04/22/2005 09:00 AM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB193 || HB114 | |
| HB193 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 193 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| = | HB 114 | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
April 22, 2005
9:10 a.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Tom Anderson
Representative Vic Kohring
Representative Lesil McGuire
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
Representative Paul Seaton, Vice Chair
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."
- MOVED CSHB 193(HES) OUT OF COMMITTEE
HOUSE BILL NO. 114
"An Act relating to the retaining of certain privileges of a
parent in a relinquishment and termination of a parent and child
relationship proceeding; relating to eligibility for permanent
fund dividends for certain children in the custody of the state;
relating to child in need of aid proceedings and juvenile
delinquency proceedings; and providing for an effective date."
- MOVED CSHB 144(HES) OUT OF COMMITTEE [ALTHOUGH NOT
NOTICED FOR THIS DATE]
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
04/19/05 (H) Heard & Held
04/19/05 (H) MINUTE(HES)
04/21/05 (H) HES AT 3:00 PM CAPITOL 106
04/21/05 (H) Scheduled But Not Heard
04/22/05 (H) HES AT 9:00 AM CAPITOL 120
BILL: HB 114
SHORT TITLE: TERM. PARENTAL RTS/CINA/DELINQUENCY CASES
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
01/26/05 (H) READ THE FIRST TIME - REFERRALS
01/26/05 (H) STA, HES, JUD
03/01/05 (H) STA AT 8:00 AM CAPITOL 106
03/01/05 (H) Heard & Held
03/01/05 (H) MINUTE(STA)
03/05/05 (H) STA AT 8:30 AM CAPITOL 106
03/05/05 (H) <Subcommittee Meeting>
03/05/05 (H) STA AT 9:30 AM CAPITOL 106
03/05/05 (H) Heard & Held
03/05/05 (H) MINUTE(STA)
03/15/05 (H) STA AT 8:00 AM CAPITOL 106
03/15/05 (H) Scheduled But Not Heard
03/19/05 (H) STA AT 9:00 AM CAPITOL 106
03/19/05 (H) <Subcommittee Meeting>
03/19/05 (H) STA AT 9:30 AM CAPITOL 106
03/19/05 (H) Scheduled But Not Heard
03/22/05 (H) STA AT 7:45 AM CAPITOL 106
03/22/05 (H) <Subcommittee Meeting>
03/22/05 (H) STA AT 8:00 AM CAPITOL 106
03/22/05 (H) Moved CSHB 114(STA) Out of Committee
03/22/05 (H) MINUTE(STA)
03/23/05 (H) STA RPT CS(STA) NT 5DP 2NR
03/23/05 (H) DP: GARDNER, GATTO, ELKINS, GRUENBERG,
SEATON;
03/23/05 (H) NR: LYNN, RAMRAS
WITNESS REGISTER
JOEL GILBERTSON, Commissioner
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified on behalf of the department.
JOHN BITNEY, Lobbyist
Thunderbird Home Health Management
Palmer, Alaska
POSITION STATEMENT: Testified during the hearing on HB 193 and
HB 114.
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.
AMY ONEY, Owner/Operator
Mama's Assisted Living Home
Anchorage, Alaska
POSITION STATEMENT: Testified during the hearing on HB 193 and
HB 114.
STACIE KRALY, Senior Assistant Attorney General
Human Services Section
Office of the Attorney General
Department of Law
Juneau, Alaska
POSITION STATEMENT: Testified during the hearing on HB 193 and
HB 114.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 9:10:35 AM.
Representatives Kohring, Anderson, Cissna, Gardner, and Wilson
were present at the call to order. Representative McGuire
arrived as the meeting was in progress.
HB 193-LICENSING MEDICAL OR CARE FACILITIES
HB 114-TERM. PARENTAL RTS/CINA/DELINQUENCY CASES
[The long titles of HB 193 and HB 114, which were discussed
together at this point, can be found in the committee calendar.]
