Legislature(2019 - 2020)SENATE FINANCE 532

03/09/2020 09:00 AM FINANCE

Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.

Download Mp3. <- Right click and save file as
Download Video part 1. <- Right click and save file as

* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ HB 96 PIONEERS' HOME AND VETERANS' HOME RATES TELECONFERENCED
Heard & Held
-- Public Testimony --
+ Bills Previously Heard/Scheduled: TELECONFERENCED
+= SB 123 ELECTRIC RELIABILITY ORGANIZATIONS TELECONFERENCED
Moved CSSB 123(RBE) Out of Committee
                 SENATE FINANCE COMMITTEE                                                                                       
                       March 9, 2020                                                                                            
                         9:02 a.m.                                                                                              
                                                                                                                                
                                                                                                                                
9:02:39 AM                                                                                                                    
                                                                                                                                
CALL TO ORDER                                                                                                                 
                                                                                                                                
Co-Chair  von  Imhof  called the  Senate  Finance  Committee                                                                    
meeting to order at 9:02 a.m.                                                                                                   
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Natasha von Imhof, Co-Chair                                                                                             
Senator Bert Stedman, Co-Chair                                                                                                  
Senator Click Bishop                                                                                                            
Senator Lyman Hoffman                                                                                                           
Senator Donny Olson                                                                                                             
Senator Bill Wielechowski                                                                                                       
Senator David Wilson                                                                                                            
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
None                                                                                                                            
                                                                                                                                
ALSO PRESENT                                                                                                                  
                                                                                                                                
Representative  Zach Fields,  Sponsor; Tristan  Walsh, Staff                                                                    
for  Representative  Zach  Fields;  Clinton  Lasley,  Deputy                                                                    
Commissioner,  Department  of  Health and  Social  Services;                                                                    
Brad Rider, Self, Juneau; Janet Henderson, Self, Juneau                                                                         
                                                                                                                                
PRESENT VIA TELECONFERENCE                                                                                                    
                                                                                                                                
Ave  Thompson,  Self,  Anchorage;  Lew  Tobin,  Pioneers  of                                                                    
Alaska,  Nome; Thelma  Kay Andrew,  Pioneer Igloo  16 &  17,                                                                    
Ketchikan LIO; David Karp,  Citizen, Nome; Katherine Bishop,                                                                    
Local  Organizing   Ministry  St.  Michaels,   Palmer;  Lynn                                                                    
Willis, Self, MatSu LIO; Cris Eichenlaub, Self, Eagle River                                                                     
                                                                                                                                
SUMMARY                                                                                                                       
                                                                                                                                
SB 123    ELECTRIC RELIABILITY ORGANIZATIONS                                                                                    
                                                                                                                                
          CSSB 123(RBE) was REPORTED out of committee with                                                                      
          a "do pass" recommendation and with one new zero                                                                      
          fiscal note from the Department of Commerce,                                                                          
          Community and Economic Development.                                                                                   
                                                                                                                                
HB 96     PIONEERS' HOME AND VETERANS' HOME RATES                                                                               
                                                                                                                                
          HB 96 was HEARD and HELD in committee for further                                                                     
          consideration.                                                                                                        
                                                                                                                                
SENATE BILL NO. 123                                                                                                           
                                                                                                                                
     "An  Act   relating  to  the  regulation   of  electric                                                                    
     utilities and  electric reliability  organizations; and                                                                    
     providing for an effective date."                                                                                          
                                                                                                                                
9:03:23 AM                                                                                                                    
                                                                                                                                
Co-Chair von Imhof read the  title and requested a review of                                                                    
the fiscal note.                                                                                                                
                                                                                                                                
Co-Chair  Stedman  reviewed  a  new zero  fiscal  note  from                                                                    
Department of Commerce,  Community and Economic Development,                                                                    
OMB  Component 2417.  He read  from the  fiscal analysis  on                                                                    
Page 2:                                                                                                                         
                                                                                                                                
     SB 123 gives the  Regulatory Commission of Alaska (RCA)                                                                    
     new   authority   to   certify   electric   reliability                                                                    
     organizations,  including   the  ability  to   form  an                                                                    
     electric  reliability  organization  (ERO) if  the  RCA                                                                    
     determines no  person has applied for  certification as                                                                    
     an ERO.  SB 123 provides  a funding mechanism  for, and                                                                    
     permissible composition  of, the governing board  of an                                                                    
     ERO.                                                                                                                       
                                                                                                                                
