Legislature(2005 - 2006)CAPITOL 106
04/19/2005 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB193 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 193 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
April 19, 2005
3:35 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Paul Seaton, Vice Chair
Representative Tom Anderson
Representative Vic Kohring
Representative Lesil McGuire
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
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."
- HEARD AND HELD
OVERVIEW OF SCHOOL COST DIFFERENTIAL
- OVERVIEW CANCELED
PREVIOUS COMMITTEE ACTION
BILL: HB 193
SHORT TITLE: LICENSING MEDICAL OR CARE FACILITIES
SPONSOR(S): RULES BY REQUEST OF THE GOVERNOR
03/02/05 (H) READ THE FIRST TIME - REFERRALS
03/02/05 (H) HES, JUD, FIN
03/15/05 (H) HES AT 3:00 PM CAPITOL 106
03/15/05 (H) Scheduled But Not Heard
03/17/05 (H) HES AT 3:00 PM CAPITOL 106
03/17/05 (H) Heard & Held
03/17/05 (H) MINUTE(HES)
04/07/05 (H) HES AT 3:30 PM CAPITOL 106
04/07/05 (H) Heard & Held
04/07/05 (H) MINUTE(HES)
04/19/05 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
RICHARD MANDSAGER, M.D., Director
Division of Public Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified on behalf of the department
during the hearing on HB 193.
STACIE KRALY, Senior Assistant Attorney General
Human Services Section
Office of the Attorney General
Department of Law
Juneau, Alaska
POSITION STATEMENT: During the hearing on HB 193, answered
questions.
AMY ONEY, Owner/Operator
Mama's Assisted Living Home
Anchorage, Alaska
POSITION STATEMENT: Testified in support of amending HB 193.
JUDY JACHIM
Fairbanks, Alaska
POSITION STATEMENT: Testified during the hearing on HB 193.
CANDY CARROLL
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of Amendment 1 to HB
193.
MONTA LANE
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of amending HB 193.
MARY RAYMOND, Coordinator
LVR
Homer, Alaska
POSITION STATEMENT: Testified on behalf of five assisted living
homes during the hearing on HB 193.
SHERRY METTLER
Northern Lighthouse Assisted Living Home
Anchorage, Alaska
POSITION STATEMENT: Testified on behalf of 38 assisted living
home representatives in support of Amendment 1 to HB 193.
JON SHERWOOD, Medical Assistance Administrator
Office of the Commissioner
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified on behalf of the department
during the hearing on HB 193.
MERRI BELLE DIAS
Matanuska-Susitna Valley, Alaska
POSITION STATEMENT: Testified in support of amendments to HB
193.
VIRGINIA STONKUS, Chief
Certifications and Licensing
Division of Public Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered a question during the hearing on
HB 193.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:35:59 PM.
Representatives Kohring, McGuire, Anderson, Cissna, and Gardner
were present at the call to order. Representative Seaton
arrived as the meeting was in progress.
HB 193-LICENSING MEDICAL OR CARE FACILITIES
CHAIR WILSON announced that the first order of business was
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."
3:37:06 PM
REPRESENTATIVE CISSNA moved to adopt the committee substitute
(CS) for HB 193, Version 24-GH1016\F, Mischel, 4/19/05, as a
work draft. There being no objection, Version F was before the
committee.
RICHARD MANDSAGER, M.D., Director, Division of Public Health,
Department of Health and Social Services, explained the added
change on page 8 of CSHB 193, following line 16, where the
Department of Health and Social Services is added as the
administrative hearing entity for hearings related to the
centralized registry. He explained that on page 14, line 21,
the word "volunteer" is added; volunteers are subject to the
registry when they have an ongoing, unsupervised relationship
with a client. He pointed out that on page 14, line 23, the
word "decisions" was added. On page 14, line 27, he related,
there is the addition of defined medical assistant's fraud, so
an entity, provider, or employee that commits medical assistance
fraud is included in the registry.
REPRESENTATIVE CISSNA inquired as to how the registry will
function with the high turnover rates that are associated with
human service workers.
DR. MANDSAGER rephrased Representative Cissna's question, "I
think what you are asking is: ...'If they change jobs ...
annually, for a while, for some reason or another, how often
does this whole process have to be gone through?'"
3:41:54 PM
STACIE KRALY, Senior Assistant Attorney, Human Services Section,
Department of Law, said that she envisions a regulatory
provision or waiver such that the same background check could be
used when the timeframe between jobs is relatively short.
