is responsible for the development, implementation, and maintenance of a statewide comprehensive emergency medical services system and, accordingly, shall
     (1) coordinate public and private agencies engaged in the planning and delivery of emergency medical services, including trauma care, to plan an emergency medical services system;

     (2) assist public and private agencies to deliver emergency medical services, including trauma care, through the award of grants in aid;

     (3) conduct, encourage, and approve programs of education and training designed to upgrade the knowledge and skills of health personnel involved in emergency medical services, including trauma care;

     (4) establish and maintain a process under which hospitals and clinics could represent themselves to be trauma centers because they voluntarily meet criteria adopted by the department; criteria adopted by the department to implement this paragraph must be based on an applicable national evaluation system.




Sec. 18.08.015. Patient information system.
 (a) The department may establish an emergency medical services patient care information system. If the department collects information on emergency medical services patient care, the department shall establish a format for the data collection. The purpose of the system is to
     (1) collect data on the incidence, severity, and causes of trauma injuries;

     (2) integrate this data on trauma injuries with information available from other public and private sources on trauma injuries; and

     (3) improve the delivery of prehospital and hospital emergency medical services.

 (b) A person, organization, or government agency that provides a prehospital emergency medical service through a certificate issued under this chapter shall participate in the system by making available to the department the minimum data requested in a format that is compatible with the format developed by the department to implement (a) of this section. The minimum data must include the
     (1) type of medical emergency or nature of the call;

     (2) response time; and

     (3) prehospital treatment provided.

 (c) A hospital that provides emergency medical services shall make available to the department an abstract of the records of all patients admitted to the hospital's trauma and general surgery services for trauma care. The abstracts must be in a format that is compatible with the format developed by the department under (a) of this section.

 (d) The department shall consult with the Alaska Council on Emergency Medical Services in designing, implementing, and revising the system.

 (e) The department may delegate the responsibility for collecting data under this section to other public agencies or to private persons on contract to the department.

 (f) In this section, "system" means the emergency medical services patient care information system established under this section.




Sec. 18.08.020. Alaska Council on Emergency Medical Services.
There is established in the department the Alaska Council on Emergency Medical Services. The council shall advise the commissioner and the governor with regard to the planning and implementation of a statewide emergency medical services system.


Sec. 18.08.030. Composition.
The council consists of 11 members appointed by the governor. The governor shall provide for appropriate geographical distribution in the appointments and shall appoint
     (1) two members who are physicians with experience in emergency medicine or trauma care;

     (2) one member who is a registered nurse with experience in emergency nursing;

     (3) three members who are active as prehospital emergency care providers, at least one of whom resides in a community that is not connected by land or marine highway, or a combination of land and marine highway, to a community in which a hospital is located; in this paragraph, "highway" has the meaning given in AS 28.90.990;

     (4) one member who is an emergency medical services administrator;

     (5) one member who is an administrator of a hospital or Native health care organization; and

     (6) three members who are consumers of emergency medical services who each reside in a different judicial district in the state.




Sec. 18.08.040. Term of office.
 (a) Members of the council shall be appointed for staggered terms of four years.

 (b) [Repealed, 27 ch 36 SLA 1993.]
 (c) A vacancy occurring in the membership of the council shall be filled by appointment by the governor in the same manner as original appointments, and when a seat is vacated before expiration of a term, the vacancy shall be filled for the unexpired portion of the vacated term.




Sec. 18.08.050. Compensation and per diem.
Members of the council receive no salary, but are entitled to per diem, reimbursement for travel, and other expenses authorized by law for boards and commissions.


Sec. 18.08.060. Meetings.
The council shall meet at the call of the chairman not less frequently than twice a year. A majority of members constitutes a quorum.


Sec. 18.08.070. Special committees.
The council may create special committees or task forces outside its membership and may appoint persons who are not members of the council to serve as advisors or consultants to any committee created to carry out the purposes of the council.


Sec. 18.08.075. Authority of emergency medical technician.
 (a) An emergency medical technician who responds to an emergency with an ambulance service or first responder service, who has in the technician's possession a current emergency medical technician identification card, and who provides emergency medical care or other emergency medical service, has the authority to
     (1) control and direct activities at the accident site or emergency until the arrival of law enforcement personnel;

     (2) order a person other than the owner to leave a building or place in the vicinity of the accident or other emergency for the purpose of protecting the person from injury;

     (3) temporarily block a public highway, street, or private right-of-way while at the scene of an accident, illness, or emergency;

     (4) trespass upon property at or near the scene of an accident, illness, or emergency at any time of day or night;

     (5) enter a building, including a private dwelling, or premises where a report of an injury or illness has taken place or where there is a reasonable cause to believe an individual has been injured or is ill to render emergency medical care; and

     (6) direct the removal or destruction of a motor vehicle or other thing that the emergency medical technician determines is necessary to prevent further harm to injured or ill individuals.

 (b) A person who knowingly refuses to comply with an order of an emergency medical technician authorized under (a) of this section is, upon conviction, guilty of a class B misdemeanor. In this subsection, "knowingly" has the meaning given in AS 11.81.900(a).




Sec. 18.08.080. Regulations.
 (a) The department shall adopt, with the concurrence of the Department of Public Safety, regulations establishing standards and procedures for the issuance, renewal, reissuance, revocation, and suspension of certificates required under AS 18.08.084, as well as other regulations necessary to carry out the purposes of this chapter.

 (b) The department may charge fees set by regulation for the certification of individuals and organizations under this chapter.




Sec. 18.08.082. Issuance of certificates; designations.
 (a) The department shall prescribe by regulation a course of training or other requirements prerequisite to the issuance of certificates that provide for the following:
     (1) certification of a person who meets the training and other requirements as an emergency medical technician, emergency medical technician instructor, or emergency medical dispatcher;

     (2) authorization for an emergency medical technician certified under this chapter to provide under the written or oral direction of a physician the advanced life support services enumerated on the certificate or enumerated on a written document filed with the department by the technician's medical director and approved by the department under its regulations;

     (3) certification that a person, organization, or government agency that provides an emergency medical service, conducts a training course for a mobile intensive care paramedic, or represents itself as a trauma center meets the minimum standards prescribed by the department for that service, course, or designation; and

     (4) authorization for an emergency medical service certified under this chapter to provide under the written or oral direction of a physician the advanced life support services enumerated on the certificate or enumerated on a written document filed with the department by the medical director for the emergency medical service and approved by the department under its regulations.

 (b) The department is the central certifying agency for personnel certified under (a)(1) and (2) of this section and under regulations adopted under AS 18.08.080.

 (c) The commissioner shall establish special designations in regulation for varying levels of trauma care provided by any certified trauma center in the state that shall be used to set compensation eligibility and amounts under AS 18.08.085. The designations shall be based on nationally recognized standards and procedures.




Sec. 18.08.084. Certificate required.
 (a) One may not represent oneself, nor may an agency or business represent an agent or employee of that agency or business, as an emergency medical dispatcher, emergency medical technician, or emergency medical technician instructor certified by the state unless the person represented is certified for that occupation under AS 18.08.082.

 (b) A person, organization, or government agency may not represent itself as an emergency medical service or ambulance service certified by the state unless the person, organization, or government agency is certified as an emergency medical service under AS 18.08.082.

 (c) A person may not provide, offer, or advertise to provide advanced life support services outside a hospital unless authorized by law.

 (d) A person, organization, or government agency that provides, offers, or advertises to provide an emergency medical service may not provide advanced life support services unless authorized under AS 18.08.082.

 (e) A hospital, clinic, or other entity may not represent itself as being a trauma center unless it is certified under AS 18.08.082 as meeting the criteria established for a trauma center.

 (f) A person, organization, or government agency may not offer or conduct a training course that is represented as a course for mobile intensive care paramedics unless the person, organization, or agency is certified under AS 18.08.082 to offer or conduct that course.




Sec. 18.08.085. Trauma care fund; creation.
 (a) The trauma care fund is created. The purpose of the fund is to compensate certified trauma centers in the state that receive a special designation under AS 18.08.082(c) and that achieve or maintain the highest appropriate level of trauma care designation.

 (b) The fund consists of money appropriated to it by the legislature, including donations, recoveries of or reimbursements for awards made from the fund, income from the fund, and other program receipts from activities under this chapter. Appropriations to the fund do not lapse.

 (c) The commissioner shall administer the fund in accordance with the provisions of this chapter. The commissioner shall spend money from the trauma care fund for the purpose established in (a) of this section.

 (d) The commissioner shall establish compensation standards under this section. The standards must include funding priorities for trauma centers receiving a special designation under AS 18.08.082(c). The commissioner may seek the advice of a special committee for review of statewide trauma care and compensation standards.

 (e) The commissioner may not provide more than 25 percent of the total assets, including earnings, of the fund in a fiscal year to one trauma center.




Sec. 18.08.086. Immunity from liability.
 (a) A person certified under AS 18.08.082 who administers emergency medical services to an injured or sick person, a person or public agency that employs, sponsors, directs, or controls the activities of persons certified under AS 18.08.082 who administer emergency medical services to an injured or sick person, or a health care professional or emergency medical dispatcher acting within the scope of the person's certification who directs or advises a person to administer emergency medical services to an injured or sick person is not liable for civil damages as a result of an act or omission in administering those services or giving that advice or those directions if the administering, advising, and directing are done in good faith and the injured or sick person reasonably seems to be in immediate danger of serious harm or death. This subsection does not preclude liability for civil damages that are the proximate result of gross negligence or intentional misconduct, nor preclude imposition of liability on a person or public agency that employs, sponsors, directs, or controls the activities of persons certified under AS 18.08.082 if the act or omission is a proximate result of a breach of duty to act created under this chapter. For the purposes of this subsection, "gross negligence" means reckless, wilful, or wanton misconduct.

 (b) A physician who in good faith arranges for, requests, recommends, or initiates the transfer of a patient from a hospital to another hospital is not liable for civil damages as a result of arranging, requesting, recommending, or initiating the transfer if
     (1) in the exercise of that degree of knowledge or skill possessed, or that degree of care ordinarily exercised by physicians practicing the same specialty in the same or similar communities to that in which the physician is practicing, the physician determines that treatment of the patient's medical condition is beyond the capability of the transferring hospital or the medical community in which the hospital is located;

     (2) the physician has confirmed that the receiving facility is more capable of treating the patient; and

     (3) the physician has secured a prior agreement from the receiving facility to accept and render the necessary treatment to the patient.

 (c) A registered or advanced practice registered nurse or licensed practical nurse who escorts a patient in a means of conveyance not equipped as an ambulance is not liable for civil damages as a result of an act or omission in administering patient care services, if done in good faith and if the life of the injured or sick person is in danger. This subsection does not preclude liability for civil damages that are the result of gross negligence or intentional misconduct.

 (d) A person certified as an emergency medical technician instructor, a person or entity certified to conduct a training course for mobile intensive care paramedics, and a person who employs or contracts with a certified emergency medical technician instructor or with a person or entity certified to conduct a training course for mobile intensive care paramedics is not liable for civil damages as a result of a negligent act or omission during a training course that injures the person or property of a person participating in the training course.




Sec. 18.08.087. Disclosure of medical records.
When requested for the purpose of evaluating the performance of an emergency medical technician, mobile intensive care paramedic, or physician who provided emergency medical care or other assistance to a sick or injured person, a licensed physician, advanced practice registered nurse, or physician assistant may disclose to an emergency medical technician, a mobile intensive care paramedic, or physician the medical or hospital records of a sick or injured person to whom the paramedic, technician, or physician is providing or has rendered emergency medical care or assistance. However, the disclosing physician, advanced practice registered nurse, or physician assistant shall limit disclosure under this section to the records that are considered necessary by the discloser for evaluation of the paramedic's, technician's, or physician's performance in providing the emergency medical care or assistance. A mobile intensive care paramedic, emergency medical care technician, or physician to whom confidential records are disclosed under this section may not further disclose the information to a person not entitled to receive that information under this section or another law.


Sec. 18.08.088. Penalty.
A person who violates a provision of this chapter is guilty of a misdemeanor and upon conviction is punishable by a fine of not more than $1,000, or by imprisonment for not more than 90 days, or by both. Each violation is a separate offense.


Sec. 18.08.089. Authority to pronounce death.
 (a) A mobile intensive care paramedic or physician assistant registered or licensed under AS 08.64.107 or an emergency medical technician certified under this chapter may make a determination and pronouncement of death of a person under the following circumstances:
     (1) the paramedic or emergency medical technician is an active member of an emergency medical service certified under this chapter;

     (2) neither a physician licensed under AS 08.64 nor a physician exempt from licensure under AS 08.64 is immediately available for consultation by radio or telephone communications;

     (3) the paramedic, physician assistant, or emergency medical technician has determined, based on acceptable medical standards, that the person has sustained irreversible cessation of circulatory and respiratory functions.

 (b) A mobile intensive care paramedic, physician assistant, or emergency medical technician who has determined and pronounced death under this section shall document the clinical criteria for the determination and pronouncement on the person's emergency medical service report form and notify the appropriate medical director or collaborative physician as soon as communication can be established. The paramedic, physician assistant, or emergency medical technician shall provide to the person who signs the death certificate the
     (1) name of the deceased;

     (2) presence of a contagious disease, if known; and

     (3) date and time of death.

 (c) Except as otherwise provided under AS 18.50.230, a physician licensed under AS 08.64 shall certify a death determined under (b) of this section within 24 hours after the pronouncement by the mobile intensive care paramedic, physician assistant, or emergency medical technician.

 (d) In this section,
     (1) "acceptable medical standards" means cardiac arrest accompanied by
          (A) the presence of injuries incompatible with life, including incineration, decapitation, open head injury with loss of brain matter, or detruncation;

          (B) the presence of rigor mortis;

          (C) the presence of post mortem lividity; or

          (D) failure of the patient to respond to properly administered resuscitation efforts;

     (2) "failure of the patient to respond" means without restoration of spontaneous pulse or respiratory effort by the patient;

     (3) "properly administered resuscitation efforts" means
          (A) when a person authorized to perform advanced cardiac life support techniques is not available and the patient is not hypothermic, at least 30 minutes of properly performed cardiopulmonary resuscitation;

          (B) when a person authorized to perform advanced cardiac life support techniques is not available and the patient is hypothermic, at least 60 minutes of cardiopulmonary resuscitation properly performed in conjunction with rewarming techniques as described in the current State of Alaska Hypothermia and Cold Water Near-Drowning Guidelines published by the division of public health, Department of Health and Social Services; or

          (C) at least 30 minutes of cardiopulmonary resuscitation and advanced cardiac life support techniques properly performed by a person authorized to perform advanced life support services.




Sec. 18.08.090. [Renumbered as AS 18.08.200.]
Sec. 18.08.095. Air ambulance service.
An air ambulance service provider that provides air ambulance services to an individual covered under an air ambulance membership agreement with the provider may not deny emergency medical services to any person on the basis that the person is not covered under an air ambulance membership agreement. In this section, "air ambulance membership agreement" and "air ambulance service provider" have the meanings given in AS 21.61.110.


Sec. 18.08.200. Definitions.
In this chapter,
     (1) "advanced life support" means emergency care techniques provided under the written or oral orders of a physician that include manual electric cardiac defibrillation, administration of antiarrhythmic agents, intravenous therapy, intramuscular therapy, or use of endotracheal intubation devices;

     (2) "ambulance" means any publicly or privately owned means of conveyance intended to be used and maintained or operated for the transportation of persons who are sick, injured, wounded, or otherwise helpless;

     (3) "commissioner" means the commissioner of health and social services;

     (4) "consumer of emergency medical services" means a person who is not a provider of emergency medical services as defined in this section;

     (5) "department" means the Department of Health and Social Services;

     (6) "emergency medical care" means the services utilized in responding to the perceived individual needs for immediate medical care in order to prevent loss of life or aggravation of physiological or psychological illness or injury;

     (7) "emergency medical dispatcher" means a trained public safety telecommunicator with additional training and specific emergency medical knowledge essential for the efficient management of emergency medical communications;

     (8) "emergency medical service" means the provision of emergency medical care and transportation of the sick and injured;

     (9) "emergency medical services system" means a system that provides for the arrangement of personnel, facilities, and equipment for the effective and coordinated delivery of health care services, including trauma care, under emergency conditions, occurring either as a result of the patient's condition or of natural disasters or similar situations, and that is administered by a statewide network that has the authority and resources to provide effective administration of the system;

     (10) "emergency medical technician" means a person trained in emergency medical care and certified in accordance with the regulations prescribed under AS 18.08.080;

     (11) "paramedic training program" means a training program prescribed in regulations of the department that includes classroom, clinical, and field internship components designed to provide an individual with the knowledge and skills necessary to function as a mobile intensive care paramedic;

     (12) "provider of emergency medical services" means a person whose occupation or profession is, or has been, the delivery or administration of emergency medical services; a person who has a fiduciary position with, or has a fiduciary interest in, a health activity, facility or other health agency, or a legal or financial interest in the rendering of any component of emergency medical services; and

     (13) "trauma care" includes injury prevention, triage, prehospital care, hospital care, and rehabilitative services for major single system or multisystem injuries that require immediate medical or surgical intervention or treatment to prevent death or permanent disability.




Chapter 09. Statewide Health Care.
Article 1. Alaska Health Care Commission.
Sec. 18.09.010. Alaska Health Care Commission.
The Alaska Health Care Commission is established in the Department of Health and Social Services. The purpose of the commission is to provide recommendations for and foster the development of a statewide plan to address the quality, accessibility, and availability of health care for all citizens of the state.


Sec. 18.09.020. Composition; chair.
The commission consists of 14 members as follows:
     (1) 11 voting members appointed by the governor as follows:
          (A) the state officer assigned the duties of medical director for the department, who shall serve as chair;

          (B) one member who represents the tribal health community in the state;

          (C) one member who represents a statewide chamber of commerce who is not financially associated with the health care industry;

          (D) one member who represents the Alaska State Hospital and Nursing Home Association;

          (E) one member who is a health care provider and
               (i) engaged in the active practice of the health care provider's profession in the state;

               (ii) licensed to practice in the state;

               (iii) not affiliated with the Alaska State Hospital and Nursing Home Association;

          (F) one member who represents the health insurance industry in the state;

          (G) one member who is
               (i) a health care consumer;

               (ii) a resident of the state; and

               (iii) not employed by and does not have a business interest in the health care industry;

          (H) one member who is a licensed primary care physician in the state and who is in the active practice of family medicine, primary care internal medicine, or pediatric medicine;

          (I) one member who represents the Alaska Mental Health Trust Authority;

          (J) one member who represents community health centers in the state;

          (K) one member who is involved in the United States Department of Veterans Affairs health care industry;

     (2) three nonvoting members appointed as follows:
          (A) one ex officio member from the house of representatives, appointed by the speaker of the house of representatives;

          (B) one ex officio member from the senate, appointed by the president of the senate;

          (C) an ex officio member representing the Office of the Governor.




Sec. 18.09.030. Public members' terms of office.
 (a) Public members of the commission serve for staggered terms of three years or until a successor is appointed.

 (b) If a vacancy occurs in a public member's seat on the commission, the governor shall make an appointment for the unexpired portion of that member's term.

 (c) A public member may serve not more than two consecutive terms.

 (d) In this section, "public member" means those members appointed under AS 18.09.020(1)(B) (K).




Sec. 18.09.040. Executive director.
The commission may employ an executive director, who may not be a member of the commission and who may be current staff of the department. The executive director serves at the pleasure of the commission. The commission shall establish the duties of the executive director. The executive director is in the partially exempt service under AS 39.25 (State Personnel Act).


Sec. 18.09.050. Staff.
The department may assign employees of the department to serve as staff to the commission. The commission shall prescribe the duties of the commission staff.


Sec. 18.09.060. Bylaws.
The commission, on approval of a majority of its membership and consistent with state law, shall adopt and amend bylaws governing proceedings and other activities, including provisions concerning
     (1) a quorum to transact commission business and other aspects of procedure;

     (2) frequency and location of meetings;

     (3) establishment, functions, and membership of committees; and

     (4) conflicts of interest that require
          (A) a member to declare a substantial financial interest in an official action and to request to be excused from voting in that instance;

          (B) a ruling by the chair on a request by a member to be excused from voting;

          (C) an opportunity to override a ruling by the chair on a majority vote;

          (D) filing of a written disclosure form with the department that lists all potential conflicts of interest of a member valued at more than $5,000 annually if the interest is related to health care system income affecting the member or a member of the member's immediate family.




Sec. 18.09.070. Duties of the commission.
 (a) The commission shall serve as the state health planning and coordinating body. Consistent with state and federal law, the commission shall provide recommendations for and foster the development of a statewide health plan containing the following:
     (1) a comprehensive statewide health care policy;

     (2) a strategy for improving the health of all residents of the state that
          (A) encourages personal responsibility for disease prevention, healthy living, and acquisition of health insurance;

          (B) reduces health care costs by using savings from
               (i) enhanced market forces;

               (ii) fraud reduction;

               (iii) health information technology;

               (iv) management efficiency;

               (v) preventative medicine;

               (vi) successful innovations identified by other states; and

               (vii) other cost-saving measures;

          (C) eliminates known health risks, including unsafe water and wastewater systems;

          (D) develops a sustainable health care workforce;

          (E) improves access to quality health care; and

          (F) increases the number of insurance options for health care services.

 (b) The commission may hold public hearings to gather information and opinions from health care consumers on matters before the commission. Hearings shall be conducted under AS 44.62.210, except that the commission shall provide public notice of hearings not less than 15 days before the conduct of the hearing and include not fewer than three notices published in the statewide news media.

 (c) The commission shall submit to the governor and the legislature by January 15 of each year an annual report regarding the commission's recommendations and activities. The report shall include voting records, copies of financial disclosures, and conflicts of interest statements.




Sec. 18.09.080. Compensation, per diem, and expenses.
A member appointed to the commission under AS 18.09.020(1) is entitled to per diem, reimbursement for travel, and other expenses authorized by law for boards and commissions under AS 39.20.180.


Article 2. Statewide Immunization Program.
Sec. 18.09.200. Statewide immunization program established; commissioner's duties.
 (a) In addition to health promotion and vaccine registration activities of the department, a statewide immunization program is established in the department for the purpose of monitoring, purchasing, and distributing included vaccines to providers approved by the department who agree to provide the included vaccines to state residents under terms consistent with the program and state and federal law.

 (b) The commissioner shall
     (1) establish a procedure that provides for participation by an assessable entity;

     (2) maintain a list of recommended vaccines for inclusion in the program;

     (3) for each included vaccine, establish the initial vaccine assessment for the first year of the program and thereafter make annual assessments based on the determinations made by the council established under AS 18.09.210;

     (4) notify assessable entities and other program participants of the annual vaccine assessment for each vaccine included in the program;

     (5) devise a method for crediting to assessable entities and other program participants overpayments of vaccine assessments made for reasons related to administrative error, program termination, or lower than anticipated actual usage of the program by covered individuals;

     (6) coordinate collective purchases of included vaccines;

     (7) establish a procedure for statewide distributions of vaccines purchased under the program; and

     (8) review vaccine assessment appeals for error.




Sec. 18.09.210. State Vaccine Assessment Council; members; duties.
 (a) The State Vaccine Assessment Council is established in the department for the purpose of determining the amount of vaccine assessments made by the commissioner to be paid by assessable entities and other program participants in the state under procedures established by the council.

 (b) The council consists of eight members appointed by the commissioner as follows:
     (1) the department's chief medical officer for public health or the chief medical officer's designee, who shall serve as chair;

     (2) two health care providers licensed in the state, one of whom must be a pediatrician;

     (3) three members representing health care insurers licensed in the state under AS 21.54, one of whom must be a plan administrator; each insurer must represent a different organization in the state;

     (4) a representative of a tribal or public health insurance plan;

     (5) the director of the division of insurance or the director's designee.

 (c) A member appointed to the council under (b)(2) (4) of this section serves without compensation and reimbursement of expenses for a term of three years or until a successor is appointed. A member may not serve more than two consecutive terms.

 (d) The council shall meet at the call of the chair and conduct business by majority vote.

 (e) The department shall provide staff and other assistance to the council.