CHAIR WILSON said the department has stressed the importance of
keeping licensing separate from the [financing portion] of the
program. She told the committee that there is a bill sitting in
committee that can be gutted and used for certain proposals.
She said there is a disconnect between the two portions of the
program, and she explained that whenever a decision is made on
the licensing side, she would like to have somebody from the
funding side involved.
9:14:05 AM
REPRESENTATIVE GARDNER said HB 193 was originally envisioned as
a bill that would be worked on over the interim and brought back
the following year; however, that changed to the point that the
bill is "moving through the system at a pretty good clip." She
asked what could be done to ensure that a separate bill
regarding the funding issues is also moved at a good pace.
CHAIR WILSON said that because the vehicle for the bill already
exists, it could be pushed on to other committees.
9:14:57 AM
REPRESENTATIVE CISSNA emphasized the amount of people who are
not getting served. She said, "There's more of the department
than there are legislators here, and if, in fact, they're
willing to put this kind of muscle into getting your bill
through - and ... I'll want to have a guarantee that that's
going to happen - I'd love it."
9:16:10 AM
REPRESENTATIVE ANDERSON stated that he would not want to gut the
bill for use as a separate vehicle for the financial aspect
unless there is a commitment from the commissioner of the
Department of Health and Social Services (DHSS) and an analysis
of what the department would be supporting. He explained that
the commissioner can "use the governor, and they can call folks,
and the bill dies in the next committee." He encouraged making
amendments to address all the issues within [HB 193], saying
that doing so would result in a better chance of helping the
people running assisted living homes.
9:17:35 AM
JOEL GILBERTSON, Commissioner, Office of the Commissioner,
Department of Health and Social Services (DHSS), stated:
The position of the department hasn't changed; we're
perfectly willing to implement the change. We're
looking for the advice of the legislature on how to
move forward on this. We will have all of our staff
available at the hearings. We'll provide testimony as
to the effect and implications of the amendment and
we'll work through the process. I don't think there's
any effort by the department to not see this get
passed, and so I'm kind of confused by that tone.
9:18:47 AM
JOHN BITNEY, Lobbyist, Thunderbird Home Health Management,
stated that regulations impact the ability of the assisted
living homes to stay in business, and he stressed the importance
of the bill.
REPRESENTATIVE ANDERSON asked for details regarding the gutting
of a bill to include the financial aspect of the issue before
the committee.
CHAIR WILSON initially offered her understanding that the
vehicle to use would be HB 112; however, after some discussion,
she said the vehicle the committee would use is HB 114.
9:21:35 AM
COMMISSIONER GILBERTSON said that the language for [the new HB
114] has been recently drafted. He said there is not yet an
official fiscal note; however, "the current expectation from the
department with the language that we provided is that the total
fund cost would be $363,500 and the general fund cost would be
$181,000."
CHAIR WILSON said, "If we put on that that it is the intent of
this committee that those funds come out of the whatever,
[Budget Review Unit (BUR)] - I mean I don't know how you do
that, but whichever one it is that is with the personal care
attendants, it's to come out of that area - then you guys would
have a guide of what is expected of us. Can we do that?"
COMMISSIONER GILBERTSON replied that he may be the wrong person
to ask.
REPRESENTATIVE CISSNA said, "Because this amendment that is in
here doesn't have the restructuring so that you could have
companion services. ... And ... if, in fact, as the new
amendment on that was written, ... it's not supposed to have a
fiscal impact; it merely broadens."
9:23:31 AM
MR. BITNEY said:
What the amendment proposes is to create a piece of
legislation that the sole content of it is a statement
of intent by the legislature. So, that's the extent
of what the legislation does.
[SEVERAL UNIDENTIFIED SPEAKERS] said, "No, it's not."
MR. BITNEY corrected himself and acknowledged, "It has now been
modified to say the uncodified law."
CHAIR WILSON directed attention to a document entitled,
"Proposal to Implement Proposed 300%'er Change." She asked that
the committee bring HB 114 before the committee.
