Legislature(2005 - 2006)CAPITOL 120


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved CSHB 193(HES) Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
Moved CSHB 114(HES) Out of Committee
HB 193-LICENSING MEDICAL OR CARE FACILITIES                                                                                   
HB 114-TERM. PARENTAL RTS/CINA/DELINQUENCY CASES                                                                              
[The  long titles  of HB  193 and  HB 114,  which were  discussed                                                               
together at this point, can be found in the committee calendar.]                                                                
CHAIR WILSON said  the department has stressed  the importance of                                                               
keeping licensing  separate from  the [financing portion]  of the                                                               
program.  She told the committee  that there is a bill sitting in                                                               
committee  that can  be gutted  and used  for certain  proposals.                                                               
She said  there is a disconnect  between the two portions  of the                                                               
program, and  she explained that  whenever a decision is  made on                                                               
the  licensing side,  she would  like to  have somebody  from the                                                               
funding side involved.                                                                                                          
9:14:05 AM                                                                                                                    
REPRESENTATIVE GARDNER  said HB 193 was  originally envisioned as                                                               
a bill that would be worked  on over the interim and brought back                                                               
the following year;  however, that changed to the  point that the                                                               
bill is "moving  through the system at a pretty  good clip."  She                                                               
asked  what  could  be  done  to  ensure  that  a  separate  bill                                                               
regarding the funding issues is also moved at a good pace.                                                                      
CHAIR WILSON said  that because the vehicle for  the bill already                                                               
exists, it could be pushed on to other committees.                                                                              
9:14:57 AM                                                                                                                    
REPRESENTATIVE  CISSNA emphasized  the amount  of people  who are                                                               
not getting  served.  She  said, "There's more of  the department                                                               
than  there  are  legislators  here, and  if,  in  fact,  they're                                                               
willing  to  put this  kind  of  muscle  into getting  your  bill                                                               
through  - and  ... I'll  want to  have a  guarantee that  that's                                                               
going to happen - I'd love it."                                                                                                 
9:16:10 AM                                                                                                                    
REPRESENTATIVE ANDERSON stated that he  would not want to gut the                                                               
bill  for use  as a  separate  vehicle for  the financial  aspect                                                               
unless  there  is  a  commitment from  the  commissioner  of  the                                                               
Department of Health  and Social Services (DHSS)  and an analysis                                                               
of what  the department would  be supporting.  He  explained that                                                               
the commissioner can "use the  governor, and they can call folks,                                                               
and the bill  dies in the next committee."   He encouraged making                                                               
amendments  to address  all the  issues within  [HB 193],  saying                                                               
that doing  so would  result in  a better  chance of  helping the                                                               
people running assisted living homes.                                                                                           
9:17:35 AM                                                                                                                    
JOEL  GILBERTSON,  Commissioner,   Office  of  the  Commissioner,                                                               
Department of Health and Social Services (DHSS), stated:                                                                        
     The position  of the  department hasn't  changed; we're                                                                    
     perfectly  willing  to  implement the  change.    We're                                                                    
     looking for  the advice  of the  legislature on  how to                                                                    
     move forward  on this.  We  will have all of  our staff                                                                    
     available at the hearings.   We'll provide testimony as                                                                    
     to  the effect  and implications  of the  amendment and                                                                    
     we'll work through the process.   I don't think there's                                                                    
     any  effort  by the  department  to  not see  this  get                                                                    
     passed, and so I'm kind of confused by that tone.                                                                          
9:18:47 AM                                                                                                                    
JOHN  BITNEY,  Lobbyist,   Thunderbird  Home  Health  Management,                                                               
stated  that  regulations  impact  the ability  of  the  assisted                                                               
living homes to stay in  business, and he stressed the importance                                                               
of the bill.                                                                                                                    
REPRESENTATIVE ANDERSON  asked for details regarding  the gutting                                                               
of a  bill to include  the financial  aspect of the  issue before                                                               
the committee.                                                                                                                  
CHAIR  WILSON  initially  offered   her  understanding  that  the                                                               
vehicle to use  would be HB 112; however,  after some discussion,                                                               
she said the vehicle the committee would use is HB 114.                                                                         
9:21:35 AM                                                                                                                    
COMMISSIONER GILBERTSON  said that the  language for [the  new HB
