Legislature(1999 - 2000)

04/06/1999 06:04 PM FIN

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
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SENATE BILL NO. 58                                                                                                              
"An Act establishing an in-home and community-based                                                                             
services program for certain adults with long-term                                                                              
care needs; and providing for an effective date."                                                                               
                                                                                                                                
This was the first hearing on this bill.                                                                                        
                                                                                                                                
Senator Gary Wilken spoke to the bill. This was the second                                                                      
of four bills containing recommendations made by the Long                                                                       
Term Care Task Force. It was Recommendation #14 of the                                                                          
report. It addressed those adults who wished to receive                                                                         
long-term care in their home rather than an institution.                                                                        
                                                                                                                                
The bill belonged in the SFC because of the $425,000 fiscal                                                                     
note, he continued. The costs would come from expansion of                                                                      
the money provided for care to Alaskan's in need of long-                                                                       
term care. This would cover long term care that was not                                                                         
covered by Medicaid because it was not direct health care.                                                                      
It was for services that would be given in-home such as                                                                         
adult daycare, respite care, basic chore and homemaker                                                                          
services, nutrition and transportation services (i.e. Meals                                                                     
on Wheels), at-home skilled nursing and therapy care,                                                                           
personal care, etc. These were levels of care that could                                                                        
help those who were aging and had diminished capacity. If                                                                       
they were helped on a regular basis, they would kept out of                                                                     
the more expensive professional homes.                                                                                          
                                                                                                                                
Senator Gary Wilken referred the members to written                                                                             
testimony provided by Kay Burrows. Others were present and                                                                      
willing to testify.                                                                                                             
                                                                                                                                
He stressed that it was an expensive bill but would save                                                                        
money later on by keeping these adults out of institutions.                                                                     
                                                                                                                                
The Administration planned to recommend the committee                                                                           
lessen the fiscal note because the bill also allowed for                                                                        
access to federal funds in other services.                                                                                      
                                                                                                                                
He had an amendment to offer.                                                                                                   
                                                                                                                                
Senator Al Adams had a question regarding the fiscal note.                                                                      
He wanted to know if funding would be given to similar                                                                          
health care programs that operated in rural areas.  Senator                                                                     
Gary Wilken did not know and deferred to the testifiers.                                                                        
                                                                                                                                
Alison Elgee returned to the table. She testified that the                                                                      
bill addressed a gap in the present delivery of long-term                                                                       
care services. The department did very well for people who                                                                      
were fortunate enough to have the independent financial                                                                         
resources to afford long-term care and for those people who                                                                     
met the financial eligibility requirements of Medicaid.                                                                         
What the department found was missing were services for the                                                                     
people who were in between; those who had a moderate                                                                            
income, those who had some needs that were not at the level                                                                     
of care needs that warranted a nursing home environment.                                                                        
                                                                                                                                
Many people would be able to stay in their homes longer if                                                                      
services could get to them earlier. There was advantage to                                                                      
early prevention in terms of addressing long term care                                                                          
needs.  The longer those needs went unaddressed, the more                                                                       
likely an individual would eventually require nursing home                                                                      
levels of care.                                                                                                                 
                                                                                                                                
She felt it was worth noting that the Legislation would                                                                         
require participants to first draw on their own resources,                                                                      
either third-party insurance payments or their personal                                                                         
financial resources.  However for many, that amount was                                                                         
insufficient.  For example, a home health nurse visit in                                                                        
the Anchorage area cost $120 per visit.  Many people could                                                                      
remain at home if they had somebody coming to check on them                                                                     
twice a week, but the cost of that would be over $1000 per                                                                      
month.  This was often beyond many people's personal                                                                            
resources.                                                                                                                      
                                                                                                                                
She stressed that while the bill added a new cost to the                                                                        
state, the department believed it would provide a future                                                                        
cost avoidance in terms of the kinds of costs the state                                                                         
would be asked to carry for patients in institutional long-                                                                     
term care.                                                                                                                      
                                                                                                                                