 (f) The council shall
     (1) establish and implement a plan of operation to
          (A) determine the amount of the annual vaccine assessment, subject to review by the commissioner, for each included vaccine for each covered individual following the initial vaccine assessment amounts determined by the commissioner;

          (B) use a method for determining the vaccine assessment amount that attributes to each assessable entity and other program participant the proportionate costs of included vaccines for covered individuals;

          (C) establish procedures for the collection and deposit of the vaccine assessment;

          (D) establish procedures for collecting and updating data from assessable entities and other program participants as necessary for the operation of the program and the determination of the annual vaccine assessment; the data collected must include the number of covered individuals by each assessable entity and other program participant and the annual vaccine program usage by each covered individual;

          (E) devise a system for reducing surplus payments made by an assessable entity and other program participant by crediting past overpayments to current year vaccine assessments;

     (2) submit to the commissioner and to the legislature, not later than July 1 of each year, an annual financial report, including assessment determinations and overall costs of the program, in a form acceptable to the commissioner and the legislature;

     (3) monitor compliance with the program requirements and vaccine assessments and submit a periodic noncompliance report to the commissioner and the director of insurance that lists assessable entities and other program participants that failed to
          (A) remit vaccine assessments as determined by the council and approved by the commissioner; or

          (B) comply with a reporting or auditing requirement under the program after notice from the council.




Sec. 18.09.220. Vaccine assessment and reporting requirements.
 (a) An assessable entity and other program participant shall
     (1) pay to the department the annual combined vaccine assessments as determined under the program for the included vaccines covered by the assessable entity or other program participant for each covered individual on a schedule adopted by the council;

     (2) provide information requested by the council to determine the number of covered individuals, actual vaccine usage under the program, and other data necessary to calculate and monitor compliance with the vaccine assessment; and

     (3) provide audited financial statements upon request of the council.

 (b) A vaccine assessment must include a reasonable contribution toward support of the program and appropriate reserve funds, as determined by the council. A vaccine assessment may not include a provider fee for the administration of the vaccine.

 (c) A vaccine assessment shall be construed as a medical expense of the assessable entity or other program participant.

 (d) An assessable entity or other program participant may appeal a determination of a vaccine assessment made by the council to the commissioner within 10 days after receiving notification of the assessment. The commissioner shall review the appeal and all materials relevant to the assessment that is the subject of the appeal and shall modify the assessment if the commissioner finds substantial evidence of an error.

 (e) [Repealed, 6 ch 17 SLA 2019.]




Sec. 18.09.225. Other program participants.
 (a) A health care provider or group of providers may opt into the program if approved by the commissioner under regulations adopted by the department.

 (b) An assessable entity may not deny a claim for coverage by a health care provider of vaccines not distributed under the program.

 (c) A health care provider may not bill a payor for or resell a vaccine distributed under the program.




Sec. 18.09.230. Vaccine Assessment Fund.
 (a) The vaccine assessment fund is created in the general fund for the purpose of providing funding for the program. The fund consists of money appropriated to it by the legislature, including program receipts attributable to vaccine assessments under AS 18.09.220, fees under AS 18.09.240, money from other sources, and interest earned on money in the fund. Appropriations to the fund do not lapse.

 (b) The commissioner shall administer the fund in accordance with the provisions of this chapter. The commissioner may spend money appropriated to the fund for the purposes of the program under AS 18.09.200 and to pay the costs of administering the program without further appropriation.




Sec. 18.09.240. Penalties.
An assessable entity or other program participant that fails to pay a required annual vaccine assessment after notification of the assessment or fails to comply with a request for information necessary for determination of the assessment may be assessed an additional noncompliance fee as determined by the commissioner under regulations adopted by the department.


Article 3. General Provisions.
Sec. 18.09.900. Regulations.
The department may adopt regulations under AS 44.62 (Administrative Procedure Act) to carry out the purposes of this chapter.


Sec. 18.09.990. Definitions.
In this chapter,
     (1) "assessable entity" means
          (A) a health care insurer as defined in AS 21.54.500;

          (B) an entity that provides the state health care plan described in AS 39.30.090 and 39.30.091;

          (C) a public or private entity that offers a publicly funded plan in the state, to the extent participation in the program is authorized by law;

          (D) a third-party administrator as defined in AS 21.97.900;

     (2) "commission" means the Alaska Health Care Commission established in AS 18.09.010;

     (3) "commissioner" means the commissioner of health and social services;

     (4) "council" means the State Vaccine Assessment Council;

     (5) "covered individual" means an adult or child who resides in the state and who is provided insurance coverage for an included vaccine by an assessable entity or who is a patient of another program participant;

     (6) "department" means the Department of Health and Social Services.

     (7) "included vaccine" means a vaccine recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, United States Department of Health and Human Services, and included on a list maintained by the commissioner for inclusion in the program;

     (8) "other program participant" and "another program participant" mean a health care provider or group of providers who have opted into the program under AS 18.09.225 to both purchase vaccines for and administer vaccinations to residents of the state;

     (9) "program" means the statewide immunization program;

     (10) "provider" means a person licensed or certified by the state to administer vaccines or provide health care services or a partnership, corporation, or other entity made up of persons licensed or certified to administer vaccines or provide health care services;

     (11) "vaccine" means a preparation of killed microorganisms, living attenuated organisms, living fully virulent organisms, or other substances that are administered to humans for the purpose of producing or artificially increasing specific immunity to life-threatening and disabling diseases.




Chapter 10. Health Units and Districts.
Sec. 18.10.010. Local health unit and health board.
Each community or settlement outside an incorporated city is a health unit. In each health unit there shall be a board of health composed of the president of the school board and two citizens of the unit selected by the school board. At least one of the members of the health board must, where practicable, be a licensed physician. In a health unit where there is no school board, the commissioner shall appoint three residents of the unit to the local board of health, at least one member of which must, where practicable, be a licensed physician.


Sec. 18.10.020. Health unit in incorporated city.
AS 18.10.010 applies to an incorporated city unless the city otherwise provides for the establishment and maintenance of a local board of health or a health officer.


Sec. 18.10.030. Health units in Native villages and communities.
In a Native village, or community composed largely of Natives, where the formation of a board of health is impracticable, the commissioner may delegate to a representative of the Alaska Native Service the authority granted to the local boards of health.


Sec. 18.10.040. Health districts.
Two or more contiguous health units of two or more local boards of health for contiguous incorporated cities may be constituted a health district by the department. Members of the board of health for this type of health district shall be appointed by the department from residents of each health unit or incorporated city represented in the health district in the numbers and for the periods of time determined by the department.


Sec. 18.10.050. Commissioner to supervise local health boards.
Each local board of health whether inside or outside incorporated cities, and each representative of the Alaska Native Service acting in the capacity of health officer is responsible to and under the supervision of the commissioner.


Secs. 18.10.060 18.10.250. Consolidated Health Districts. [Repealed, 39 ch 69 SLA 1970.]
Sec. 18.10.260. Definitions.
In this chapter,
     (1) "commissioner" means the commissioner of health and social services;

     (2) "department" means the Department of Health and Social Services.




Chapter 12. Living Wills and Do Not Resuscitate Orders.
Secs. 18.12.010 18.12.100. Living Wills and Do Not Resuscitate Orders. [Repealed, 15 ch 83 SLA 2004. For current provisions see AS 13.52.]
Chapter 13. Genetic Privacy.
Sec. 18.13.010. Genetic testing.
 (a) Except as provided in (b) of this section,
     (1) a person may not collect a DNA sample from a person, perform a DNA analysis on a sample, retain a DNA sample or the results of a DNA analysis, or disclose the results of a DNA analysis unless the person has first obtained the informed and written consent of the person, or the person's legal guardian or authorized representative, for the collection, analysis, retention, or disclosure;

     (2) a DNA sample and the results of a DNA analysis performed on the sample are the exclusive property of the person sampled or analyzed.

 (b) The prohibitions of (a) of this section do not apply to DNA samples collected and analyses conducted
     (1) under AS 44.41.035 or comparable provisions of another jurisdiction;

     (2) for a law enforcement purpose, including the identification of perpetrators and the investigation of crimes and the identification of missing or unidentified persons or deceased individuals;

     (3) for determining paternity;

     (4) to screen newborns as required by state or federal law;

     (5) for the purpose of emergency medical treatment.

 (c) A general authorization for the release of medical records or medical information may not be construed as the informed and written consent required by this section. The Department of Health and Social Services may by regulation adopt a uniform informed and written consent form to assist persons in meeting the requirements of this section. A person using that uniform informed and written consent is exempt from civil or criminal liability for actions taken under the consent form. A person may revoke or amend their informed and written consent at any time.




Sec. 18.13.020. Private right of action.
A person may bring a civil action against a person who collects a DNA sample from the person, performs a DNA analysis on a sample, retains a DNA sample or the results of a DNA analysis, or discloses the results of a DNA analysis in violation of this chapter. In addition to the actual damages suffered by the person, a person violating this chapter shall be liable to the person for damages in the amount of $5,000 or, if the violation resulted in profit or monetary gain to the violator, $100,000.


Sec. 18.13.030. Criminal penalty.
 (a) A person commits the crime of unlawful DNA collection, analysis, retention, or disclosure if the person knowingly collects a DNA sample from a person, performs a DNA analysis on a sample, retains a DNA sample or the results of a DNA analysis, or discloses the results of a DNA analysis in violation of this chapter.

 (b) In this section, "knowingly" has the meaning given in AS 11.81.900.

 (c) Unlawful DNA collection, analysis, retention, or disclosure is a class A misdemeanor.




Sec. 18.13.100. Definitions.
In this chapter,
     (1) "DNA" means deoxyribonucleic acid, including mitochondrial DNA, complementary DNA, and DNA derived from ribonucleic acid;

     (2) "DNA analysis" means DNA or genetic typing and testing to determine the presence or absence of genetic characteristics in an individual, including tests of nucleic acids or chromosomes in order to diagnose or identify a genetic characteristic; "DNA analysis" does not include a routine physical measurement, a test for drugs, alcohol, cholesterol, or the human immunodeficiency virus, a chemical, blood, or urine analysis, or any other diagnostic test that is widely accepted and in use in clinical practice;

     (3) "genetic characteristic" includes a gene, chromosome, or alteration of a gene or chromosome that may be tested to determine the existence or risk of a disease, disorder, trait, propensity, or syndrome, or to identify an individual or a blood relative; "genetic characteristic" does not include family history or a genetically transmitted characteristic whose existence or identity is determined other than through a genetic test.




Article 1. Prenatal Blood Tests.
Chapter 15. Disease Control and Threats to Public Health.
Secs. 18.15.010 18.15.050. Infectious and contagious diseases. [Repealed, 2 ch 63 SLA 1972.]
Secs. 18.15.060 18.15.110. Physical examination of nonresident employees. [Repealed, 1 ch 130 SLA 1976.]
Secs. 18.15.120 18.15.137. Tuberculosis. [Repealed, 12 ch 54 SLA 2005.]
Sec. 18.15.138. Penalty. [Repealed, 13 ch 73 SLA 1995.]
Secs. 18.15.139 18.15.149. Court authorization of detention; title to and inventory of equipment allotted to private institutions; religious treatment for tuberculosis; screening of school employees; limited immunity; definitions. [Repealed, 12 ch 54 SLA 2005.]
Sec. 18.15.150. Taking of blood sample.
Each licensed physician and in the absence of a licensed physician each licensed graduate nurse who attends a pregnant woman for conditions relating to the pregnancy during the period of gestation or at delivery shall take, or have taken, a sample of the blood of the woman at the time of the woman's first professional visit or within 10 days after the visit, unless the serological test is contrary to the tenets or practice of the religious creed of which the woman is an adherent. The blood specimen shall be submitted to an approved laboratory or clinic for a standard serological test of syphilis. Any other person permitted by law to attend pregnant women but not permitted by law to take blood samples shall have a sample of blood taken by a licensed physician, or on order of a licensed physician, and shall submit the sample to an approved laboratory or clinic for a standard serological test for syphilis.


Sec. 18.15.160. Test for syphilis.
For the purposes of AS 18.15.150 18.15.180 a standard serological test is a test for syphilis approved by the department and shall be performed in a laboratory or clinic approved by the department. On request the laboratory test required by AS 18.15.150 18.15.180 shall be performed without charge at the laboratories of the department.


Sec. 18.15.170. Report of birth.
In reporting a birth and stillbirth, the physician and other person required to make the report shall state on the certificate whether a serological test for syphilis has been made upon a specimen of blood taken from the woman who bore the child and the approximate date when the specimen was taken. A birth certificate may not state the result of the test.


Sec. 18.15.180. Penalty.
A licensed physician or licensed nurse attending a pregnant woman during the period of gestation or at delivery, or a representative of a laboratory or clinic who violates AS 18.15.150 18.15.180 is guilty of a misdemeanor and, upon conviction, is punishable by a fine of not more than $500. However, a person attending a pregnant woman during the period of gestation or at delivery, who requests the specimen in accordance with AS 18.15.150, and whose request is refused, is not guilty of a misdemeanor.


Sec. 18.15.190. [Renumbered as AS 18.15.900.]
Article 2. Phenylketonuria (PKU) and Other Heritable Diseases.
Sec. 18.15.200. Screening for phenylketonuria.
 (a) A physician who attends a newborn child shall cause this child to be tested for phenylketonuria (PKU). If the mother is delivered in the absence of a physician, the nurse who first visits the child shall cause this test to be performed.

 (b) The department shall adopt regulations regarding the method used and the time or times of testing as accepted medical practice indicates.

 (c) The necessary laboratory tests and the test materials, reporting forms, and mailing cartons shall be provided by the department.

 (d) All tests considered positive by the screening method shall be reported by the screening laboratory to the physician and to the department. The department shall provide services for the performance of a quantitative blood phenylalanine test or its equivalent for diagnostic purposes. A confirmed diagnosis of phenylketonuria shall be reported to the physician and to the department. The department shall provide services for treatment and clinical follow-up of any diagnosed case.

 (e) When presumptive positive screening tests have been reported to the department, it shall provide, on request, either the true blood phenylalanine test or subsidize the performance of this test at an approved laboratory.

 (f) A licensed physician or licensed nurse attending a newborn or infant who violates this section is guilty of a misdemeanor and, upon conviction, is punishable by a fine of not more than $500. However, a person attending a newborn or infant whose request for appropriate specimens from the newborn or infant is denied by the parent or guardian is not guilty of a misdemeanor. The fact that a child has not been subjected to the test because a request for appropriate specimens has been denied by the parents or guardian shall be reported to the department.

 (g) In this section, "physician" means a doctor of medicine licensed to practice medicine in this state, or an officer in the regular medical service of the armed forces of the United States or the United States Public Health Service assigned to duty in this state.




Sec. 18.15.205. Screening for congenital heart disease.
 (a) A provider of birthing services who attends a birth in the state shall ensure that, as close to 24 hours after the birth as feasible, screening for congenital heart defects through pulse oximetry equipment and methods appropriate for use on a newborn is performed on the newborn, unless screening is refused under (d) of this section.

 (b) A provider of birthing services who attends a birth in the state shall, as soon as possible after screening conducted under (a) of this section, make a referral for confirmatory testing on a newborn whose pulse oximetry results are abnormal and provide advice to the parent or legal guardian regarding the need for appropriate interventions.

 (c) The provider who performs pulse oximetry screening under (a) of this section shall report to the parents and attending physicians of the newborn and to the department the results of screening.

 (d) Before performing screening for congenital heart disease under (a) of this section, a provider of birthing services shall provide to a parent or legal guardian of a newborn information on the screening and the option to refuse the screening.

 (e) The department shall establish procedures for submitting reports of newborn screening results to the department and for summarizing reported data.

 (f) In this section, "provider of birthing services" means a physician, midwife, nurse, or other qualified professional who attends the delivery of a newborn in the course of the provider's practice.




Sec. 18.15.210. Testing for certain other heritable diseases.
The department shall administer and provide services for testing for other heritable diseases that lead to intellectual disabilities, developmental disabilities, or both, and physical disabilities as screening programs accepted by current medical practice and as developed.


Article 3. Hepatitis B.
Sec. 18.15.250. Hepatitis B testing and vaccination program for volunteer emergency personnel.
 (a) The department shall establish a program under which hepatitis B testing and vaccination is reasonably accessible at no charge to all volunteer emergency medical and rescue personnel in the state who provide an emergency medical or rescue service primarily within an unincorporated community or within a municipality that does not provide funding for the service.

 (b) A municipality that has the power to do so shall establish a program under which hepatitis B testing and vaccination is reasonably accessible at no charge to all law enforcement officers and all volunteer or employed emergency medical and rescue personnel who provide service to the public within the municipality. The department shall, upon request, assist a municipality in establishing a program required under this subsection.

 (c) The Department of Public Safety shall establish a program under which hepatitis B testing and vaccination is reasonably accessible at no charge to all officers of the state troopers. The Department of Health and Social Services shall, upon request, assist the Department of Public Safety in establishing a program required under this subsection.

 (d) In this section,
     (1) "emergency medical and rescue personnel" means a trauma technician, emergency medical technician, rescuer, or mobile intensive care paramedic;

     (2) "employed" means that the person is a paid employee of a first responder service, a rescue service, an ambulance service, or a fire department that provides emergency medical or rescue services as part of its duties;

     (3) "law enforcement officer" means a member of the police force of a municipality;

     (4) "volunteer" means that the person is an active volunteer of a first responder service, a rescue service, an ambulance service, or a fire department that provides emergency medical or rescue services as part of its duties.




Article 4. Chlamydia and Gonorrhea.
Sec. 18.15.270. Testing procedures.
 (a) The department shall make available on a statewide basis the best current testing method available to detect gonorrhea and chlamydia.

 (b) The department shall use the best current testing method available for diagnosis of gonorrhea and chlamydia.




Article 5. Blood Tests of Persons Charged with Sex Offenses.
Sec. 18.15.300. Order for blood test; disclosure of results.
 (a) A defendant charged in a criminal complaint, indictment, presentment, or information filed with a magistrate or court with a violation of AS 11.41.410 11.41.450 that includes sexual penetration as an element of the offense, or a minor with respect to whom a petition has been filed in a juvenile court alleging a violation of AS 11.41.410 11.41.450 that includes sexual penetration as an element of the offense, may be ordered by a court having jurisdiction of the complaint, indictment, information, presentment, or juvenile petition to submit to testing as provided in AS 18.15.300 18.15.320.

 (b) An alleged victim listed in the complaint, indictment, information, presentment, or juvenile petition, the parent or guardian of an alleged victim who is a minor or incompetent, or the prosecuting attorney on the behalf of an alleged victim, may petition the court for an order authorized under this section.

 (c) Upon receipt of a petition filed under (b) of this section, the court shall determine if (1) probable cause exists to believe that a crime for which a test may be ordered under (a) of this section has been committed, and (2) probable cause exists to believe that sexual penetration took place between the defendant or minor and the alleged victim in an act for which the defendant or minor is charged under (a) of this section. In making the determination, the court may rely exclusively on the evidence presented at a grand jury proceeding or preliminary hearing.

 (d) If the court finds probable cause exists to believe that (1) a crime for which a test may be ordered under (a) of this section has been committed, and (2) sexual penetration described in (c)(2) of this section took place, the court shall order that the defendant or minor provide two specimens of blood for testing as provided in AS 18.15.300 18.15.320.

 (e) Copies of the blood test results shall be provided to the defendant or minor, each requesting victim, the victim's designee or, if the victim is a minor or incompetent, the victim's parents or legal guardian. If the defendant or minor is being incarcerated or detained at the time of the blood test or thereafter, the blood test results shall be provided to the officer in charge and the chief medical officer of the facility in which the defendant or minor is incarcerated or detained, including an incarceration or detention ordered as a result of conviction or judgment of delinquency or child in need of aid for an act for which the defendant or minor is charged under (a) of this section.

 (f) A court may not order a test under this section
     (1) before seven days after the defendant or minor's arrest;

     (2) after the entry of a disposition favorable to a defendant; or

     (3) if the defendant is convicted or adjudicated delinquent or in need of aid, after 90 days after the issuance of the judgment and sentence or of the judgment in a juvenile action.

 (g) In this section,
     (1) "disposition favorable to the defendant" means an adjudication by a court other than a conviction, or if the defendant is a minor not being prosecuted as an adult, that the minor is not adjudicated delinquent or a child in need of aid, for an offense for which a blood test could be ordered under this section;

     (2) "sexual penetration" has the meaning given in AS 11.81.900(b).




Sec. 18.15.310. Testing; test results.
 (a) The withdrawal of blood for a test under AS 18.15.300 - 18.15.320 shall be performed in a medically approved manner. Only a physician or physician assistant licensed under AS 08.64, registered or advanced practice registered nurse, licensed practical nurse, or certified emergency medical technician may withdraw blood specimens for the purposes of AS 18.15.300 - 18.15.320.

 (b) The court shall order that the blood specimens withdrawn under AS 18.15.300 18.15.320 be transmitted to a licensed medical laboratory and that tests be conducted on them for medically accepted indications of exposure to or infection by the human immunodeficiency virus (HIV) and other sexually transmitted diseases for which medically approved testing is readily and economically available as determined by the court.

 (c) Copies of test results that indicate exposure to or infection by HIV or other sexually transmitted diseases shall also be transmitted to the department.

 (d) The test results shall be provided to the designated recipients with the following disclaimer:

"The tests were conducted in a medically approved manner but tests cannot determine exposure to or infection by HIV or other sexually transmitted diseases with absolute accuracy. Persons receiving this test result should continue to monitor their own health and should consult a physician as appropriate."

 (e) The court shall order all persons, other than the test subject, who receive test results under AS 18.15.300 18.15.320 to maintain the confidentiality of personal identifying data relating to the test results except for disclosures by the victim, or if the victim is a minor or incompetent by the victim's parents or legal guardian, as
     (1) is necessary to obtain medical or psychological care or advice or to ensure the health of the victim's spouse, immediate family, persons occupying the same household as the victim, or a person in a dating, courtship, or engagement relationship with the victim;

     (2) is necessary to pursue civil remedies against the test subject; or

     (3) otherwise permitted by the court.

 (f) The specimens and the results of tests ordered under AS 18.15.300 18.15.320 are not admissible evidence in a criminal or juvenile proceeding.

 (g) A person performing testing, transmitting test results, or disclosing information under AS 18.15.300 18.15.320 is immune from civil liability for an act or omission under authority of AS 18.15.300 18.15.320. However, this subsection does not preclude liability for a grossly negligent or intentional violation of a provision of AS 18.15.300 18.15.320.

 (h) If the results of a blood test conducted under AS 18.15.300 indicate exposure to or infection by HIV or other sexually transmitted diseases for which testing was conducted, the department shall provide (1) free counseling and free testing to a victim for HIV and other sexually transmitted diseases reasonably communicable through the offense; and (2) counseling to the alleged perpetrator or defendant upon request of the alleged perpetrator or defendant. The department shall provide referral to appropriate health care facilities and support services at the request of the victim.

 (i) In this section,
     (1) "AIDS" means acquired immunodeficiency syndrome or HIV symptomatic disease;

     (2) "counseling" means providing a person with information and explanations relating to AIDS and HIV that are medically appropriate for that person, including all or part of the following:
          (A) accurate information regarding AIDS and HIV;

          (B) an explanation of behaviors that reduce the risk of transmitting AIDS and HIV;

          (C) an explanation of the confidentiality of information relating to AIDS diagnoses and HIV tests;

          (D) an explanation of information regarding both social and medical implications of HIV tests;

          (E) disclosure of commonly recognized treatment or treatments of AIDS and HIV;

     (3) "HIV" means the human immunodeficiency virus.




Sec. 18.15.320. Cost of performing test; reimbursement.
 (a) The cost of performing a blood test under AS 18.15.300 shall be paid by the department.

 (b) If a defendant for whom a blood test has been ordered under AS 18.15.300 is convicted of an offense for which the defendant was charged, and for which a blood test could be ordered under AS 18.15.300, the court shall order the defendant to reimburse the department for the cost of the test and may order the Department of Corrections to deduct the amount of the test from any pay the inmate receives under AS 33.30.201.




Article 6. Public Health Authority and Powers.
Sec. 18.15.350. SARS control program authorization. [Repealed, 12 ch 54 SLA 2005.]
Sec. 18.15.355. Prevention and control of conditions of public health importance.
 (a) The department may use the powers and provisions set out in AS 18.15.355 18.15.395 to prevent, control, or ameliorate conditions of public health importance or accomplish other essential public health services and functions.

 (b) In performing its duties under AS 18.15.355 18.15.395, the department may
     (1) establish standards
          (A) for the prevention, control, or amelioration of conditions of public health importance;

          (B) to accomplish other essential public health services and functions; and

     (2) adopt regulations to implement and interpret AS 18.15.355 18.15.395.