9:26:18 AM
REPRESENTATIVE ANDERSON moved to bring before the committee CSHB
114(STA), [although the committee did not notice HB 114 for this
date].
CHAIR WILSON objected for discussion purposes.
REPRESENTATIVE ANDERSON moved Amendment 1, which read as
follows:
Page 1, line 1 thru 8:
Delete all material in the Title and Insert "An
Act relating to Medicaid personal needs allowance for
assisted living home residents."
Page 1, line 10 thru page 12, line 15:
Delete all material and Insert new bill sections
to read:
*Sec.1. The uncodified law of the State of Alaska is
amended by adding a new section to read:
It is the Intent of the Legislature that the
Department of Health and Social Services Repeal 7 AAC
43.1058(k)(1)(B) effective July 1, 2005.
*Sec.2.
The Department of Health and Social Services shall
adopt new emergency regulations establishing a
personal needs allowance for recipients residing in an
assisted living facility equal to the monthly income
limit set in AS 47.04.020(b)(6) minus $260. Until
such time as the department can adopt these
regulations at 7 AAC 43.1058(k)(1)(B), the department
shall apply personal needs allowance for recipients
residing in an assisted living facility equal to the
monthly income limit set in AS 47.04.020(b)(6) minus
$260. This meets the requirements for a finding of a
public, health safety and welfare emergency under AS
44.62.250.
*Sec.3. Section 1 of the Act takes effect July 1,
2005.
*Sec.4. Section 2 of this Act takes effect July 2,
2005.
9:27:18 AM
JON SHERWOOD, Medical Assistance Administrator, Office of the
Commissioner, Department of Health and Social Services, reviewed
the changes made by Amendment 1. He explained that 7 AAC
43.1058(k)(1)(B) is the provision and regulation that requires
individuals living in assisted living homes, receiving Medicaid
waiver services, and who have incomes in excess of the [Adult
Public Assistance] APA payment levels to use the excess income
toward their Medicaid expenses. He said, "These are the 300
'percenters' - the people who ..., under the current
regulations, can no longer pay as much in rent, room and board,
as they used to." Section 2 replaces that provision with a new
one, setting the limit $260 less than it was before.
MR. SHERWOOD drew attention to two pages following the amending
language, which show how things work before and after the
regulation changes, as well as the cost impact of the reversing
change to 300 percenters.
MR. BITNEY, in response to a question from Representative
Anderson, pointed out that [Amendment 1] "assists," but does not
include a "cap" that was included in HB 193.
CHAIR WILSON suggested, "That's part of the proposed, new
regulations that haven't gone into effect, and that's still an
open area."
MR. SHERWOOD said that in regard to the comments heard about new
proposed licensing regulations, the department is extending the
regulation comment period, will plan on holding at least one
more hearing, and will notify the assisted living providers. He
offered his understanding that the extension would be through
June, which is 45 days longer.
CHAIR WILSON said she thinks that's reasonable.
9:32:30 AM
REPRESENTATIVE MCGUIRE said she believes the cap already is a
part of regulation. She said:
There are two components: There's the first part that
says that we're going to lower the rate to $18.64 a
day ..., and that was part of the refinancing, and we
all understand and have agreed that that's the right
thing to do from a financial perspective. But then
the second part of it was the part that said $564 a
month, no matter what, as a cap. And that was part of
the [regulations] that already are in place.
AMY ONEY, Owner/Operator, Mama's Assisted Living Home, mentioned
[the committee substitute (CS) for HB 193, Version 24-GH1016\F,
Mischel, 4/19/05]. She stated:
This is a regulation that went into effect last
summer, but they have not enforced it. The
enforcement date is set for July 1 of this year. And
what that does is: our daily reimbursement rates on
the Medicaid waiver side are calculated according to
what's a direct care cost and what's called an
administrative and general cost. Once you figure out
your direct care rate per person, per day, then they
allow an administrative general rate to be calculated
as a percentage of the rate. What this cap does is it
puts it in at 25 percent. But [due to] the allocation
that the department has done - putting whatever costs
into direct care or administrative and general costs -
some homes are ... looking at losing a net between
$30,000-$50,000, with this cap, just because of how
the department allocated ... [its] costs on ... our
cost-based negotiation statements.