DR. MANDSAGER explained that on page 15, line 12, a new
subsection was added to ensure that reporting occurs if there
have been any episodes within the past 10 years.
CHAIR WILSON asked for an example.
MS. KRALY said:
the concept for this provision was ... for the
centralized registry ... an individual who had been
... terminated from employment 20 years ago, we wanted
... a time sensitive period with respect to these
findings that would allow for a good, current picture
of an individual ... if we're going to go back further
than 10 years we felt that, like, under the criminal
registry ... there's a discretionary and a mandatory
bar, depending on how old the offense is. We felt
that 10 years was an appropriate time to look at these
sort of civil abuse issues to determine whether or not
they should be included on the registry.
MS. KRALY further explained :
The premise of the ["24 hours"] is that as soon as
there is an allegation of harm or a termination ...
the department [would] be advised of that. The name
doesn't go on the registry until all of the
adjudicatory due process provisions have been met, but
that we would be provided immediate notice ... we just
wanted things to get moving quickly to afford a due
process as quickly as possible.
DR. MANDSAGER mentioned that page 15, line 23, establishes that
information in the registry is confidential. He explained that
there is the opportunity to create access to the registry
through using a password, so that the process is electronic and
does not require staff.
DR. MANDSAGER said that there is a clarification of immunity
protections on page 15, line 28, following [Subsection (i)] such
that one making a report is not subject to liability. He
continued:
Page 16, line 18, defines the phrase "entity," which
is used in this bill .... There's one other element
in here that was suggested by the Municipality of
Anchorage, in the Senate hearing last week, and it's
on page 23, line 19 ... this was a concern that the
bill was not explicit as current law is that if a
municipality with "home rule" powers wants to take on
child care licensing authorities it would be clarified
that they can do that .... This makes clear that the
powers in current statute are continued into this.
DR. MANDSAGER said that Anchorage licenses approximately 50
percent of the child care entities in the state. He explained
that the aforementioned amendment entitles municipalities to
this power of licensing.
3:47:01 PM
REPRESENTATIVE KOHRING inquired as to the possibility of moving
HB 193 out of the House Health, Education and Social Services
Standing Committee.
CHAIR WILSON stated that she has not read the entire bill, and
would like to do so before moving it out of committee.
REPRESENTATIVE CISSNA began discussion of Amendment 1, labeled
24-GH1016\G.2, Mischel, 4/19/05, which [she offered on behalf of
herself and Representative Anderson]. Amendment 1 read
[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 optional
Medicaid coverage and to medical assistance coverage
for companion services"
Page 15, following line 29:
Insert new bill sections to read:
"* Sec. 20. AS 47.07.070(a) is amended to read:
(a) Except as provided under (d) - (f) of this
section, the [THE] department shall, by regulation,
set rates of payment for health facilities under this
chapter and AS 47.25.120 - 47.25.300 in accordance
with 42 U.S.C. 1396 (Title XIX, Social Security Act,
Medical Assistance) and this section. A rate
established under this section takes effect under
AS 44.62 (Administrative Procedure Act) but not until
approved in writing by the commissioner. The
commissioner may delegate the performance of these
functions.
* Sec. 21. AS 47.07.070 is amended by adding new
subsections to read:
(d) For residential support living services
provided to an eligible recipient of medical
assistance living in an assisted living home licensed
under AS 47.33, the minimum daily reimbursement rate
to the assisted living home for room and board
expenses is $28.
(e) The department may not establish a maximum
daily rate for room and board expenses charged by an
assisted living home.
(f) A calculation of the rate for administrative
and general costs for a provider, including an
assisted living home, shall be determined in the same
way as a calculation of the administrative and general
cost rate for a Pioneers' Home. In this subsection,
"administrative and general costs" means those
expenses that are common to the overall operation of a
provider providing home and community-based waiver
services and that are not directly assignable to or
borne by a specific program or recipient of a home and
community-based service.
* Sec. 22. AS 47.07.030(c) is amended to read:
(c) Notwithstanding (b) of this section, the
department shall [MAY] offer a service for which the
department has received a waiver from the federal
government if the department was authorized, directed,
or requested to apply for the waiver by law or by a
concurrent or joint resolution of the legislature and
the service will result in cost savings to the
department by allowing an eligible recipient who would
otherwise require institutional care to live at home.