Sec. 18.15.360. Data collection.
 (a) The department is authorized to collect, analyze, and maintain databases of information related to
     (1) risk factors identified for conditions of public health importance;

     (2) morbidity and mortality rates for conditions of public health importance;

     (3) community indicators relevant to conditions of public health importance;

     (4) longitudinal data on traumatic or acquired brain injury from the registry established under AS 47.80.500(c)(1);

     (5) health care services and price information collected under AS 18.23.400; and

     (6) any other data needed to accomplish or further the mission or goals of public health or provide essential public health services and functions.

 (b) The department is authorized to obtain information from federal, state, and local governmental agencies, Alaska Native organizations, health care providers, pre-hospital emergency medical services, or other private and public organizations operating in the state. The department may also use information available from other governmental and private sources, reports of hospital discharge data, information included in death certificates, other vital statistics, environmental data, and public information. The department may request information from and inspect health care records maintained by health care providers that identify individuals or characteristics of individuals with reportable diseases or other conditions of public health importance.

 (c) The department may collect information to establish and maintain a comprehensive vaccination registry to aid, coordinate, and promote effective and cost-efficient disease prevention and control efforts in the state.

 (d) The department may not acquire identifiable health information under this section without complying with the provisions of AS 18.15.355 18.15.395 and regulations adopted under those statutes.




Sec. 18.15.362. Acquisition and use of identifiable health information; public health purpose.
The department may acquire and use identifiable health information collected under AS 18.15.355 18.15.395 only if the
     (1) acquisition and use of the information relates directly to a public health purpose;

     (2) acquisition and use of the information is reasonably likely to contribute to the achievement of a public health purpose; and

     (3) public health purpose cannot otherwise be achieved at least as well with nonidentifiable health information.




Sec. 18.15.365. Information security safeguards.
 (a) The department shall acquire, use, disclose, and store identifiable health information collected under AS 18.15.355 18.15.395 in a confidential manner that safeguards the security of the information, and maintain the information in a physically and technologically secure environment.

 (b) The department shall expunge, in a confidential manner, identifiable health information collected under AS 18.15.355 18.15.395 when the use of the information by the department no longer furthers the public health purpose for which it is required.

 (c) A person who knowingly discloses identifiable health information in violation of this section or a regulation adopted under this section is guilty of a class B misdemeanor. In this subsection, "knowingly" has the meaning given in AS 11.81.900(a).

 (d) A person who intentionally discloses identifiable health information in violation of this section or a regulation adopted under this section is guilty of a class A misdemeanor. In this subsection, "intentionally" has the meaning given in AS 11.81.900(a).




Sec. 18.15.370. Reportable disease list.
The department shall maintain a list of reportable diseases or other conditions of public health importance that must be reported to the department. The list may include birth defects, cancers, injuries, and diseases or other conditions caused by exposure to microorganisms; pathogens; or environmental, toxic, or other hazardous substances. The department shall regularly maintain and may revise the list. The department may also establish registries for diseases and conditions that must be reported to the department.


Sec. 18.15.375. Epidemiological investigation.
 (a) The department may investigate conditions of public health importance in the state through methods of epidemiological investigation. The department may also ascertain the existence of cases of illness or other conditions of public health importance, investigate potential sources of exposure or infection and ensure that they are subject to proper control measures, and determine the extent of the disease outbreak, epidemic, risk to health and safety, or disaster.

 (b) Investigations under this section may include identification of individuals who have been or may have been exposed to or affected by a condition of public health importance, interviewing and testing those individuals, examining facilities or materials that may pose a threat to the public health, and interviewing other individuals. In conducting the investigations the department may
     (1) identify all individuals thought to have been exposed to any agent that may be a potential cause of the disease outbreak, epidemic, or disaster;

     (2) interview, test, examine, or screen an individual where needed to assist in the positive identification of those exposed or affected or to develop information relating to the source or spread of the disease or other condition of public health importance; and

     (3) inspect health care records maintained by a health care provider.

 (c) When testing, screening, or examining an individual under this section, the department shall adhere to the following requirements:
     (1) the department may not require the testing, examination, or screening of an individual without the consent of the individual or the individual's legal guardian, except as otherwise provided in this section or other law;

     (2) the department may require testing, examination, or screening of a nonconsenting individual only upon an order of a state medical officer, and only upon a finding that the individual has or may have been exposed to a contagious disease that poses a significant risk to the public health; the order must be personally served on the person to be tested, examined, or screened within a reasonable period of time before the testing, examination, or screening is to take place;

     (3) the department shall obtain an ex parte order in accordance with (d) of this section if the individual to be tested, examined, or screened objects to the state medical officer's order;

     (4) a health care practitioner shall perform an examination under this section; the individual to be examined may, under conditions specified by the state medical officer, choose the health care practitioner who will perform the examination;

     (5) a testing, examination, or screening program shall be conducted for the sole purpose of identifying a condition of public health importance that poses a threat to the public health and may be avoided, cured, alleviated, or made less contagious through safe and effective treatment, modifications in individual behavior, or public health intervention;

     (6) before testing, examination, or screening, the department shall explain to the individual or individual's legal representative the nature, scope, purposes, benefits, risks, and possible results of the testing, examination, or screening;

     (7) in conjunction with or directly after the dissemination of the results of the testing, examination, or screening, the department shall fully inform the individual or individual's legal representative of the results of the testing, examination, or screening.

 (d) A judicial officer may issue an ex parte order for testing, examination, or screening upon a showing of probable cause, supported by oath or affirmation, that the individual has or may have been exposed to a contagious disease that poses a significant risk to the public health. The court shall specify the duration of the ex parte order for a period not to exceed five days. To conduct the testing, examination, or screening of an individual who is not being detained under an order of isolation or quarantine, the court may order a peace officer to take the individual into protective custody until a hearing is held on the ex parte petition if a hearing is requested.

 (e) The individual subject to the ex parte order must be given, with the petition and order, a form to request a hearing to vacate the ex parte order. If a hearing is requested to vacate the ex parte order, the court shall hold the hearing within three working days after the date the request is filed with the court. The public shall be excluded from a hearing under this subsection unless the individual subject to the ex parte order elects to have the hearing open.




Sec. 18.15.380. Medical treatment.
 (a) A health care practitioner or public health agent who examines or treats an individual who has or may have been exposed to a contagious disease shall instruct the individual about the measures for preventing transmission of the disease and the need for treatment.

 (b) The department may administer medication or other medical treatment, including the use of directly observed therapy where appropriate, to a consenting individual who has or may have been exposed to a contagious disease.

 (c) An individual has the right to refuse treatment and may not be required to submit to involuntary treatment as long as the individual is willing to take steps outlined by the state medical officer to prevent the spread of a communicable disease to others. However, an individual who exercises the right to refuse treatment under this subsection may be responsible for paying all costs incurred by the state in seeking and implementing a quarantine or isolation order made necessary by a refusal of treatment by the individual. The department shall notify an individual who refuses treatment under this subsection that the refusal may result in an indefinite period of quarantine or isolation and that the individual may be responsible for payment of the costs of the quarantine or isolation.




Sec. 18.15.385. Isolation and quarantine.
 (a) The department may isolate or quarantine an individual or group of individuals if isolation or quarantine is the least restrictive alternative necessary to prevent the spread of a contagious or possibly contagious disease to others in accordance with regulations adopted by the department consistent with the provisions of this section and other law.

 (b) The department shall adhere to the following conditions and standards when isolating or quarantining an individual or group of individuals:
     (1) isolation and quarantine shall be by the least restrictive means necessary to prevent the spread of a contagious or possibly contagious disease that poses a significant risk to public health; isolation and quarantine may include confinement to private homes or other private and public premises; absent exceptional circumstances that would jeopardize public health, a person shall be allowed to choose confinement in the person's home;

     (2) isolated individuals shall be confined separately from quarantined individuals;

     (3) the health status of an isolated or quarantined individual shall be monitored regularly to determine whether the individual continues to require isolation or quarantine;

     (4) if a quarantined individual subsequently becomes infected or is reasonably believed to have become infected with a contagious or possibly contagious disease, the individual shall promptly be removed to isolation;

     (5) the department shall immediately terminate an isolation and quarantine order when an individual poses no substantial risk of transmitting a contagious or possibly contagious disease to others.

 (c) The department may authorize a health care practitioner, public health agent, or another person access to an individual in isolation or quarantine as necessary to meet the needs of the isolated or quarantined individual. An individual who enters isolation or quarantine premises with or without authorization of the department may be isolated or quarantined if needed to protect the public health.

 (d) Before quarantining or isolating an individual, the department shall obtain a written order from the superior court authorizing the isolation or quarantine, unless the individual consents to the quarantine or isolation. The department shall file a petition for a written order under this subsection. The petition must
     (1) allege
          (A) the identity of each individual proposed to be quarantined or isolated;

          (B) the premises subject to isolation or quarantine;

          (C) the date and time the isolation or quarantine is to begin;

          (D) the suspected contagious disease;

          (E) that the individual poses a significant risk to public health;

          (F) whether testing, screening, examination, treatment, or related procedures are necessary;

          (G) that the individual is unable or unwilling to behave so as not to expose other individuals to danger of infection; and

          (H) that the department is complying or will comply with (b) of this section; and

     (2) be accompanied by an affidavit signed by a state medical officer attesting to the facts asserted in the petition, including specific facts supporting the allegations required by (1)(D) and (G) of this subsection; the petition shall be personally served according to court rules, along with notice of the time and place of the hearing under (f) of this section.

 (e) Notwithstanding (d) of this section, when the department has probable cause to believe that the delay involved in seeking a court order imposing isolation or quarantine would pose a clear and immediate threat to the public health and isolation or quarantine is the least restrictive alternative and is necessary to prevent the spread of a contagious or possibly contagious disease, a state medical officer in the department may issue an emergency administrative order to temporarily isolate or quarantine an individual or group of individuals. An emergency administrative order of temporary quarantine or isolation by a state medical officer is enforceable by any peace officer in the state. Within 24 hours after implementation of the emergency administrative order, the department shall notify the superior court by filing a petition under (d) of this section that also alleges that the emergency action was necessary to prevent or limit the transmission of a contagious or possibly contagious disease to others that would pose an immediate threat to the public health. The petition must be signed by a state medical officer.

 (f) An individual served with a petition under (d) of this section or an emergency administrative order to temporarily isolate or quarantine under (e) of this section has the right to a court hearing. The court shall hold a hearing within 48 hours after a petition is filed. The department may request a continuance of the hearing for up to five days. The court may grant the continuance for good cause shown and in extraordinary circumstances, giving due regard to the rights of the affected individuals, the protection of the public health, the severity of the need for isolation or quarantine, and other evidence. During a continuance, an isolated or quarantined individual shall remain in isolation or quarantine. The court may order the consolidation of individual claims into group claims if the number of individuals affected is so large as to render individual participation impractical, there are questions of law or fact common to the individual claims or rights to be determined, the group claims or rights are typical of the affected individuals' claims or rights, and the entire group can be adequately represented. The public shall be excluded from a hearing under this section unless the individual elects to have the hearing open under (g)(2) of this section.

 (g) During the hearing, the individual has the right to
     (1) view and copy all petitions and reports in the court file of the individual's case;

     (2) elect to have the hearing open to the public;

     (3) have the rules of evidence and civil procedure applied so as to provide for the informal but efficient presentation of evidence;

     (4) have an interpreter if the individual does not understand English;

     (5) present evidence on the individual's behalf;

     (6) cross-examine witnesses who testify against the individual;

     (7) call experts and other witnesses to testify on the individual's behalf; and

     (8) participate in the hearing; under this paragraph, participation may be by telephone if the individual presents a substantial risk of transmitting a contagious or possibly contagious disease to others.

 (h) At the conclusion of the hearing, the court may commit the individual to isolation or quarantine for not more than 30 days if the court finds, by clear and convincing evidence, that the isolation or quarantine is necessary to prevent or limit the transmission to others of a disease that poses a significant risk to the public health. The court may issue other orders as necessary. Orders are enforceable by a peace officer of this state. The order must
     (1) identify the isolated or quarantined individual or group of individuals by name or shared or similar characteristics or circumstances;

     (2) specify factual findings warranting isolation or quarantine under this section;

     (3) include any conditions necessary to ensure that isolation or quarantine is carried out within the stated purposes and restrictions of this section; and

     (4) be served on the affected individual or group of individuals in accordance with existing court rules.

 (i) Before the expiration of an order issued under (h) of this section, the court may continue isolation or quarantine for additional periods not to exceed 30 days upon a showing by the department by clear and convincing evidence that the action is necessary to prevent or limit the transmission to others of a disease that poses a significant risk to the public health.

 (j) An isolated or quarantined individual or group of individuals may apply to the court for an order to show cause why isolation or quarantine should not be terminated. The court shall rule on the application to show cause within 48 hours after filing. An isolated or quarantined individual or group of individuals may request a hearing in the court for remedies regarding breaches of the conditions of isolation or quarantine. A request for a hearing may not stay or enjoin an isolation or quarantine order. Where extraordinary circumstances justify the immediate granting of relief, the court shall fix a date for hearing on the alleged matters within 24 hours after receipt of the request. Otherwise, the court shall fix a date for hearing on the alleged matters within five days after receipt of a request.

 (k) The provisions of this section apply to minors. All notices required to be served on an individual shall also be served on the parents or guardians of an individual who is an unemancipated minor.

 (l) The department shall adopt regulations to protect, as much as possible, the privacy rights of individuals subject to isolation or quarantine under this section.

 (m) The department may quarantine or isolate individuals who have been exposed to hazardous materials that can cause serious illness or injury by transmission of the hazardous material to others. The provisions of this section concerning isolation and quarantine of individuals to prevent the spread of contagious or possibly contagious diseases shall apply to isolation or quarantine of individuals who have been exposed to hazardous materials.

 (n) A person who knowingly violates this section or a regulation adopted under this section is guilty of a class B misdemeanor. In this subsection, "knowingly" has the meaning given in AS 11.81.900(a).

 (o) A person who intentionally violates this section or a regulation adopted under this section is guilty of a class A misdemeanor. In this subsection, "intentionally" has the meaning given in AS 11.81.900(a).




Sec. 18.15.390. Powers of the department in a public health disaster.
If the governor declares a condition of disaster emergency under AS 26.23.020(c) due to an outbreak of disease or a credible threat of an imminent outbreak of disease, the department, in coordination with the Department of Military and Veterans' Affairs, may
     (1) close, direct, and compel the evacuation of, or decontaminate or cause to be decontaminated, any facility if there is reasonable cause to believe that the facility may endanger the public health;

     (2) decontaminate or cause to be decontaminated or destroy any material if there is reasonable cause to believe that the material may endanger the public health;

     (3) inspect, control, restrict, and regulate, by rationing and using quotas, prohibitions on shipments, allocation, or other means, the use, sale, dispensing, distribution, or transportation of food, fuel, clothing, medicines, and other commodities, as may be reasonable and necessary to respond to the disaster;

     (4) adopt and enforce measures to provide for the safe disposal of infectious waste or contaminated material as may be reasonable and necessary to respond to the disaster; these measures may include the collection, storage, handling, destruction, treatment, transportation, or disposal of infectious waste or contaminated material;

     (5) require all bags, boxes, or other containers of infectious waste or contaminated material to be clearly identified as containing infectious waste or contaminated material and, if known, the type of infectious waste or contaminated material;

     (6) adopt and enforce measures to provide for the safe disposal of human remains as may be reasonable and necessary to respond to the disaster; these measures may include the embalming, burial, cremation, interment, disinterment, transportation, or disposal of human remains;

     (7) take possession or control of any human remains, require clear labeling of human remains before disposal with all available information to identify the decedent and the circumstances of death, and require that the human remains of a deceased individual with a contagious disease or transmissible agent have an external, clearly visible tag indicating that the human remains are infected and, if known, the contagious disease or transmissible agent;

     (8) require persons in charge of disposing of any human remains to maintain and promptly deliver to the department a written or electronic record of each set of human remains, the disposal of the remains, and all available information to identify the decedent, including fingerprints, photographs, dental information, and a deoxyribonucleic acid (DNA) specimen of the human remains;

     (9) order the disposal of the human remains of an individual who has died of a contagious disease or transmissible agent through burial or cremation within 24 hours after death, taking into account the religious, cultural, family, and individual beliefs of the deceased individual and the individual's family;

     (10) require any business or facility holding a funeral establishment permit issued under AS 08.42.100 to accept human remains, to provide the use of the business or facility as is reasonable and necessary to respond to the disaster, and, if necessary, to transfer the management and supervision of the business or facility to the state during the course of the disaster;

     (11) procure, by condemnation or otherwise, a business or facility authorized to embalm, bury, cremate, inter, disinter, transport, and dispose of human remains under the laws of this state as may be reasonable and necessary to respond to the disaster, with the right to take immediate possession of the facilities;

     (12) appoint and prescribe the duties of emergency assistant medical examiners as may be required for the proper performance of the duties of the office; the appointment of emergency assistant medical examiners may not exceed the termination of the declaration of a state of disaster; the department may terminate an emergency appointment made under this paragraph for any reason.




Sec. 18.15.392. Representation; guardian ad litem.
An individual who is the respondent in proceedings under AS 18.15.375(e) or 18.15.385 has the right to be represented by counsel in the proceedings. If the individual cannot afford an attorney, the court shall direct the Public Defender Agency to provide an attorney. The court may, on its own motion or upon request of the individual's attorney or a party, direct the office of public advocacy to provide a guardian ad litem for the individual.


Sec. 18.15.393. Report to legislature.
The department shall annually report to the legislature the activities conducted by the department under AS 18.15.355 18.15.395, including information pertaining to the number of individuals quarantined, the purpose for the quarantine, and the length of the quarantine.


Sec. 18.15.395. Definitions.
In AS 18.15.355 18.15.395, unless the context otherwise requires,
     (1) "Alaska Native organization" means an organization recognized by the United States Indian Health Service to provide health-related services;

     (2) "condition of public health importance" means a disease, syndrome, symptom, injury, or other threat to health that is identifiable on an individual or community level and can reasonably be expected to lead to adverse health effects in the community;

     (3) "contagious disease" means an infectious disease that can be transmitted from individual to individual;

     (4) "contaminated material" means wastes or other materials exposed to or tainted by chemical, radiological, or biological substances or agents;

     (5) "court" means a court of competent jurisdiction under state law;

     (6) "decontaminate" means to remove or neutralize chemical, radiological, or biological substances or residues from individuals, buildings, objects, or areas;

     (7) "directly observed therapy" means a technique used to ensure that an infectious individual complies with the individual's treatment regimen, whereby a health worker observes the individual to ensure the ingestion of the individual's medication for each dose the individual is required to take over the course of the individual's treatment;

     (8) "disease outbreak" means the sudden and rapid increase in the number of cases of a disease or other condition of public health importance in a population;

     (9) "epidemic" means the occurrence in a community or region of a group of similar conditions of public health importance that are in excess of normal expectancy and derived from a common or propagated source;

     (10) "essential public health services and functions" mean services and functions to
          (A) monitor health status to identify and solve community health problems;

          (B) investigate and diagnose health problems and health hazards in the community;

          (C) inform and educate individuals about and empower them to deal with health issues;

          (D) mobilize public and private sector collaboration and action to identify and solve health problems;

          (E) develop policies, plans, and programs that support individual and community health efforts;

          (F) enforce statutes and regulations of this state that protect health and ensure safety;

          (G) link individuals to needed health services and facilitate the provision of health care when otherwise unavailable;

          (H) ensure a competent public health workforce;

          (I) evaluate effectiveness, accessibility, and quality of personal and population-based health services; or

          (J) research for new insights and innovative solutions to health problems;

     (11) "health care practitioner" means a physician, advanced practice registered nurse, or physician assistant licensed or otherwise authorized to practice their respective professions in this state;

     (12) "health care provider" means any person that provides health care services; "health care provider" includes a hospital, medical clinic or office, special care facility, medical laboratory, physician, pharmacist, dentist, physician assistant, nurse, paramedic, emergency medical or laboratory technician, community health worker, and ambulance and emergency medical worker;

     (13) "identifiable health information" means any information, whether oral, written, electronic, visual, pictorial, physical, or any other form, that relates to an individual's past, present, or future physical or mental health status, condition, treatment, service, products purchased, or provisions of care and
          (A) that reveals the identity of the individual whose health care is the subject of the information; or

          (B) regarding which there is a reasonable basis to believe that the information could be used, either alone or with other information that is, or should reasonably be known to be, available to predictable recipients of the information, to reveal the identity of that individual;

     (14) "infectious disease" means a disease caused by a living organism or other pathogen, including a fungus, bacteria, parasite, protozoan, or virus; an infectious disease may be transmissible from individual to individual, animal to individual, or insect to individual;

     (15) "infectious waste" means
          (A) biological waste, including blood and blood products, excretions, exudates, secretions, suctioning and other body fluids, and waste materials saturated with blood or body fluids;

          (B) cultures and stocks, including
               (i) etiologic agents and associated biologicals;

               (ii) specimen cultures and dishes and devices used to transfer, inoculate, and mix cultures;

               (iii) wastes from production of biologicals and serums; and

               (iv) discarded, killed, or attenuated vaccines;

          (C) except for teeth or formaldehyde or other preservative agents, pathological waste, including
               (i) biopsy materials and all human tissues;

               (ii) anatomical parts that emanate from surgery, obstetrical procedures, necropsy or autopsy, and laboratory procedures; and

               (iii) animal carcasses exposed to pathogens in research and the bedding and other waste from those animals; and

          (D) sharps, including needles, intravenous tubing with needles attached, scalpel blades, lancets, breakable glass tubes, and syringes that have been removed from their original sterile containers;

     (16) "isolation" means the physical separation and confinement of an individual who is, or group of individuals who are, infected or reasonably believed to be infected with a contagious or possibly contagious disease from nonisolated individuals, to prevent or limit the transmission of the disease to nonisolated individuals;

     (17) "least restrictive" means the policy or practice that least infringes on the rights or interests of others;

     (18) "public health agent" means an official or employee of the department who is authorized to carry out provisions of AS 18.15.355 18.15.395;

     (19) "public health purpose" means the prevention, control, or amelioration of a condition of public health importance, including an analysis or evaluation of a condition of public health importance and an evaluation of a public health program;

     (20) "public information" means information that is generally open to inspection or review by the public;

     (21) "quarantine" means the physical separation and confinement of an individual or group of individuals who are or may have been exposed to a contagious or possibly contagious disease and who do not show signs or symptoms of a contagious disease from nonquarantined individuals to prevent or limit the transmission of the disease to nonquarantined individuals;

     (22) "screening" means the systematic application of a testing or examination to a defined population;

     (23) "specimen" means blood; sputum; urine; stool; or other bodily fluids, wastes, tissues, and cultures necessary to perform required tests;

     (24) "state medical officer" means a physician licensed to practice medicine by this state and employed by the department, with responsibilities for public health matters;

     (25) "testing" means any diagnostic or investigative analysis or medical procedure that determines the presence or absence of or exposure to a condition of public health importance, or its precursor, in an individual;

     (26) "transmissible agent" means a biological substance capable of causing disease or infection through individual to individual, animal to individual, or other modes of transmission;

     (27) "vaccination" means a suspension of attenuated or noninfectious microorganisms or derivative antigens administered to stimulate antibody production or cellular immunity against a pathogen for the purpose of preventing, ameliorating, or treating an infectious disease.




Article 7. Blood Testing of Prisoners and Others for Bloodborne Pathogens.
Sec. 18.15.400. Bloodborne pathogen testing of prisoners, certain adult or juvenile offenders, and public safety officers; required disclosures and consent.
 (a) When requested by a public safety officer who may have received a significant exposure from an adult or juvenile offender or a prisoner, the employing agency shall follow the testing procedures of AS 18.15.400 18.15.450 if
     (1) a physician licensed under AS 08 determines that a significant exposure to the public safety officer has occurred;

     (2) the physician for the public safety officer needs the adult or juvenile offender's or prisoner's bloodborne pathogens test results to begin, continue, modify, or discontinue treatment in accordance with the most current guidelines of the United States Public Health Service, because of possible exposure to a bloodborne pathogen; and

     (3) the public safety officer consents to providing a blood sample for testing for a bloodborne pathogen.

 (b) Before employing the testing procedures of AS 18.15.400 18.15.450 or disclosing any information about the adult or juvenile offender or prisoner or public safety officer, the employing agency shall inform the
     (1) adult or juvenile offender or prisoner that
          (A) the adult or juvenile offender's or prisoner's bloodborne pathogens test results, without the adult or juvenile offender's or prisoner's name or other uniquely identifying information, shall be reported to the public safety officer if requested and that test results collected are for medical purposes and may not be used as evidence in any criminal proceedings or civil proceedings;

          (B) the adult or juvenile offender or prisoner may refuse to provide a blood sample and that the adult or juvenile offender's or prisoner's refusal may result in a request for a court order to require the adult or juvenile offender or prisoner to provide a blood sample; and

          (C) the employing agency will advise the public safety officer of the confidentiality requirements and penalties before the officer's health care provider discloses any test results;

     (2) public safety officer of the confidentiality requirements of AS 18.15.440 and that the public safety officer may be subject to penalties for unauthorized release of test results about the adult or juvenile offender or prisoner.

