Legislature(2021 - 2022)BUTROVICH 205
03/18/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB89 | |
| SB98 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 89 | TELECONFERENCED | |
| *+ | SB 98 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 89-ASSISTED LIVING HOMES: HOUSE RULES
1:32:48 PM
VICE CHAIR HUGHES announced the consideration of SENATE BILL NO.
89 "An Act relating to house rules for assisted living homes."
intent to hear an overview and take testimony. She called on
Director John Lee to testify.
1:34:11 PM
JOHN LEE, Director, Division of Senior and Disabilities
Services, Department of Health and Social Services (DHSS),
Palmer, Alaska, asked his team to introduce themselves.
MR.LEE said that SB 89 deals with assisted living homes, home
and community-based services. In Alaska these are 1915(c) waiver
services. That means that Alaska gets a federal match of 50
percent for the waiver programs. The waiver programs offer
optional, low-cost home and community-based options for people
who would otherwise be in institutions. These programs provide
services that keep people in their communities and keep costs
low.
1:36:24 PM
MR. LEE said that Alaska statutes are not in compliance with
federal regulations that require home and community-based
service providers to give people who are on waivers the same
access to community as people not on waivers. For example, the
state law allows assisted living homes to establish house rules
around visitations, but the federal statutes require that these
providers allow individuals to exercise the same choices and
options as if they were in their own homes. This bill makes a
couple of statutory changes so the state can be in compliance
with the final rule of federal codes that govern these programs.
Ongoing participation in the waiver depends on the state being
compliant. The federal government has given states until 2023 to
make the statutory changes to be in compliance with the final
rules.
MR. LEE said that the simple insertion of language into the
assisted living home statute will bring the state into
compliance with the Centers for Medicaid and Medicare Services
(CMS) home and community-based setting requirements. The bill
would ensure that recipients of waiver services will be able to
live under conditions as much like a person's home as possible.
About 700 assisted living home providers in state will be
required to abide by the conditions defined in the bill. This
new statutory language will afford all residents living in
assisted living homes the same rights, regardless of whether the
home accepts Medicaid for payment or not. There are 650 homes
already in compliance with the conditions set forth in this
legislation. The states have until March of 2023 to comply with
this rule. That was an extension of the timeline. Because of the
pandemic, CMS gave states additional time to comply. There is no
fiscal impact from the bill.
MR. LEE presented the sectional:
Section 1: Amends AS 47.33.060 House Rules for
Assisted Living Homes to explicitly require
consistency with federal regulation when house rules
are established.
Section 2: Adds a new section to AS 47.33.060 House
Rules for Assisted Living Homes to make explicit that
assisted living homes that provide waiver services may
not adopt house rules inconsistent with federal
regulations.
Section 3: Carries the statutory amendments proposed
in Section 1 and Section 2 of the bill to AS
47.33.300(a) regarding a resident's rights to have
visitors.
1:40:02 PM
SENATOR COSTELLO said that a number of individuals in Alaska in
assisted living homes and community-based homes have a high
percentage who experience early onset of dementia or are
somewhere on the spectrum of dementia. When she looks at the
highlighted portion of the bill that says individuals can have
visitors of their choosing at any time, she wonders whether
people who have power of attorney or family members overseeing
their matters can determine who the visitors are.
MR. LEE answered that if individuals have guardians, the
guardians do have the ability to make choices on behalf of the
individual. One of the responsibilities of the guardian is to
make decisions as close to what those individuals would make on
their own.
SENATOR BEGICH asked if Section 4 is still required, which has
provisional language relating to the executive orders submitted
by the governor to the 32nd Alaska State Legislature in the
first regular session. Since that has been withdrawn, he asked
whether Section 4 should be eliminated.
MR. LEE deferred to Tony Newman.
1:42:08 PM
TONY NEWMAN, Deputy Director, Division of Senior and
Disabilities Services, Department of Health and Social Services
(DHSS), Juneau, Alaska, said that Section 4 could be eliminated,
but the division would need to defer to the Department of Law.
SENATOR BEGICH explained that he is not intending to slow the
bill. He is just bringing that to the attention of the author.
That could be removed later in the process if it is no longer
relevant.
VICE CHAIR HUGHES said an order may be reissued if the
legislature did not reconvene. Mr. Lee might want to make sure
that it would suit that possible future scenario.