114] has  been recently  drafted.   He said there  is not  yet an                                                               
official fiscal note; however, "the  current expectation from the                                                               
department with the  language that we provided is  that the total                                                               
fund cost  would be $363,500 and  the general fund cost  would be                                                               
CHAIR WILSON said,  "If we put on  that that it is  the intent of                                                               
this  committee  that  those  funds come  out  of  the  whatever,                                                               
[Budget  Review Unit  (BUR)] -  I mean  I don't  know how  you do                                                               
that, but  whichever one  it is  that is  with the  personal care                                                               
attendants, it's to  come out of that area -  then you guys would                                                               
have a guide of what is expected of us.  Can we do that?"                                                                       
COMMISSIONER GILBERTSON replied  that he may be  the wrong person                                                               
to ask.                                                                                                                         
REPRESENTATIVE CISSNA  said, "Because  this amendment that  is in                                                               
here  doesn't  have the  restructuring  so  that you  could  have                                                               
companion  services.   ...   And  ...  if, in  fact,  as the  new                                                               
amendment on  that was written, ...  it's not supposed to  have a                                                               
fiscal impact; it merely broadens."                                                                                             
9:23:31 AM                                                                                                                    
MR. BITNEY said:                                                                                                                
     What the  amendment proposes  is to  create a  piece of                                                                    
     legislation that the sole content  of it is a statement                                                                    
     of intent  by the legislature.   So, that's  the extent                                                                    
     of what the legislation does.                                                                                              
[SEVERAL UNIDENTIFIED SPEAKERS] said, "No, it's not."                                                                           
MR. BITNEY corrected  himself and acknowledged, "It  has now been                                                               
modified to say the uncodified law."                                                                                            
CHAIR  WILSON   directed  attention   to  a   document  entitled,                                                               
"Proposal to Implement Proposed 300%'er  Change."  She asked that                                                               
the committee bring HB 114 before the committee.                                                                                
9:26:18 AM                                                                                                                    
REPRESENTATIVE ANDERSON moved to  bring before the committee CSHB
114(STA), [although the committee did  not notice HB 114 for this                                                               
CHAIR WILSON objected for discussion purposes.                                                                                  
REPRESENTATIVE  ANDERSON   moved  Amendment  1,  which   read  as                                                               
     Page 1, line 1 thru 8:                                                                                                     
          Delete all material in the Title and Insert "An                                                                     
     Act relating  to Medicaid personal needs  allowance for                                                                  
     assisted living home residents."                                                                                         
     Page 1, line 10 thru page 12, line 15:                                                                                     
          Delete all material and Insert new bill sections                                                                      
     to read:                                                                                                                   
     *Sec.1. The  uncodified law of  the State of  Alaska is                                                                    
     amended by adding a new section to read:                                                                                   
          It is the Intent of the Legislature that the                                                                          
     Department of  Health and Social Services  Repeal 7 AAC                                                                    
     43.1058(k)(1)(B) effective July 1, 2005.                                                                                   
     The  Department of  Health  and  Social Services  shall                                                                    
     adopt   new   emergency  regulations   establishing   a                                                                    
     personal needs allowance for  recipients residing in an                                                                    
     assisted living  facility equal  to the  monthly income                                                                    
     limit  set in  AS  47.04.020(b)(6) minus  $260.   Until                                                                    
     such   time  as   the   department   can  adopt   these                                                                    
     regulations at  7 AAC 43.1058(k)(1)(B),  the department                                                                    
     shall  apply personal  needs  allowance for  recipients                                                                    
     residing in  an assisted  living facility equal  to the                                                                    
     monthly income  limit set  in AS  47.04.020(b)(6) minus                                                                    
     $260.  This  meets the requirements for a  finding of a                                                                    
     public, health  safety and  welfare emergency  under AS                                                                    
     *Sec.3.  Section 1  of  the Act  takes  effect July  1,                                                                    
     *Sec.4.  Section 2  of this  Act takes  effect July  2,                                                                    
9:27:18 AM                                                                                                                    
JON  SHERWOOD, Medical  Assistance Administrator,  Office of  the                                                               
Commissioner, Department of Health  and Social Services, reviewed                                                               
the  changes made  by  Amendment  1.   He  explained  that 7  AAC                                                               
43.1058(k)(1)(B) is  the provision  and regulation  that requires                                                               