 (c) If the disclosures have been made, the employing agency shall ask the adult or juvenile offender or prisoner if the adult or juvenile offender or prisoner has ever had a positive test for a bloodborne pathogen. The employing agency shall disclose the adult or juvenile offender's or prisoner's existing bloodborne pathogens test results to the public safety officer without the adult or juvenile offender's or prisoner's name or other uniquely identifying information.




Sec. 18.15.410. Consent for testing; court order for testing; exception.
 (a) When a public safety officer has made a request under AS 18.15.400, except as provided in (b) or (c) of this section or in AS 18.15.420, before collecting and testing the blood of an adult or juvenile offender or a prisoner, the employing agency shall first obtain the consent of the adult offender or prisoner or the adult or juvenile offender's or prisoner's representative if the adult or juvenile offender or prisoner is unable to provide the consent.

 (b) Consent of an adult or juvenile offender's or a prisoner's representative is not required if the employing agency has made reasonable efforts to locate the adult or juvenile offender's or prisoner's representative and the representative cannot be found within 24 hours after a significant exposure. If testing of available blood occurs without consent because the adult or juvenile offender or prisoner is unconscious or unable to provide consent, and a representative cannot be located, the employing agency shall provide the information required in AS 18.15.400 to the adult or juvenile offender, prisoner, or representative whenever it is possible to do so.

 (c) If an adult or juvenile offender or a prisoner dies before an opportunity to consent to blood collection or testing, consent is not required, and the adult or juvenile offender's or prisoner's blood may be collected and tested.

 (d) If the adult or juvenile offender or prisoner or the adult or juvenile offender's or prisoner's representative, if appropriate, consents and a sample of the adult or juvenile offender's or prisoner's blood
     (1) is available, the employing agency shall have the blood tested for bloodborne pathogens;

     (2) is not available, the employing agency shall collect a sample and have the blood sample tested for bloodborne pathogens.

 (e) The employing agency may not withhold care or treatment on the requirement that the adult or juvenile offender or prisoner consent to testing for bloodborne pathogens.




Sec. 18.15.420. Testing without consent.
 (a) When a public safety officer has made a request under AS 18.15.400, the employing agency shall file a petition in the superior court for a court order requiring the adult or juvenile offender or prisoner to provide a blood sample for testing for bloodborne pathogens. The employing agency shall serve the petition on the adult or juvenile offender or prisoner at least 48 hours before a hearing on the petition. The petition must include the following information supported by affidavit:
     (1) a statement that the employing agency followed the procedures in AS 18.15.400 18.15.450 and attempted to obtain bloodborne pathogens test results according to those sections;

     (2) a statement that
          (A) the public safety officer and employing agency have documented the officer's exposure to blood or body fluids during performance of the officer's work duties;

          (B) the employing agency has asked the adult or juvenile offender or prisoner to consent under AS 18.15.410, and the adult or juvenile offender or prisoner does not consent;

          (C) the employing agency has provided the public safety officer and the adult or juvenile offender or prisoner with the disclosures required under AS 18.15.400; and

          (D) the employing agency has informed the public safety officer of the confidentiality requirements of AS 18.15.440 and the penalties for unauthorized release of adult or juvenile offender or prisoner information;

     (3) a statement that a physician licensed under AS 08 and knowledgeable about the most current recommendations of the United States Public Health Service has determined that a significant exposure has occurred to the public safety officer; and

     (4) a statement that a physician has documented that the public safety officer has provided a blood sample and consented to testing for bloodborne pathogens, and bloodborne pathogens test results are needed for beginning, continuing, modifying, or discontinuing medical treatment for the public safety officer.

 (b) A court shall order an adult or juvenile offender or a prisoner to provide a blood sample for bloodborne pathogen testing if the court finds that
     (1) there is probable cause to believe that a significant exposure to the public safety officer from the adult or juvenile offender or prisoner has occurred;

     (2) a licensed physician for the public safety officer needs the test results for beginning, continuing, modifying, or discontinuing medical treatment for the public safety officer; or

     (3) a compelling need for the testing and test results exists; in making this finding, the court shall consider the need for the test against the privacy or other interests of the adult or juvenile offender or prisoner.

 (c) The court may impose appropriate safeguards against unauthorized disclosure by specifically identifying the persons to have access to the test results and the uses of the test results when ordering a test under (b) of this section.

 (d) After testing is completed under this section, the employing agency shall inform the adult or juvenile offender or prisoner whose blood was tested of the results. The employing agency shall inform the public safety officer's physician of the adult or juvenile offender's or prisoner's test results without the adult or juvenile offender's or prisoner's name or other uniquely identifying information.




Sec. 18.15.440. Confidentiality; penalties for unauthorized disclosure; immunity.
 (a) Bloodborne pathogens test results of an adult or juvenile offender or a prisoner are confidential and may not be disclosed except as provided in AS 18.15.400 18.15.450 and as needed for the treatment or medical care of an adult or juvenile offender or a prisoner specific to a bloodborne pathogen-related illness.

 (b) An adult or juvenile offender or a prisoner may bring a civil action against a person who knowingly, in violation of AS 18.15.400 18.15.450, releases the adult or juvenile offender's or prisoner's name or other uniquely identifying information with the test results or otherwise releases the test results.

 (c) The employing agency, a physician, and designated health care personnel are immune from liability in any civil, administrative, or criminal action relating to the disclosure of test results of an adult or juvenile offender or a prisoner to a public safety officer and the testing of a blood sample from an adult or juvenile offender or a prisoner for bloodborne pathogens if a good faith effort has been made to comply with AS 18.15.400 18.15.450.




Sec. 18.15.445. Assistance by departments and municipalities.
The department, the Department of Public Safety, the Department of Corrections, and each municipality shall assist public safety officers and employing agencies in complying with the requirements of AS 18.15.400 18.15.450.


Sec. 18.15.450. Definitions for AS 18.15.400 18.15.450.
In AS 18.15.400 18.15.450,
     (1) "adult or juvenile offender" means a person in custody, arrested, or charged under a criminal complaint or a minor being held or subject to a petition under AS 47.12;

     (2) "bloodborne pathogens" means pathogenic microorganisms that are present in human blood and can cause disease in humans; these pathogens include hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV);

     (3) "employing agency" means the
          (A) department that employs a state employee who is, or contracts with another person who is or employs, a public safety officer;

          (B) municipality that employs a municipal employee who is, or contracts with another person who is or employs, a public safety officer or that contracts with, sponsors, or accepts the services of a public safety officer who volunteers for a volunteer fire department or emergency medical services agency;

          (C) Department of Public Safety for a public safety officer who volunteers for a volunteer fire department or emergency medical services agency that provides services in the unorganized borough outside of a municipality;

     (4) "prisoner" has the meaning given in AS 33.30.901;

     (5) "public safety officer" means a state or municipal juvenile or adult correctional, probation, or parole officer, a contractor or employee of a contractor in a correctional facility, a juvenile detention or treatment facility staff member, or a peace officer or firefighter, emergency medical technician, or mobile intensive care paramedic employed by or volunteering for the state or a municipality or volunteer fire department or emergency medical services provider;

     (6) "significant exposure" means contact likely to transmit a bloodborne pathogen, in a manner supported by the most current guidelines and recommendations of the United States Public Health Service at the time an evaluation takes place, that includes
          (A) percutaneous injury, contact of mucous membrane or nonintact skin, or prolonged contact of intact skin; and

          (B) contact, in a manner that may transmit a bloodborne pathogen, with blood, tissue, or potentially infectious body fluids.




Article 8. General Provisions.
Sec. 18.15.900. Definition.
In this chapter, "department" means the Department of Health and Social Services.


Chapter 16. Regulation of Abortions.
Sec. 18.16.010. Abortions.
 (a) An abortion may not be performed in this state unless
     (1) the abortion is performed by a physician licensed by the State Medical Board under AS 08.64.200;

     (2) the abortion is performed in a hospital or other facility approved for the purpose by the Department of Health and Social Services or a hospital operated by the federal government or an agency of the federal government;

     (3) before an abortion is knowingly performed or induced on a pregnant, unmarried, unemancipated woman under 18 years of age, notice or consent have been given as required under AS 18.16.020 or a court has authorized the minor to proceed with the abortion without parental involvement under AS 18.16.030 and the minor consents; for purposes of enforcing this paragraph, there is a rebuttable presumption that a woman who is unmarried and under 18 years of age is unemancipated;

     (4) the woman is domiciled or physically present in the state for 30 days before the abortion; and

     (5) the applicable requirements of AS 18.16.060 have been satisfied.

 (b) Nothing in this section requires a hospital or person to participate in an abortion, nor is a hospital or person liable for refusing to participate in an abortion under this section.

 (c) A person who knowingly violates a provision of this section, upon conviction, is punishable by a fine of not more than $1,000, or by imprisonment for not more than five years, or by both.

 (d) [Repealed, 6 ch 14 SLA 1997.]
 (e) A person who performs or induces an abortion in violation of (a)(3) of this section is civilly liable to the pregnant minor and the minor's parents, guardian, or custodian for compensatory and punitive damages.

 (f) It is an affirmative defense to a prosecution or claim for a violation of (a)(3) of this section that the pregnant minor provided the person who performed or induced the abortion with false, misleading, or incorrect information about the minor's age, marital status, or emancipation, and the person who performed or induced the abortion did not otherwise have reasonable cause to believe that the pregnant minor was under 17 years of age, unmarried, or unemancipated.

 (g) It is a defense to a prosecution or claim for violation of (a)(3) of this section that, in the clinical judgment of the physician or surgeon, compliance with the requirements of (a)(3) of this section was not possible because, in the clinical judgment of the physician or surgeon, an immediate threat of serious risk to the life or physical health of the pregnant minor from the continuation of the pregnancy created a medical emergency necessitating the immediate performance or inducement of an abortion. In this subsection,
     (1) "clinical judgment" means a physician's or surgeon's subjective professional medical judgment exercised in good faith;

     (2) "defense" has the meaning given in AS 11.81.900(b);

     (3) "medical emergency" means a condition that, on the basis of the physician's or surgeon's good faith clinical judgment, so complicates the medical condition of a pregnant minor that
          (A) an immediate abortion of the minor's pregnancy is necessary to avert the minor's death; or

          (B) a delay in providing an abortion will create serious risk of medical instability caused by a substantial and irreversible impairment of a major bodily function of the pregnant minor.

 (h) A physician or other health care provider is liable for failure to obtain the informed consent of a person as required under AS 18.16.060 if the claimant establishes by a preponderance of the evidence that the provider has failed to inform the person of the common risks and reasonable alternatives to the proposed abortion procedure and that, but for that failure, the person would not have consented to the abortion procedure.

 (i) It is a defense to any action for the alleged failure to obtain the informed consent of a person under (h) of this section that
     (1) the risk not disclosed is too commonly known or is too remote to require disclosure; or

     (2) the person who is the subject of the alleged failure to obtain the informed consent stated to the physician or other health care provider that the person would or would not undergo the abortion procedure regardless of the risk involved or that the person did not want to be informed of the matters to which the person would be entitled to be informed.

 (j) In an action under (h) of this section, there is a rebuttable presumption that an abortion was performed with the pregnant woman's informed consent if the person who performed the abortion submits into evidence a copy of the woman's written certification required under AS 18.16.060(b).




Sec. 18.16.020. Notice or consent required before minor's abortion.
 (a) A person may not knowingly perform or induce an abortion upon a minor who is known to the person to be pregnant, unmarried, under 18 years of age, and unemancipated unless, before the abortion, at least one of the following applies:
     (1) either
          (A) one of the minor's parents, the minor's legal guardian, or the minor's custodian has been given notice of the planned abortion not less than 48 hours before the abortion is performed, or

          (B) the parent, legal guardian, or custodian has consented in writing to the performance or inducement of the abortion; if a parent has consented to the abortion the 48 hour waiting period referenced in (A) of this paragraph does not apply;

     (2) a court issues an order under AS 18.16.030 authorizing the minor to consent to the abortion without notice or consent of a parent, guardian, or custodian, and the minor consents to the abortion;

     (3) a court, by its inaction under AS 18.16.030, constructively has authorized the minor to consent to the abortion without notice and consent of a parent, guardian, or custodian, and the minor consents to the abortion; or

     (4) the minor is the victim of physical abuse, sexual abuse, or a pattern of emotional abuse committed by one or both of the minor's parents or by a legal guardian or custodian of the minor and the abuse is documented by a declaration of the abuse in a signed and notarized statement by
          (A) the minor; and

          (B) another person who has personal knowledge of the abuse who is
               (i) the sibling of the minor who is 21 years of age or older;

               (ii) a law enforcement officer;

               (iii) a representative of the department of Health and Social Services who has investigated the abuse;

               (iv) a grandparent of the minor; or

               (v) a stepparent of the minor.

 (b) In (a)(1) of this section, actual notice must be given or attempted to be given in person or by telephone by either the physician who has referred the minor for an abortion or by the physician who intends to perform the abortion. An individual designated by the physician may initiate the notification process, but the actual notice shall be given by the physician. The physician giving notice of the abortion must document the notice or attempted notice in the minor's medical record and take reasonable steps to verify that the person to whom the notice is provided is the parent, legal guardian, or custodian of the minor seeking an abortion. Reasonable steps to provide notice must include
     (1) if in person, requiring the person to show government-issued identification along with additional documentation of the person's relationship to the minor; additional documentation may include the minor's birth certificate or a court order of adoption, guardianship, or custodianship;

     (2) if by telephone, initiating the call, attempting to verify through a review of published telephone directories that the number to be dialed is that of the minor's parent, legal guardian, or custodian, and asking questions of the person to verify that the person's relationship to the minor is that of parent, legal guardian, or custodian; when notice is attempted by telephone but the physician or physician's designee is unsuccessful in reaching the parent, legal guardian, or custodian, the physician's designee shall continue to initiate the call, in not less than two-hour increments, for not less than five attempts, in a 24-hour period.

 (c) If actual notice is attempted unsuccessfully after reasonable steps have been taken as described under (b) of this section, the referring physician or the physician intending to perform an abortion on a minor may provide constructive notice to the minor's parent, legal guardian, or custodian. Constructive notice is considered to have been given 48 hours after the certified notice is mailed. In this subsection, "constructive notice" means that notice of the abortion was provided in writing and mailed by certified mail, delivery restricted to addressee only, to the last known address of the parent, legal guardian, or custodian after taking reasonable steps to verify the mailing address.

 (d) A physician who suspects or receives a report of abuse under this section shall report the abuse as provided under AS 47.17.020.

 (e) A physician who is informed that the pregnancy of a minor resulted from criminal sexual assault of the minor must retain, and take reasonable steps to preserve, the products of conception and evidence following the abortion for use by law enforcement officials in prosecuting the crime.




Sec. 18.16.030. Judicial bypass for minor seeking an abortion.
 (a) A woman who is pregnant, unmarried, under 18 years of age, and unemancipated who wishes to have an abortion without notice to or the consent of a parent, guardian, or custodian may file a complaint in the superior court requesting the issuance of an order authorizing the minor to consent to the performance or inducement of an abortion without notice to or the consent of a parent, guardian, or custodian.

 (b) The complaint shall be made under oath and must include all of the following:
     (1) a statement that the complainant is pregnant;

     (2) a statement that the complainant is unmarried, under 18 years of age, and unemancipated;

     (3) a statement that the complainant wishes to have an abortion without notice to or the consent of a parent, guardian, or custodian;

     (4) an allegation of either or both of the following:
          (A) that the complainant is sufficiently mature and well enough informed to decide intelligently whether to have an abortion without notice to or the consent of a parent, guardian, or custodian; or

          (B) that one or both of the minor's parents or the minor's guardian or custodian was engaged in physical abuse, sexual abuse, or a pattern of emotional abuse against the minor, or that the consent of a parent, guardian, or custodian otherwise is not in the minor's best interest;

     (5) a statement as to whether the complainant has retained an attorney and, if an attorney has been retained, the name, address, and telephone number of the attorney.

 (c) The court shall fix a time for a hearing on any complaint filed under (a) of this section and shall keep a record of all testimony and other oral proceedings in the action. The hearing shall be held at the earliest possible time, but not later than the fifth business day after the day that the complaint is filed. The court shall enter judgment on the complaint immediately after the hearing is concluded. If the hearing required by this subsection is not held by the fifth business day after the complaint is filed, the failure to hold the hearing shall be considered to be a constructive order of the court authorizing the complainant to consent to the performance or inducement of an abortion without notice to or the consent of a parent, guardian, or custodian, and the complainant and any other person may rely on the constructive order to the same extent as if the court actually had issued an order under this section authorizing the complainant to consent to the performance or inducement of an abortion without such consent.

 (d) If the complainant has not retained an attorney, the court shall appoint an attorney to represent the complainant.

 (e) If the complainant makes only the allegation set out in (b)(4)(A) of this section and if the court finds by clear and convincing evidence that the complainant is sufficiently mature and well enough informed to decide intelligently whether to have an abortion, the court shall issue an order authorizing the complainant to consent to the performance or inducement of an abortion without the consent of a parent, guardian, or custodian. If the court does not make the finding specified in this subsection, it shall dismiss the complaint.

 (f) If the complainant makes only the allegation set out in (b)(4)(B) of this section and the court finds that there is clear and convincing evidence of physical abuse, sexual abuse, or a pattern of emotional abuse of the complainant by one or both of the minor's parents or the minor's guardian or custodian, or by clear and convincing evidence the consent of the parents, guardian, or custodian of the complainant otherwise is not in the best interest of the complainant, the court shall issue an order authorizing the complainant to consent to the performance or inducement of an abortion without the consent of a parent, guardian, or custodian. If the court does not make the finding specified in this subsection, it shall dismiss the complaint.

 (g) If the complainant makes both of the allegations set out in (b)(4) of this section, the court shall proceed as follows:
     (1) the court first shall determine whether it can make the finding specified in (e) of this section and, if so, shall issue an order under that subsection; if the court issues an order under this paragraph, it may not proceed under (f) of this section; if the court does not make the finding specified in (e) of this section, it shall proceed under (2) of this subsection;

     (2) if the court under (1) of this subsection does not make the finding specified in (e) of this section, it shall proceed to determine whether it can make the finding specified in (f) of this section and, if so, shall issue an order under that subsection; if the court does not make the finding specified in (f) of this section, it shall dismiss the complaint.

 (h) The court may not notify the parents, guardian, or custodian of the complainant that the complainant is pregnant or wants to have an abortion.

 (i) If the court dismisses the complaint, the complainant has the right to appeal the decision to the supreme court, and the superior court immediately shall notify the complainant that there is a right to appeal.

 (j) If the complainant files a notice of appeal authorized under this section, the superior court shall deliver a copy of the notice of appeal and the record on appeal to the supreme court within four days after the notice of appeal is filed. Upon receipt of the notice and record, the clerk of the supreme court shall place the appeal on the docket. The appellant shall file a brief within four days after the appeal is docketed. Unless the appellant waives the right to oral argument, the supreme court shall hear oral argument within five days after the appeal is docketed. The supreme court shall enter judgment in the appeal immediately after the oral argument or, if oral argument has been waived, within five days after the appeal is docketed. Upon motion of the appellant and for good cause shown, the supreme court may shorten or extend the maximum times set out in this subsection. However, in any case, if judgment is not entered within five days after the appeal is docketed, the failure to enter the judgment shall be considered to be a constructive order of the court authorizing the appellant to consent to the performance or inducement of an abortion without notice to or the consent of a parent, guardian, or custodian, and the appellant and any other person may rely on the constructive order to the same extent as if the court actually had entered a judgment under this subsection authorizing the appellant to consent to the performance or inducement of an abortion without notice to or the consent of another person. In the interest of justice, the supreme court, in an appeal under this subsection, shall liberally modify or dispense with the formal requirements that normally apply as to the contents and form of an appellant's brief.

 (k) Each hearing under this section, and all proceedings under (j) of this section, shall be conducted in a manner that will preserve the anonymity of the complainant. The complaint and all other papers and records that pertain to an action commenced under this section, including papers and records that pertain to an appeal under this section, shall be kept confidential and are not public records under AS 40.25.110 40.25.120.

 (l) The supreme court shall prescribe complaint and notice of appeal forms that shall be used by a complainant filing a complaint or appeal under this section. The clerk of each superior court shall furnish blank copies of the forms, without charge, to any person who requests them.

 (m) A filing fee may not be required of, and court costs may not be assessed against, a complainant filing a complaint under this section or an appellant filing an appeal under this section.

 (n) Blank copies of the forms prescribed under (l) of this section and information on the proper procedures for filing a complaint or appeal shall be made available by the court system at the official location of each superior court, district court, and magistrate in the state. The information required under this subsection must also include notification to the minor that
     (1) there is no filing fee required for either form;

     (2) no court costs will be assessed against the minor for procedures under this section;

     (3) an attorney will be appointed to represent the minor if the minor does not retain an attorney;

     (4) the minor may request that the superior court with appropriate jurisdiction hold a telephonic hearing on the complaint so that the minor need not personally be present;

     (5) the minor may request that the superior court with appropriate jurisdiction issue an order directing the minor's school to excuse the minor from school to attend court hearings held under this section and to have the abortion if one is authorized by the court and directing the school not to notify the minor's parent, legal guardian, or custodian that the minor is pregnant, seeking an abortion, or is absent for purposes of obtaining an abortion.




Sec. 18.16.040. Reports.
For each month in which an abortion is performed on a minor by a physician, the physician shall file a report with the Department of Health and Social Services indicating the number of abortions performed on a minor for that month, the age of each minor, the number of previous abortions performed on each minor, if any, and the number of pregnancies of each minor, if any, and the number of consents provided under each of the exceptions enumerated under AS 18.16.020(a)(1) (4). A report filed under this section may not include identifying information of the minor other than the minor's age.


Sec. 18.16.050. Partial-birth abortions.
 (a) Notwithstanding compliance with AS 18.16.010, a person may not knowingly perform a partial-birth abortion unless a partial-birth abortion is necessary to save the life of a mother whose life is endangered by a physical disorder, illness, or injury and no other medical procedure would suffice for that purpose. Violation of this subsection is a class C felony.

 (b) A woman upon whom a partial-birth abortion is performed may not be prosecuted under this section or under any other law if the prosecution is based on this section.

 (c) In this section, "partial-birth abortion" means an abortion in which the person performing the abortion partially vaginally delivers a living fetus before killing the fetus and completing the delivery.




Sec. 18.16.060. Informed consent requirements.
 (a) Except as provided in (d) of this section, a person may not knowingly perform or induce an abortion without the voluntary and informed consent of
     (1) a woman on whom an abortion is to be performed or induced;

     (2) the parent, guardian, or custodian of a pregnant, unemancipated minor if required under AS 18.16.020; or

     (3) a pregnant, unemancipated minor if authorized by a court under AS 18.16.030.

 (b) Consent to an abortion is informed and voluntary when the woman or another person whose consent is required certifies in writing that the physician who is to perform the abortion, a member of the physician's staff who is a licensed health care provider, or the referring physician has verbally informed the woman or another person whose consent is required of the name of the physician who will perform the procedure and the gestational estimation of the pregnancy at the time the abortion is to be performed and has provided either
     (1) the Internet information required to be maintained under AS 18.05.032; the physician or a member of the physician's staff who is a licensed health care provider shall provide a copy of the Internet information if a person requests a written copy; if a member of the physician's staff provides the information required under this paragraph, the member of the physician's staff shall offer the opportunity to consult with the physician; or

     (2) information about the nature and risks of undergoing or not undergoing the proposed procedure that a reasonable patient would consider material to making a voluntary and informed decision of whether to undergo the procedure.

 (c) The information required in (b) of this section shall be provided before the procedure in a private setting to protect privacy, maintain the confidentiality of the decision, ensure that the information focuses on the individual circumstances, and ensure an adequate opportunity to ask questions. Provision of the information telephonically or by electronic mail, regular mail, or facsimile transmittal before the person's appointment satisfies the requirements of this subsection as long as the person whose consent is required under (a) of this section has an opportunity to ask questions of the physician after receiving the information.