SENATOR BEGICH said he received a legal opinion on the order.
Unless it is issued tomorrow, there will be no ability in the
first regular session for there to be a regular order. At this
point, if it is left in it would be irrelevant. He doesn't know
the answer. He doesn't want to hold the bill up for that but is
bringing it to the attention of the bill's author.
VICE CHAIR HUGHES said that if the words "in the first regular
session" would be removed it would be possible an order could be
reissued and if the legislature decided not to convene and stop
it, it would be applicable. She leaves it to Mr. Lee.
SENATOR WILSON asked what the consequences are for the providers
who are not in compliance with the new guidelines.
MR. LEE explained that once the statute goes into effect,
licensed providers will need to be in compliance.
1:45:06 PM
CRAIG BRAXTER, Program Manager, Residential Licensing, Health
Care Services, Department of Health and Social Services (DHSS),
Anchorage, Alaska said that the residential licensing agency
would reach out to those providers and have them update those
house rules to reflect the change. Of the 50 or so providers who
are not currently certified, as new licensees their house rules
would now have to reflect the visitation requirements if
certified. A fair number of the 50 providers are provisionally
licensed and are in the process of seeking certification. It is
probably even fewer than 50 who would be affected. The handful
that would not be affected are the ones who have opted not to be
certified or who have lost certification. They essentially just
have to expand visitation hours. Most facilities have visitation
hours usually between 8 to 8. They would need to update those
visitation hours.
SENATOR WILSON asked what the penalty is if they don't do this
or if they aren't notified or fall through the cracks.
MR. BAXTER replied that if they refuse to update their house
rules, probably the first time someone had a visitor barred the
agency would intervene and notify them of noncompliance and then
ask for a plan of correction and try to resolve that with the
facility. If the facility continued to not allow visitation in
compliance with those rules, then the agency may issue a warning
notice or elevate it to a higher enforcement action. They do try
to work with a facility to come into compliance. If someone
filed an appeal, the agency goes through the administrative
appeals process to resolve the issue as well.
1:47:22 PM
SENATOR COSTELLO noted that many assisted living homes were not
able to accept visitors because of COVID. She asked if this is
in response to that or is that a separate issue entirely.
MR. LEE answered that is a common question. This statute is
needed regardless of COVID. COVID has nothing to do with this
bill except that during COVID certain regulations were able to
be suspended. The bill is needed to be in compliance with the
code of federal regulations.
SENATOR COSTELLO asked how many complaints are received from
individuals or families in homes and what agency deals with
those complaints.
MR. LEE responded that it depends on the complaint. If it is
about a program that Senior Disability Services provides, then
the complaints will come to Senior Disability Services.
Licensing complaints about providers could go to Craig Baxter.
The recipient community is in favor of this bill, to make sure
providers and the state allow people to live their lives as they
choose. This will be well received by the recipient community.
There are already more than 650 providers out of 700 in
compliance.
SENATOR COSTELLO said that her questions are not directly
related to the bill. She asked if the division requires a survey
of residents' families.
MR. LEE said the division partners with providers and recipients
frequently. He deferred to Ms. Keilman-Cruz.
1:51:52 PM
LYNNE KEILMAN-CRUZ, Chief of Quality, Division of Senior and
Disabilities Services, Department of Health and Social Services
(DHSS), Anchorage, Alaska, replied that Senior Disabilities has
a central reporting intake. Individuals and families can make
complaints that are then routed to each of the oversight
divisions, such as residential licensing and the quality
assurance program. The division does not do surveys but does
require homes or entities with certifications to conduct their
own satisfaction surveys and report those to the division.
SENATOR COSTELLO said that was her question. The surveys are
done and the results are provided to Ms. Keilman-Cruz's office.
She asked if the results are public.
MS. KEILMAN-CRUZ answered they are not typically public. The
division uses them as a quality overview of how the providers
are doing. They conduct their own internal surveys. Until a
complaint is completely adjudicated, the division would not
release those complaints.
SENATOR COSTELLO asked if Ms. Keilman-Cruz' agency can provide
information on complaints that have been finalized so that the
public officials can have sense of a nature of the situation in
Alaska. The state has one of the fastest growing senior
populations. It would be interesting for the committee to know
the nature of some of the complaints after the past five years.