individuals living  in assisted living homes,  receiving Medicaid                                                               
waiver services,  and who  have incomes in  excess of  the [Adult                                                               
Public Assistance]  APA payment levels  to use the  excess income                                                               
toward  their Medicaid  expenses.   He said,  "These are  the 300                                                               
'percenters'   -  the   people   who  ...,   under  the   current                                                               
regulations, can no  longer pay as much in rent,  room and board,                                                               
as they used  to."  Section 2 replaces that  provision with a new                                                               
one, setting the limit $260 less than it was before.                                                                            
MR. SHERWOOD drew  attention to two pages  following the amending                                                               
language,  which  show  how  things work  before  and  after  the                                                               
regulation changes, as  well as the cost impact  of the reversing                                                               
change to 300 percenters.                                                                                                       
MR.  BITNEY,  in  response  to  a  question  from  Representative                                                               
Anderson, pointed out that [Amendment  1] "assists," but does not                                                               
include a "cap" that was included in HB 193.                                                                                    
CHAIR  WILSON  suggested,  "That's  part  of  the  proposed,  new                                                               
regulations that  haven't gone into  effect, and that's  still an                                                               
open area."                                                                                                                     
MR. SHERWOOD said that in regard  to the comments heard about new                                                               
proposed licensing  regulations, the department is  extending the                                                               
regulation  comment period,  will plan  on holding  at least  one                                                               
more hearing, and will notify  the assisted living providers.  He                                                               
offered  his understanding  that the  extension would  be through                                                               
June, which is 45 days longer.                                                                                                  
CHAIR WILSON said she thinks that's reasonable.                                                                                 
9:32:30 AM                                                                                                                    
REPRESENTATIVE MCGUIRE  said she  believes the  cap already  is a                                                               
part of regulation.  She said:                                                                                                  
     There are two components:   There's the first part that                                                                    
     says that  we're going  to lower the  rate to  $18.64 a                                                                    
     day ..., and  that was part of the  refinancing, and we                                                                    
     all understand  and have agreed  that that's  the right                                                                    
     thing to  do from  a financial  perspective.   But then                                                                    
     the second  part of it  was the  part that said  $564 a                                                                    
     month, no matter what, as a  cap.  And that was part of                                                                    
     the [regulations] that already are in place.                                                                               
AMY ONEY, Owner/Operator, Mama's  Assisted Living Home, mentioned                                                               
[the committee  substitute (CS) for HB  193, Version 24-GH1016\F,                                                               
Mischel, 4/19/05].  She stated:                                                                                                 
     This  is  a  regulation  that  went  into  effect  last                                                                    
     summer,   but  they   have  not   enforced  it.     The                                                                    
     enforcement date is  set for July 1 of this  year.  And                                                                    
     what that  does is:   our daily reimbursement  rates on                                                                    
     the Medicaid  waiver side  are calculated  according to                                                                    
     what's  a  direct  care  cost   and  what's  called  an                                                                    
     administrative and  general cost.  Once  you figure out                                                                    
     your direct  care rate per  person, per day,  then they                                                                    
     allow an  administrative general rate to  be calculated                                                                    
     as a percentage of the rate.   What this cap does is it                                                                    
     puts it in at 25 percent.   But [due to] the allocation                                                                    
     that the  department has done -  putting whatever costs                                                                    
     into direct care or administrative  and general costs -                                                                    
     some  homes are  ... looking  at losing  a net  between                                                                    
     $30,000-$50,000,  with this  cap, just  because of  how                                                                    
     the  department allocated  ... [its]  costs on  ... our                                                                    
     cost-based negotiation statements.                                                                                         
     ... It  may not  have been what  we ...  walked through                                                                    
     the door and applied for, but  ... they kind of tell us                                                                    
     what categories  things are going  to be  allocated to,                                                                    
     and  they've allocated,  in some  homes, a  much higher                                                                    
     rate than  25 percent.  So,  this cap will come  in and                                                                    
     they  will  lose  their   reimbursement  rates  on  the                                                                    
     Medicaid side  - quite a  significant amount.   And so,                                                                    
     we're saying  it's not a  realized deal at  the moment;                                                                    
     just back  it off  and don't  implement.   Because it's                                                                    