Senator Al Adams repeated his question if rural health care                                                                     
providers would be eligible for funds to provide the                                                                            
services.  Alison Elgee replied that the funds would follow                                                                     
the client and there would be no provider excluded from                                                                         
receiving it.  Therefore, rural providers would be able to                                                                      
receive compensation for services provided.                                                                                     
                                                                                                                                
Senator Al Adams then asked about the proposed Amendment #1                                                                     
that deleted coverage for sub-acute care.  Alison Elgee                                                                         
explained the amendment further defined the section that                                                                        
addressed services that would not be covered by this                                                                            
legislation. In the original bill, the services provided                                                                        
that the program would not cover intermediate or skilled                                                                        
care hospital services or services in the Pioneer Homes.                                                                        
There was some feeling that it needed to include sub-acute                                                                      
care, which was a different level of care than acute care                                                                       
or nursing home care.                                                                                                           
                                                                                                                                
Senator Gary Wilken shared that Linda Fink was present to                                                                       
specifically address this matter.                                                                                               
                                                                                                                                
Co-Chair John Torgerson asked how the department would                                                                          
define "moderate income".  Alison Elgee responded that the                                                                      
department would develop regulations to define eligibility.                                                                     
The reason they did not try to define moderate from an                                                                          
income perspective was because even an individual with a                                                                        
monthly income of $2500 might not be able to afford the                                                                         
$1000 services given their other financial circumstances.                                                                       
The department would look at the cost for the package of                                                                        
services necessary for the individual and then look at the                                                                      
available income.                                                                                                               
                                                                                                                                
Co-Chair John Torgerson said that worried him. There was no                                                                     
cap on the bill. He noted the growing percentage of the                                                                         
senior population in Alaska. He guessed the fiscal note was                                                                     
way understated.                                                                                                                
                                                                                                                                
Co-Chair John Torgerson asked for clarification of the                                                                          
language on page 5 line 9 saying, "the department may waive                                                                     
any requirement of this section if the department                                                                               
determines that it is not cost effective to require                                                                             
performance". He felt it was an exemption from the already                                                                      
limited co-pay requirements. Alison Elgee replied that                                                                          
sometimes it cost more to instigate collection than the                                                                         
actual debt.  This would allow the department to determine                                                                      
when it was not worthwhile to pursue a collection.  Co-                                                                         
Chair John Torgerson countered that was not what the                                                                            
language said.                                                                                                                  
                                                                                                                                
Co-Chair John Torgerson said he would work with Senator                                                                         
Gary Wilken to address the co-pay and income limits.                                                                            
                                                                                                                                
Alison Elgee pointed out that the bill specifically stated                                                                      
that this was not an entitlement program and would be                                                                           
limited to the funding appropriated by the Legislature.                                                                         
                                                                                                                                
Senator Gary Wilken misspoke earlier about the fiscal note.                                                                     
It may be driven down considerably, not for federal money,                                                                      
but the state would have access to foundation funds, such                                                                       
as the Robert Wood Johnson Foundation. Kay Burrows would be                                                                     
able to address later.                                                                                                          
                                                                                                                                
Senator Sean Parnell looked at the minutes from the Senate                                                                      
Health and Social Services Committee.  Senator Kim Elton                                                                        
had asked her if the client base was being served in any                                                                        
other way currently, or if these would be new clients. Her                                                                      
response was that by spending some money now would save                                                                         
more money in the long term.  Senator Sean Parnell asked                                                                        
her to quantify how that would be achieved.  Alison Elgee                                                                       
detailed the costs of nursing home care.  By providing in-                                                                      
home care now, more people would be kept out of the nursing                                                                     
homes.  She said that even for those who entered nursing                                                                        
homes as paying clients, their assets were often depleted                                                                       
and they ended up being cared for at the government's                                                                           
expense. This program would offer these people support, not                                                                     
force them to spend down all their assets and delay or                                                                          
prevent their admittance into a nursing home. She noted                                                                         
that the state was only reimbursed for only 60-percent of                                                                       
the Medicaid costs.                                                                                                             
                                                                                                                                
Senator Sean Parnell understood that but wanted to know if                                                                      
she had identified the pool of people this would apply to                                                                       
and determine the number of people who would leave the                                                                          
state if this service were not available. Was this a                                                                            
complete new pool of people who would never become Medicaid                                                                     
dependent? He could believe the argument that to spend                                                                          
money now would save later, but he needed to see some                                                                           
backup data.                                                                                                                    
                                                                                                                                