MS. KEILMAN-CRUZ said the division could give an overview of the
types and amounts of complaints and Craig Baxter can discuss the
licensing inspection and investigation process.
1:55:20 PM
VICE CHAIR HUGHES asked her to provide that to Senator Wilson's
office. She has general questions, like Senator Costello, to
help the committee be informed about assisted living homes. She
asked if a person is looking for a home for loved one, is there
a resource to look at ratings or a way to evaluate assisted
living homes.
MR. LEE replied that are not a lot of online ratings for
assisted living facilities. One of things his division provides
for individuals who qualify for the waiver program is a way to
connect them with care coordinators who are charged with helping
individuals navigate their options and help them evaluate the
quality of care of facilities they may be placed in.
MR. BAXTER said that his office conducts between 500-600
inspections annually and 300-400 investigations annually. Once
those reports become public, any member of the public can reach
out to his office for copies of reports or surveys. His office
has a list of licensed providers on its website. There are a
handful of agencies that some facilities are associated with,
like A Place for Mom. Those agencies request routine inspection
reports from his office so they can make sure their recommended
facilities are in compliance. Outside of that there is no rating
system that the state or anyone else publishes for all the
assisted living homes.
SENATOR HUGHES asked if 700 providers are adequate for the
growing senior population.
MR. LEE answered that to be 100 percent honest, it depends on
where someone lives. In Anchorage, Mat-Su, Fairbanks, and the
larger areas, there is an adequate supply. The real issue is the
more remote populations. It depends on where someone lives.
1:59:59 PM
MR. NEWMAN said that to his knowledge no analysis has been done
recently that demonstrates either a surplus or a shortage in
Alaska, but they know that Alaska does have the fastest growing
senior population in the country. The number of licensed
assisting homes in Alaska has been growing dramatically. The
stakeholders would probably say Alaska could always use more
assisted living homes that are well tailored to meet the needs
of varied clients.
VICE CHAIR HUGHES noted there is a Pioneer Home in her district
and the residents suffered from loneliness and the home tried to
make better arrangements for visits during the high point of the
pandemic as the homes were trying to protect that population.
She asked if assisted living homes had similar strict rules as
far as visitation.
MR. BAXTER answered that the Pioneer Homes are licensed in the
same way as the rest are. The same guidelines and health orders
applied to all.
VICE CHAIR HUGHES said that to come into compliance with federal
law, her understanding is that assisted living homes would need
allow visitors at any time. Mr. Baxter had mentioned that some
had visiting hours from 8 a.m. to 8 p.m. She asked if assisted
living homes must accept visitors 24/7 now.
MR. LEE said that the statute will require that the individuals
have opportunities to have visitors at the time of their
choosing, so yes.
VICE CHAIR HUGHES said that the state must be in compliance
March 2023 and about 50 homes that still need to come into
compliance. She asked if they will be relicensed before March
2023, so will that occur naturally.
2:03:27 PM
MR. BAXTER answered that will happen naturally. The majority of
licenses are biennial, a two-year cycle. Most new homes are
provisionally licensed on a one-year cycle. It would be easy for
the division to do it as part of the natural licensing cycle by
2023. If a home was not able to be in compliance by that time,
the division will reach out to the home to work on that.
SENATOR COSTELLO asked if the bill addresses online visits.
MR. LEE said that is an excellent question in light of the
pandemic value of distance delivery.
MR. BAXTER replied that residents already have the right under
AS 47.33.300 to engage in private communication, telephonically,
in person, or using the internet. That cannot be restricted by a
facility. If a facility were restricting someone's ability to
get online and contact people, that would be an issue unless a
guardian had restricted that.
SENATOR COSTELLO said she is not thinking of a facility
restricting that but more in terms of the facility providing the
opportunities. She asked if visitors include online visitors and
if the resident doesn't own a device, does the legislation
require the facilities to provide the opportunity.
MR. LEE answered that the final rule does not direct states to
have that requirement. The proposed bill does not require the
provider to provide that. There are resources to help people get
devices, but the bill is silent on that. The attempt with the
bill is for the state to be compliant with the final rules
without adding any additional requirements.
SENATOR COSTELLO clarified that her line of inquiry is about the
definition of visitor. She is hearing that it is an in-person
visitor and not an electronic visit. That is how she read the
bill, but she thought it worth bringing up because many
individuals do not have family here in Alaska and it would be
nice for that opportunity to be provided to residents.