Co-Chair  von  Imhof  noted  that  invited  testifiers  were                                                                    
online to  answer questions. She relayed  that the committee                                                                    
                                        rd                                                                                      
had heard  the bill on Tuesday,  March 3,  and  had reviewed                                                                    
the multi-step process  the bill had gone through  to get to                                                                    
this  point. She  solicited  further  comments or  questions                                                                    
from the committee.                                                                                                             
                                                                                                                                
Co-Chair  Stedman  MOVED  to report  CSSB  123(RBE)  out  of                                                                    
Committee   with   individual    recommendations   and   the                                                                    
accompanying fiscal  note. There being NO  OBJECTION, it was                                                                    
so ordered.                                                                                                                     
                                                                                                                                
CSSB  123(RBE) was  REPORTED  out of  committee  with a  "do                                                                    
pass" recommendation and with one  new zero fiscal note from                                                                    
the   Department  of   Commerce,   Community  and   Economic                                                                    
Development.                                                                                                                    
                                                                                                                                
9:05:57 AM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
9:08:13 AM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
CS FOR HOUSE BILL NO. 96(FIN)                                                                                                 
                                                                                                                                
     "An Act relating to Alaska Pioneers' Home and Alaska                                                                       
     Veterans' Home payments, rates, and services."                                                                             
                                                                                                                                
Co-Chair von  Imhof relayed  that the  bill was  being heard                                                                    
for  the  first time.  She  noted  that Senator  Wilson  had                                                                    
joined the meeting.                                                                                                             
                                                                                                                                
9:09:10 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ZACH  FIELDS, SPONSOR, thanked  the committee                                                                    
and the senate co-sponsors of the legislation.                                                                                  
                                                                                                                                
Representative  Fields discussed  the  presentation "An  Act                                                                    
Relating to  Alaska Pioneers Home and  Alaska Veterans' Home                                                                    
Rates - CSHB 96" (copy on file).                                                                                                
                                                                                                                                
Representative  Fields looked  at  Slide 2,  "Goal of  House                                                                    
Bill 96":                                                                                                                       
                                                                                                                                
     ?Maintain Pioneer Home's commitment to Alaska's elders                                                                     
     ?Stabilize     revenue     and    improve     financial                                                                    
     sustainability of Pioneer Homes                                                                                            
     ?Provide certainty and predictability to residents and                                                                     
     department                                                                                                                 
                                                                                                                                
Representative Fields  reminded the committee that  the bill                                                                    
would correct a recent very  large rate increase and provide                                                                    
predictability into  the future for pioneer  home residents.                                                                    
He noted that  the bill had been introduced  before the rate                                                                    
increase had taken affect.                                                                                                      
                                                                                                                                
9:10:21 AM                                                                                                                    
                                                                                                                                
Representative   Fields  spoke   to   Slide  3,   "Committee                                                                    
Substitute for House Bill 96":                                                                                                  
                                                                                                                                
     ?Adjusts rates for inflation since 2004                                                                                    
     ?Adds Levels IV and V to be consistent with Agnew Beck                                                                     
     Report and SB74                                                                                                            
     ?Allows for the Pioneer Home Division's suggested                                                                          
     index, Social Security Cost of Living Adjustment                                                                           
     ?Passed 35-4 in House of Representatives                                                                                   
                                                                                                                                
Representative Fields explained that  between 2004 and 2018,                                                                    
rates  at  the   pioneer  homes  had  not   kept  pace  with                                                                    
inflation.  The   bill  too   into  account   inflation  and                                                                    
represented  a rate  increase relative  to 2018,  at a  more                                                                    
modest  increase than  the one  implemented  by the  current                                                                    
administration. He  relayed that the adjustment  of rates to                                                                    
up  to the  Social Security  Index rate  of inflation  would                                                                    
provide  greater predictability  and certainty.  He lamented                                                                    
that  the previous  regulatory process  for adjusting  rates                                                                    
had produced uncertainty and loss  in the value of the rates                                                                    
overtime. He reiterated  that the bill had  passed the house                                                                    
before the  administration's large  rate increases  had been                                                                    
advertised, but after they had  taken effect in Summer 2019.                                                                    
He  spoke of  the  bills   vote numbers  on  the house  side                                                                    
during the previous session.                                                                                                    
                                                                                                                                