* Sec. 23. AS 47.07.030 is amended by adding a new
subsection to read:
(e) The department shall apply for a waiver
under (c) of this section and offer companion services
in a recipient's home to an eligible recipient to the
extent that the companion services are necessary and
will result in cost savings to the department over the
provision of institutional care for the recipient.
Companion services may be covered under this
subsection for nighttime care. In this subsection,
"companion services" means nonmedical care,
supervision, and socialization provided to a
functionally impaired adult in accordance with a
therapeutic goal in the recipient's plan of care."
Renumber the following bill sections accordingly.
Page 39, following line 31:
Insert a new bill section to read:
"* Sec. 52. AS 47.07.070(c) is repealed."
Renumber the following bill sections accordingly.
Page 40, following line 9:
Insert a new bill section to read:
"* Sec. 56. The uncodified law of the State of
Alaska is amended by adding a new section to read:
REGULATIONS ANNULLED. 7 AAC 43.1058(j) and 7 AAC
43.1058(k)(1)(B) are annulled."
Renumber the following bill sections accordingly.
Page 45, 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:
RETROACTIVITY. Sections 20 and 21 of this Act
are retroactive to June 26, 2004."
Renumber the following bill sections accordingly.
Page 45, line 4:
Delete "Sections 51, 54, and 56"
Insert "Sections 20, 21, 57, 60, 62, and 64"
Conform all internal bill section references on page
40, lines 13, 15, 16, 18, 19, 21, and 24; on page 41,
lines 3, 14, and 21 - 23; on page 42, lines 3 - 15,
20, 26, and 29; on page 43, lines 8, 9, 11, 13, 14,
19, 22, 24, and 28; page 44, lines 24, 25, and 28; and
on page 45, lines 3 - 10.
REPRESENTATIVE CISSNA explained that the Amendment 1 would apply
to the rates charged and to the liability of the recipients of
the home as well as providing community-based services, at-home
health care, and companion services if it is a cost savings.
She opined that this could provide an incentive for the
department to look into cost savings related to keeping people
in their homes.
3:50:52 PM
DR. MANDSAGER notified the committee of a change added on the
companion bill to HB 193 in the Senate that allows, "a person
that is coming to pick-up or visit a child-care facility to have
an unloaded firearm in a locked or covered case .... Since we
haven't provided amendment language, I am proposing that we
would provide that to the next committee after it leaves here
.... I suppose we could bring it here too, just so the bills
stay the same, as much as possible on both sides."
CHAIR WILSON stated the she would like to take Representative
Cissna's amendment and divide it into sections, and adopt the
amendment section by section.
3:53:56 PM
REPRESENTATIVE ANDERSON offered that Representative Cissna had
moved Amendment 1, and thus with an objection Amendment 1 could
be discussed section by section. He said this would eliminate
the creation of multiple amendments.
CHAIR WILSON objected and stated that Amendment 1 will be dealt
with as she originally suggested. She referred to page 15,
following line 29 and highlighted the new sections, Sections
20-23.
The committee took an at-ease from 3:56:47 to 4:00:52.
4:01:07 PM
AMY ONEY, Co-Owner/Operator, Mama's Assisted Living Home,
explained that last year, the Division of Senior Services put a
cap on the room and board rates that the assisted living homes
could collect from their residents. The cap was set at $18.54 a
day, she related. She emphasized that her program cannot
provide service for that amount of money. She continued:
So, what this amendment has done: ... it's rolled the
clock back to go back into those ... regulations that
were passed last year, and it's given us $28 a day,
minimum - which is what we had before - and it has
taken their ability to put a maximum rate on there.
... If they had more income than that, that still
qualified for the Medicaid waiver, they kept the $100,
and we were able to collect room and board above the
$28, if those people had those resources.
MS. ONEY, in response to a question from Chair Wilson,
explained:
We actually provide the service, so what would happen
is, every month when people get their ... entitlement
checks, they are entitled to keep $100 and, depending
on the contract that the home created with that
resident, they were allowed to keep a minimum of $100.
The home could charge whatever room and board rate
they needed to survive, and that resident was
guaranteed at least $100 to live on for the room and
board side.