... It may not have been what we ... walked through
the door and applied for, but ... they kind of tell us
what categories things are going to be allocated to,
and they've allocated, in some homes, a much higher
rate than 25 percent. So, this cap will come in and
they will lose their reimbursement rates on the
Medicaid side - quite a significant amount. And so,
we're saying it's not a realized deal at the moment;
just back it off and don't implement. Because it's
already passed, but it's due to go into effect July 1.
CHAIR WILSON said she would like to know if the proposed
regulations being worked on by the department will "affect this
in any way."
9:35:27 AM
STACIE KRALY, Senior Assistant Attorney General, Human Services
Section, Office of the Attorney General, Department of Law, said
she would like to compartmentalize the subjects at hand "so
we're all talking about the same thing." She continued:
There's a regulation that deals with the rate issue,
and what Representative McGuire talked about is a cap.
... That is what we're talking about repealing through
this amendment. And as you will see in the proposal,
we've figured out a way, legislatively, to ... do this
through emergency regulations, which is an expedited
basis, so that financial fix for what ... we talked
about previously as the APA refinance will be fixed.
...
What Ms. Oney was just talking about, which is the 25
percent administrative cost-based rate cap, is a
different regulatory provision under 7 AAC 43, which
deals with administrative costs related to Medicaid
waiver clients. That is not a part of this mix, and
it had ... - from my understanding in sitting through
all of these committee meetings - not really been
talked about in the grand scheme of things. We
adopted those regulations last year and put a cap on
this administrative cost rate, so there will be some
adjustments there, with respect to what people provide
us information ... [from which] we'll calculate what's
called administrative cost rate base at 25 percent.
At this point that's not on the table, but it's
certainly something that could be looked at - may need
to be looked at - but it hasn't' been a part of this
mix. ... So, that's what we passed last June [and]
went into effect [on] ... May 16 of last year, which
is effective this coming year. We gave them a whole
year to ... ease into this new, ... structured
setting.
CHAIR WILSON remarked that Ms. Kraly is talking about an amount
of 25 percent, but "we've heard testimony that it's more than 25
percent." She asked for clarification.
MR. SHERWOOD stated that when the department changed the
regulation, it considered the existing providers and imposed
caps not just on assisted living homes, but on all waiver
providers. He indicated that the smaller providers have a 25
percent cap, while "everyone else has an 18 percent cap." He
said the department was looking to establish reasonableness of
administrative and general costs. He said it's a compromise
made to ensure that the right amount is paid for a service.
9:39:41 AM
CHAIR WILSON asked if there is an appeals process.
MS. KRALY offered her understanding that the rates are
calculated, and if there is a dispute over the rate, a
"director-level review" is provided within the department. She
said the cap is firm, but there may have to be some adjustments
made. She said out of the whole range of assisted living homes,
25 percent was "within the ball park of what most assisted
living homes operate under."
CHAIR WILSON declared, "Since that has not been part of our
deliberations, I'm not going to touch that."
9:40:35 AM
REPRESENTATIVE MCGUIRE asked Chair Wilson to reconsider her
stand. She explained that the regulation process is one that is
supposed to involve the public and the stakeholders, and she
said she believes [the department] does a good job.
Nevertheless, she said it is an extremely complex system, and
the legislature bears the responsibility of changing the
Administrative Procedures Act so that "real notice gets out and
real input gets in." She stated concern that the regulations
are already firm and will be put in action July 1, [2005] and
the legislature is done with session, mid-May. She said if
there is a concern, "there's no way, other than through an
emergency [regulation] process, for you to come back and adjust
that percentage." She offered an example.