9:11:38 AM                                                                                                                    
                                                                                                                                
Representative Fields  referenced Slide 4, "  Pioneer Homes:                                                                    
Background":                                                                                                                    
                                                                                                                                
     ?Established in 1913                                                                                                       
     ?Originally created as home for indigent men as                                                                            
     Territory of Alaska grew and aged                                                                                          
     ?Expanded throughout the 20th Century: there are                                                                           
     currently   homes   in    Sitka,   Fairbanks,   Palmer,                                                                    
     Anchorage, Ketchikan and Juneau                                                                                            
     ?Population in 2019 was 592                                                                                                
     ?Rates currently adjusted by regulation                                                                                    
     ?2004-2018 Inflation rose 30%, but rates only rose                                                                         
     15%. In 2019, rates rose as high 140%.                                                                                     
                                                                                                                                
Representative Fields shared that  the Palmer Pioneers  Home                                                                    
had become  a Veterans  home  approximately 2 years  ago and                                                                    
was a  prime example  of how  the homes  had adapted  to the                                                                    
changing needs of Alaskan elders.                                                                                               
                                                                                                                                
9:12:28 AM                                                                                                                    
                                                                                                                                
Co-Chair Stedman took  note of the vote number  in the house                                                                    
and thought  that the numbers  were irrelevant.  He stressed                                                                    
that the senate would follow its own process.                                                                                   
                                                                                                                                
Representative   Fields   appreciated   Co-Chair   Stedmans                                                                     
perspective.                                                                                                                    
                                                                                                                                
9:13:08 AM                                                                                                                    
                                                                                                                                
Representative   Fields  turned   to   Slide  5,   "Resident                                                                    
Population,"  which  showed  a  bar  graph  entitled  'Payer                                                                    
Source' that depicted the number  of residents by the source                                                                    
of payment. He commented that  before the rate increases had                                                                    
taken affect most residents were  self-pay, which meant that                                                                    
they paid the advertised  rate out-of-pocket. He pointed out                                                                    
that since the  rate hikes had taken affect,  there had been                                                                    
a significant decline  in the number of  residents that were                                                                    
self-pay. He  said that there  was a  corresponding increase                                                                    
in the number of residents  that were on payment assistance.                                                                    
He  said  that  during  public  testimony  many  people  had                                                                    
testified that  they did not  want to go on  pay assistance,                                                                    
but the  large increases  made it  impossible for  people to                                                                    
self-pay.  He   thought  another  problem  was   an  adverse                                                                    
selection  process, in  which fewer  people could  self-pay,                                                                    
resulting in a larger financial burden on the state.                                                                            
                                                                                                                                
9:14:58 AM                                                                                                                    
                                                                                                                                
Co-Chair  Stedman requested  further detail  on the  Payment                                                                    
Assistance portion of the bar graph.                                                                                            
                                                                                                                                
Representative  Fields stated  that  prior  to the  previous                                                                    
year, the  Pioneer Homes did  not have separate  budget line                                                                    
items   for   operations   and   payment   assistance.   The                                                                    
administration had  broken the two  items out in a  new way,                                                                    
which  did not  materially  change the  way  that the  homes                                                                    
operated.  He explained  that  payment  assistance was  just                                                                    
subsidies  to residence  who  could not  afford  to pay  the                                                                    
advertised  rates. Fewer  residents were  self-pay and  were                                                                    
being subsidized by the state.                                                                                                  
                                                                                                                                
9:16:38 AM                                                                                                                    
                                                                                                                                
Co-Chair Stedman  disclosed that  he had two  family members                                                                    
currently in Pioneer Homes  utilizing payment assistance. He                                                                    
thought it  would be nice  to explain the nature  of payment                                                                    
assistance. He  said that once  a person had  liquidated all                                                                    
their  assets,  they  could go  on  payment  assistance.  He                                                                    
understood that when  a resident went up to  care Level III,                                                                    
Medicaid would be limited to  $2000. He noted that people in                                                                    
Level I  care were moving  out of the Pioneer  Homes because                                                                    
of the rate increase.                                                                                                           
                                                                                                                                
Co-Chair  Stedman  wanted the  sponsor  to  discuss the  pay                                                                    
structures  and  care  levels  in   order  to  have  a  full                                                                    
understanding of the potential burden on seniors.                                                                               
                                                                                                                                