 (d) Notwithstanding (a) of this section, informed consent that meets the requirements of (a) (c) of this section is not required in the case of a medical emergency or if the pregnancy is the result of sexual assault under AS 11.41.410 11.41.427, sexual abuse of a minor under AS 11.41.434 11.41.440, incest under AS 11.41.450, or an offense under a law of another jurisdiction with elements similar to one of these offenses. In this subsection, "medical emergency" means a condition that, on the basis of a physician's good faith clinical judgment, so complicates the medical condition of a pregnant woman that
     (1) the immediate termination of the woman's pregnancy is necessary to avert the woman's death; or

     (2) a delay in providing an abortion will create serious risk of substantial and irreversible impairment of a major bodily function of the woman.




Sec. 18.16.090. Definitions.
In this chapter,
     (1) "abortion" means the use or prescription of an instrument, medicine, drug, or other substance or device to terminate the pregnancy of a woman known to be pregnant, except that "abortion" does not include the termination of a pregnancy if done with the intent to
          (A) save the life or preserve the health of the unborn child;

          (B) deliver the unborn child prematurely to preserve the health of both the pregnant woman and the woman's child; or

          (C) remove a dead unborn child;

     (2) "unemancipated" means that a woman who is unmarried and under 17 years of age has not done any of the following:
          (A) entered the armed services of the United States;

          (B) become employed and self-subsisting;

          (C) been emancipated under AS 09.55.590; or

          (D) otherwise become independent from the care and control of the woman's parent, guardian, or custodian.




Chapter 18. Hospice and Home Care Programs.
[Repealed, 44 ch 57 SLA 2005.]

Article 1. Regulation of Hospitals.
Chapter 20. Hospitals and Nursing Facilities.
Secs. 18.20.010 18.20.040. Purpose; license required; application and fees; issuance and renewal of license and posting. [Repealed, 45 ch 57 SLA 2005.]
Sec. 18.20.045. Insurance required. [Repealed, 40 ch 177 SLA 1978.]
Secs. 18.20.050 18.20.070. Denial, suspension, or revocation of license; regulations and standards; compliance with regulations. [Repealed, 45 ch 57 SLA 2005.]
Sec. 18.20.075. Risk management.
 (a) To be eligible for a license, each hospital shall have in operation an internal risk management program that shall
     (1) investigate the frequency and causes of incidents in hospitals that cause injury to patients;

     (2) develop and implement measures to minimize the risk of injury to patients; in developing these measures each hospital shall take into account recommendations of its medical staff, private underwriters, industry standards, experience of other hospitals, and recommendations of licensing boards of other health care providers; and

     (3) analyze patient grievances that relate to patient care.

 (b) The department shall adopt by regulation standards for the risk management programs in hospitals in the state which may vary according to the size of the hospital, the type of care offered by the hospital, and other factors found relevant by the department. Regulations adopted under this subsection are subject to AS 44.62 (Administrative Procedure Act).




Sec. 18.20.076. Reports of suspended or revoked staff privileges. [Repealed, 21 ch 87 SLA 1987.]
Sec. 18.20.080. Inspection and consultation for alterations.
 (a) The department shall make annual inspections and investigations of hospital facilities. The department may accept accreditation by the Joint Commission on the Accreditation of Hospitals in lieu of an annual inspection by the department for the year in which the accreditation was granted if the accreditation standards of the commission are substantially similar to the inspection standards of the department.

 (b) The department may by regulation require that a licensee or applicant desiring to make a specified type of alteration or addition to its facilities or to construct new facilities shall, before commencing the alteration, addition, or new construction, submit plans and specifications to the department for preliminary inspection and approval or recommendations with respect to compliance with its regulations and standards.




Sec. 18.20.085. Hospital records retention.
 (a) Unless specified otherwise by the department a hospital shall retain and preserve records that relate directly to the care and treatment of a patient for a period of seven years following the discharge of the patient. However, the records of a patient under 19 years of age shall be kept until at least two years after the patient has reached the age of 19 years or until seven years following the discharge of the patient, whichever is longer. Records consisting of X-ray film are required to be retained for five years.

 (b) The department shall by regulation define the types of records and the information required to be included in the records retained and preserved under (a) of this section. The department may by regulation specify records and information to be retained for longer periods than those set out in (a) of this section.

 (c) If a hospital ceases operation, it shall make immediate arrangements, as approved by the department, for the preservation of its records.

 (d) This section is subject to AS 18.23.100.

 (e) In this section, "hospital" includes those facilities defined as hospitals under AS 18.20.130 and 18.20.210.




Sec. 18.20.090. Disclosure of information. [Repealed, 45 ch 57 SLA 2005.]
Sec. 18.20.095. Mental health patient's right to select staff; duties of hospital staff.
 (a) Except as provided in (d) of this section, a patient 18 years of age or older who is receiving mental health treatment and being provided intimate care at a hospital shall have a right to have care provided by a staff member who is the gender that the patient requests.

 (b) A supervisor or manager employed by a hospital shall
     (1) post a notice of the right provided under (a) of this section in a conspicuous place; and

     (2) if, after reasonable and good faith efforts to comply, the hospital is unable to comply with the requirement under (a) of this section,
          (A) document in the patient record that intimate care was provided by a licensed staff member of the gender opposite to the gender requested by the patient under (a) of this section; or

          (B) if a licensed staff member is not on duty at the time of the patient's request under (a) of this section, document in the patient record that the care was provided by an unlicensed staff member of the gender opposite to that requested under (a) of this section.

 (c) Staff members employed by a hospital shall, in regard to patients receiving mental health treatment,
     (1) provide privacy for each patient, especially for patients who are the opposite gender and especially when patient care involves intimate bodily functions, unavoidable intimate touching, or nudity;

     (2) except when necessitated by a medical emergency that is documented in the patient's record, avoid entering patient care areas for a person of the opposite gender and areas specified for persons of the opposite gender; and

     (3) conduct routine safety checks and rounds of bedrooms, bathrooms, and shower areas only of patients who are the same gender as the staff member.

 (d) A hospital is exempt from the requirements of (a) of this section if the treating psychiatrist for the patient at the hospital determines that compliance would adversely affect patient treatment and the psychiatrist documents the determination in the patient's record.

 (e) In this section,
     (1) "intimate care" means hygienic care, including bathing, dressing, changing, and toileting, that involves a patient's perineal area and, for a female patient, the patient's breasts; "intimate care" does not include activities done in preparation for medical procedures;

     (2) "licensed staff member" means a person who is employed by the hospital to provide direct patient care and who is licensed or certified in the state as a physician or physician assistant under AS 08.64, direct-entry midwife under AS 08.65, nurse or nurse aide under AS 08.68, or physical therapist or occupational therapist under AS 08.84;

     (3) "mental health treatment" means admission to a hospital primarily for electroconvulsive treatment or treatment with psychotropic medication, or admission to and retention in a health care institution for other mental health treatment;

     (4) "staff member" means a person employed by a hospital to provide direct patient care.




Sec. 18.20.100. Annual report of department. [Repealed, 35 ch 126 SLA 1994.]
Secs. 18.20.110 , 18.20.120. Misdemeanor to establish or conduct hospital without license; definitions. [Repealed, 45 ch 57 SLA 2005.]
Sec. 18.20.130. Definitions.
In AS 18.20.075 18.20.130,
     (1) "department" means the Department of Health and Social Services;

     (2) "hospital" means an institution or establishment, public or private, devoted primarily to providing diagnosis, treatment, or care over a continuous period of 24 hours each day for two or more nonrelated individuals suffering from illness, physical or mental disease, injury or deformity, or any other condition for which medical or surgical services would be appropriate.




Article 2. Alaska Hospital and Medical Facilities Survey and Construction Act.
Sec. 18.20.140. Purpose.
The purpose of AS 18.20.140 18.20.220 is to make an inventory of existing hospitals and medical facilities, community mental health centers, and facilities for persons with intellectual and developmental disabilities; to survey the need for construction of hospitals and medical facilities, community mental health centers, and facilities for persons with intellectual and developmental disabilities; and to develop a program and plan of construction for each.


Sec. 18.20.141. Department functions.
The department shall be the sole agency for the administration of the plan as required by the federal act. The department shall develop and administer any programs necessary for compliance with the federal act.


Sec. 18.20.150. Duties of department.
 (a) For each of the following groups of facilities, hospitals and medical facilities (Group 1), community mental health centers (Group 2), and facilities for persons with intellectual and developmental disabilities (Group 3), the department shall
     (1) make a statewide inventory of existing public, nonprofit, and proprietary facilities;

     (2) survey the need for construction of these facilities;

     (3) on the basis of the inventory and survey, develop a program for the construction of public and other nonprofit facilities for each of these groups that will, in conjunction with existing facilities, afford the necessary physical facilities for furnishing adequate facility services to all residents of the state.

 (b) [Repealed, 19 ch 6 SLA 1998.]
 (c) The department shall
     (1) provide for adequate facilities to furnish needed services for persons unable to pay for them in accordance with regulations adopted under the federal act;

     (2) submit any reports that the surgeon general considers necessary for compliance with the federal act;

     (3) do all things on behalf of the state necessary to obtain benefits under the federal act.




Sec. 18.20.160. Priority of projects.
The state plan must set out the relative need for the projects included in the construction program determined in accordance with the regulations adopted under the federal act, and provide for the construction, maintenance, and operation to the extent financial resources permit, in the order of the relative need.


Sec. 18.20.170. Application for construction projects.
The state, a political subdivision of the state, or a public or other nonprofit agency requesting federal funds for a health facility construction project must apply to the department. The application must conform to federal and state requirements.


Sec. 18.20.180. Approval of applications.
The commissioner of the department shall give every applicant an opportunity for a fair hearing. If, after giving reasonable opportunity for development and presentation of applications in the order of relative need, the commissioner of the department finds that a project application complies with the requirements of AS 18.20.170 and conforms with the state plan, the commissioner shall approve and recommend the application and forward it to the surgeon general.


Sec. 18.20.190. Inspection of projects.
The commissioner of the department shall inspect each construction project approved by the surgeon general from time to time. If the commissioner finds that work has been performed upon the project or purchases have been made in accordance with the approved plans and specifications, the commissioner shall certify to the surgeon general that this is the fact and that payment of an installment of federal funds is due the applicant.


Sec. 18.20.200. Acceptance of grants.
The department may accept on behalf of the state and may deposit separate and apart from public money and funds, a grant from the federal government, or gift or contribution from any source made to assist in meeting the cost of carrying out the purposes of AS 18.20.140 18.20.220. Federal funds received and not expended for these purposes shall be repaid to the United States.


Sec. 18.20.210. Definitions.
In AS 18.20.140 18.20.220,
     (1) "community mental health center" means a facility providing services for the prevention or diagnosis of mental illness, or care and treatment of mentally ill patients, or rehabilitation of mentally ill persons, which services are provided principally for persons residing in a particular community or communities in or near which the facility is situated;

     (2) "department" means the Department of Health and Social Services;

     (3) "facility for persons with intellectual and developmental disabilities" means a facility specially designed for the diagnosis, treatment, education, training, or custodial care of persons with intellectual and developmental disabilities, including facilities for training specialists and sheltered workshops for persons with intellectual and developmental disabilities, but only if the workshops are part of facilities that provide or will provide comprehensive services for persons with intellectual and developmental disabilities;

     (4) "federal act" means Title VI of the Public Health Service Act (42 U.S.C. 291 et seq.) concerning hospitals and medical facilities and the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 (P.L. 88-164) concerning facilities for persons with intellectual and developmental disabilities and community mental health centers, both as now or hereafter amended;

     (5) "hospital" includes a public health center and general, tuberculosis, mental, chronic disease, and other type of hospital, and related facilities, including laboratory, outpatient department, nurses' homes, and training facilities, and central services facilities operated in connection with a hospital, but does not include a hospital furnishing primarily domiciliary care;

     (6) "medical facilities" means diagnostic and treatment centers, rehabilitation facilities, and nursing homes, as those terms are defined in the federal act, and other medical facilities for which federal aid may be authorized under the federal act;

     (7) "nonprofit facility for persons with intellectual and developmental disabilities" and "nonprofit community mental health center" mean, respectively, a facility for persons with intellectual and developmental disabilities and a community mental health center that is owned and operated by one or more nonprofit corporations or associations no part of the net earnings of which inures, or may lawfully inure, to the benefit of any private shareholder or individual; and the term "nonprofit private agency or organization" means an agency or organization that is such a corporation or association or that is owned and operated by one or more of such corporations or associations;

     (8) "nonprofit hospital" and "nonprofit medical facility" mean a hospital or medical facility owned and operated by a nonprofit corporation or association, no part of the net earnings of which inures, or may lawfully inure, to the benefit of a private shareholder or individual;

     (9) "public health center" means a publicly owned facility providing public health services, including related facilities such as laboratory, clinic, and administrative offices operated in connection with the public health center;

     (10) "surgeon general" means the Surgeon General of the Public Health Service or any other federal agency designated to administer the federal act.




Sec. 18.20.220. Short title.
AS 18.20.140 18.20.220 may be cited as the Alaska Hospital and Medical Facilities Survey and Construction Act.


Secs. 18.20.230 18.20.260. Leaving general hospital without arranging for payment; posting of law required; receipt of services without intent to pay a misdemeanor; definition. [Repealed, 45 ch 57 SLA 2005.]
Article 3. Nursing Facilities.
Sec. 18.20.300. State policy.
It is the policy of the state to ensure that the quality of care in nursing facilities in this state is maintained at a high standard in accordance with applicable state and federal law and regulations and to ensure the health, safety, and quality of life of nursing facility residents in Alaska is maintained or enhanced.


Sec. 18.20.302. Criminal background check for employees. [Repealed, 45 ch 57 SLA 2005.]
Sec. 18.20.305. Nursing facility regulations.
The department shall adopt necessary regulations to implement AS 18.20.300 18.20.390 in accordance with AS 44.62 (Administrative Procedure Act). The department shall, by regulation, specify criteria as to when and how the sanctions specified in AS 18.20.310 will be applied. The criteria must provide for the imposition of incrementally more severe penalties for deficiencies that are uncorrected or pervasive, or that present a threat to the health, safety, or welfare of nursing facility residents.


Sec. 18.20.310. Sanctions for noncompliance.
 (a) If the department finds that a nursing facility, or a partner, officer, director, owner of five percent or more of the nursing facility's assets, or managing employee of the nursing facility substantially failed or refused to comply with AS 08.68.340 08.68.390, AS 08.70, AS 18.20.075 18.20.085, AS 47.07, or with a regulation adopted under any of those statutes, or, for a nursing facility that provides Medicaid services under AS 47.07, failed or refused to comply with the Medicaid requirements of 42 U.S.C. 1396r (Title XIX of the Social Security Act, as amended) or a regulation adopted under that statute, the department may take the following actions:
     (1) ban the admission of new residents to the nursing facility;

     (2) as provided in AS 18.20.320, deny payment under AS 47.07 and AS 47.25.120 47.25.300 for any Medicaid or general relief-medical resident admitted to the nursing facility after notice by the department of denial of payment; residents who are eligible for Medicaid or general relief-medical are not responsible for payment when the department takes action under this paragraph;

     (3) assess a civil fine in accordance with AS 18.20.340;

     (4) suspend or terminate the nursing facility's participation in the Medicaid program;

     (5) suspend, revoke, or refuse to renew the nursing facility's license issued under this chapter;

     (6) seek an appointment of temporary administration as provided in AS 18.20.360 or of a receiver under AS 18.20.370;

     (7) in case of an emergency, seek an order from the court either to close the nursing facility or to transfer residents from that facility, or both.

 (b) An order of the department imposing a sanction described in
     (1) (a)(1), (4), or (5) of this section takes effect immediately upon service of the order on the nursing facility; however, if the facility can demonstrate to the department's satisfaction that the deficiencies prompting the order do not jeopardize the health or safety of facility residents or seriously limit the nursing facility's capacity to provide adequate care, the department's order takes effect 10 days after service;

     (2) (a)(2) or (3) of this section takes effect 10 days after service of the order on the nursing facility.

 (c) A hearing may be requested under AS 18.20.330 regarding a sanction imposed by the department under this section.




Sec. 18.20.320. Denial of payment.
The department shall deny payment under AS 47.07 or AS 47.25.120 47.25.300 to a nursing facility
     (1) that is not in compliance, and, for the preceding three months, has not been in compliance, with the requirements of 42 U.S.C. 1396r (Title XIX of the Social Security Act, as amended), and regulations adopted under that statute, until correction of the deficiency; or

     (2) if the department finds, on three consecutive reviews, that the nursing facility provided substandard quality of care; the department shall deny payment under this paragraph for new admissions until the facility has demonstrated to the satisfaction of the department that it is in compliance with the Medicaid requirements of 42 U.S.C. 1396r, and that it will remain in compliance with the requirements.




Sec. 18.20.330. Appeal; hearing.
 (a) Notwithstanding AS 44.62.330 44.62.630, the department, by regulation, shall establish a hearing procedure by which a nursing facility may present evidence to refute a deficiency found by the department, and by which it may appeal, in a hearing conducted by the office of administrative hearings (AS 44.64.010), a sanction imposed by order of the department under AS 18.20.310. A request for a hearing shall be made in writing within 10 days after service of the department's order on the nursing facility. Except for an order that takes effect immediately under AS 18.20.310(b)(1), a request under this subsection has the effect of staying the department's order until the hearing is concluded and the department makes a final determination.

 (b) An appeal, or request for stay, regarding a sanction imposed by the court under AS 18.20.310(a)(6) or (7), 18.20.360, or 18.20.370, shall be filed with the court in accordance with the Rules of Civil Procedure.




Sec. 18.20.340. Civil fines.
In accordance with regulations adopted by the department under AS 44.62.010 44.62.300, the department may assess and collect, with interest, a civil fine of up to $10,000 a day for each day a nursing facility is or was out of compliance with any of the federal or state statutes or regulations listed in AS 18.20.310. The department shall annually increase the maximum amount of the civil fine authorized in this section by a percentage equal to the percentage of increase in all items of the Consumer Price Index for all urban consumers for Anchorage, Alaska. Each day upon which the same or a substantially similar noncompliance occurs is a separate violation subject to the assessment of a separate civil fine. A civil fine assessed under this section is not reimbursable under AS 47.07 or AS 47.25.120 47.25.300. The department shall deduct the amount of a civil fine from reimbursement due or to be due the nursing facility under AS 47.07 or AS 47.25.120 47.25.300. The department may also use any remedy available under law to pursue collection of an unpaid fine.


Sec. 18.20.350. Nursing facility resident security fund.
 (a) There is established in the department, as a fund separate from other public money of the state, the nursing facility resident security fund. This fund consists of all civil fines collected under AS 18.20.310(a)(3) and 18.20.340 related to noncompliance with 42 U.S.C. 1396r(b), (c), or (d), and all interest earned on money in the fund.

 (b) The nursing facility resident security fund shall be administered by the department. Money in the fund may only be used for the protection of the health or property of residents of nursing facilities found to be out of compliance with 42 U.S.C. 1396r(b), (c), or (d), or a regulation adopted under those statutes, including payment for the costs of relocation of residents to other facilities, maintenance of operation of a facility pending correction of deficiencies or closure, and reimbursement to a resident for personal money lost.




Sec. 18.20.360. Temporary management.
 (a) If the department determines that the health or safety of the residents of a nursing facility is immediately jeopardized as the result of the nursing facility's failure or refusal to comply with a state statute or regulation, or failure or refusal to comply with the Medicaid requirements in 42 U.S.C. 1396r (Title XIX of the Social Security Act) or a regulation adopted under that statute, the department shall immediately petition the superior court for an order for appointment of temporary administration to
     (1) oversee the operation of the facility; and

     (2) ensure the health and safety of the facility's residents while orderly closure of the facility occurs or the deficiencies necessitating temporary administration are corrected.

 (b) The court shall grant the petition if it finds by a preponderance of the evidence that the conditions in (a) of this section exist.




Sec. 18.20.370. Receivership.
 (a) The department may petition the superior court for establishment of a receivership for a nursing facility if the department finds that one of the following conditions exists and the current operator has demonstrated an inability or unwillingness to take action necessary to immediately correct the conditions alleged:
     (1) the facility is operating without a license;

     (2) the health, safety, or welfare of the facility's residents is immediately jeopardized;

     (3) the facility demonstrates a pattern and practice of violating state or federal statutes or regulations in such a way that minimum resident care is jeopardized.

 (b) The court shall grant the petition if it finds by a preponderance of the evidence that one or more of the conditions in (a) of this section exist and the current operator is unable or unwilling to take action necessary to correct the condition.




Sec. 18.20.390. Definitions.
In AS 18.20.300 18.20.390, unless the context requires otherwise,
     (1) "department" means the Department of Health and Social Services;

     (2) "general relief-medical" means the medical assistance program authorized in AS 47.25.120 47.25.300;

     (3) "Medicaid" means the medical assistance program authorized in AS 47.07;

     (4) "nursing facility" means an institution, or a distinct part of an institution, as defined in 42 U.S.C. 1396r.




Article 4. Overtime Limitations for Nurses.
Sec. 18.20.400. Limitations on nursing overtime.
 (a) Except as provided in (c) of this section, a nurse in a health care facility may not be required or coerced, directly or indirectly,
     (1) to work beyond a predetermined and regularly scheduled shift that is agreed to by the nurse and the health care facility; or

     (2) to accept an assignment of overtime if, in the judgment of the nurse, the overtime would jeopardize patient or employee safety.

 (b) Except as provided by (c) of this section, after working a predetermined and regularly scheduled shift that is agreed to by the nurse and the health care facility as authorized by (a)(1) of this section, a nurse in a health care facility shall be allowed not less than 10 consecutive hours of off-duty time immediately following the end of that work.

 (c) Subsection (a) of this section does not apply to
     (1) a nurse who is employed by a health care facility providing services for a school, school district, or other educational institution, when the nurse is on duty for more than 14 consecutive hours during an occasional special event, such as a field trip, that is sponsored by the employer;

     (2) a nurse voluntarily working overtime on an aircraft in use for medical transport, so long as the shift worked is allowable under regulations adopted by the Board of Nursing based on accreditation standards adopted by the Commission on Accreditation of Medical Transport Systems;

     (3) a nurse on duty in overtime status
          (A) who is participating in the performance of a medical procedure or surgery that has begun but has not been completed;

          (B) because of an unforeseen emergency situation that could jeopardize patient safety; in this subparagraph, "unforeseen emergency situation" means an unusual, unpredictable, or unforeseen situation caused by an act of terrorism, disease outbreak, natural disaster, major disaster as defined in 42 U.S.C. 5122, or disaster emergency under AS 26.23.020 or 26.23.140, but does not include a situation in which a health care facility has reasonable knowledge of increased patient volume or inadequate staffing because of some other cause, if that cause is foreseeable;

          (C) because the health care facility has a scheduling problem caused by unforeseen weather conditions that prevent a second nurse from arriving at the facility to relieve the nurse on duty; in this subparagraph, "unforeseen weather conditions" means unusual, unpredictable, or unforeseen weather so extreme as to impair travel to the health care facility, but does not include a situation in which the health care facility has knowledge of the weather conditions far enough in advance to act so that a scheduling problem under this subparagraph can reasonably be avoided; or

          (D) at a health care facility located in a rural community that declares a temporary nurse staffing emergency under AS 18.20.410;

     (4) a nurse fulfilling on-call time that is agreed on by the nurse and a health care facility before it is scheduled unless fulfilling the on-call time would, in the nurse's judgment, create an unacceptable risk to the physical safety of the nurse, a patient, or an employee of the facility;

     (5) a nurse voluntarily working overtime so long as the work is consistent with professional standards and safe patient care and does not exceed 14 consecutive hours;

     (6) a nurse voluntarily working beyond 80 hours in a 14-day period so long as the nurse does not work more than 14 consecutive hours without a 10-hour break and the work is consistent with professional standards and safe patient care;

     (7) a nurse who
          (A) is employed
               (i) at a psychiatric treatment hospital that treats only children or at a residential psychiatric treatment center, as defined under AS 18.07.111, that treats only children; in this sub-subparagraph, "children" means persons under 19 years of age who are receiving psychiatric treatment from a hospital or center or who are residing in a center and who were under 18 years of age on the date that the treatment or period of residence commenced;

               (ii) at a residential psychiatric treatment center as defined under AS 47.32.900; or

               (iii) at a secure residential psychiatric treatment center as defined under AS 47.12.990;

          (B) voluntarily agrees to work a 16-hour shift for the period between 5:00 p.m. on a Friday and 8:00 a.m. on the Monday that immediately follows and receives pay and benefits for that work that are equal to or greater than the pay and benefits the nurse would receive for working 20 regular hours in the same position; and

          (C) during the period described in (B) of this paragraph does not work a 16-hour shift consecutive with another shift of eight hours or more without an intervening break of at least eight hours;

     (8) the first two hours on overtime status when the health care facility is obtaining another nurse to work in place of the nurse in overtime status, so long as the nurse in overtime status is not on duty for more than 14 consecutive hours.




