Legislature(2001 - 2002)
02/05/2002 03:04 PM House HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 366-RATES FOR ASSISTED LIVING FACILITIES CHAIR DYSON announced the next order of business to be HOUSE BILL NO. 366, "An Act relating to assisted-living homes; and providing for an effective date." Number 2262 REPRESENTATIVE COGHILL, sponsor of HB 366, introduced the bill by giving a brief history of assisted-living legislation. He implied that he was surprised by the size of the fiscal note accompanying HB 366; he had anticipated a zero fiscal note. He noted that in 2000, the legislature passed legislation that provided for an increase to $70 of the assisted-living home daily rate. His impression of that legislation, he stated, was that it would provide "three hots and a cot" to clients. Any medical expenses would fall under Medicaid. He said, "As it turns out, that's not exactly true." He indicated that new regulations are changing [the intended application of the legislation]. House Bill 366 is an attempt to [implement the intent of previous assisted-living-care legislation] by setting the amount at $70 a day, he explained. Number 2348 REPRESENTATIVE COGHILL said that his idea was to call this amount a "per diem", which would settle the issue [of providing room and board for clients]. He thought HB 366 was going to provide for that [at no additional cost] until he received the fiscal note hours before the hearing. He stated he would draw up a proposed committee substitute (CS) to address [the shortcomings of the present language]. He said he thinks that the expansion of long-term care will be a critical issue in Alaska. TAPE 02-5, SIDE B Number 2370 REPRESENTATIVE COGHILL queried: How will Alaska provide care for indigent clients? "We settled on what we thought was $70 a couple of years ago; that's not exactly true as I understand it," he said. He noted that dealing with both state and federal laws is problematic. Number 2326 WES INGRUM testified via teleconference in favor of HB 366. He stated that he thinks the real issue is patient liability. The new regulations written by the division have the effect of reducing the dollars available for client care, he said. Those regulations place more responsibility on the provider relative to the hours of service, the activities of daily living (ADL), and the instrumental activities of daily living (IADL). The most problematic area, he noted, is concerning the issue of the ADL, which can include clients who require two-person transfers or 24-hour-awake staffing. Number 2290 MR. INGRUM pointed out that Alaska has no acuity-based fee which addresses how many ADLs are provided to residents or (indisc.). The $70 a day in HB 73 was originally intended to cover room and board. He stated that HB 366 seeks to clarify that, although some small changes still need to be made. The intent, he noted, needs to be delineated to identify the basic services of room and board. This affects both small homes and large facilities that provide assisted living. A stable fee basis in Alaska is necessary to attract new facilities and staff to provide appropriate care. Currently, the regulations make dollars for necessary service unavailable. This will jeopardize the well- being of the Alaskan residents in assisted-living facilities. He pointed out that anything done to reduce dollars [available for assisted-living care] will reduce the level of observation and care for clients. Number 2218 MR. INGRUM stated that the assisted-living-care client population is increasing in Alaska. Proportionate growth in facilities and staff is not occurring due to a lack of funding, he offered. Number 2197 REPRESENTATIVE WILSON asked, "What's the difference between ADL and [IADL]?" MR. INGRUM responded that an IADL is a minor activity of daily living such as writing a letter or balancing a checkbook. A person could be quite functional and perform all the instrumental activities of daily living, he explained, but be unable to perform the IADLs and some ADLs such as personal hygiene, health care, and medication use. One of the first subjects of ADL is medication management, which is extremely critical; some of a client's other problems may be reduced when he/she is appropriately medicated. Number 2126 MARY NICHOLSON, Nicholson Assisted Living, testified via teleconference in support of HB 366. She thanked Representative Coghill for introducing the bill. The bill, she noted, would enable vulnerable adults to stay in assisted-living situations. Nursing home care is much more expensive for the state, she furnished. Number 2109 REPRESENTATIVE WILSON asked Ms. Nicholson for clarification on the difference between ADL and IADL and how the funding for each impacts assisted-living-care providers. MS. NICHOLSON stated that the general relief requested in HB 366 for room and board increases over several years. This has nothing to do with the ADL that comes under the services in the augmented rate for room and board, which is in addition to the per diem rate, she