... Our waiver reimbursements do not cover any of the
food expense; they don't cover our rent. They
delegate certain percentages out - ... I think it's 22
percent of our wages have to paid by room and board
money. Our utilities, our home maintenance - any kind
of ... expenses that we didn't put into our budget
that wouldn't have been covered by Medicaid
reimbursement - we have to cover out of room and board
monies. And by them putting on a cap for $18.54 per
day on what we're allowed to collect per resident, per
day, if they have any more money than that, we have to
pay it back to the state now. We have to short our
Medicaid reimbursements by whatever amount they're
above the minimum, so that every single person in
assisted living right now is supposedly supposed to be
paying ... a total of $564 a month. And that's all we
get per resident, per month to pay these room and
board expenses.
MS. ONEY detailed the room and board expenses for her operation.
In response to a question from Chair Wilson, she listed the
amount of money each of the four homes she and her husband run
are losing per month since the cap was incurred: $2,400,
$2,000, $1,670, and $2,888.
4:07:05 PM
MS. ONEY, in response to a question from Representative Gardner,
said the home that is losing $2,888 has five residents in it.
She said each home's expense requirements differ depending upon
property values, expenses, utilities, and resident needs.
REPRESENTATIVE GARDNER proffered:
I think I have the number worked out, which is $5584.
And I think it probably is fair to say the difference
in cost between you running your home and somebody
running a private home for 5 people is that they have
to provide staff for them, as well, and
transportation. ... That's calculated: ... $18.56
times 5 people, is $92 a day for 5 people, times 30
days in the month, the cost would be $2,784, and then
she's losing $2800. So, in round numbers, the cost,
then, for running that home is $5584, for 5 people,
which is ... $1100 a month. So, if you think, for
those kinds of services, for $1100 a month, that's not
an outrageous amount of money.
MS. ONEY related that because of the budget, as a result of the
Medicaid waiver, she has to pay her staff much less than the
staff of the Pioneer Home is paid.
4:09:55 PM
REPRESENTATIVE MCGUIRE suggested that Ms. Oney could go through
the costs associated with the operation of an assisted living
home.
MS. ONEY explained that her homes serve a population including
elderly with dementia and disabled adults. She pointed out that
her homes provide 24-hour care, including three meals per day,
plus snacks.
MS. ONEY stated that room and board expenses, with Medicaid
waiver clients, are separated out from services. She explained
that when she goes to the Medicaid waiver people with her
budget, they tell her what they will cover for service -
providing physical hands-on care, versus the time spent doing
laundry, cleaning, rooms, and food preparation. She continued:
So, what they do is they take a random analysis and
say, "Okay, we're going to pay ... 78 percent under
the cost of care of your wages, or any of your wage
expense ...." But since you get room and board money
from the residents, you have to pay them out of this
other coffer over here; you have to provide 22 percent
of those employee wages out of the room and board
expenses. And when you have a 24-hour staff ... [paid
at] $11 an hour, you can imagine that, out of $18.64 a
day, it takes, I think, two clients just to pay your
22 percent [for] your staff just to be in the home -
and that's only if you have one person on staff. But
a couple homes, including two of mine, have two people
on during the day, so that significantly increases
that amount of that 22 percent of your employment
costs.
MS. ONEY said Medicaid considers the layout of the home. They
do not pay the percentage of rent for bedrooms, bathrooms,
kitchens, or laundry facilities. She explained, "So, if ... you
have a five-bedroom facility, you'll lose more of your
reimbursement, because more of your floor plan is taken up by
bedroom space." She indicated that the amount that Medicaid
does not cover for those areas is 35 percent; therefore that
money must come out of room and board monies. She noted that
food expenses in the average home is $1,000 a month. She said,
"So, you can see, if you're spending two person's allowance on
your food allowance and over two people on your wages, there's
no money left over to make up these other expenses that we're
supposed to cover." For those who have owner occupied homes, in
which the owners live on the premises, Medicaid excludes the
personal space before doing the allocations. For example, if
there is a 1,000 square foot home and 200 square feet belong to
the owner, then Medicaid's calculations would be on the
remaining 800 feet.
CHAIR WILSON inquired as to Ms. Oney's opinion as to whether the
aforementioned calculation is fair.