     already passed, but it's due to go into effect July 1.                                                                     
CHAIR WILSON said she would like to know if the proposed                                                                        
regulations being worked on by the department will "affect this                                                                 
in any way."                                                                                                                    
9:35:27 AM                                                                                                                    
STACIE KRALY,  Senior Assistant Attorney General,  Human Services                                                               
Section, Office of the Attorney  General, Department of Law, said                                                               
she  would like  to  compartmentalize the  subjects  at hand  "so                                                               
we're all talking about the same thing."  She continued:                                                                        
     There's a  regulation that deals  with the  rate issue,                                                                    
     and what Representative McGuire  talked about is a cap.                                                                    
     ... That is what  we're talking about repealing through                                                                    
     this amendment.   And as you will see  in the proposal,                                                                    
     we've figured out a way,  legislatively, to ... do this                                                                    
     through  emergency regulations,  which is  an expedited                                                                    
     basis, so  that financial  fix for  what ...  we talked                                                                    
     about previously  as the APA  refinance will  be fixed.                                                                    
     What Ms. Oney  was just talking about, which  is the 25                                                                    
     percent  administrative  cost-based   rate  cap,  is  a                                                                    
     different regulatory  provision under  7 AAC  43, which                                                                    
     deals  with administrative  costs  related to  Medicaid                                                                    
     waiver clients.   That is not  a part of this  mix, and                                                                    
     it had ...  - from my understanding  in sitting through                                                                    
     all  of  these committee  meetings  -  not really  been                                                                    
     talked  about  in  the  grand scheme  of  things.    We                                                                    
     adopted those  regulations last year  and put a  cap on                                                                    
     this administrative  cost rate,  so there will  be some                                                                    
     adjustments there, with respect  to what people provide                                                                    
     us information ... [from  which] we'll calculate what's                                                                    
     called administrative cost rate base at 25 percent.                                                                        
     At  this  point  that's  not on  the  table,  but  it's                                                                    
     certainly something that could be  looked at - may need                                                                    
     to be  looked at - but  it hasn't' been a  part of this                                                                    
     mix.   ... So,  that's what we  passed last  June [and]                                                                    
     went into  effect [on] ...  May 16 of last  year, which                                                                    
     is effective  this coming year.   We gave them  a whole                                                                    
     year  to  ...  ease   into  this  new,  ...  structured                                                                    
CHAIR WILSON remarked  that Ms. Kraly is talking  about an amount                                                               
of 25 percent, but "we've heard  testimony that it's more than 25                                                               
percent."  She asked for clarification.                                                                                         
MR.  SHERWOOD  stated  that  when   the  department  changed  the                                                               
regulation,  it considered  the  existing  providers and  imposed                                                               
caps  not  just on  assisted  living  homes,  but on  all  waiver                                                               
providers.   He indicated  that the smaller  providers have  a 25                                                               
percent cap,  while "everyone else  has an  18 percent cap."   He                                                               
said the  department was looking  to establish  reasonableness of                                                               
administrative  and general  costs.   He said  it's a  compromise                                                               
made to ensure that the right amount is paid for a service.                                                                     
9:39:41 AM                                                                                                                    
CHAIR WILSON asked if there is an appeals process.                                                                              
MS.  KRALY   offered  her  understanding   that  the   rates  are                                                               
calculated,  and  if  there  is   a  dispute  over  the  rate,  a                                                               
"director-level review"  is provided within the  department.  She                                                               
said the cap  is firm, but there may have  to be some adjustments                                                               
made.  She said out of  the whole range of assisted living homes,                                                               
25  percent was  "within  the  ball park  of  what most  assisted                                                               
living homes operate under."                                                                                                    
CHAIR  WILSON declared,  "Since that  has  not been  part of  our                                                               
deliberations, I'm not going to touch that."                                                                                    
9:40:35 AM                                                                                                                    
REPRESENTATIVE  MCGUIRE  asked  Chair Wilson  to  reconsider  her                                                               
stand.  She explained that the  regulation process is one that is                                                               
supposed  to involve  the public  and the  stakeholders, and  she                                                               
said   she   believes  [the   department]   does   a  good   job.                                                               