Co-Chair  von   Imhof  reiterated  there  were   two  people                                                                    
available to testify once the presentation was completed.                                                                       
                                                                                                                                
9:19:41 AM                                                                                                                    
                                                                                                                                
Representative Fields thought that  one of the problems with                                                                    
the   payment  assistance   structure   and  forcing   asset                                                                    
liquidation,  did not  work for  married  couples where  one                                                                    
person was  in the  Pioneer Home  and one was  not.   He had                                                                    
heard from many people in  the situation and considered it a                                                                    
good thing when  a spouse could live  independently and even                                                                    
help pay  the rates. He did  not believe that it  made sense                                                                    
to force people to liquidate their assets to afford care.                                                                       
                                                                                                                                
9:21:04 AM                                                                                                                    
                                                                                                                                
Co-Chair Stedman  stated that he  was unaware of  a scenario                                                                    
described by  Representative Fields.  He thought  there were                                                                    
nuances that were important to  understand. He thought there                                                                    
might be individuals listening to  the hearing that might be                                                                    
affected by what  they heard during committee  meetings.  He                                                                    
reiterated that he had not  had any constituents express the                                                                    
scenario described by the bill sponsor.                                                                                         
                                                                                                                                
Co-Chair von Imhof  thought in the last two  years there had                                                                    
been  a  big  difference  in rates  and  was  curious  about                                                                    
corresponding resident  behavior. She  noted that  there had                                                                    
been a  change from three levels  of care to five  levels of                                                                    
care. She  wondered about changes  in resident  behavior due                                                                    
to the care level changes.                                                                                                      
                                                                                                                                
9:24:02 AM                                                                                                                    
                                                                                                                                
Representative Fields considered Slide 6, "CSHB 96":                                                                            
                                                                                                                                
     Proposed Levels of Care:                                                                                                   
     Level I: $2,976/mo                                                                                                         
     Level II: $5,396/mo                                                                                                        
     Level III: $7,814/mo                                                                                                       
     Level IV: $8,500/mo                                                                                                        
     Level V: Rate to be determined by the Department to                                                                        
     reflect the cost of care for services listed and                                                                           
     complex behavior management                                                                                                
                                                                                                                                
     ?Rates serve as base starting point, adjusted for                                                                          
     inflation from 2004                                                                                                        
     ?Rate increases may be annual, and will be capped at                                                                       
     the most recent Social Security Cost of Living                                                                             
     Adjustment                                                                                                                 
     ?Allows rates to more consistently track inflation-                                                                        
     based increases in cost of care                                                                                            
                                                                                                                                
Representative Fields shared that  before the rate increases                                                                    
there had  been three  levels of care;  there were  now five                                                                    
levels of  care. He referenced  a 2018 report  by Agnew:Beck                                                                    
Consulting entitled  "Staffing Plan  + Cost  Impact Analysis                                                                    
for the Alaska Pioneer Homes,"  (copy on file). He continued                                                                    
that there were different opportunities  to bill at a higher                                                                    
rate  for higher  care levels.  He said  that this  level of                                                                    
care had not existed in  Pioneer Homes before; the Anchorage                                                                    
Pioneer  Home was  in  the process  of  adding a  Behavioral                                                                    
Health wing.  He said  that the  bill did  not cap  rates at                                                                    
Level IV. He  thought it was worth noting that  for Level IV                                                                    
care, given  the acuity of  the care, some of  the residents                                                                    
could transfer  from the Alaska Psychiatric  Institute (API)                                                                    
to Pioneer Homes, which could be  a savings to the state. He                                                                    
said that the lover four levels were capped.                                                                                    
                                                                                                                                
Co-Chair  von Imhof  wondered who  determined the  levels of                                                                    
care and  who would determine  when a patient  had graduated                                                                    
from  one  level  to another  and  therefore  another  price                                                                    
range.                                                                                                                          
                                                                                                                                
9:26:54 AM                                                                                                                    
                                                                                                                                
Representative  Fields stated  that  the bill  put the  five                                                                    
levels  of care  into statute,  it would  be a  departmental                                                                    
decision to  move a patient  up in  care when the  acuity of                                                                    
care  increased.  He  had   heard  that  families  sometimes                                                                    
disagreed with the assignment.                                                                                                  
                                                                                                                                