MS. ONEY related:
I don't think it's correct in basing it on the square
foot ... because most of the care we do takes place in
their own personal bedrooms. So, to exclude that from
personal care space, just in order to shift the funds
over and make us pay that, the allocation formula is
off, because the care is being provided, the Medicaid
portions of our contracts with those people are being
provided in the bedroom. They're also being provided
in the kitchen, when we do special diets based on
their medical needs, and ... when we have to cater to
each one - even if it's the littlest things as they
have no teeth and they can't chew harder foods - the
extra time preparation is actually caring for them,
not necessarily just feeding them ....
MS. ONEY, after hearing Chair Wilson's question repeated, said
she thinks it's fair to exclude personal space. She continued
as follows:
What this actually addresses is the balance of our
budget that's allocated by the personal space of the
residents. And so, when we have, say, a $10,000
budget a month ..., and they say half of that is
personal space and room and board cost, we have to
come up with - from the resident's contribution -
$5000 a month to meet our $10,000 budget. And so,
what this ... amendment does, is it prevents them from
limiting that. Because even if you ... make the $564
a month that they capped it at, [and] you round it off
to $500, you're looking at the maximum ...
contribution to the homes on the room and board side
of ... a 5 bed home, you're looking at $2500. That's
what they've limited us to collect. They prevent us
from going to the homes. If we want to provide a
better quality home and we wanted to ask the families
for help, they have prevented us from doing that. We
cannot go to the families to have them participate in
increasing the level of care of ... the residents.
They have maximized what we can do, and they've put a
maximum on it at an amount that doesn't work. We're
sustaining these losses that we've sustained since
last year, just so that we could be here before you
this year. We've been working with [Representatives
McGuire, Anderson, and Cissna] ... on these issues
ever since the regulations passed last year, and they
[assured] us, "Hang on there ...." So, this is our
hanging on, saying, "We've done it for a year, we
can't do it for another year; we can't continue these
losses." By having us operate at a home, we're
personally supplementing the [Division of Senior and
Disabilities Services] DSDS budget, because these
people are still receiving the level of care that they
would without it, because we're meeting our contract -
but we're doing it at a loss. So, we're actually
subsidizing the budget is what it's coming down to.
4:20:12 PM
CHAIR WILSON commented that she agrees with much of what Ms.
Oney has said, but she asked what is to prevent abuse of the
system by personal care attendants. She mentioned an increase
of $70 million in two years.
MS. ONEY responded:
The state funds are being monitored when we put in our
"cost of care" budgets. The room and board funds that
we were meeting on our own through the contributions
of each resident ... [are] limited, because a person
can only qualify for the waiver program if they make
under a certain amount each month. And the department
will be the first to testify [that] it doesn't apply
to everybody. Maybe 30 percent earn more than the
minimums that they're talking about. But by
preventing the homes from, say, taking two people that
earn less each month - the minimums - and maybe
they'll share a smaller room or maybe ... they'll
receive the same level of care, but ... they'll have
different aspects to their living arrangements than,
say, someone who had $1,400 a month coming in for room
and board that might get a private room with a ...
view, ... so that they're receiving something for the
extra money they're contributing to us, but we're able
to meet these expenses.
By not allowing us to take in those people that do
come in with $1,400 or even $1,000 a month, and making
us pay that difference now into the state - because
say they made $1,000 and, again for round number, the
cap was at $500 - we're paying $500 back to the state
now. Instead of letting us use that $500 to feed them
and meet these expenses, it's getting reimbursed for
the amount of Medicaid waiver funds that we receive.
So, they are reducing the state's expenses, but at the
expense of our homes. Because we still have to feed
these people. ... This new regulation set here comes
in and tells us how to clean our homes and how many
times we have to wash a towel. They're monitoring the
things we do by room and board, and we have to
regulate - we have to show and document the things we
do - but they're making it impossible to meet the
expenses of doing that. In fact, they're increasing
our expenses ... in about five weeks with the new
regulations they're putting on the table now. So,
we're not asking for anything different than the way
it was last year; ... we're just asking them to roll
back that maximum amount. ... We're being forced to
compromise our level of care that we can give to
anybody.
4:23:57 PM
CHAIR WILSON expressed concern that people could be taken
advantage of as a result of what they are able to afford for
living expenses. She added that it would be unfair to have
people with more available money receive better care services.
MS. ONEY restated that the cap mandates $18.54 per day, per
resident, for room and board.
CHAIR WILSON recalled that Ms. Oney had previously said that if
a resident had an extra $1000 each month, that she would want to
keep that money to use towards living expenses.