Nevertheless, she  said it  is an  extremely complex  system, and                                                               
the  legislature   bears  the  responsibility  of   changing  the                                                               
Administrative Procedures Act  so that "real notice  gets out and                                                               
real input  gets in."   She stated  concern that  the regulations                                                               
are already  firm and will  be put in  action July 1,  [2005] and                                                               
the  legislature is  done with  session,  mid-May.   She said  if                                                               
there  is a  concern,  "there's  no way,  other  than through  an                                                               
emergency [regulation] process,  for you to come  back and adjust                                                               
that percentage."  She offered an example.                                                                                      
REPRESENTATIVE McGUIRE stated,  "An idea would be  to include the                                                               
repeal of  that [regulation] in  at least the initial  draft, and                                                               
let it  work through the process  and have some of  the testimony                                                               
at  least,  elicited, either  in  [the  House Judiciary  Standing                                                               
Committee]  or in  [the House  Finance Committee].   She  said at                                                               
that point  if the  repeal is too  controversial or  doesn't make                                                               
sense, it can be pulled out.                                                                                                    
CHAIR  WILSON stated  that she  would  keep her  decision as  is,                                                               
knowing that the bill would next  be heard in the House Judiciary                                                               
Standing Committee,  where Representative McGuire, as  the chair,                                                               
could do as she wishes.  She emphasized the need for speed.                                                                     
CHAIR  WILSON  reminded  committee  members  that  there  was  an                                                               
amendment before them and asked if there were any more concerns.                                                                
9:44:30 AM                                                                                                                    
REPRESENTATIVE CISSNA  said everyone is struggling  to understand                                                               
the math  involved and who  will and will  not be affected.   She                                                               
said her office is working on  creating a task force to meet with                                                               
the industry and  stakeholders, because "this is  pivotal for the                                                               
future of Alaska in a lot of  ways that we're just not looking at                                                               
9:46:33 AM                                                                                                                    
REPRESENTATIVE MCGUIRE thanked Chair Wilson.                                                                                    
CHAIR WILSON  said she  is hoping that  "the process  works," and                                                               
she indicated that she would like to continue to get feedback.                                                                  
REPRESENTATIVE CISSNA  stated her assumption that  "we're talking                                                               
about the  amendment and  that does not  include the  home health                                                               
CHAIR WILSON answered, "Not right now."                                                                                         
REPRESENTATIVE CISSNA stated her  understanding that [home health                                                               
care] was  part of [HB  193] and was  separated out, but  was not                                                               
disbanded.   She stated that  it is an  extraordinarily important                                                               
part of  the bill  because "it's the  preventative part"  and can                                                               
keep costs down.                                                                                                                
9:49:15 AM                                                                                                                    
CHAIR WILSON  said she is  concerned about  that.  She  said, "We                                                               
have seen  what happened to  the personal care  attendant program                                                               
that was supposed to save money, so  I would like to work on that                                                               
a little  bit more."   She added, "I  will address that,  but not                                                               
REPRESENTATIVE  CISSNA said,  "It actually  fits in  [HB] 193,  I                                                               
think, better.   And  it's got  to be addressed.   Because  it is                                                               
actually affecting  ... the  people that  are at  home.   I truly                                                               
believe that  we're forcing  people out of  their homes  and into                                                               
assisted living,  because they're qualified  for it; they  can go                                                               
there."  She offered further details.                                                                                           
CHAIR  WILSON removed  her objection  to Amendment  1 to  HB 114.                                                               
There being no further objections, Amendment 1 was adopted.                                                                     
9:50:32 AM                                                                                                                    
REPRESENTATIVE ANDERSON moved to report  HB 114, as amended, with                                                               
individual  recommendations, an  indeterminate  fiscal note,  and                                                               
proposed  intent  language.    There  being  no  objection,  CSHB
114(HES)  was  reported  from the  House  Health,  Education  and                                                               
Social Services Standing Committee.                                                                                             
HB 193-LICENSING MEDICAL OR CARE FACILITIES                                                                                   
9:51:53 AM                                                                                                                    
CHAIR WILSON announced that the  committee would now focus solely                                                               
on  HOUSE  BILL NO.  193,  "An  Act  relating to  the  licensing,                                                               
regulation,   enforcement,  and   appeal  rights   of  ambulatory                                                               
surgical centers,  assisted living homes, child  care facilities,                                                               
child  placement  agencies,  foster  homes,  free-standing  birth                                                               