9:27:53 AM                                                                                                                    
Representative  Fields  displayed  Slide 7,  "Complexity  of                                                                    
Care":                                                                                                                          
                                                                                                                                
     Current Levels                                                                                                         
     Level  I: Services  include  housing, meals,  emergency                                                                
     assistance, recreation, home activities                                                                                    
     Level II: Services include all Level I services plus                                                                   
     Medicaid   administration,  health   related  services,                                                                    
     staff  assistance, incl  assistance with  daily living,                                                                    
     supervision, reminders. (Non-night shift)                                                                                  
     Level  III: Services  include all  services of  Level I                                                                
     and  Level  II,  with   24-  hour  hands-on  assistance                                                                    
     provided.                                                                                                                  
                                                                                                                                
     Proposed Levels                                                                                                        
     Level  I: Services  include  housing, meals,  emergency                                                                
     assistance, and recreation.                                                                                                
                                                                                                                                
     Level  II:  Services  include   Level  I  services  and                                                                
     medication  administration,  health  related  services,                                                                    
     and  intermittent assistance  with activities  of daily                                                                    
     living.                                                                                                                    
                                                                                                                                
     Level  III:  Services  include Level  I  and  Level  II                                                                
     services   as  well   as   extensive  assistance   with                                                                    
     activities of daily living.                                                                                                
                                                                                                                                
     Level IV:  Services include  Level I,  II, and  III, as                                                                
     well  as  nursing  services  for 24  hour  a  day,  and                                                                    
     intermittent behavior management.                                                                                          
                                                                                                                                
     Level V: Services include all  those included in Levels                                                                
     I-IV, as well as extensive behavior management.                                                                            
                                                                                                                                
9:31:05 AM                                                                                                                    
                                                                                                                                
Co-Chair von  Imhof wondered whether moving  from regulation                                                                    
to statute would compromise flexibility.                                                                                        
                                                                                                                                
9:31:32 AM                                                                                                                    
                                                                                                                                
Representative Fields replied that  it was a potential risk.                                                                    
He said  that when  crafting the  regulation, he  focused on                                                                    
balancing providing certainty on  rates, while also adapting                                                                    
to  changing circumstances  in the  population. He  believed                                                                    
that  the  expanded levels  of  care  reflected the  current                                                                    
population, but he could not speak to 20 years from now.                                                                        
9:32:08 AM                                                                                                                    
                                                                                                                                
Representative  Fields  highlighted   Slide  8,  "Rates  and                                                                    
Impacts," which  showed a bar  graph entitled  'Pioneer Home                                                                    
Rates,'  and an  article cover  page entitled  'Pioneer Home                                                                    
residents   and   families  struggle   with   'heartbreaking                                                                    
decisions  after rate  increase.'  He shared  that the  blue                                                                    
lines represented  the old rates  for Levels I-III  of care,                                                                    
the  orange bars  reflected the  administrations  rates  for                                                                    
Levels I-V, and  the green bars showed the  rates as defined                                                                    
in the  bill. He pointed  out that  the green bars  showed a                                                                    
more modest change in the  rates. He highlighted that one of                                                                    
the  stressors  on  families  was the  impact  of  the  rate                                                                    
increases as  the patient changed  levels. He  discussed the                                                                    
article headlined on  the right-hand side of  the slide. The                                                                    
story detailed struggles with  the recent destabilizing rate                                                                    
increases.                                                                                                                      
                                                                                                                                
9:34:39 AM                                                                                                                    
                                                                                                                                
Senator  Hoffman  asked  about  the effective  date  of  the                                                                    
legislation and the implementation of the rates.                                                                                
                                                                                                                                
9:34:52 AM                                                                                                                    
                                                                                                                                
Representative Fields  replied that the bill  was introduced                                                                    
when the rates  were advertised. He remarked  that there was                                                                    
a conversation with the Legislative  Legal Division that had                                                                    
suggested  a window  of time  before the  department had  to                                                                    
adapt  to the  new rates.  He did  not object  to adding  an                                                                    
effective   date   and   deferred   further   questions   to                                                                    
legislative legal.                                                                                                              
                                                                                                                                
9:35:41 AM                                                                                                                    
                                                                                                                                
Co-Chair von  Imhof surmised  that there would  not be  a CS                                                                    
introduced that included an effective date.                                                                                     
                                                                                                                                