said. There is an augmented rate for clients requiring more than room and board; this covers the ADLs and the IADLs. Number 2018 REPRESENTATIVE COGHILL agreed that the issue with assisted- living care is that it provides non-medical care. Anything beyond room and board is medical care. This is where Medicaid funds begin to be utilized. He indicated that new regulations have clouded the funding issue, and that he'd introduced HB 366 to bring clarity to the subject of funding. Number 1973 DEBBIE CASH, Owner-Operator, Debbie's Fireside Home, testified via teleconference in support of HB 366. She listed the many items that fall under the definition of room and board. She noted that these costs have increased over the past years. She indicated that new dietary documentation requirements are [unfunded mandates] and [require the knowledge of a dietician]. Some clients in her home, were they to be placed in a nursing home, would cost the state $390 a day for room and board, she offered. She questioned how the legislature could justify not spending $70 a day for room and board and $70 a day for a client's [ADL and IADL] needs. She compared this $140 a day [in an assisted-care facility] to the $390 a day at a nursing home. She concluded, "We are giving you guys a very fair shake." She stated that older people deserve to live with respect. She added that she was able to purchase a wheelchair-accessible van for transporting clients with the additional funding. Number 1780 BOBBY CASH testified via teleconference. He expressed his perplexity at the way payments to assisted-living-care providers are diminished by various funding entities. He stated that he hoped the state would establish an amount it would pay and then follow through with that amount. He noted that transportation of clients was an issue for providers. Number 1680 MONTA FAYE LANE, President, Assisted Living Association of Alaska, testified regarding her experience as an assisted- living-home owner. She began providing assisted-living care in 1991. She was initially prohibited from accepting wheelchair- bound clients or clients who needed to be lifted. Clients who became bed-bound under her care needed to be transferred to nursing homes quickly, according to guidelines from the attorney general, Ms. Lane stated. She offered an overview of the changes in regulations and funding from 1991 to 1995 when the Division of Senior Services was established. Number 1537 MS. LANE said that the waiver program, established in 1995, permitted clients requiring more care to choose assisted living. This is what the Medicaid waiver-choice program provided, she explained. The general relief was $34.50 a day for clients who could not pay for their own care. That was supplemented with the waiver, which was $44.60 a day. These two amounts combined had to cover room and board plus medical needs. She noted that a plan of care is prescribed for clients covered by the Medicaid waiver. This plan of care must be administered by a certified nurse's aide (CNA). She stated that small assisted-living-care providers have difficulty procuring CNAs when the Pioneers' Home entry-level wage for CNAs is about $14 an hour. Number 1409 MS. LANE referenced legislation in 1999 intended to raise payments to assisted-living-care providers that failed to pass. She noted that SB 73 in 2000 raised the rate to $50 a day; the raise did not go into effect until September of that year. The rate increased to $60 a day in June 2001, and is slated to be raised to $70 a day in July 2002, she offered. The administration's proposal, she indicated, is to take 60 percent of that $70 away from assisted-living-care providers and increase the Medicaid [payment]. She stated that providers are delivering medical services for which they receive $70.19 a day. So providers are receiving $130.19 a day, she said, in contrast to $396 at nursing homes and $290 at the Pioneers' Homes. Number 1351 REPRESENTATIVE COGHILL pointed out that a provider's receipt of two different funds, one for home care and another for medical, could be construed by some to be being paid twice [for the same services]. Number 1320 MS. LANE replied that she has never been paid twice. The rate received by providers was set by the division, she explained. Federal and state law dictate Medicaid payments as well, she offered. Number 1291 REPRESENTATIVE COGHILL noted that this issue would be part of future discussion [pertaining to HB 366] of payments by Medicaid and payments under the general relief dollars. Number 1245 CHAIR DYSON expressed appreciation for assisted-living-care providers. He acknowledged two witnesses who concurred with Ms. Lane's testimony. Number 1182 MS. LANE remarked that her observation has been that some doctors are refusing to treat Medicaid patients. She asked, "What are you going to do if the assisted-living homes refuse Medicaid clients?" CHAIR DYSON replied that Ms. Lane's point was well taken. [HB 366 was held over.]
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