Legislature(1999 - 2000)
04/06/1999 06:04 PM FIN
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
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.