9:35:46 AM                                                                                                                    
                                                                                                                                
Representative Fields replied that it would be unnecessary.                                                                     
                                                                                                                                
9:35:59 AM                                                                                                                    
                                                                                                                                
Co-Chair  von  Imhof  remarked  that  the  extrapolation  of                                                                    
numbers on Slide 8 began in  2004 and wondered why that year                                                                    
had been chosen.                                                                                                                
9:36:18 AM                                                                                                                    
                                                                                                                                
Representative Fields  replied that  he wanted  a reasonable                                                                    
time horizon, he thought 15 years was reasonable.                                                                               
                                                                                                                                
9:36:52 AM                                                                                                                    
                                                                                                                                
Representative Fields looked at  Slide 9, "Cost of Long-Term                                                                    
Care in Pacific Northwest."  He stated that residents looked                                                                    
for other  options after the rate  increase. He acknowledged                                                                    
that the background was complicated,  there was not a market                                                                    
replacement  for  Pioneer Homes.  He  said  that there  were                                                                    
market  alternatives for  people  in Pioneer  Homes who  had                                                                    
Level I  care, such as  assisted living or in-home  care. He                                                                    
said that the  slide examined the relative cost  of care for                                                                    
assisted living  and nursing homes in  the Pacific Northwest                                                                    
region,  and  in Alaska.  He  relayed  that assisted  living                                                                    
programs  with lower  levels  of acuity  of  care, which  in                                                                    
Pioneer Homes  would closely approximate  with Levels  I and                                                                    
II  of  care,  the  cost in  the  Pacific  Northwest  ranged                                                                    
between $5,000 and  $6,000. He said that  Levels III through                                                                    
V was  more like nursing  home care,  in terms of  acuity of                                                                    
care;   however,   Pioneer   Homes  were   assisted   living                                                                    
facilities  and did  not bill  at a  Medicare rate.  Pioneer                                                                    
Homes  provided nursing  home care  at higher  levels, while                                                                    
billing at the Medicare  reimbursement rates. He shared that                                                                    
some  portions of  some  Pioneer Homes  used  to be  nursing                                                                    
homes  but lost  certification because  facilitates did  not                                                                    
meet    current    Americans   with    Disabilities    (ADA)                                                                    
requirements.   He   related   that  some   facilities   had                                                                    
investigated  renovations to  have part  of certain  Pioneer                                                                    
Homes  be  nursing homes.  He  shared  that Agnew  Beck  had                                                                    
produced  a  report  that   had  revealed  possibilities  of                                                                    
nursing care  in Pioneer  Homes. He said  that under  HB 96,                                                                    
competitive  rates would  be maintained  at lower  levels of                                                                    
care, higher  levels of  care would  be more  expensive than                                                                    
market rates  for assisted living  homes. He  warned against                                                                    
an  adverse  selection  process  that  forced  out  self-pay                                                                    
residents, inadvertently  creating a larger state  cost year                                                                    
after year.                                                                                                                     
                                                                                                                                
9:40:13 AM                                                                                                                    
                                                                                                                                
Senator  Wilson had  talked to  the sponsor  about the  fact                                                                    
that  although the  Pioneer Homes  were  not nursing  homes,                                                                    
skilled  nursing level  services  were  provided within  the                                                                    
facilities.  He spoke  of  the CPI  increases,  the cost  of                                                                    
living and the cost of  healthcare in the state and wondered                                                                    
whether those numbers had been considered.                                                                                      
                                                                                                                                
9:41:09 AM                                                                                                                    
                                                                                                                                
Co-Chair Stedman noted  that smaller areas of  the state did                                                                    
not  have  nursing  home and  assisted  living  options  and                                                                    
thought that  the numbers  on the  slide were  applicable to                                                                    
Anchorage  but not all areas of the state.                                                                                      
                                                                                                                                