centers,  home health  agencies, hospices  or agencies  providing                                                               
hospice  services, hospitals,  intermediate  care facilities  for                                                               
the  mentally  retarded,  maternity  homes,  nursing  facilities,                                                               
residential  child   care  facilities,   residential  psychiatric                                                               
treatment  centers,   and  rural  health  clinics;   relating  to                                                               
criminal history requirements, and  a registry, regarding certain                                                               
licenses,  certifications, approvals,  and authorizations  by the                                                               
Department  of  Health  and Social  Services;  making  conforming                                                               
amendments; and providing for an effective date."                                                                               
REPRESENTATIVE ANDERSON said, "My amendment's withdrawn."                                                                       
The committee took an at-ease from 9:53:00 to 9:53:30.                                                                          
9:53:33 AM                                                                                                                    
CHAIR  WILSON  announced  that   before  the  committee  was  the                                                               
committee  substitute  (CS)  for  HB  193,  Version  24-GH1016\F,                                                               
Mischel, 4/19/05.                                                                                                               
9:53:53 AM                                                                                                                    
STACIE KRALY,  Senior Assistant Attorney General,  Human Services                                                               
Section,  Office  of the  Attorney  General,  Department of  Law,                                                               
mentioned subjects  for possible  amendments.   In response  to a                                                               
question  from Chair  Wilson, she  clarified that  the amendments                                                               
are  not  in  reference  to   a  report  to  the  committee  from                                                               
Legislative  Legal  and Research  Services.    Rather, the  first                                                               
deals   with  the   abuse  registry   and   was  discussed   with                                                               
Representatives Cissna  and Seaton, and the  second was requested                                                               
by  the   Municipality  of  Anchorage  to   correct  an  omission                                                               
regarding the "day child care licensing."                                                                                       
CHAIR WILSON, after  ascertaining that the bill will  be heard by                                                               
the   House  Judiciary   Standing  Committee,   said  she   feels                                                               
comfortable knowing that some of  the people on the House Health,                                                               
Education and Social Services Standing  Committee are also on the                                                               
House Judiciary Standing Committee.                                                                                             
9:57:26 AM                                                                                                                    
MS.  KRALY indicated  that  the first  amendment  idea would  add                                                               
provisions to the abuse registry  section of the bill that would:                                                               
create  the  Department  of  Health  &  Social  Services  as  the                                                               
administrative  hearing authority  for the  centralized registry;                                                               
add "volunteer"  as a type  of individual  to be included  on the                                                               
registry;  add  decisions regarding  the  type  of findings  that                                                               
could result  in the entry of  a registry, which would  allow for                                                               
administrative  decisions  to be  part  of  the process;  include                                                               
medical assistance  fraud as a  violation that would  be included                                                               
on  the  registry; add  a  new  subsection requiring  any  abuse,                                                               
allegations  of neglect,  and exploitation  occurring within  the                                                               
last  10 years  to be  reported; define  the central  registry as                                                               
confidential,  with password  protected Internet  access; add  an                                                               
immunity protection  for people  who [report] abuse,  neglect, or                                                               
exploitation;  and define  "entity" to  track entities  under the                                                               
centralized licensing  statute.  She  added that the rest  of the                                                               
amendment would address renumbering.                                                                                            
10:00:19 AM                                                                                                                   
REPRESENTATIVE ANDERSON  asked if  the amendment is  written and,                                                               
if so, what the reference to it is.                                                                                             
MS. KRALY called it "Amendment 1 to work draft CSHB 193\G."                                                                     
CHAIR WILSON  pointed out that  Version G does not  match Version                                                               
REPRESENTATIVE  ANDERSON moved  Conceptual  Amendment 1,  stating                                                               
that Legislative  Legal and Research  Services would  conform the                                                               
amendment to  Version F.   There  being no  objection, Conceptual                                                               
Amendment 1 was adopted.                                                                                                        
MS. KRALY outlined  that the idea for the second  amendment.  She                                                               
explained that  currently, there  is a  provision under  AS 47.35                                                               
which allows  the department to  delegate its  licensing function                                                               
to a municipality that wants to  take on that function.  To date,                                                               
the  only municipality  that has  done  that is  Anchorage.   She                                                               
said, "We just didn't get that  into the new version, and we want                                                               
that partnership to continue, so we've made that amendment."                                                                    