REPRESENTATIVE McGUIRE stated, "An idea would be to include the
repeal of that [regulation] in at least the initial draft, and
let it work through the process and have some of the testimony
at least, elicited, either in [the House Judiciary Standing
Committee] or in [the House Finance Committee]. She said at
that point if the repeal is too controversial or doesn't make
sense, it can be pulled out.
CHAIR WILSON stated that she would keep her decision as is,
knowing that the bill would next be heard in the House Judiciary
Standing Committee, where Representative McGuire, as the chair,
could do as she wishes. She emphasized the need for speed.
CHAIR WILSON reminded committee members that there was an
amendment before them and asked if there were any more concerns.
9:44:30 AM
REPRESENTATIVE CISSNA said everyone is struggling to understand
the math involved and who will and will not be affected. She
said her office is working on creating a task force to meet with
the industry and stakeholders, because "this is pivotal for the
future of Alaska in a lot of ways that we're just not looking at
here."
9:46:33 AM
REPRESENTATIVE MCGUIRE thanked Chair Wilson.
CHAIR WILSON said she is hoping that "the process works," and
she indicated that she would like to continue to get feedback.
REPRESENTATIVE CISSNA stated her assumption that "we're talking
about the amendment and that does not include the home health
care."
CHAIR WILSON answered, "Not right now."
REPRESENTATIVE CISSNA stated her understanding that [home health
care] was part of [HB 193] and was separated out, but was not
disbanded. She stated that it is an extraordinarily important
part of the bill because "it's the preventative part" and can
keep costs down.
9:49:15 AM
CHAIR WILSON said she is concerned about that. She said, "We
have seen what happened to the personal care attendant program
that was supposed to save money, so I would like to work on that
a little bit more." She added, "I will address that, but not
today."
REPRESENTATIVE CISSNA said, "It actually fits in [HB] 193, I
think, better. And it's got to be addressed. Because it is
actually affecting ... the people that are at home. I truly
believe that we're forcing people out of their homes and into
assisted living, because they're qualified for it; they can go
there." She offered further details.
CHAIR WILSON removed her objection to Amendment 1 to HB 114.
There being no further objections, Amendment 1 was adopted.
9:50:32 AM
REPRESENTATIVE ANDERSON moved to report HB 114, as amended, with
individual recommendations, an indeterminate fiscal note, and
proposed intent language. There being no objection, CSHB
114(HES) was reported from the House Health, Education and
Social Services Standing Committee.
HB 193-LICENSING MEDICAL OR CARE FACILITIES
9:51:53 AM
CHAIR WILSON announced that the committee would now focus solely
on HOUSE BILL NO. 193, "An Act relating to the licensing,
regulation, enforcement, and appeal rights of ambulatory
surgical centers, assisted living homes, child care facilities,
child placement agencies, foster homes, free-standing birth
centers, home health agencies, hospices or agencies providing
hospice services, hospitals, intermediate care facilities for
the mentally retarded, maternity homes, nursing facilities,
residential child care facilities, residential psychiatric
treatment centers, and rural health clinics; relating to
criminal history requirements, and a registry, regarding certain
licenses, certifications, approvals, and authorizations by the
Department of Health and Social Services; making conforming
amendments; and providing for an effective date."
REPRESENTATIVE ANDERSON said, "My amendment's withdrawn."
The committee took an at-ease from 9:53:00 to 9:53:30.
9:53:33 AM
CHAIR WILSON announced that before the committee was the
committee substitute (CS) for HB 193, Version 24-GH1016\F,
Mischel, 4/19/05.
9:53:53 AM
STACIE KRALY, Senior Assistant Attorney General, Human Services
Section, Office of the Attorney General, Department of Law,
mentioned subjects for possible amendments. In response to a
question from Chair Wilson, she clarified that the amendments
are not in reference to a report to the committee from
Legislative Legal and Research Services. Rather, the first
deals with the abuse registry and was discussed with
Representatives Cissna and Seaton, and the second was requested
by the Municipality of Anchorage to correct an omission
regarding the "day child care licensing."