MS. ONEY explained that the previously mentioned $1,000 would
not be extra money. She said the home is on a cost
reimbursement program and there is no room in the budget for a
profit. She said, "If we don't match exactly what we put out,
we write them a check back." She said the home needs to have
the ability to have a buffer of money, so that it can take care
of unexpected expenses, such as when the washing machine breaks
down. She added that a person with extra money would not be
taken advantage of because he/she always has the choice to go to
another home.
[Although the chair called an at-ease for technical
difficulties, the recording actually continued.]
REPRESENTATIVE ANDERSON offered information concerning the
history of the issues in discussion related to regulations of
assisted living homes. He related that assisted living home
owners have been voicing their concerns about the new
regulations of the department and the department has maintained
its opinions and has not attempted to accommodate their needs.
He stated that the legislature has the option to hear the needs
of assisted living home owners and address their needs through
legislation.
CHAIR WILSON stated that the House Health, Education and Social
Services Standing Committee would hear public testimony.
4:32:23 PM
MS. ONEY, in response to a question from Representative Gardner,
said that she knows of at least four assisted living homes that
have closed as a result of the [$18.54] cap, but surmised that
the actual number is higher.
4:34:56 PM
JUDY JACHIM testified, "We cannot continue to operate at the way
things have been." She related that she supports legislation
that would make wages offered in assisted living homes
comparable to wages offered in pioneers' homes. She said she
has found it difficult to follow the administrative changes that
have been made in the last year without anyone consulting [those
running assisted living homes]. In response to a request for
clarification from Chair Wilson, she emphasized that things are
not better than they were.
CANDY CARROLL stated her support of Amendment 1, which she said
would help very much. She opined that the cap is restrictive
and needs to be removed; [assisted living homes] "need to be put
on the same level as the pioneers' home[s]."
4:37:18 PM
MONTA LANE said that she had just barely taken a look at CSHB
193, Version G, and supports the changes that Representative
Anderson has proposed. She said she doesn't agree with many of
the past regulations. She stated, "If they're having problems
in ... Alaska with [assisted living] homes that are not
compliant and not doing their job, they have the prosecutorial
authority to go in there and pull the license of those homes,
without making all of these regulations and these amendments
that ... [are impossible] to follow." Ms. Lane emphasized the
number of regulations that the assisted living homes have been
required to follow by various state boards and departments. She
related that many of them have been impossible to follow.
Nevertheless, she reiterated her support of "[Representative
Anderson's bill." She added:
I hope you guys do, too, because there's a lot of
things in assisted living that you guys need to get it
together and see to it that it's done. Because we do
a great service for the State of Alaska. We are the
cheapest rent in town and now you've got us down to
rock bottom. Man, we can't go any lower, and I'd
really like to see some of you down there in Juneau
... [pay for room and board] on $18.65 a day.
MS. LANE noted that two assisted living homes in the Fairbanks
area have closed and two more that may have to close. She
indicated that she [runs] the oldest assisted living home in the
Interior and if anyone comes to her for advice and
recommendations, as they have for the past 15 years, "believe
me, my attitude is going to change about assisted living," she
opined.
CHAIR WILSON reminded those testifying that she would like to
hear about the amendment, not the bill, itself.
MARY RAYMOND, Coordinator, LVR, explained that she was speaking
on behalf of five different assisted living homes: Johnson's
Assisted Living, Main Street Assisted Living, Fernridge TLC
Assisted Living, the [Indisc.] Assisted Living, and the Majestic
View Assisted Living. She stated:
We are all very concerned about how the regulations
have come down on us and how the financing has gone.
The amendments do look like they promise some, but for
the last 20 years, the assisted living home has been
promoted because it is more efficient, it is
financially better, and people can stay where they
wish. And ... the big issue is the assisted living
home. So, please hear us.
MS. RAYMOND indicated that the Legislative Information Office
(LIO) teleconference connection was down; therefore a good
portion of the committee's comments was missed. However, she
stated her appreciation that the committee is willing to
consider the issue carefully. She concluded that if people are
going to be able to get the care that they have asked for, "this
needs to be looked into and it needs to be financed."