REPRESENTATIVE   ANDERSON   moved   [Conceptual]   Amendment   2,                                                               
explaining that  the committee should  have the wording  in their                                                               
MS.  KRALY announced  that her  assistants revealed  to her  that                                                               
Version  F,  which is  before  the  committee, already  has  both                                                               
Amendment 1 and 2 included in the language.                                                                                     
REPRESENTATIVE   ANDERSON   withdrew    his   motion   to   adopt                                                               
[Conceptual] Amendment 2.                                                                                                       
REPRESENTATIVE ANDERSON  moved to rescind the  committee's action                                                               
in  adopting  Conceptual Amendment  1,  because  he said  it  was                                                               
unnecessary.   There  being  no objection,  the  action to  adopt                                                               
Conceptual Amendment 1 was rescinded.                                                                                           
10:03:00 AM                                                                                                                   
REPRESENTATIVE CISSNA moved to  adopt [Conceptual] Amendment [3],                                                               
as follows [original punctuation provided]:                                                                                     
     Page 1, line 9, following "Services,":                                                                                   
          Insert "relating to public assistance for health                                                                    
     facilities and assisted living  homes, to rates charged                                                                  
     by an  assisted living  home, and  to the  liability of                                                                  
     recipients of  home or community-based services  to pay                                                                  
     for   those   services;   relating  to   expansion   of                                                                  
     reimbursable   waiver  services   under  the   Medicaid                                                                  
     waivers  for Older  Alaskans and  Adults with  Physical                                                                  
     Disabilities to include adult companion services"                                                                        
     On page 2 of the  draft amendment, delete two amendment                                                                  
          Sec.22 to amend AS 47.07.030(c), is deleted from                                                                    
     the amendment.                                                                                                             
          Sec.23 to add a new subsection (e) to AS                                                                            
     47.07.030, is deleted from the amendment.                                                                                  
     Page 45 of the bill, CSHB 193, following line 3:                                                                         
          Insert a new bill section to read:                                                                                    
          "*Sec.64: The uncodified law of the State of                                                                        
     Alaska is amended by adding a new section to read:                                                                         
               MEDICAID   WAIVERS   TO   BE   AMENDED:   The                                                                  
     department shall  proceed immediately to  seek approval                                                                    
     under  42 U.S.C.  __(Title XIX,  Social Security,  Act,                                                                    
     Medical  Assistance) to  amend the  Home and  Community                                                                    
     Based  Waivers  for  Older  Alaskans  and  Adults  with                                                                    
     Physical Disabilities, to  add adult companion services                                                                    
     as a  reimbursable waiver service within  both waivers,                                                                    
     either as  a discrete  waiver service,  or as  a waiver                                                                    
     service  which may  be  combined  with current  waivers                                                                    
     services such  as respite or  chore services or  with a                                                                    
     new waiver  service such  as waiver  personal attendant                                                                    
     services, as  may be more  efficient to  administer and                                                                    
     more beneficial  to the  recipient of  waiver services.                                                                    
     The addition  of adult companion  services to  the Home                                                                    
     and  Community  Based  Waiver for  Older  Alaskans  and                                                                    
     Adults  with  Physical   Disabilities  is  intended  to                                                                    
     restore   the   non-medical   care,   supervision   and                                                                    
     socialization  provided  to   a  functionally  impaired                                                                    
     adult who is  a waiver recipient, such  as was formerly                                                                    
     provided as  a part  of respite  services prior  to the                                                                    
     limiting  amendment   to  7   AAC  43.1040.Reimbursable                                                                    
     Waiver Services,  effective May 15,  2004, specifically                                                                    
     7 AAC 43.1049(d)(4)(A),  which prohibits the department                                                                    
     from paying  for respite services that  allow a primary                                                                    
     caregiver  to  work,  and  7   AAC  43.1040  __,  which                                                                    
     prohibits  the  department   from  paying  for  respite                                                                    
     services  during sleeping  or nighttime  hours.   Adult                                                                    
     companion services,  subject to all  other restrictions                                                                    
     and requirements of the waivers  for Older Alaskans and                                                                    
     Adults with  Physical Disabilities, shall  be available                                                                    
     to  use as  part of  the recipient's  approved plan  of                                                                    
     care to allow  a primary caregiver to work,  to allow a                                                                    