Sec. 18.20.410. Temporary nurse staffing emergency.
 (a) If, after making a substantial and reasonable effort to increase the number of available nurses on staff and failing in that effort, a health care facility in a rural community determines it is not able to meet the overtime limitations in AS 18.20.400 without putting the safety of its patients at risk of serious harm, the health care facility may declare a temporary nurse staffing emergency. A declaration of a temporary nurse staffing emergency under this section
     (1) must be made in a writing, signed by the administrator of the health care facility or the administrator's designee, that describes the facility's reasonable effort to avoid the temporary nurse staffing emergency; and

     (2) may not exceed 30 days.

 (b) Immediately after declaring a temporary nurse staffing emergency under (a) of this section, a health care facility shall file with the division of labor standards and safety, Department of Labor and Workforce Development, a report that includes a copy of the signed writing required under (a) of this section. A report under this subsection is a public document.

 (c) In addition to the requirements of (a) and (b) of this section, a health care facility shall notify the legislature immediately by delivery of a written report to the Alaska Legislative Council each time the facility declares a temporary nurse staffing emergency under AS 18.20.400(c) that exceeds two occurrences in a six-month period that begins on January 1 or July 1 of the year in which the declaration occurs, or three occurrences in the one-year period that begins on January 1 of that year. A report under this subsection must include a copy of each report that is required of the health care facility under (b) of this section for the one-year period that begins on January 1 of the year the excessive declaration under this subsection occurs.




Sec. 18.20.420. Health care facility complaint process for overtime work by nurses.
A health care facility shall provide for an anonymous process by which a patient or a nurse may make a complaint about staffing levels and patient safety that relate to overtime work by nurses and to limitations on overtime work by nurses under AS 18.20.400.


Sec. 18.20.430. Enforcement, offenses, and penalties.
 (a) The commissioner shall administer AS 18.20.400 18.20.499 and adopt regulations for implementing and enforcing AS 18.20.400 18.20.499.

 (b) A complaint alleging a violation of AS 18.20.400 18.20.499 must be filed with the commissioner within 30 days after the date of the alleged violation. The commissioner shall provide a copy of the complaint to the health care facility named in the filing within three business days after receiving the complaint.

 (c) If the commissioner finds that a health care facility has knowingly violated an overtime provision of AS 18.20.400 18.20.499, the following civil penalties shall apply:
     (1) for a first violation of AS 18.20.400 18.20.499, the commissioner shall reprimand the health care facility;

     (2) for a second violation of AS 18.20.400 18.20.499 within 12 months, the commissioner shall reprimand the health care facility and assess a penalty of $500;

     (3) for a third violation of AS 18.20.400 18.20.499 within 12 months, the commissioner shall reprimand the health care facility and assess a penalty of not less than $2,500 but not more than $5,000;

     (4) for each violation of AS 18.20.400 18.20.499 after a third violation of AS 18.20.400 18.20.499 within 12 months, the commissioner shall reprimand the health care facility and assess a penalty of not less than $5,000 but not more than $25,000.

 (d) As an employer, a health care facility violates an overtime provision of AS 18.20.400 18.20.499 "knowingly" when the facility is either aware that its conduct is of a nature prohibited by the overtime provision or aware that the circumstances described in the overtime prohibition exist; however, when knowledge of the existence of a particular fact is required to establish that the violation was knowing, that knowledge exists when the facility is aware of a substantial probability of its existence, unless the facility reasonably believes it does not exist.




Sec. 18.20.440. Prohibition of retaliation.
A health care facility may not discharge, discipline, threaten, discriminate against, penalize, or file a report with the Board of Nursing against a nurse for exercising rights under AS 18.20.400 18.20.499 or for the good faith reporting of an alleged violation of AS 18.20.400 18.20.499.


Sec. 18.20.450. Report requirements.
 (a) A health care facility shall file with the division of labor standards and safety, Department of Labor and Workforce Development, a semiannual report on a form provided by the department. The report for the six-month period ending June 30 must be filed before the following August 1, and the report for the six-month period ending December 31 must be filed before the following February 1. The report must include, for each nurse employed by the health care facility or under contract with the health care facility, the number of overtime hours worked and the number of hours the nurse was on call. A health care facility that does not employ a nurse who worked overtime hours or who was on call during the reporting period is not required to describe hours worked as overtime and on-call hours for individual nurses but may instead complete the report by stating on the form that there are no reportable hours.

 (b) A primary care outpatient facility is not subject to the reporting requirements of (a) of this section.




Sec. 18.20.460. Provisions not applicable to nurses employed in federal or tribal facilities.
The provisions of AS 18.20.400 18.20.499 do not apply to a nurse employed in a health care facility that is operated by
     (1) the federal government; or

     (2) a tribal organization as defined in 25 U.S.C. 450b.




Sec. 18.20.470. Notice to employees.
A health care facility shall post and maintain, in places readily accessible to individuals in the service of the health care facility, printed statements that describe employee rights and employer obligations under AS 18.20.400 18.20.499 and regulations adopted under AS 18.20.430. The commissioner shall supply the printed statements to a health care facility without cost to the facility.


Sec. 18.20.499. Definitions.
In AS 18.20.400 18.20.499,
     (1) "commissioner" means the commissioner of labor and workforce development;

     (2) "health care facility" means a private, municipal, or state hospital; independent diagnostic testing facility; primary care outpatient facility; skilled nursing facility; kidney disease treatment center, including freestanding hemodialysis units; intermediate care facility; ambulatory surgical facility; Alaska Pioneers' Home or Alaska Veterans' Home administered by the Department of Health and Social Services under AS 47.55; correctional facility owned or administered by the state; private, municipal, or state facility employing one or more public health nurses; long-term care facility; psychiatric hospital; residential psychiatric treatment center, as defined in AS 18.07.111 or AS 47.32.900; secure residential psychiatric treatment center under AS 47.12.990; juvenile detention facility; juvenile detention home, juvenile work camp, or treatment facility as defined in AS 47.12.990;

     (3) "nurse" means an individual licensed to practice registered nursing or practical nursing under AS 08.68 who provides nursing services through direct patient care or clinical services and includes a nurse manager when delivering in-hospital patient care;

     (4) "on-call" means a status in which a nurse must be ready to report to the health care facility and may be called to work by the health care facility;

     (5) "overtime" means the hours worked in excess of a predetermined and regularly scheduled shift that is agreed to by a nurse and a health care facility;

     (6) "rural community" means a village or city that has a population of less than 10,000, as determined by the Department of Labor and Workforce Development, and is in
          (A) the unorganized borough; or

          (B) an organized borough that has a population of less than 25,000, as determined by the Department of Labor and Workforce Development.




Article 5. Discharge of Hospital Patients.
Sec. 18.20.500. Aftercare assessment and designation of caregiver.
Before discharging a patient, a hospital shall assess the patient's ability for self-care after discharge and provide the patient with the opportunity to designate a caregiver who agrees to provide aftercare for the patient in a private residence after discharge.


Sec. 18.20.510. Planning, instruction, and training.
 (a) A hospital shall give the patient and the patient's designated caregiver the opportunity to participate in planning for the patient's discharge from the hospital.

 (b) Before discharge, a hospital shall provide a patient and the patient's designated caregiver with instruction and training as necessary for the designated caregiver to perform medical and nursing aftercare following discharge.




Sec. 18.20.520. Notification of discharge.
A hospital shall notify a patient's designated caregiver of the patient's discharge or transfer.


Sec. 18.20.530. Discharge policies.
 (a) A hospital shall adopt and maintain written discharge policies. The policies must comply with AS 18.20.500 18.20.590.

 (b) The discharge policies of a hospital must specify the requirements for documenting the identity of a patient's designated caregiver and the details of the discharge plan for the patient, including professional follow-up as specified in the discharge plan.

 (c) The discharge policies of a hospital may incorporate established evidence- based practices that include
     (1) standards for accreditation adopted by a nationally recognized hospital accreditation organization; or

     (2) the conditions of participation for hospitals adopted by the Centers for Medicare and Medicaid Services.

 (d) The discharge policies of a hospital must ensure that the discharge planning is appropriate to the condition of the patient, and the hospital shall interpret the discharge policies in a manner and as necessary to meet the needs and condition of the patient and the abilities of the patient's designated caregiver.

 (e) AS 18.20.500 18.20.590 do not require that a hospital adopt discharge policies that would
     (1) delay a patient's discharge or transfer to another facility; or

     (2) require the disclosure of protected health information without obtaining a patient's consent as required by state and federal laws governing health information privacy and security.




Sec. 18.20.540. Construction of provisions.
The provisions of AS 18.20.500 18.20.590 may not be construed to
     (1) create a right of action against a hospital, a hospital employee, or a contractor of the hospital, including a person who contracts with the hospital to provide instruction to a designated caregiver, based on an action performed or not performed under AS 18.20.500 18.20.590; or

     (2) replace, change, or otherwise affect rights or remedies that are provided under another provision of law, including common law.




Sec. 18.20.550. Coordination with other authority.
AS 18.20.500 18.20.590 may not be interpreted to interfere with the powers or duties of
     (1) an agent operating under a valid advance health care directive under AS 13.52; or

     (2) a legal guardian of the patient.




Sec. 18.20.590. Definitions.
In AS 18.20.500 18.20.590,
     (1) "aftercare" includes
          (A) assistance with the activities of daily living or activities that are instrumental to the activities of daily living;

          (B) wound care, medication administration, medical equipment operation, mobility assistance, and other medical or nursing tasks; and

          (C) other assistance related to the patient's condition at the time of discharge;

     (2) "designated caregiver" means a caregiver designated by the patient who agrees to provide aftercare to the patient in a private residence;

     (3) "discharge" means a patient's release from a hospital following the patient's admission to the hospital;

     (4) "hospital" has the meaning given in AS 18.20.130, but does not include a hospital that is limited to the treatment of mental disorders;

     (5) "private residence" does not include a rehabilitative facility, a hospital, a nursing home, an assisted living facility, a group home, or another licensed health care facility.




Article 1. Patient Records; Medical Review Organizations.
Chapter 23. Health Care Services Information and Review Organizations.
Sec. 18.23.005. Patient access to records.
Notwithstanding the provisions of AS 18.23.005 18.23.070 or any other law, a patient is entitled to inspect and copy any records developed or maintained by a health care provider or other person pertaining to the health care rendered to the patient.


Sec. 18.23.010. Limitation on liability for persons providing information to review organization.
 (a) A person providing information to a review organization is not subject to action for damages or other relief by reason of having furnished that information unless the information is false and the person providing the information knew or had reason to know the information was false.

 (b) A privilege of confidentiality arising from a physician-patient relationship may not be invoked to withhold pertinent information from review by a review organization.




Sec. 18.23.020. Limitation on liability for members of review organizations.
A person who is a member or employee of, or who acts in an advisory capacity to, or who furnishes counsel or services to a review organization is not liable for damages or other relief in an action brought by another whose activities have been or are being scrutinized or reviewed by a review organization, by reason of the performance of a duty, function, or activity of the review organization, unless the performance of the duty, function, or activity was motivated by malice toward the affected person. A person is not liable for damages or other relief in an action by reason of performance of a duty, function, or activity as a member of a review organization or by reason of a recommendation or action of the review organization when the person acts in the reasonable belief that the action or recommendation is warranted by facts known to the person or to the review organization after reasonable efforts to ascertain the facts upon which the review organization's action or recommendation is made.


Sec. 18.23.030. Confidentiality of records of review organization.
 (a) Except as provided in (b) of this section, all data and information acquired by a review organization in the exercise of its duties and functions shall be held in confidence and may not be disclosed to anyone except to the extent necessary to carry out the purposes of the review organization and is not subject to subpoena or discovery. Except as provided in (b) of this section, a person described in AS 18.23.020 may not disclose what transpired at a meeting of a review organization except to the extent necessary to carry out the purposes of a review organization, and the proceedings and records of a review organization are not subject to discovery or introduction into evidence in a civil action against a health care provider arising out of the matter that is the subject of consideration by the review organization. Information, documents, or records otherwise available from original sources are not immune from discovery or use in a civil action merely because they were presented during proceedings of a review organization, nor may a person who testified before a review organization or who is a member of it be prevented from testifying as to matters within the person's knowledge, but a witness may not be asked about the witness's testimony before a review organization or opinions formed by the witness as a result of its hearings, except as provided in (b) of this section.

 (b) Testimony, documents, proceedings, records, and other evidence adduced before a review organization that are otherwise inaccessible under this section may be obtained by a health care provider who claims that denial is unreasonable or may be obtained under subpoena or discovery proceedings brought by a plaintiff who claims that information provided to a review organization was false and claims that the person providing the information knew or had reason to know the information was false.

 (c) Nothing in AS 18.23.005 18.23.070 prevents a person whose conduct or competence has been reviewed under AS 18.23.005 18.23.070 from obtaining, for the purpose of appellate review of the action of the review organization, any testimony, documents, proceedings, records, and other evidence adduced before the review organization.

 (d) Notwithstanding the provisions of (b) and (c) of this section, information contained in a report submitted to the State Medical Board, and information gathered by the board during an investigation, under AS 08.64.336 is not subject to subpoena or discovery unless and until the board takes action to suspend, revoke, limit, or condition a license of the person who is the subject of the report or investigation.




Sec. 18.23.040. Penalty for violation.
Other than as authorized by AS 18.23.030, a disclosure of data and information acquired by a review committee or of what transpired at a review meeting is a misdemeanor and punishable by imprisonment for not more than one year or by a fine of not more than $500.


Sec. 18.23.050. Protection of patient.
Nothing in AS 18.23.005 18.23.070 relieves a person of liability that the person has incurred or may incur to a person as a result of furnishing health care to the patient.


Sec. 18.23.060. Parties bound by review.
When a review organization reviews matters under AS 18.23.070(5)(A)(viii) a party is not bound by a ruling of the organization in a controversy, dispute, or question unless the party agrees in advance, either specifically or generally, to be bound by the ruling.


Sec. 18.23.065. [Renumbered as AS 18.23.005.]
Sec. 18.23.070. Definitions for AS 18.23.005 18.23.070.
In AS 18.23.005 18.23.070, unless the context otherwise requires,
     (1) "administrative staff" means the staff of a hospital or clinic;

     (2) "health care" means professional services rendered by a health care provider or an employee of a health care provider, and services furnished by a sanatorium, rest home, nursing home, boarding home, or other institution for the hospitalization or care of human beings;

     (3) "health care provider" means an acupuncturist licensed under AS 08.06; a chiropractor licensed under AS 08.20; a dental hygienist licensed under AS 08.32; a dentist licensed under AS 08.36; a nurse licensed under AS 08.68; a dispensing optician licensed under AS 08.71; an optometrist licensed under AS 08.72; a pharmacist licensed under AS 08.80; a physical therapist or occupational therapist licensed under AS 08.84; a physician licensed under AS 08.64; a podiatrist; a psychologist and a psychological associate licensed under AS 08.86; a hospital as defined in AS 47.32.900, including a governmentally owned or operated hospital; and an employee of a health care provider acting within the course and scope of employment;

     (4) "professional service" means service rendered by a health care provider of the type the provider is licensed to render;

     (5) "review organization" means
          (A) a hospital governing body or a committee whose membership is limited to health care providers and administrative staff, except where otherwise provided for by state or federal law, and that is established by a hospital, by a clinic, by one or more state or local associations of health care providers, by an organization of health care providers from a particular area or medical institution, or by a professional standards review organization established under 42 U.S.C. 1320c-1, to gather and review information relating to the care and treatment of patients for the purposes of
               (i) evaluating and improving the quality of health care rendered in the area or medical institution;

               (ii) reducing morbidity or mortality;

               (iii) obtaining and disseminating statistics and information relative to the treatment and prevention of diseases, illness, and injuries;

               (iv) developing and publishing guidelines showing the norms of health care in the area or medical institution;

               (v) developing and publishing guidelines designed to keep the cost of health care within reasonable bounds;

               (vi) reviewing the quality or cost of health care services provided to enrollees of health maintenance organizations;

               (vii) acting as a professional standards review organization under 42 U.S.C. 1320c;

               (viii) reviewing, ruling on, or advising on controversies, disputes, or questions between a health insurance carrier or health maintenance organization and one or more of its insured or enrollees; between a professional licensing board, acting under its powers of discipline or license revocation or suspension, and a health care provider licensed by it when the matter is referred to a review organization by the professional licensing board; between a health care provider and the provider's patients concerning diagnosis, treatment, or care, or a charge or fee; between a health care provider and a health insurance carrier or health maintenance organization concerning a charge or fee for health care services provided to an insured or enrollee; or between a health care provider or the provider's patients and the federal or a state or local government, or an agency of the federal or a state or local government;

               (ix) acting on the recommendation of a credential review committee or a grievance committee;

          (B) the State Medical Board established by AS 08.64.010;

          (C) a committee established by the commissioner of health and social services and approved by the State Medical Board to review public health issues regarding morbidity or mortality; at least 75 percent of the committee members must be health care providers;

          (D) the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).




Article 2. Form of Medical Records.
Sec. 18.23.100. Use of electronic medical records.
A health care provider may maintain and preserve its medical records in an electronic format that protects the physical security of the records and protects the records from access by unauthorized persons. A health care provider who maintains and preserves the records in an electronic format that provides these protections is not required to maintain a separate paper copy. The Department of Health and Social Services may adopt regulations under AS 44.62 (Administrative Procedure Act) to regulate the implementation of this section.


Article 3. Electronic Health Information Exchange System.
Sec. 18.23.300. Creation of health information exchange system.
 (a) The department shall establish and implement a statewide electronic health information exchange system and ensure the interoperability and compliance of the system with state and federal specifications and protocols for exchanging health records and data.

 (b) The system established under this section must
     (1) include infrastructure planning that involves
          (A) the designation by the commissioner of a qualified entity or combination of qualified entities in the state that
               (i) has an advisory or governing body made up of health system stakeholders that include members identified under (d) of this section;

               (ii) applies for available federal and state funding for planning and implementation of the system authorized by the commissioner;

               (iii) submits an annual budget for approval of the commissioner;

               (iv) complies with nondiscrimination and conflict of interest policies;

               (v) meets and complies with federal and state health information policies and standards;

               (vi) provides cost and cost saving data associated with the development and use of the system to the department;

          (B) the development of statewide infrastructure to support the electronic health information exchange system established under this section and to connect electronic health records to the infrastructure;

          (C) the development of a statewide technology plan, with the participation of identified stakeholders, to promote the implementation and sustained use by public and private health care payors and providers of electronic health records and the system established under this section in order to ensure interoperability among government-operated health information systems and other public and private health information and reporting systems;

          (D) the development of policies and standards, consistent with federal and state law, to safeguard the privacy and security of health information;

          (E) the development of a training and workforce development plan for implementing and serving the system;

          (F) an estimate of costs of the hardware, software, services, and support needed to implement and maintain the technical infrastructure; and

     (2) include implementation measures that
          (A) provide for installation and training on the use of the system;

          (B) set out a plan to encourage health care provider, payor, and patient use of electronic records over a sustained period of time;

          (C) provide support to providers for workflow redesign, quality improvement, and care management services;

          (D) provide for participation by all identified stakeholders in the planning and implementation of the system;

          (E) comply with federal and state health information policies; and

          (F) provide for periodic evaluation and improvement of the system.

 (c) The department may enter into contracts, seek and accept available federal and private funds and equipment, and adopt regulations necessary to carry out the purposes of this section.

 (d) The designee under (b)(1)(A) of this section may be a private for-profit or nonprofit entity or entities under contract with the state. The advisory or governing body of the designee must include
     (1) the commissioner;

     (2) eight other individuals, each of whom represents one of the following interests:
          (A) hospitals and nursing home facilities;

          (B) private medical care providers;

          (C) community-based primary care providers;

          (D) federal health care providers;

          (E) Alaska tribal health organizations;

          (F) health insurers;

          (G) health care consumers;

          (H) employers or businesses; and

     (3) two nonvoting liaison members who shall serve to enhance communication and collaboration between the designee and both the Board of Regents of the University of Alaska and the commission established in the governor's office to review health care policy.




Sec. 18.23.305. Department; duties.
In carrying out its duties under AS 18.23.300, the department shall
     (1) in accordance with federal recommendations, determine the manner in which the system is developed and operated;

     (2) provide oversight and technical assistance needed for planning and implementing the system;

     (3) authorize and facilitate applications for available federal funding for planning and implementing the system;

     (4) ensure compliance with applicable federal and state health information policies and standards;

     (5) ensure compliance with federal and state law and standards that safeguard the privacy and security of health information;

     (6) ensure that the health information exchange system becomes self-sustaining through a combination of user fees and other private and public funding sources.




Sec. 18.23.310. Confidentiality and security of information.
 (a) The department shall establish appropriate security standards to protect the transmission and receipt of individually identifiable information contained in the system established under AS 18.23.300. The standards must
     (1) include controls over access to and collection, organization, and maintenance of records and data that protect the confidentiality of the individual who is the subject of a health record;

     (2) include a secure and traceable electronic audit system for identifying access points and trails;

     (3) meet the most stringent applicable federal or state privacy law governing the protection of the information contained in the system.

 (b) A person may not release or publish individually identifying health information from the system for purposes unrelated to the treatment or billing of the patient who is the subject of the information. Use or distribution of the information for a marketing purpose is strictly prohibited.

 (c) The department shall establish procedures for a patient who is the subject of a health record contained in the system
     (1) to opt out of the system;

     (2) to consent to the distribution of the patient's records contained in the system;

     (3) to be notified of a violation of the confidentiality provisions required under this section;

     (4) on request to the department, to view an audit report created under this section for the purpose of monitoring access to the patient's records.




Sec. 18.23.315. Health information exchange system report to the legislature.
The department shall provide to the legislature, on or before December 31 of each year, an annual report on the progress of the health information exchange system in the state, including a specific set of recommendations for long-term participation and financial support by the state.


Sec. 18.23.320. Contract conditions.
A contract entered into to carry out the purposes of AS 18.23.300 must require that the contractor meet applicable federal and state requirements for protecting health information privacy and security and nationally recognized standards for interoperability of health information technology.


Sec. 18.23.325. Definitions.
In AS 18.23.300 18.23.325,
     (1) "commissioner" means the commissioner of health and social services;

     (2) "department" means the Department of Health and Social Services;

     (3) "system" means the statewide electronic health information exchange system established under AS 18.23.300.




Article 4. Health Care Services and Price Information.
Sec. 18.23.400. Disclosure and reporting of health care services, price, and fee information.
 (a) A health care provider shall annually compile a list, including a brief description in plain language that an individual with no medical training can understand, of the 10 health care services most commonly performed by the health care provider in the state in the previous calendar year from each of the six sections of Category I, Current Procedural Terminology, adopted by the American Medical Association and, for each of those services, state
     (1) the procedure code;

     (2) the undiscounted price; and

     (3) any facility fees.

 (b) A health care facility in the state shall annually compile a list, including a brief description in plain language that an individual with no medical training can understand, of the 10 health care services most commonly performed at the health care facility in the previous calendar year from each of the six sections of Category I, Current Procedural Terminology, adopted by the American Medical Association and, for each of those services, state
     (1) the procedure code;

     (2) the undiscounted price; and

     (3) any facility fees.

 (c) If, in the annual reporting period under this section, fewer than the number of health care services described under (a) or (b) of this section are performed by a health care provider or at a health care facility in the state, the provider or facility shall include in the list required under this section all of the health care services performed by the provider or at the facility from each of the six sections described under (a) or (b) of this section.

 (d) A health care provider who provides health care services at a health care facility in a group practice is not required to compile and publish a list under (a) and (e) of this section if
     (1) the health care facility where the provider is in a group practice compiles and publishes a list in compliance with (b) and (e) of this section; and

     (2) the prices and fees that the provider charges are reflected in the list compiled and published by the health care facility.

 (e) A health care provider and health care facility shall publish the lists compiled under (a) and (b) of this section by January 31 each year
     (1) by providing the list to the department for entry in the department's database under AS 18.15.360 along with the name and location of the health care provider or health care facility;

     (2) by posting a copy of the list
          (A) in a font not smaller than 20 points;

          (B) in a conspicuous public reception area at the health care provider's office or health care facility where the services are performed;

          (C) that includes the address for the department's Internet website;

          (D) that may include a statement explaining that the undiscounted price may be higher or lower than the amount an individual actually pays for the health care services described in the list;

          (E) that includes a statement substantially similar to the following: "You will be provided with an estimate of the anticipated charges for your nonemergency care upon request. Please do not hesitate to ask for information."; and

          (F) that lists any health care insurers with which the health care provider or health care facility has a contract to provide health care services as an in-network preferred provider; and

     (3) if the health care provider or health care facility has an Internet website, by posting the list on the website.