Alison Elgee offered staff from the Department of Health                                                                        
and Social Services who could better address those                                                                              
concerns.  From the Division of Senior Services, she could                                                                      
tell him that the division had presently 587 older Alaskans                                                                     
on the Medicaid waiver that would otherwise be eligible for                                                                     
nursing home services at that average $12,500 per year                                                                          
cost.                                                                                                                           
                                                                                                                                
The department was trying to anticipate the increased needs                                                                     
as a result of the growth of the senior population.  There                                                                      
had been a number of documents the committee had reviewed                                                                       
that looked at the demographics of that population.                                                                             
Presently, over 30,000 people in the state were over the                                                                        
age of 65 and the department anticipated that figure would                                                                      
more than double by the year 2015.                                                                                              
                                                                                                                                
Senator Sean Parnell requested further clarification of the                                                                     
savings. Presumably, this legislation was done in part                                                                          
because the members felt it was the right thing to do and                                                                       
in part because it was fiscally responsible.  However, if                                                                       
the committee was going to say that it saved money, it                                                                          
ought to be identified how many patients would end up                                                                           
costing money down the road. Otherwise he had the same                                                                          
concerns as Co-Chair John Torgerson that this was open-                                                                         
ended program.  He continued sharing his desire to have the                                                                     
savings detailed.                                                                                                               
                                                                                                                                
KATHY KLOSTER, daughter of deceased Alzheimer patient, and                                                                      
Administrator, St. Ann's Care Center, testified. She spoke                                                                      
of her father's experience. She said these in-home services                                                                     
were important from a dignity standpoint.                                                                                       
                                                                                                                                
As Administrator, she spoke of the changing roles of                                                                            
nursing homes.  In the past, patients came to the homes to                                                                      
die.  Now many were coming for treatment and care and then                                                                      
return to society. There were two things mandated to                                                                            
nursing home administrators.  The first was to help                                                                             
patients maintain their highest level of practicable                                                                            
functions. If they could walk, it was the staff's                                                                               
obligation to help them continue to walk. The second                                                                            
mandate was to allow the patients to live in the least                                                                          
restrictive environment. The responsibility for nursing                                                                         
homes was to move patients out of the homes when possible.                                                                      
They could do that if in-home based services were                                                                               
available.                                                                                                                      
                                                                                                                                
Senator Gary Wilken moved for adoption of Amendment #1,                                                                         
saying it was a technical amendment dealing with acute and                                                                      
sub-acute care.  He requested Linda Fink come to table to                                                                       
explain.                                                                                                                        
                                                                                                                                
LINDA FINK, Assistant Director, Alaska State Hospital and                                                                       
Nursing Home Association explained the amendment was to add                                                                     
sub-acute care into the list of institutionalized care.                                                                         
This was one other area that needed to be delineated.                                                                           
                                                                                                                                
Co-Chair John Torgerson asked what this did to the fiscal                                                                       
note.  Linda Fink said it did nothing and detailed it would                                                                     
keep people out of the program that would need those kinds                                                                      
of care.                                                                                                                        
                                                                                                                                
Linda Fink added that the amendment also inserted "private"                                                                     
so that there were no organizations left out.                                                                                   
                                                                                                                                
Senator Sean Parnell wanted to understand where this fit                                                                        
into the bill. Co-Chair John Torgerson asked if this was                                                                        
intended to not provide payment for subacute care.  Linda                                                                       
Fink responded that was correct for this program.                                                                               
                                                                                                                                
Senator Sean Parnell asked where these services were                                                                            
currently provided. Fink answered that they were covered                                                                        
under Medicare.  Senator Sean Parnell clarified that this                                                                       
bill would not require the state to pay for sub acute care.                                                                     
                                                                                                                                
Amendment #1 was adopted without objection.                                                                                     
                                                                                                                                
Co-Chair John Torgerson ordered the bill held in committee                                                                      
to work on clarifying language and income limits.                                                                               
                                                                                                                                

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