     primary  caregiver  to  sleep during  normal  nighttime                                                                    
     hours when the recipient of  care cannot be safely left                                                                    
     unsupervised during the caregiver's  sleep hours, or to                                                                    
     allow supervision  or monitoring of a  recipient who is                                                                    
     not  otherwise safe  while  sleeping.   The  department                                                                    
     shall  enact   such  regulations   as  are   needed  to                                                                    
     implement  this  section.    In  this  section,  "adult                                                                    
     companion    services"    means    non-medical    care,                                                                    
     supervision   or    socialization,   provided    to   a                                                                    
     functionally  impaired  adult   in  accordance  with  a                                                                    
     therapeutic  goal in  the  recipient's  waiver plan  of                                                                    
     care.    In  this   section  "therapeutic  goal"  shall                                                                    
     include the goals of delaying  or avoiding placement of                                                                    
     the  recipient  in   a  more  restrictive  environment,                                                                    
     including an assisted living home  or nursing home, and                                                                    
     supporting the vital needs of  the primary caregiver of                                                                    
     the recipient."                                                                                                            
     Section  64 of  the draft  Amendment, Mischel,  4/19/05                                                                  
     shall be renumbered as Section 65.                                                                                       
CHAIR WILSON objected for discussion purposes.                                                                                  
REPRESENTATIVE  CISSNA   began  her  explanation   of  Conceptual                                                               
Amendment 3.                                                                                                                    
CHAIR WILSON  said that she  would like to  move the bill  out of                                                               
committee; however,  she would  like to call  a work  session for                                                               
the upcoming Monday,  in order to understand  the bill completely                                                               
and ensure it has "sideboards."                                                                                                 
10:04:46 AM                                                                                                                   
REPRESENTATIVE  CISSNA  said  she  came to  the  table  with  the                                                               
understanding that "we  were talking about this too."   She said,                                                               
"This is  where the cost  savings to  the little folks  comes in;                                                               
this is the preventative  part.  This is the part  where if we do                                                               
this  thing  right  we  really  save some  money  and  we  affect                                                               
people's lives."   She called  a point of  order that there  is a                                                               
motion on the floor.                                                                                                            
CHAIR  WILSON said  she would  be against  voting on  [Conceptual                                                               
Amendment 3].  She explained  that she is not necessarily against                                                               
the  concept  but  wants  to ensure  the  committee  doesn't  put                                                               
something into effect that will "grow our budget in huge steps."                                                                
REPRESENTATIVE  CISSNA  noted  that  the committee  has  had  the                                                               
language for 24 hours.                                                                                                          
The committee took an at-ease from 10:06:01 AM to 10:09:06 AM.                                                              
CHAIR WILSON issued a caveat:                                                                                                   
     I feel  very, very [strongly]  about the fact  that the                                                                    
     personal  care attendant  program, which  was going  to                                                                    
     save this  state money ...  and was going to  be better                                                                    
     for everybody  in the long  run, absolutely  is totally                                                                    
     out of hand.  It  went from approximately $8 million to                                                                    
     approximately  $80 million  in five  years.   We cannot                                                                    
     afford that.   ...   I have gotten assurances  from the                                                                    
     judicial  chair that  she will  deal with  this and  we                                                                    
     have to have sideboards  on this because of constraints                                                                    
     on our time;  we only have 18 days left.   I will allow                                                                    
     this  with  the understanding  that  it  will be  dealt                                                                    
     with, because I'm not  comfortable with this amendment,                                                                    
     ... [and]  I feel we  haven't had  time to look  at ...                                                                    
     those sideboards.                                                                                                          
10:10:26 AM                                                                                                                   
CHAIR WILSON  removed her objection to  [Conceptual Amendment 3].                                                               
There  being no  further  objection, Conceptual  Amendment 3  was                                                               
10:10:37 AM                                                                                                                   
REPRESENTATIVE  ANDERSON moved  to report  CSHB 193,  Version 24-                                                               
GH1016\F,  Mischel, 4/19/05,  as amended,  out of  committee with                                                               
individual  recommendations and  the  accompanying fiscal  notes.                                                               
There being no  objection, CSHB 193(HES) was reported  out of the                                                               
House Health, Education and Social Services Standing Committee.                                                                 

Document Name Date/Time Subjects