4:44:49 PM
SHERRY METTLER, Northern Lighthouse Assisted Living Home,
testified on behalf of herself and "representatives of 38
different assisted living homes." She stated, "We're all in
agreement on the same thing - that we stand behind this
amendment because of what the cut in the room and board has done
to the assisted living homes." She clarified that the amendment
of which she spoke was Amendment 1. She said the support is a
wholehearted one, because the amendment is necessary to allow
the homes to stay in business and supply necessities, especially
under the new regulations that are coming out that are mandating
"so many different things that are still allocated to that
$18.57 a day room and board." Ms. Mettler said that concludes
the shared testimony, but indicated she could say more regarding
the original bill version.
CHAIR WILSON said she would send Ms. Mettler Version F, and she
assured her that she would have an opportunity to voice her
opinions again on the following Thursday.
4:48:41 PM
DR. MANDSAGER stated that the intent of the administration was
to "put licensing and regulation in one place and the payment
elsewhere in the department." He said his area of expertise is
not in regard to payments. He offered his understanding that
"none of these organizations have talked to us about all of the
issues we've heard about for the last hour," but rather the
issues have been heard through the regulatory commission process
and the appeals process. He said, "I would appeal to keep
thinking about the intent of this bill, which is to keep
licensing here and financing there. And it may be an
appropriate bill, I don't know, but I would advocate that it not
be in this bill."
4:49:48 PM
JON SHERWOOD, Medical Assistance Administrator, Office of the
Commissioner, Department of Health and Social Services, related,
on behalf of the Department, that the changes made to assisted
living home reimbursement were on par with "cost containment
measures" contained in the FY '05 budget. He explained that
reversing those changes would have a budget impact on the
general fund. He mentioned, "Only about 30 percent of the
people living in assisted living who receive waiver services
actually have more than their basic 'APA [Adult Public
Assistance] payment' available, and a percentage of those live
in facilities that don't charge differing room and board rates.
So, we are talking about some subset of that 30 percent who I
think the concerns that were raised would apply to."
CHAIR WILSON inquired as to the number of assisted living homes
across the state.
DR. MANDSAGER said that there are about 480 presently, and they
are growing at an annual rate of about 10 to 15 percent.
CHAIR WILSON clarified that of the 480, about one-third of those
have clients that have extra income which can be used for
additional or improved [assisted living home] services.
MR. SHERWOOD said that about 30 percent of the people for whom
the department pays for care, through the Medicaid waiver, have
the benefit of extra income. He explained that not every
assisted living home serves Medicaid waiver clients.
CHAIR WILSON asked if wealthy people used Medicaid services.
MR. SHERWOOD explained:
There are income limits to the Medicaid program, and
there are certain ways, through the use of trust
devices, people can ... voluntarily impoverish
themselves to qualify, but it's not someone who has
... unrestricted access to high levels of income or
has a lot of assets.
CHAIR WILSON ruminated:
So, these people are on Medicaid but they've got more
than the minimum to spend ..., and so, these are
people that want more services than you are willing to
pay for?
MR. SHERWOOD explained as follows:
Under Medicaid, if we pay for care in an assisted
living home, federal law requires that we do not pay
for room and board; individuals are supposed to
provide for their room and board, either out of their
personal income or any cash assistance they might ...
qualify for. ... So, we have to make sure that a
certain part of the cost of the assisted living home
rate is allocated to room and board. There are
virtually no federal requirements about how the state
does that, but we do have to ensure that there's a
room and board charge, we cannot pay for some portion
of the care, it must be allocated to room and board.
CHAIR WILSON summarized that the bottom line is whether the
assisted living home or the state gets any available extra
money.
MR. SHERWOOD said that Chair Wilson's comment is a fair
summation of the situation. He explained that there can be a
standardized room and board charge and the excess money can go
to reduce the costs of Medicaid or assisted living homeowners
can charge varying amounts for room and board, and then
additional monies would go to the providers.
CHAIR WILSON inquired as to additional payments in assisted
living homes and what the possible benefits could be.
MR. SHERWOOD said that every assisted living home has a contract
of care and most people would have standardized care according
to the contract.
4:55:22 PM
REPRESENTATIVE MCGUIRE said that as a result of the new
regulations, assisted living homes are closing. She asked Mr.
Sherwood where these adults will be placed if regulation
constraints continue and assisted living homes are not an option
in the future.
MR. SHERWOOD related that the last statistics that the
department presented to the Administrative Regulation Review
Committee indicated that the number of licensed assisted living
homes was still increasing in Alaska. In response to a follow-
up question from Representative McGuire, he offered his
understanding that those statistics were compiled in March.