Co-Chair von  Imhof agreed. She  stressed the  importance of                                                                    
designating  the  differences  between a  nursing  home  and                                                                    
assisted living:  the types of  care, cost,  demographics of                                                                    
patients  served, and  reimbursement rates.   She  felt that                                                                    
other  states had  been more  successful in  recognizing the                                                                    
two  types of  care. She  thought  that both  types of  care                                                                    
could  happen  in  the same  facility  and  recognized  that                                                                    
upgrades would  need to be  done at  the cost of  the state.                                                                    
She  felt that  it  should be  recognized  that the  states                                                                     
population  was  going  to  continue to  age  and  that  the                                                                    
problem would not  go away but would  evolve. She reiterated                                                                    
Senator Wilsons   question about  how the state  should grow                                                                    
rates that were fair and  accurate of the cost of healthcare                                                                    
in the state.                                                                                                                   
                                                                                                                                
Representative  Fields agreed  that Alaska  had the  fastest                                                                    
growing senior  population, per capita,  in the  country. He                                                                    
cited  that  there  were  communities  in  the  state  where                                                                    
Pioneer  Homes provided  half of  all  total long-term  care                                                                    
beds. He  noted that the  alternative of sending  a relative                                                                    
to the Lower 48 could be heartbreaking for a family.                                                                            
                                                                                                                                
9:44:50 AM                                                                                                                    
                                                                                                                                
Senator Bishop  asked about the total  population of Pioneer                                                                    
Homes.                                                                                                                          
                                                                                                                                
Representative Fields recalled there  were 592 residents the                                                                    
previous year.                                                                                                                  
                                                                                                                                
9:45:11 AM                                                                                                                    
                                                                                                                                
Co-Chair Stedman  commented that in his  region people lived                                                                    
in the state  a long time and did not  leave; they stayed in                                                                    
their home  until they could  no longer live in  their home.                                                                    
He emphasized that  very few people had  the financial means                                                                    
to leave  the state for  care. He stressed  concentrating on                                                                    
those that could not afford to  go out of state for care and                                                                    
reiterated that those that could were a very select few.                                                                        
                                                                                                                                
Representative Fields agreed.                                                                                                   
                                                                                                                                
9:46:59 AM                                                                                                                    
                                                                                                                                
Representative Fields  addressed Slide 10,  "Social Security                                                                    
Cost of Living Adjustment":                                                                                                     
                                                                                                                                
    -CSHB 96 would link rate increases to the SS COLA.                                                                          
     -Preferred metric for Pioneer Homes, as majority of                                                                        
     resident's primary source of income is Social                                                                              
     Security.                                                                                                                  
     -Would create stable, predictable rate increases.                                                                          
     -Would allow rates to rise following cost of care and                                                                      
     resident's main source of income.                                                                                          
                                                                                                                                
Representative Fields noted that the  bill was linked to the                                                                    
social  security cost  of living  adjustment.  He felt  that                                                                    
there was  no perfect CPI  for Pioneer homes because  of the                                                                    
mix  of available  types care.  He shared  that there  was a                                                                    
long-term  care index  that he  could  share with  committee                                                                    
members  that was  perhaps more  reflective  of an  assisted                                                                    
living  type  of environment.  He  reiterated  the need  for                                                                    
predictability  and   affordability  for  those   living  in                                                                    
Pioneer Homes.                                                                                                                  
                                                                                                                                
9:48:38 AM                                                                                                                    
                                                                                                                                
Co-Chair Stedman  liked the  direction of  the bill.  He was                                                                    
concerned  with inflation-proofing  the  rate structure  and                                                                    
thought it might make it  more difficult for the controlling                                                                    
board to deal with budgets.  He thought the committee should                                                                    
give some  consideration to whether  the rates should  be on                                                                    
autopilot or should  be reviewed from time to  time to reset                                                                    
the rates. He  mentioned the difficulty of  dealing with the                                                                    
cost drivers in the operating budget.                                                                                           
                                                                                                                                
Representative Fields  stated that  the bill as  written did                                                                    
change  the   process  for  rates.  The   bill  allowed  the                                                                    
department to  change rates, annually  and up to  the social                                                                    
security  cost  of  living adjustment,  without  the  public                                                                    
comment process. He had thought  one potential change to the                                                                    
bill  could  be  advertising those  regulations  for  public                                                                    
review.                                                                                                                         
                                                                                                                                
Co-Chair  von Imhof  summarized  that the  bill allowed  the                                                                    
department flexibility to change  the rates annually without                                                                    
public  input.  If  the department  wanted  to  raise  rates                                                                    
beyond the CPI listed in  the bill, the public process would                                                                    
be followed.                                                                                                                    
                                                                                                                                