CHAIR WILSON, after ascertaining that the bill will be heard by
the House Judiciary Standing Committee, said she feels
comfortable knowing that some of the people on the House Health,
Education and Social Services Standing Committee are also on the
House Judiciary Standing Committee.
9:57:26 AM
MS. KRALY indicated that the first amendment idea would add
provisions to the abuse registry section of the bill that would:
create the Department of Health & Social Services as the
administrative hearing authority for the centralized registry;
add "volunteer" as a type of individual to be included on the
registry; add decisions regarding the type of findings that
could result in the entry of a registry, which would allow for
administrative decisions to be part of the process; include
medical assistance fraud as a violation that would be included
on the registry; add a new subsection requiring any abuse,
allegations of neglect, and exploitation occurring within the
last 10 years to be reported; define the central registry as
confidential, with password protected Internet access; add an
immunity protection for people who [report] abuse, neglect, or
exploitation; and define "entity" to track entities under the
centralized licensing statute. She added that the rest of the
amendment would address renumbering.
10:00:19 AM
REPRESENTATIVE ANDERSON asked if the amendment is written and,
if so, what the reference to it is.
MS. KRALY called it "Amendment 1 to work draft CSHB 193\G."
CHAIR WILSON pointed out that Version G does not match Version
F.
REPRESENTATIVE ANDERSON moved Conceptual Amendment 1, stating
that Legislative Legal and Research Services would conform the
amendment to Version F. There being no objection, Conceptual
Amendment 1 was adopted.
MS. KRALY outlined that the idea for the second amendment. She
explained that currently, there is a provision under AS 47.35
which allows the department to delegate its licensing function
to a municipality that wants to take on that function. To date,
the only municipality that has done that is Anchorage. She
said, "We just didn't get that into the new version, and we want
that partnership to continue, so we've made that amendment."
REPRESENTATIVE ANDERSON moved [Conceptual] Amendment 2,
explaining that the committee should have the wording in their
packets.
MS. KRALY announced that her assistants revealed to her that
Version F, which is before the committee, already has both
Amendment 1 and 2 included in the language.
REPRESENTATIVE ANDERSON withdrew his motion to adopt
[Conceptual] Amendment 2.
REPRESENTATIVE ANDERSON moved to rescind the committee's action
in adopting Conceptual Amendment 1, because he said it was
unnecessary. There being no objection, the action to adopt
Conceptual Amendment 1 was rescinded.
10:03:00 AM
REPRESENTATIVE CISSNA moved to adopt [Conceptual] Amendment [3],
as follows [original punctuation provided]:
Page 1, line 9, following "Services,":
Insert "relating to public assistance for health
facilities and assisted living homes, to rates charged
by an assisted living home, and to the liability of
recipients of home or community-based services to pay
for those services; relating to expansion of
reimbursable waiver services under the Medicaid
waivers for Older Alaskans and Adults with Physical
Disabilities to include adult companion services"
On page 2 of the draft amendment, delete two amendment
sections:
Sec.22 to amend AS 47.07.030(c), is deleted from
the amendment.
Sec.23 to add a new subsection (e) to AS
47.07.030, is deleted from the amendment.
Page 45 of the bill, CSHB 193, following line 3:
Insert a new bill section to read:
"*Sec.64: The uncodified law of the State of
Alaska is amended by adding a new section to read:
MEDICAID WAIVERS TO BE AMENDED: The
department shall proceed immediately to seek approval
under 42 U.S.C. __(Title XIX, Social Security, Act,
Medical Assistance) to amend the Home and Community
Based Waivers for Older Alaskans and Adults with
Physical Disabilities, to add adult companion services
as a reimbursable waiver service within both waivers,
either as a discrete waiver service, or as a waiver
service which may be combined with current waivers
services such as respite or chore services or with a
new waiver service such as waiver personal attendant
services, as may be more efficient to administer and
more beneficial to the recipient of waiver services.