VICE CHAIR HUGHES shared that she knows the facility in Juneau
was accommodating during her father's final weeks with visits
through phones or tablets during the pandemic.
2:08:39 PM
SENATOR WILSON asked knowing that assisted living providers have
a lot of issues with billing Medicaid, if the department
provides technical assistant for that. Medicaid audits are high
for assisted living facilities.
MS. KEILMAN-CRUZ answered that her agency supplies lots of
technical assistance and has an open door policy for facilities
to ask questions through the provider certification and
compliance unit. When her agency does investigations, many times
it is offering technical assistance to come into compliance.
Residential licensing supplies the same sort of technical
assistance. For billing specifically, there are online programs
and trainings to assist with billing.
MR. BAXTER said his agency also offers a variety of training
opportunities to new and existing facilities regarding licensing
complaints. It does not deal with Medicaid billing but with
compliance and standards. Providers can reach out to his agency
for help.
VICE CHAIR HUGHES noted there is no fiscal note and asked if
there is potential for increased staffing if there are more
visitors in an assisted living home or will that be minimal.
MR. BAXTER replied his office already works closely with Senior
and Disabilities Services to bring the 650 homes into compliance
and he has not noted any increase in staffing because of this.
2:12:32 PM
VICE CHAIR HUGHES opened public testimony.
2:12:46 PM
ROBIN MINARD, Chief Communication Officer, Mat-Su Health
Foundation, Wasilla, Alaska, said that currently Alaska allows
assisted living to establish house rules for visitors. While the
state law says the house rules may not be unreasonably
restrictive, the federal regulation is more explicit, stating
that individuals on waivers must be able to have visitors of
their choosing at any time. The Mat-Su Health Foundation
supports this change because it affords residents of assisted
living homes the ability to make decisions for themselves.
Alaskans in these settings deserve living conditions as close as
possible to those they would have in their own homes. Mat-Su has
the fastest growing senior population in the state. By 2030 more
than one in five Mat-Su residents will age 60 or older and those
over age 85 will increase by 188 percent. These residents are
often the most vulnerable and require more intense services. She
urged the committee to pass SB 89 so the most vulnerable and
most treasured citizens can enjoy the living conditions they
deserve.
2:14:57 PM
VICE CHAIR HUGHES closed public testimony and noted the written
testimony that had been submitted in support of the bill. She
held SB 89 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 89 Version A.PDF |
HHSS 5/4/2021 3:00:00 PM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 Transmital Letter.pdf |
SFIN 4/7/2021 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 Sectional Analysis Version GS 1675 A.pdf |
HHSS 5/13/2021 3:00:00 PM SFIN 4/7/2021 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 Fiscal Note 1 DHSS.PDF |
HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 FAQ on Final Rule prepared by Coalition for Community Choice.pdf |
HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM SFIN 4/7/2021 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 Final Rule 42 CFR 441.301c.pdf |
SFIN 4/7/2021 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 One Page Summary.pdf |
HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM SFIN 4/7/2021 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 Settings Information webpage.pdf |
HHSS 4/29/2021 3:00:00 PM SFIN 4/7/2021 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 All Ways Caring Letter of Support.pdf |
HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 Letter of Support Samash_Redacted.pdf |
HHSS 4/29/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 98 Version 32 GS 1708 A.PDF |
SHSS 3/18/2021 1:30:00 PM |
SB 98 |
| SB 98 Transmittal Letter.pdf |
SFIN 4/7/2021 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 98 |
| SB 98 Sectional Analysis Version GS 1708 A.pdf |
SFIN 4/7/2021 9:00:00 AM SFIN 3/31/2022 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 98 |
| SB98 Fiscal Note 1 DHSS Medicaid.PDF |
SHSS 3/18/2021 1:30:00 PM |
SB 98 |
| SB98 Fiscal Note 2 DHSS Senior Svcs.PDF |
SHSS 3/18/2021 1:30:00 PM |
SB 98 |
| SB98 Fiscal Note 3 DHSS Health Care Svcs.PDF |
SHSS 3/18/2021 1:30:00 PM |
SB 98 |
| SB 98 Adult Foster Care for Disabled Graphic.pdf |
SFIN 4/7/2021 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 98 |