 (f) The department shall annually compile the lists provided under (a) and (b) of this section by health care service and, where relevant, health care provider and health care facility name and location, post the information on the department's Internet website, and enter the information in the database maintained under AS 18.15.360.

 (g) If a patient who is receiving nonemergency health care services requests an estimate from a health care provider, health care facility, or health care insurer of the reasonably anticipated charges for treating the patient's specific condition, the health care provider, health care facility, or health care insurer
     (1) shall provide a good faith estimate before the nonemergency health care services are provided and not later than 10 business days after receiving the request;

     (2) shall provide the estimate in whichever of the following formats the patient requests: orally, in writing, or by electronic means; if the estimate is provided orally, the health care provider, health care facility, or health care insurer shall keep a record of the estimate;

     (3) is not required to disclose the charges for the total anticipated course of treatment for the patient, but if the estimate does not include charges for the total anticipated course of treatment, the estimate must include a statement explaining that the estimate only includes charges for a portion of the total anticipated course of treatment; and

     (4) may provide an estimate that includes a reasonable range of charges for anticipated health care services if the charges for the services will vary significantly in response to conditions that the health care provider, health care facility, or health care insurer cannot reasonably assess before the services are provided.

 (h) A good faith estimate provided by a health care provider or health care facility under (g) of this section must include
     (1) a brief description in plain language that an individual with no medical training can understand of the health care services, products, procedures, and supplies that are included in the estimate;

     (2) a notice disclosing the health care provider's or health care facility's in-network or out-of-network status that is substantially similar to one of the following forms:
          (A) "(Name of health care provider or health care facility) is a contracted, in-network preferred provider for ONLY the following plan networks: (list each network or state 'NONE. YOU MAY INCUR OUT-OF-NETWORK CHARGES.')"

          (B) "(Name of health care provider or health care facility) is a contracted, in-network preferred provider for your insurance plan."; or

          (C) "(Name of health care provider or health care facility) is NOT a contracted, in-network preferred provider for your insurance plan. YOU MAY INCUR OUT-OF-NETWORK CHARGES.";

     (3) the procedure code for each health care service included in the estimate;

     (4) any facility fees, along with an explanation of the facility fees; and

     (5) the identity, or suspected identity, of any other person that may charge the patient for a service, product, procedure, or supply in connection with the health care services included in the estimate, along with an explanation of whether the charges are included in the estimate.

 (i) A health care provider or health care facility that provides a good faith estimate to a patient under (g) and (h) of this section or a health care insurer that provides a good faith estimate to a patient under (g) of this section is not liable for damages or other relief if the estimate differs from the amount actually charged to the patient.

 (j) The requirement for a health care facility to provide a good faith estimate of reasonably anticipated charges for nonemergency health care services under (e)(2)(E), (g), and (h) of this section does not apply to a health care facility that is an emergency department.

 (k) A health care provider or a health care facility that fails to comply with the requirements of (a) (e), (g), or (h) of this section or a health care insurer that fails to comply with the requirements of (g) of this section is liable for a civil penalty not to exceed $10,000 for each violation. The department may impose a penalty
     (1) for failure to comply with (a) (e) of this section of not more than $100 for each day of noncompliance after March 31; or

     (2) for failure to provide a good faith estimate under (g) or (h) of this section of not more than $100 for each day of noncompliance.

 (l) A health care provider, health care facility, or health care insurer penalized under (k) of this section is entitled to a hearing conducted by the office of administrative hearings under AS 44.64.

 (m) A municipality may not enact or enforce an ordinance that is inconsistent with or imposes health care price or fee disclosure requirements in addition to the requirements under this section or regulations adopted under this section.

 (n) In this section,
     (1) "department" means the Department of Health and Social Services;

     (2) "facility fee" means a charge or fee billed by a health care provider or health care facility that is in addition to fees billed for a health care provider's professional services and is intended to cover building, electronic medical records system, billing, and other administrative and operational expenses;

     (3) "health care facility" means a private, municipal, or state hospital, psychiatric hospital, emergency department, independent diagnostic testing facility, residential psychiatric treatment center as defined in AS 47.32.900, kidney disease treatment center (including freestanding hemodialysis units), office of a private physician or dentist whether in individual or group practice, ambulatory surgical center as defined in AS 47.32.900, freestanding birth center as defined in AS 47.32.900, and rural health clinic as defined in AS 47.32.900; "health care facility" does not include
          (A) the Alaska Pioneers' Home and the Alaska Veterans' Home administered by the department under AS 47.55;

          (B) an assisted living home as defined in AS 47.33.990;

          (C) a nursing facility licensed by the department to provide long-term care;

          (D) a facility operated by an Alaska tribal health organization; and

          (E) a hospital operated by the United States Department of Veterans Affairs or the United States Department of Defense, or any other federally operated hospital or institution;

     (4) "health care insurer" has the meaning given in AS 21.54.500;

     (5) "health care provider" means an individual licensed, certified, or otherwise authorized or permitted by law to provide health care services in the ordinary course of business or practice of a profession;

     (6) "health care service" means a service or procedure provided in person or remotely by telemedicine or other means by a health care provider or at a health care facility for the purpose of or incidental to the care, prevention, or treatment of a physical or mental illness or injury;

     (7) "nonemergency health care service" means a health care service other than a health care service that is immediately necessary to prevent the death or serious impairment of the health of the patient;

     (8) "patient" means an individual to whom health care services are provided in the state by a health care provider or at a health care facility;

     (9) "third party" means a public or private entity, association, or organization that provides, by contract, agreement, or other arrangement, insurance, payment, price discount, or other benefit for all or a portion of the cost of health care services provided to a recipient; "third party" does not include a member of the recipient's immediate family;

     (10) "undiscounted price" means an amount billed for a service rendered without complications or exceptional circumstances; "undiscounted price" does not include a negotiated discount for an in-network or out-of-network service rendered or the cost paid by a third party for that service.




Article 1. Construction and Equipment Aid to Nonprofit Hospitals.
Chapter 25. Assistance to Hospitals and Health Facilities.
Sec. 18.25.010. Department to render aid.
The department may facilitate the purchase, construction, and repair of, and obtain necessary equipment for, nonprofit hospitals operated by municipalities, communities, and associations in the state.


Sec. 18.25.020. Determination of necessity.
The department shall initiate appropriate action under AS 18.25.010 18.25.030 when it determines which projects are of most immediate necessity, and shall allot money to the municipalities, communities, and associations on a matching basis, or in accordance with their financial ability and urgency of the need.


Sec. 18.25.030. Intent.
It is the intent of AS 18.25.010 18.25.030 to provide financial aid to municipalities, communities, and associations for which an attempt at complete financing by themselves of a necessary project would entail great hardship. It is also intended that the department utilize the money authorized under AS 18.25.010 18.25.030 so far as can be arranged to assist the municipalities, communities, and associations in matching funds with the federal government under applicable federal law for hospital assistance.


Article 2. Aid for Operation Deficits of Community Operated Nonprofit Hospitals and Clinics.
Sec. 18.25.040. Department to render aid.
The department may assist in cases of operational deficits of community operated nonprofit hospitals and clinics in the state.


Sec. 18.25.050. Determination of necessity.
The department shall initiate appropriate action in accordance with the provisions of AS 18.25.040 18.25.060 as soon as the department determines which projects are of most immediate necessity.


Sec. 18.25.060. Intent.
It is the intent of AS 18.25.040 18.25.060 to provide financial aid, or funds to match available federal funds to aid localities or municipalities whose taxable values are limited in scope and for whom an attempt at community financing of a community operated nonprofit hospital or clinic would entail insurmountable hardship.


Article 3. Assistance for Community Health Facilities.
Sec. 18.25.070. Department to render assistance.
The department may assist in the purchase, construction, repair, and equipping of facilities to improve and protect community health, and may provide financial assistance for the operation of the facilities in case of operational deficits.


Sec. 18.25.080. Intent and purpose.
It is the intent of AS 18.25.070 18.25.110 to assist communities and areas in developing and improving health service facilities by the purchase, construction, renovation, or establishment of hospitals, health centers, or clinics, or quarters for personnel, and the purchase of furnishings, supplies, and equipment and making the other expenditures necessary to carry out the purpose of AS 18.25.070 18.25.110. Assistance is to be given in areas that would otherwise be denied adequate facilities, because the taxable values are limited in scope and an attempt at total community financing of a project would cause hardship or prevent its realization. It is also intended that the department utilize the money authorized under AS 18.25.070 18.25.110 so far as can be arranged to assist municipalities in matching funds with the federal government under federal law.


Sec. 18.25.090. Use of purchases.
Purchases under AS 18.25.070 18.25.110 are to be used for the purpose for which appropriated and when the purpose is discontinued the items shall be returned to the department for use elsewhere.


Sec. 18.25.100. Regulations authorized.
The department shall adopt regulations for
     (1) the establishment of criteria, minimum requirements, and standards for assistance to communities under AS 18.25.070 18.25.110;

     (2) the establishment of the fiscal and accounting procedures and controls considered necessary for the payment of grants;

     (3) the compilation of data and information from the communities concerned that will support the need for assistance under AS 18.25.070 18.25.110;

     (4) the establishment of procedures by which communities may apply for assistance;

     (5) accepting financial or other assistance from the federal government under federal law to carry out the purpose of AS 18.25.070 18.25.110 through matching funds or grants;

     (6) cooperation and coordination with other state boards, departments, or agencies engaged in construction programs in areas applying for assistance under AS 18.25.070 18.25.110.




Sec. 18.25.110. Report of grants made.
Within 10 days of the convening of each legislative session, the department shall have completed a report of grants made under AS 18.25.070 18.25.110 and notified the legislature that the report is available.


Article 4. General Provisions.
Sec. 18.25.120. Definitions.
In this chapter, "department" means the Department of Health and Social Services.


Chapter 26. Alaska Medical Facility Authority.
Sec. 18.26.010. Legislative finding and policy.
 (a) The legislature finds that
     (1) there exist inadequate medical care and medical facilities in certain localities of the state, and in other localities medical care is not available and medical facilities do not exist at all;

     (2) construction funding under 42 U.S.C. 291-291z (Title VI, Public Health Service Act) and 42 U.S.C. 2661-2698(b) (P.L. 88-164, Community Mental Health Centers Construction Act of 1963) has not been forthcoming to the degree necessary, either alone or when combined with state or local funds, to ameliorate the state's need for medical care and medical facilities; and

     (3) it is essential that the people of this state have adequate medical care and medical facilities at a reasonable cost.

 (b) It is declared to be the policy of the state, in the interests of promoting the health and general welfare of all of its people, to provide acceptable alternative means of financing the constructing and equipping of needed medical facilities that, in number, size, type, distribution, operation, and services, are consistent with the orderly and economic development of medical facilities and services, are in the public interest, avoid unnecessary duplication of medical facilities and services, are economical in the use of health personnel, and will assure admission and care of high quality to all who need it. The legislature finds that this policy will be implemented by creating a public corporation called the Alaska Medical Facility Authority, with powers, duties, and functions as provided in this chapter.




Sec. 18.26.020. Creation of authority.
There is created the Alaska Medical Facility Authority the sole purpose of which is to provide and finance medical facilities for the benefit of the people of the state. The authority is a public corporation and an instrumentality of the state within the Department of Revenue, but with a separate and independent legal existence.


Sec. 18.26.030. Board of directors of the authority.
 (a) The authority shall be managed and controlled by a seven-person board of directors, who serve at the pleasure of the governor, consisting of
     (1) the commissioner of revenue, who shall also chair the board;

     (2) the commissioner of health and social services;

     (3) the commissioner of commerce, community, and economic development;

     (4) four public members, appointed by the governor.

 (b) The four public members appointed under (a)(4) of this section serve for staggered four-year terms. Each must be a resident of the state and a qualified voter at the time of appointment and shall comply with the requirements of AS 39.50 (public official financial disclosure). Each member shall hold office for the term of the appointment and until a successor has been appointed and qualified. A member is eligible for reappointment. A vacancy on the board of directors occurring other than by expiration of term shall be filled in the same manner as the original appointment but for the unexpired term only. Each member of the board, before entering upon the duties of office, shall take and subscribe to an oath to perform the duties of office faithfully, impartially, and justly to the best of the member's ability. A record of the oath shall be filed in the Office of the Governor.

 (c) If any commissioner is unable for any reason to attend a meeting of the authority, the commissioner may, by an instrument filed with the board and incorporated into the minutes of the meeting, designate another person within the commissioner's department to serve as a member at that meeting. For purposes of this chapter, an acting commissioner is a member of the board until a commissioner assumes office.




Sec. 18.26.040. Meetings, compensation, officers, and expenses.
 (a) Four members of the board constitute a quorum for the transaction of business or the exercise of a power or function at a meeting of the board. All decisions of the board shall be initiated by motion or resolution, and the vote and decision shall be recorded in the board's minute book, which is a public record. The affirmative votes of not less than two of the public members and two commissioners are required for the passage of any motion or resolution. Notice of all meetings shall be given in accordance with regulations adopted by the board. All meetings of the board shall be open to the public, except that the board may convene in executive session in the manner provided in AS 44.62.310(b) to consider subject matter under AS 44.62.310(c).

 (b) Members of the board serve without salary but each member is entitled to reimbursement from authority funds for actual and necessary expenses incurred in the performance of official duties as a member of the board. An officer or employee of the state need not forfeit office or employment or any benefits by reason of acceptance to the office of director of the authority.

 (c) The board may appoint an executive director who serves at its pleasure and may appoint and employ other persons or officers it considers advisable, including but not limited to professional advisors, architects, technical experts, agents, and support personnel. The attorney general is the legal counsel for the authority. The executive director, if any, is responsible for keeping records of all meetings of the board and is custodian of all books, documents, and papers filed with the board, the minute book, and journals. In the absence of an executive director, the board shall designate one member of the board to fulfill the duties mentioned in this subsection. The person responsible for those duties may cause copies to be made of all minutes, records, and documents of the board and may give certificates of the authority to the effect that those copies are true copies and all persons dealing with the authority may rely on those certificates.




Sec. 18.26.050. Powers of authority.
The authority has all powers necessary to carry out the purposes of this chapter including, but not limited to, the following:
     (1) to sue and be sued in its own name;

     (2) to adopt a seal and alter it at pleasure;

     (3) to adopt, amend, and repeal bylaws for its organization, management of its internal affairs, and the conduct of its business consistent with the provisions of this chapter;

     (4) to adopt regulations, in accordance with AS 44.62 (Administrative Procedure Act), governing the exercise of its corporate powers;

     (5) to acquire by purchase, construction, exchange, gift, lease, or otherwise, real or personal property, rights, rights-of-way, franchises, easements, and other interests in land, including land lying under water and riparian rights that are located in the state, taking title to it in the name of the authority;

     (6) to accept gifts, grants, or loans from, and enter into contracts or other transactions regarding them with, a federal agency or an agency or instrumentality of the state, a municipality, private organization, or other source;

     (7) to provide the financing incidental to purchasing, constructing, improving, extending, and equipping medical facilities in the state;

     (8) to lease to any political subdivision of the state or nonprofit corporation medical facilities upon terms and conditions the board considers appropriate, and to terminate any such lease upon default of the lessee;

     (9) to enter into options and agreements for the renewal or extension of leases of medical facilities leased under (8) of this section or for the conveyance or options to convey, including renewals, of those medical facilities;

     (10) to sell, exchange, donate, convey, pledge, or otherwise encumber in any manner by mortgage or by creation of any other security interest, real or personal property owned by it, or in which it has an interest, to pledge the revenue and receipts from these assets, and to arrange and provide for guarantees and other security agreements when, in the judgment of the authority, the action is in furtherance of its corporate purposes;

     (11) to issue notes and revenue bonds in amounts considered necessary by the authority to pay the cost of establishing and equipping medical facilities and to secure payment of the notes and revenue bonds as provided in this chapter;

     (12) to deposit or otherwise invest its funds, subject to agreements with bondholders, in any property or securities in which banks or trust companies may legally invest, so long as no member of the board of directors or its executive director has any personal interest, either directly or indirectly, in any such depository or investment entity and the funds are held in reserves or sinking funds, if those deposited or invested funds are not required for reasonably foreseeable disbursement;

     (13) to arrange or contract for services, privileges, works, facilities, or management and operation of a medical facility;

     (14) to fix and revise, from time to time, and to charge and collect rates, rents, fees, and charges for the use of and services furnished or to be furnished by a medical facility for which financing or financial assistance is provided under this chapter;

     (15) to insure any real or personal property or operations of the authority against any risks or hazards;

     (16) to purchase its bonds at a price not more than the principal amount of them plus accrued interest; all bonds so purchased must be cancelled;

     (17) to maintain an office at places it may designate;

     (18) to make mortgage loans or other secured loans to a medical facility, to refund or refinance outstanding obligations, mortgages, or advances issued, made, or given by the medical facility for the costs of its facilities, including the issuance of bonds and the making of loans to a medical facility, when the authority finds that such financing is in the public interest and alleviates the financial hardship upon the medical facility, is in connection with other financing by the authority for the medical facility, or may be expected to result in a lower cost of patient care and a saving to third parties, including the state or the federal government, and to others who must pay for the health care, or any combination of those factors;

     (19) to obtain, or aid in obtaining, from any department or agency of the United States or of this state or any private company, any insurance or guarantee as to, or of, or for the payment or repayment of interest or principal, or both, or any part of interest or principal on any loan, lease, or obligation, or any instrument evidencing or securing a loan, lease, or obligation entered into under this chapter; and, notwithstanding any other provisions of this chapter, to enter into any agreement, contract, or any other instrument whatsoever with respect to any such insurance or guarantee, to accept payment in the manner and form provided in it in the event of default by a medical facility, and to assign any such insurance or guarantee as security for the authority's bonds.




Sec. 18.26.060. Operation and management of medical facilities.
 (a) The authority may not maintain or operate any medical facility. However, if the operator of a medical facility or trustee under a trust agreement defaults under any material provisions of the contractual documents, the authority may operate and maintain the medical facility on an interim basis for a limited period of time as is necessary to recruit another knowledgeable and competent operator or trustee.

 (b) All references to the maintenance or operation of a medical facility within this chapter must be strictly construed as subject to the limitation of (a) of this section and are not expansions of, additions to, or in any other manner an amplification of the restrictive intent and language of (a) of this section.




Sec. 18.26.070. Expenses of authority.
All expenses of the authority incurred in carrying out the provisions of this chapter are payable solely from funds provided under this chapter, and liability may not be incurred by the authority beyond the extent to which money has been provided under this chapter. However, for the purposes of meeting the necessary expenses of initial organization and operation of the authority for the period commencing on July 9, 1978, and continuing until the authority derives money from funds provided to it under this chapter, the authority may borrow the money it requires and may repay it, with appropriate interest, over a reasonable period of time. A liability incurred under this section is a liability of the authority only, and not a liability of the state.


Sec. 18.26.080. Bonds of the authority; court jurisdiction.
 (a) The authority may borrow money and may issue bonds for it, payable from the revenue derived by it from its interest in any one or more medical facilities or from its income and receipts or other assets generally, or a designated part of them. The issuance of revenue bonds is governed by the provisions of this chapter and is not subject to the prior approval of the voters of the state. Revenue bonds, whether coupon or fully registered, are negotiable instruments for all purposes of the Uniform Commercial Code.

 (b) The authority shall issue revenue bonds only by resolution adopted by its board after finding that
     (1) the lessee or operator of the medical facility is financially responsible and competent to operate the facility, and the lease or operation contract has been approved by the authority and the lessee or operator;

     (2) financing the medical facility will be advantageous to the public welfare of the state and the community in which the medical facility is or is to be located; and

     (3) the medical facility to be constructed will comply with all applicable ordinances of the municipality.

 (c) The resolution adopted in (b) of this section shall also specify the public purpose for which the proceeds of the revenue bonds must be expended and declare the projected cost of carrying out that purpose.

 (d) The bonds may be issued as serial bonds, as term bonds, or bonds of both types. The authorizing bond resolution shall state the maturity date which may not exceed 40 years from the bond's date of issue, the rate of interest, the time of payment, the denomination, whether coupon or fully registered, whether transferable, exchangeable, or interchangeable, the registration and conversion privileges, if any, the covenant that payments are to be only in lawful money of the United States of America at the place the board authorizes, and the terms of redemption, if any. The bonds, notes, or attached interest coupons must be executed by manual or facsimile signatures of the officers of the authority designated by the board. Pending preparation of the definitive bonds, the authority may issue interim receipts or certificates which shall be exchanged for the definitive bonds.

 (e) The bond resolution shall provide for the establishment of one or more special funds, and those funds may be under the control of the board or one or more trustees. The bond resolution shall obligate the authority to deposit and expend the proceeds of the revenue bonds only into and from those funds. The authority may issue and sell revenue bonds payable as to interest and principal only out of those funds.

 (f) All bonds may be sold at public or private sale in the manner, at the time, and for the price determined by the authority.

 (g) Before the issuance of any bonds, the authority shall verify that the lease or operator agreement for the medical facility being financed by that issue is at least sufficient, in the judgment of the authority,
     (1) to pay the principal of and interest on the bonds as they become due;

     (2) to create and maintain the reserves for them as the authority considers necessary or desirable; and

     (3) to meet all obligations in connection with the lease or operator agreement, including all costs necessary to service the bonds.

 (h) Bonds of the authority may be secured by a pooling of leases by which the authority may assign its rights and pledge rents under two or more leases of medical facilities, upon terms that may be provided for in bond resolutions of the authority.

 (i) Any bond resolution may contain provisions, which constitute a part of the contract with the holders of the bonds, as to
     (1) the rentals, fees, and other amounts to be charged, and the sums to be raised in each year by them, and the use, investment, and disposition of those sums;

     (2) the setting aside of reserves or sinking funds, and the regulation, investment, and disposition of them;

     (3) limitations on the use of the medical facility;

     (4) limitations on the issuance of additional bonds, the terms upon which additional bonds may be issued and secured, the terms upon which additional bonds may rank on a parity with, or be subordinate or superior to, other bonds;

     (5) the refunding of outstanding bonds;

     (6) the procedure, if any, by which the terms of any contract with bondholders may be amended or abrogated;

     (7) any matters relating to the bonds that the authority considers desirable.

 (j) The authority may contract for the future sale of revenue bonds by which contract purchasers shall be committed to the prices, terms, and conditions stated in each contract. The authority may pay the consideration it considers proper for those commitments.

 (k) The superior court has jurisdiction to hear and determine actions or proceedings relating to the authority, including actions or proceedings brought to foreclose or otherwise enforce a mortgage, pledge, assignment, or security interest or brought by or for the benefit or security of a holder of its bonds or by a trustee for or other representative of the holders.




Sec. 18.26.090. Bond anticipation notes.
The authority may issue and sell bond anticipation notes which shall be on the terms, bear the date, mature at the time, be in the denomination and in the form, payable in the medium at the place and subject to the terms of redemption as the authority considers necessary or advisable in the manner provided in this chapter.


Sec. 18.26.100. Trust indentures and trust agreements.
In the discretion of the authority, an issue of bonds may be secured by a trust indenture, trust agreement, indenture of mortgage or deeds of trust (all considered "trust agreements" in this chapter) between the authority and a corporate trustee. The corporate trustee may be a trust company, bank, or national banking association, with corporate trust powers, located inside or outside the state or by a secured loan agreement or other instrument or under a resolution giving powers to a corporate trustee by means of which the authority may
     (1) make any covenants and agreements with the trustee or the holders of the bonds that the authority determines to be necessary or desirable, including, without limitation, covenants and agreements as to
          (A) the application, investment, deposit, use, and disposition of the proceeds of bonds of the authority or of money or other property of the authority or in which it has an interest;

          (B) the fixing and collection of rent or other consideration for, and the other terms to be incorporated in a lease or contract of sale of, a project;

          (C) the assignment by the authority of its rights in the lease or contract of sale of a project or in a mortgage or other security interest created with respect to a project to a trustee for the benefit of bondholders;

          (D) the terms and conditions upon which additional bonds of the authority may be issued;

          (E) the vesting in a trustee of rights, powers, duties, funds, or property in trust for the benefit of bondholders, including, without limitation, the right to enforce payment, performance, and all other rights of the authority or of the bondholders, under a lease, contract of sale, mortgage, security agreement, or trust agreement with respect to a project by injunction or other proceeding or by taking possession of by agent or otherwise and operating a project and collecting rent or other consideration and applying it in accordance with the trust agreement;

     (2) pledge, mortgage, or assign money, leases, agreements, property, or other assets of the authority either presently in hand or to be received in the future, or both; and

     (3) provide for any other matters of like or different character that in any way affect the security or protection of the bonds.