The addition of adult companion services to the Home
and Community Based Waiver for Older Alaskans and
Adults with Physical Disabilities is intended to
restore the non-medical care, supervision and
socialization provided to a functionally impaired
adult who is a waiver recipient, such as was formerly
provided as a part of respite services prior to the
limiting amendment to 7 AAC 43.1040.Reimbursable
Waiver Services, effective May 15, 2004, specifically
7 AAC 43.1049(d)(4)(A), which prohibits the department
from paying for respite services that allow a primary
caregiver to work, and 7 AAC 43.1040 __, which
prohibits the department from paying for respite
services during sleeping or nighttime hours. Adult
companion services, subject to all other restrictions
and requirements of the waivers for Older Alaskans and
Adults with Physical Disabilities, shall be available
to use as part of the recipient's approved plan of
care to allow a primary caregiver to work, to allow a
primary caregiver to sleep during normal nighttime
hours when the recipient of care cannot be safely left
unsupervised during the caregiver's sleep hours, or to
allow supervision or monitoring of a recipient who is
not otherwise safe while sleeping. The department
shall enact such regulations as are needed to
implement this section. In this section, "adult
companion services" means non-medical care,
supervision or socialization, provided to a
functionally impaired adult in accordance with a
therapeutic goal in the recipient's waiver plan of
care. In this section "therapeutic goal" shall
include the goals of delaying or avoiding placement of
the recipient in a more restrictive environment,
including an assisted living home or nursing home, and
supporting the vital needs of the primary caregiver of
the recipient."
Section 64 of the draft Amendment, Mischel, 4/19/05
shall be renumbered as Section 65.
CHAIR WILSON objected for discussion purposes.
REPRESENTATIVE CISSNA began her explanation of Conceptual
Amendment 3.
CHAIR WILSON said that she would like to move the bill out of
committee; however, she would like to call a work session for
the upcoming Monday, in order to understand the bill completely
and ensure it has "sideboards."
10:04:46 AM
REPRESENTATIVE CISSNA said she came to the table with the
understanding that "we were talking about this too." She said,
"This is where the cost savings to the little folks comes in;
this is the preventative part. This is the part where if we do
this thing right we really save some money and we affect
people's lives." She called a point of order that there is a
motion on the floor.
CHAIR WILSON said she would be against voting on [Conceptual
Amendment 3]. She explained that she is not necessarily against
the concept but wants to ensure the committee doesn't put
something into effect that will "grow our budget in huge steps."
REPRESENTATIVE CISSNA noted that the committee has had the
language for 24 hours.
The committee took an at-ease from 10:06:01 AM to 10:09:06 AM.
CHAIR WILSON issued a caveat:
I feel very, very [strongly] about the fact that the
personal care attendant program, which was going to
save this state money ... and was going to be better
for everybody in the long run, absolutely is totally
out of hand. It went from approximately $8 million to
approximately $80 million in five years. We cannot
afford that. ... I have gotten assurances from the
judicial chair that she will deal with this and we
have to have sideboards on this because of constraints
on our time; we only have 18 days left. I will allow
this with the understanding that it will be dealt
with, because I'm not comfortable with this amendment,
... [and] I feel we haven't had time to look at ...
those sideboards.
10:10:26 AM
CHAIR WILSON removed her objection to [Conceptual Amendment 3].
There being no further objection, Conceptual Amendment 3 was
adopted.
10:10:37 AM
REPRESENTATIVE ANDERSON moved to report CSHB 193, Version 24-
GH1016\F, Mischel, 4/19/05, as amended, out of committee with
individual recommendations and the accompanying fiscal notes.
There being no objection, CSHB 193(HES) was reported out of the
House Health, Education and Social Services Standing Committee.
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 10:10 a.m.
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