REPRESENTATIVE MCGUIRE proffered:
What I really think is happening is ... you have
certain types of people that operate these homes in a
way that their whole family might live in the home and
some of our folks that are in the homes might be kind
of cramped into rooms and given meals that maybe
aren't as good as they are in other places, but they
can definitely meet your number. And ... those are
probably going to be the homes that stay in business.
And as a result, what you're going to see is the folks
in places that are getting good meals and have a nice
room and a nice place to go to the bathroom and live
in dignity will be moving to some of these others, or
alternatively, they're going to be in the Pioneer
Home, which isn't taking anymore seniors.
4:58:00 PM
REPRESENTATIVE CISSNA referred to a legislative research report
that was published in February of 2004. She noted that a chart
on page 4 of the report shows a comparison of the assisted
living beds available in Alaska as of 2002, and the number of
assisted living beds that will be needed in 2025. The projected
need shows a change from 1,500 to 5,000. Therefore, she
surmised that there will be a need for [more assisted living
homes] for which she expressed concern about the quality of
those homes. She said if there are not enough assisted living
homes, people will end up in a nursing home or "long-term beds"
that are significantly more expensive.
5:00:23 PM
DR. MANDSAGER opined that if quality suffers, that will be seen
on the licensing side. He said he thinks the commissioner's
idea to separate the two functions is to create an internal
tension within the department. Today the tension is out on the
table with regard to the data available, how the financing can
impact the quality, and how that can be measured. According to
Mr. Sherwood's data, the number of assisted living units, as of
"last March," is 14 percent more than it was last year at the
same time. He concluded, "So, there clearly is a tension right
now about the financing that we've heard about today and then
other industry operators that are trying to get into the
business."
5:02:02 PM
MERRI BELLE DIAS, testifying on behalf of herself, noted that
she runs two homes in the Matanuska/Susitna (Mat-Su) Valley.
She stated, "I'd like to express our support for these
amendments." She confirmed that the choice of a resident in an
assisted living home, should that home close, could be to go
into a nursing home, the cost of which is $10,000-$12,000 a
month. She said that would end up costing the State of Alaska
lot more money. She said she knows of three homes that have
recently closed in her area. She said the state just started a
new certification process, which increased her paperwork from 3-
4 pages to certify a home, up to approximately 150. She
predicted that by next year there would not be more than a dozen
homes in the Mat-Su Valley.
MS. DIAS, in response to a question from Chair Wilson, said
there currently are about 30 homes in the Mat-Su Valley. She
opined that they will not be able to meet the certification
requirements, paperwork, anti-harassment policies, internal
monitoring systems, and consumer satisfaction surveys. She
related that the administrative rate [currently] covers all the
required orientation, blood borne pathogen training program, and
the cardiopulmonary resuscitation (CPR) continuing education
requirement. However, there is a possibility that it will be
cut. Regarding previous comparisons of assisted living homes to
the pioneers' homes, she said, "I think a lot of assisted living
homes ... give better, more personalized care and as a larger
facility, the pioneers' homes should be able to operate more
efficiently and cheaper."
CHAIR WILSON asked how many committee members would be willing
to be on a "work force" to continue working on the issues
raised. She also requested that the Department of Health and
Social Services provide a copy of the packet that assisted
living homes fill out in order to get certified.
5:06:09 PM
DR. MANDSAGER offered to provide a copy of the current assisted
living home regulations as well as the [assisted living home
certification] proposal that has been made available for public
comment.
5:06:31 PM
REPRESENTATIVE GARDNER requested copies of any monthly reports,
annual reports, and anything else required for someone who would
be opening an assisted living home.
MR. SHERWOOD clarified that there is a state-required Medicaid
provider certification and an enrollment packet that testifiers
have mentioned, and the department would provide a copy of it to
the committee.
5:08:10 PM
VIRGINIA STONKUS, Acting Chief, Certification and Licensing,
Division of Public Health, Department of Health and Social
Services, in response to a question from Chair Wilson, said that
the "behavioral health side" and the "senior side" have been
consolidated and there is an orientation plan, training, and
several technical assistance programs.
5:10:36 PM
CHAIR WILSON announced that a subcommittee will meet tomorrow to
plan how to address the incorporation of the new amendments for
HB 193 and any other relevant issues brought forth from
interested parties.
[HB 193 was held over.]
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 5:11:47 PM.
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