Sec. 18.26.110. Liability for issuance.
Neither the members of the authority nor any person executing the bonds is liable personally on the bonds or is subject to any personal liability or accountability by reason of the issuance of them.


Sec. 18.26.120. Bondholder claims against special funds.
Any notes or revenue bonds issued against any special funds provided for in this chapter are a valid claim of the holder of them only as against those special funds in the proportion or amount of the revenue pledged to the funds and other authority assets the board may have pledged. All notes or revenue bonds payable from a special fund shall, on the face of the note or revenue bond, name the fund and the resolution creating them.


Sec. 18.26.130. Conflict of interests.
 (a) A member of the board may not vote on a resolution of the board relating to a lease or contract to be entered into by the authority under this chapter if the member is a party to the lease or contract or has a direct ownership or equity interest in a firm, partnership, corporation, or association that would be a party to the contract or lease.

 (b) It is a conflict of interests for any person employed by the authority or any person on contract for hire, written or oral, at a fixed or hourly fee with the authority, to act in an advisory capacity to the authority or to support the use of the authority's funds in a manner that may or will result in benefit, directly or indirectly, to that employee, agent, or advisor, except upon full disclosure in writing and by oral presentation to the board of the details of the conflicting interest, including a dollar estimate of the direct and indirect monetary gain the employee, agent, or advisor may expect to derive. The board's resolution that addresses the matter in which a conflict of interests exists must set out the details of the full disclosure.

 (c) Any person who violates this section shall be
     (1) punished by a fine equivalent to the total gain derived, including gain derived from a partially disclosed or misstated disclosure of monetary gain;

     (2) barred from further acting as an employee, agent, or advisor to the authority; and

     (3) imprisoned for a term not less than three months nor more than one year.

 (d) Public notice of the board meeting at which the written and oral disclosure of the conflict is to be given must specify
     (1) a conflict-of-interests presentation is to be made at that meeting;

     (2) the name of the person making the disclosure; and

     (3) the position or title of the person so disclosing.




Sec. 18.26.140. Pledge of revenue.
A pledge of revenue or other money, obligations, or assets by the authority is binding from the time the pledge is made as against any parties having subsequent claims in tort, contract, or otherwise, irrespective of whether those parties have actual notice of the prior pledge. The pledge must be noted in the board's minute book and is constructive notice to all parties. Neither the resolution nor other instrument by which a pledge is created need be otherwise recorded, nor is the filing of any financing statement under the Uniform Commercial Code or other law required to perfect the pledge. Revenue, rent, or other money, obligations, or assets so pledged and later received by the authority are immediately subject to the lien of the pledge without any physical delivery or further act.


Sec. 18.26.150. Obligations and income of authority.
 (a) Notes or revenue bonds issued under the provisions of this chapter are not, either directly, indirectly, or contingently, an obligation, a pledge of the faith and credit of, or a charge upon any revenue or funds of the state or of any political subdivision of the state but are payable solely from the funds of the authority. The issuance of notes or revenue bonds under this chapter does not, directly, indirectly, or contingently, obligate the state or any political subdivision of the state to levy any form of taxation or to make any appropriation for their payment. Nothing in this section prevents the authority from pledging its faith and credit or the faith and credit of a medical facility to the payment of bonds authorized under this chapter.

 (b) The funds, income, or receipts of the authority do not constitute money of the state, nor is real property in which the authority has an interest considered land owned in fee by the state or to which the state may become entitled or in any way land belonging to the state, or state land referred to in art. VIII of the Alaska Constitution.




Sec. 18.26.160. Rights of bondholders.
A holder of notes or revenue bonds issued under this chapter or a trustee under a trust agreement entered into under this chapter may, except to the extent the holder's rights are restricted by the bond resolution, by any suitable form of legal proceedings, protect and enforce any rights under the laws of this state or granted by the bond resolution. Those rights include (1) the right to compel the performance of all duties of the authority required by this chapter or the bond resolution; (2) the right to enjoin unlawful activities; and (3) in the event of default (A) with respect to the payment of any principal of, or premium, if any, or interest on, any bond, or (B) in the performance of any covenant or agreement on the part of the authority in the bond resolution, the right to apply to a court having jurisdiction of the cause to appoint a receiver to administer and operate the medical facility. The receiver may pay principal of, and premiums, if any, and interest on those bonds, and has the powers, subject to the direction of the court, that are permitted by law and are accorded receivers in general equity cases. However, the receiver may not pledge additional revenue of the authority to the payment of that principal, premium, and interest.


Sec. 18.26.170. Investments by authority.
Except as otherwise provided by this chapter, the authority may invest any funds, not needed to meet current cash expenditure needs, as set out in AS 37.10.071.


Sec. 18.26.180. Bonds as securities.
Revenue bonds of the authority are securities in which the following may legally invest any funds belonging to them or within their control: all public officers and agencies of the state and of municipal corporations, officers, boards of directors and trustees of banks, trust companies, savings banks, and institutions, building and loan associations, savings and loan associations, investment companies, insurance companies and associations, all executors, administrators, guardians, trustees, and other fiduciaries.


Sec. 18.26.190. Pledge of the state.
The State of Alaska pledges to and agrees with the holders of any obligations issued under this chapter, and with those parties who may enter into contracts with the authority under this chapter, that the state will not limit or alter the rights vested in the authority by this chapter with respect to outstanding obligations until those obligations, together with the interest on them, are fully met and discharged and those contracts are fully performed on the part of the authority. However, nothing in this section precludes such a limitation or alteration if adequate provision is made by law for the protection of the holders of those obligations of the authority or persons entering into those contracts with the authority.


Sec. 18.26.200. Accounting and reports.
The authority shall keep an accurate account of all of its activities and of all of its receipts and expenditures and shall biennially, no later than the 10th day of the first regular session of each legislature, make a report of them to the governor, copies of which shall also be made available to bondholders or parties holding a secured interest in the assets of the authority. The authority shall notify the legislature that the report is available. The governor may investigate the affairs of the authority, may examine the property and records of the authority, and may prescribe methods of accounting and the rendering of periodical reports in relation to projects undertaken by the authority.


Sec. 18.26.210. State requirements.
A medical facility that has been monetarily supported, in any manner whatsoever, by the authority is subject to any state requirements relating to public buildings, structures, grounds, works, or improvements, any requirement of competitive bidding or other restriction imposed on the procedure for award of contracts, or the lease, sale, or other disposition of property of the authority.


Sec. 18.26.220. Facility compliance with health and safety laws and licensing requirements.
A medical facility constructed, acquired, improved, financed, or otherwise under the provisions of this chapter and all actions of the authority are subject to AS 18.07, AS 47.32, and any other present or future state licensing requirements for the facilities or services provided under this chapter. A medical facility issued a certificate of need under sec. 4, ch. 275, SLA 1976, by virtue of being in existence or under construction before July 1, 1976, must fully meet the requirements of AS 18.07 in order to be eligible for funding under this chapter.


Sec. 18.26.230. Authority as a public body; tax status of assets, income and bonds.
 (a) The authority, all assets at any time owned by it, the income from those assets, and all bonds issued by the authority, together with the coupons applicable to them, and the income from them, are exempt from all taxation and special assessments in this state except for gift, inheritance, and estate taxes. However, real property and personal property owned by the authority and leased to a third party is subject to property taxation if that property would be subject to taxation if owned by the lessee of it.

 (b) [Repealed, 74 ch 6 SLA 1984.]




Sec. 18.26.240. Earnings of the authority.
The earnings of the authority in excess of the amount required for the retirement of indebtedness or the accomplishment of the purposes stated in this chapter are the exclusive property of the state.


Sec. 18.26.250. Operation of certain statutes excepted; status of authority.
The authority is not a
     (1) political subdivision of the state for the purposes of AS 37.10.085, but for all other purposes the authority constitutes a political subdivision and an instrumentality of the state under this chapter;

     (2) municipality;

     (3) state agency for the purposes of AS 37.




Sec. 18.26.260. Issuance and guarantee of Alaska Medical Facility Authority bonds.
 (a) There is established as a separate account in the authority the medical facilities special bond guarantee account. The medical facilities special bond guarantee account consists of money disbursed to it by the commissioner of revenue. The assets of the medical facilities special bond guarantee account may be pledged to guarantee bonds or bond anticipation notes of the authority issued under (b) of this section.

 (b) If the commissioner of revenue and the board jointly determine that a medical facility is unable to use traditional private or public financial institutions to refinance mortgage loans and that it is in the public interest to make refinancing available,
     (1) the authority may provide financial assistance and purchase mortgage loans made to the medical facility and may issue bonds or bond anticipation notes under this chapter to provide money for the purchase of the mortgage loans or to provide the financial assistance; and

     (2) the commissioner of revenue may disburse to the medical facilities special bond guarantee account money appropriated to the commissioner for the account which the commissioner determines to be necessary to guarantee bonds or bond anticipation notes issued under (1) of this subsection.

 (c) Before entering into an agreement under (a) of this section to provide guarantees for bonds or bond anticipation notes issued or to be issued under (b) of this section, the commissioner of revenue shall determine that arrangements have been made to protect the interests of the state in the medical facilities special bond guarantee account.




Sec. 18.26.900. Definitions.
In this chapter, unless the context requires otherwise,
     (1) "authority" means the Alaska Medical Facility Authority created by this chapter;

     (2) "board" means the board of directors of the authority;

     (3) "bond resolution" means a resolution authorizing the issuance of, or providing terms and conditions related to, revenue bonds issued under this chapter and includes any trust agreement, trust indenture, mortgage agreement, or deed of trust providing terms and conditions for those bonds;

     (4) "bonds" means revenue bonds of the authority issued under this chapter, including refunding and refinancing those bonds;

     (5) "cost" includes, but is not necessarily limited to,
          (A) the cost incurred for developmental, planning, and feasibility studies, surveys, plans and specifications, and architectural, engineering, legal or other special services;

          (B) the cost of acquisition of land and any buildings and improvements on it;

          (C) the cost of site preparation and development, including demolition or removal of existing structures, construction, reconstruction, and equipment, including machinery, fixed equipment, and personal property;

          (D) carrying charges incurred during construction, up to and including the occupancy date;

          (E) interest on bonds issued to finance the project to a date six months after the estimated date of completion;

          (F) working capital not exceeding three percent of the estimated total cost of the project or three percent of the actual total final cost, whichever is larger;

          (G) the fees and charges, if any, imposed by the authority or by others;

          (H) necessary expenses incurred in connection with the initial occupancy of the project, personnel recruitment, and the cost of other items the authority determines to be reasonable and necessary;

     (6) "medical facility" includes, but is not limited to, any hospital, nursing home, intermediate care home, public health center or outpatient clinic, facility for the developmentally disabled, a rehabilitation facility, a drug abuse and alcoholism treatment facility, a mental health center, a health-care unit within a sheltered care home or home for senior citizens; "medical facility" does not include any institution, place, or building used or to be used primarily for sectarian instruction or study or as a place for devotional activities or religious work;

     (7) "operator" means any person who, by contract with the authority or by contract with a trustee who holds the position of trustee under a trust agreement with the authority, has the responsibility for the day-to-day operation and maintenance of a medical facility and over the development and implementation of long-range goals and objectives for the medical facility; it includes any person acting as an agent or representative of an operator;

     (8) "property" means any real, personal, or mixed property, or any interest in it, including without limitation any real estate, appurtenances, buildings, easements, equipment, furnishings, furniture, improvements, machinery, rights-of-way, and structures, or any interest in any of these items;

     (9) "revenue" means, with respect to any medical facility, the rent, fees, charges, interest, principal repayments, and other income or profit received or to be received, either directly or indirectly, by the authority from any source on account of the facility.




Chapter 28. State Assistance for Community Health Aide Programs.
Sec. 18.28.010. Community health aide grants.
 (a) A qualified regional health organization is entitled to a grant of $30,000 each fiscal year for the training and supervision of primary community health aides if the organization or another local or regional health organization employed at least three primary community health aides on July 1, 1984, to serve the communities proposed to be served under the grant.

 (b) During each fiscal year, a qualified regional health organization or local health organization is entitled to a grant of $8,000 multiplied by the number of primary community health aides who were employed by that organization or another local or regional health organization during the previous fiscal year who each week during the previous fiscal year averaged at least 20 hours of service in the communities proposed to be served by the grant, but not to exceed the number of primary community health aides who were employed by a local or regional health organization on July 1, 1984, to serve the communities proposed to be served under the grant.

 (c) A grant under (b) of this section may be used only for
     (1) training of primary community health aides, including tuition and travel to training programs;

     (2) supervision of primary community health aides, including travel for supervisors;

     (3) alternate community health aides.

 (d) The department shall compute and pay a grant under this section within the limits of appropriations made for the purpose.




Sec. 18.28.020. Qualifications.
To qualify for a community health aide grant a regional or local health organization must
     (1) have received money from the federal government for a community health aide program during the fiscal year for which the grant is sought;

     (2) provide the services of community health aides on a nondiscriminatory basis for the benefit of the public;

     (3) apply for the grant in accordance with application requirements of the department or negotiate a contract with the department in lieu of a grant if the regional or local health organization provides other contract services for the state; and

     (4) supply information requested by the department.




Sec. 18.28.030. Community health aide grant account. [Repealed, 12 ch 42 SLA 1997.]
Sec. 18.28.040. Liability limitation.
The state is not liable for any injury that may result from the use of money awarded by the state as a community health aide grant or paid by the state under a contract under this chapter.


Sec. 18.28.050. Regulations.
The department may adopt regulations necessary to carry out the provisions of this chapter.


Sec. 18.28.100. Definitions.
In this chapter,
     (1) "alternate community health aide" means a person who assists the primary community health aide when necessary and acts in the absence of the primary community health aide;

     (2) "community health aide" includes a primary community health aide and an alternate health aide;

     (3) "department" means the Department of Health and Social Services;

     (4) "local health organization" means a nonprofit corporation or other entity that provides health services in a rural area that is less than 4,000 square miles;

     (5) "primary community health aide" means a person who has completed the first of three levels of community health aide training offered by the Norton Sound Health Corporation at the Nome Hospital, the Kuskokwim Community College in Bethel, the Alaska Area Native Health Service in Anchorage, or another accredited training center;

     (6) "regional health organization" means a nonprofit corporation or home rule borough that provides health aide services under a contract with the Alaska Native Health Service in a rural area that is at least 4,000 square miles.




Chapter 29. Health Care Professionals Workforce Enhancement Program.
Secs. 18.29.010 18.29.099. Legislative intent; health care professions loan repayment and incentive program; purpose; advisory body; direct incentives; loan repayment; number of participants; eligibility and priority; definitions.

Sec. 18.29.100. Legislative intent.
Student loan repayments and direct incentive payments provided under this chapter are intended to increase the availability of health care services throughout the state, especially to underserved individuals or in health care professional shortage or rural areas.


Sec. 18.29.105. Program established; administration; advisory council.
 (a) The health care professionals workforce enhancement program is established in the department for the purpose of addressing the increasing shortage of certain health care professionals in the state by expanding the distribution of health care professionals.

 (b) The program established under this section must include
     (1) employer payments, as described in AS 18.29.110;

     (2) direct incentives, as described in AS 18.29.120;

     (3) student loan repayments, as described in AS 18.29.125;

     (4) procedures for the commissioner's designation and prioritization of sites eligible for participation in the program;

     (5) an application process for participation in the program as
          (A) an eligible site; or

          (B) a tier I, tier II, or tier III health care professional;

     (6) provision of public information and notices relating to the program;

     (7) a 12-year lifetime maximum for participation in the program by a tier I, tier II, or tier III health care professional.

 (c) The commissioner shall appoint an advisory council to advise the department on the program. The advisory council consists of members with health care expertise, including expertise in economic issues affecting the hiring and retention of health care professionals in the state. An employee of the department may serve only as a nonvoting member. Members of the advisory council serve at the pleasure of the commissioner and without compensation but are entitled to per diem and travel allowances authorized for boards and commissions under AS 39.20.180. The advisory council shall provide oversight and evaluation of the program and make recommendations, including recommendations relating to
     (1) identification and monitoring of underserved and health care professional shortage areas;

     (2) eligible sites;

     (3) an employer's ability to pay;

     (4) prioritization of sites and health care professionals eligible for participation in the program;

     (5) contract award priorities;

     (6) program capacities;

     (7) strategic plans; and

     (8) program data management.

 (d) The commissioner shall, in consultation with the advisory council established under (c) of this section,
     (1) administer and implement the program;

     (2) classify each eligible site as having either regular or very hard-to-fill positions, or both;

     (3) establish
          (A) procedures for allowable leaves of absence;

          (B) a civil penalty, not to exceed $1,000, for each violation by a health care professional or employer of a provision of this chapter, a regulation made under authority of this chapter, or a provision of a contract entered into under this chapter; and

          (C) a priority for participation in the program based on the availability of funding.

 (e) The department shall, on or before July 1 of each year, prepare and submit to the advisory council a report that describes the participation rates, costs, and effect of the program on the availability of health care services to underserved individuals or in health care professional shortage or rural areas for the previous calendar year.

 (f) The department may
     (1) contract for payments under the program and for the services of a consultant, expert, financial advisor, or other person the department considers necessary for the exercise of its powers and functions and to perform its duties under this chapter;

     (2) adopt regulations necessary to implement the program.




Sec. 18.29.110. Employer payments.
An employer approved for participation in the program shall make a nonrefundable quarterly payment to the department for the benefit of the employer's health care professional employee. The employer payment may come from any available source, including a philanthropic institution, health foundation, government agency, community organization, or private individual. The payment amount
     (1) must be equal to the health care professional's program payment amount established by the commissioner;

     (2) may be adjusted based on the employer's ability to pay, as determined by the commissioner and in consultation with the advisory council; and

     (3) must include the fee established under AS 44.29.022 for services provided under this chapter.




Sec. 18.29.115. Initial and renewal payments.
 (a) The department may approve student loan repayment and direct incentive payments for a qualified applicant for an initial period of three years and may approve a maximum of three renewal periods of three years each if the applicant
     (1) submits an application on a form approved by the department for
          (A) student loan repayments and, for student loan repayment renewal, demonstrates that the applicant has
               (i) a continuing student loan obligation on the same student loan that was subject to repayment under the program during the initial three-year period; or

               (ii) incurred additional student loan debt that qualifies for repayment;

          (B) direct incentive payments; or

          (C) payments under both (A) and (B) of this paragraph;

     (2) is otherwise eligible under the program; and

     (3) does not exceed the 12-year lifetime maximum for participation in the program.

 (b) The department shall combine an eligible health care professional's direct incentives and pay the total amount to the eligible health care professional in the form of one quarterly cash payment. The department shall combine an eligible health care professional's student loan repayments and pay the total amount to the lending institution or to the eligible health care professional in the form of one quarterly payment.

 (c) Except as provided in (d) of this section, the combined total amount of an eligible health care professional's direct incentives and student loan repayments may not exceed,
     (1) for a tier I health care professional employed in a regular position, $35,000 annually;

     (2) for a tier I health care professional employed in a very hard-to-fill position, $47,250 annually;

     (3) for a tier II health care professional employed in a regular position, $20,000 annually;

     (4) for a tier II health care professional employed in a very hard-to-fill position, $27,000 annually;

     (5) for a tier III health care professional employed in a regular position, $15,000 annually;

     (6) for a tier III health care professional employed in a very hard-to-fill position, $20,250 annually.

 (d) The department may annually increase the annual maximum program payment amounts in (c) of this section by the average percentage increase in the Consumer Price Index for urban wage earners and clerical workers for Urban Alaska during the previous five calendar years, as determined by the United States Department of Labor, Bureau of Labor Statistics.

 (e) The department shall prorate student loan repayments and direct incentive payments based on the number of qualified employment hours the health care professional worked in a calendar quarter. The department may not pay a student loan repayment or direct incentive before the completion of a calendar quarter in which the student loan repayment or incentive payment was earned.

 (f) The department shall deposit employer payments received and civil penalties collected under this chapter in the general fund.

 (g) The department shall pay student loan repayments and direct incentives with funds appropriated by the legislature for that purpose. The department may limit the number of program participants based on available funding. If insufficient money is appropriated to fully fund the program in a fiscal year, the department shall prorate payments based on the number of approved participants in the program.




Sec. 18.29.120. Direct incentives.
The department shall provide a direct incentive in the form of quarterly cash payments to an eligible tier I, tier II, or tier III health care professional engaged in qualified employment in an amount established by the commissioner and that is provided by employers approved under the program.


Sec. 18.29.125. Student loan repayment.
 (a) The department shall repay a portion of eligible student loans held by or made to an eligible tier I, tier II, or tier III health care professional.

 (b) A student loan is eligible for repayment if the student loan
     (1) was issued to an eligible individual under AS 18.29.130;

     (2) is a student loan as described in 26 U.S.C. 108(f)(2); and

     (3) was used by the individual for a program for which the individual received a certificate, license, or degree.

 (c) A student loan repayment under this section may not exceed 33.3 percent of the unpaid student loan balance existing in the first year of program participation multiplied by the percentage of full-time equivalent employment for each year of qualified employment, not to exceed three years.

 (d) A student loan or interest on a student loan is not eligible for repayment under this section if the student loan or interest is
     (1) to be repaid by another source, including another loan repayment or forgiveness program or an employer-sponsored loan repayment program;

     (2) consolidated with a loan that is not eligible for repayment; or

     (3) refinanced as a loan that is not eligible for repayment.




Sec. 18.29.130. Eligibility.
 (a) To be eligible for a direct incentive payment, an individual must
     (1) submit an application that is approved by the commissioner;

     (2) be engaged in qualified employment at an eligible site with a participating employer or entity;

     (3) for a tier I or tier II health care professional, be licensed or exempt from licensure as a tier I or tier II health care professional in the state;

     (4) meet a participation priority established by the commissioner; and

     (5) satisfy other criteria established by the commissioner.

 (b) To be eligible for student loan repayment, an individual must
     (1) satisfy the requirements of (a) of this section; and

     (2) have an unpaid balance on one or more eligible student loans verified by the Alaska Commission on Postsecondary Education or the department.




Sec. 18.29.190. Definitions.
In AS 18.29.100 18.29.190,
     (1) "commissioner" means the commissioner of health and social services;

     (2) "department" means the Department of Health and Social Services;

     (3) "eligible site" means a service area or health care facility that provides health care services to underserved individuals or in health care professional shortage or rural areas and that satisfies the criteria for eligibility established by the commissioner;

     (4) "employer payment" means the payment an employer makes to the department for participation in the program;

     (5) "program" means the health care professionals workforce enhancement program;

     (6) "qualified employment" means employment of a tier I, tier II, or tier III health care professional at an eligible site at which the health care professional is hired or contracted and paid to work
          (A) in a full-time or not less than half-time position;

          (B) for a term that is not less than three years;

     (7) "rural" means a community with a population of 5,500 or less that is not connected by road or rail to Anchorage or Fairbanks or with a population of 1,500 or less that is connected by road or rail to Anchorage or Fairbanks;

     (8) "tier I health care professional" means a person who spends not less than 50 percent of the person's time on direct patient health care services and who is licensed or exempt from licensure in the state as a dentist, pharmacist, physician, doctor of nursing practice, clinical psychologist, counseling psychologist, or other health care professional as determined by the commissioner;

     (9) "tier II health care professional" means a person who spends not less than 50 percent of the person's time on direct patient health care services and who is licensed or exempt from licensure in the state as a dental hygienist, advanced practice registered nurse, registered nurse, physician assistant, physical therapist, professional counselor, board certified behavior analyst, marital and family therapist, clinical social worker, or other health care professional as determined by the commissioner;

     (10) "tier III health care professional" means a person who is employed at an eligible site who is not otherwise eligible as a tier I or tier II health care professional;

     (11) "underserved individual" means an individual who
          (A) is uninsured;

          (B) receives or is eligible to receive medical assistance; or

          (C) receives or is eligible to receive health care benefits directly, through insurance, or through other means, from a plan or program funded directly, in whole or in part, by the federal government, except for the federal employee health benefits program under 5 U.S.C. 8903.




Chapter 30. Air Pollution.
[Repealed, 4 ch 120 SLA 1971.]