Representative Fields  explained that under the  bill a band                                                                    
within which  the department could  set rates  without going                                                                    
through the  public comment process  had been set;  the band                                                                    
was between  zero percent  and the  social security  rate of                                                                    
inflation.                                                                                                                      
                                                                                                                                
9:51:52 AM                                                                                                                    
                                                                                                                                
Co-Chair von Imhof thought that  public comment was a checks                                                                    
and  balance   system  for  rates.  She   thought  that  the                                                                    
legislature would be monitoring the  rates from year to year                                                                    
and agreed with  Co-Chair Stedman that setting  the rates on                                                                    
autopilot was questionable. She  lamented that inflation was                                                                    
the thief in the night.                                                                                                         
                                                                                                                                
Representative  Fields  thought one  way  to  deal with  the                                                                    
situation would be  to require the department  to go through                                                                    
the  public  comment process.  He  suggested  a sunset  date                                                                    
could be added to the bill.                                                                                                     
                                                                                                                                
Co-Chair  von Imhof  thought a  sunset date  for review  was                                                                    
considerable for contemplation.                                                                                                 
                                                                                                                                
9:53:38 AM                                                                                                                    
                                                                                                                                
Representative Fields advanced to Slide 11, "CSHB 96":                                                                          
                                                                                                                                
     Provides stability for residents and Department                                                                            
                                                                                                                                
     Ensures timely and predictable rate increases                                                                              
                                                                                                                                
     Provides peace of mind for residents                                                                                       
                                                                                                                                
    Updated levels of care to reflect aging population                                                                          
                                                                                                                                
Representative   Fields  expressed   appreciation  for   the                                                                    
committees  time  and expertise.  He stressed that  the bill                                                                    
reflected  the states   aging  population  and the  changing                                                                    
needs for greater diversity of care at Pioneer Homes.                                                                           
                                                                                                                                
9:54:41 AM                                                                                                                    
Co-Chair  Stedman requested  further detail  concerning Page                                                                    
2, Line  14 of the  bill, which  referenced a change  in the                                                                    
amount of  monthly stipend,  from $200  to $500,  a resident                                                                    
could keep while receiving state assistance.                                                                                    
                                                                                                                                
Representative  Fields stated  that the  change was  made in                                                                    
the  House Finance  Committee after  it was  considered that                                                                    
the stipend amount had not been updated for some time.                                                                          
                                                                                                                                
TRISTAN  WALSH,   STAFF  FOR  REPRESENTATIVE   ZACH  FIELDS,                                                                    
recalled that  the last  time the  stipend had  been updated                                                                    
was in 2011.                                                                                                                    
                                                                                                                                
Co-Chair Stedman  offered personal  feedback on  the amount.                                                                    
He  explained  that the  biggest  portion  of most  peoples                                                                     
wealth over  a lifetime  was their home,  and a  transfer of                                                                    
that  equity  as use  for  payment  for  the services  of  a                                                                    
Pioneer Home was the practice.  He considered that some used                                                                    
the state assistance (currently  $200 per month) stipend for                                                                    
frivolities and  thought that the amount  was reasonable. He                                                                    
did not  believe that $500  was applicable when the  cap for                                                                    
receiving assistance was $10,000, or under, in assets.                                                                          
                                                                                                                                
9:58:22 AM                                                                                                                    
                                                                                                                                
Senator  Olson  thanked the  sponsor  for  putting the  bill                                                                    
forward. He  considered the question of  the monthly stipend                                                                    
and calculated that an increase  would be beneficial. He was                                                                    
in   favor   of  the   $500   stipend,   which  equated   to                                                                    
approximately $17 per day.                                                                                                      
                                                                                                                                
9:59:25 AM                                                                                                                    
                                                                                                                                
Mr.  Walsh  addressed  a  Sectional  Analysis  for  CSHB  96                                                                    
Version S (copy on file):                                                                                                       
                                                                                                                                
     Section  1. This  section amends  AS 47.55.020(b),  the                                                                  
     statute  regarding  admission  to a  Pioneer  Home,  to                                                                    
     raise the amount of monthly  income a resident may keep                                                                    
     for  incidental  expenses  from   $200  to  $500.  This                                                                    
     section also  makes conforming  changes to  reflect new                                                                    
     language added in Section 5 of this bill.                                                                                  
                                                                                                                                
     Section  2. This  section amends  AS 47.55.020(d),  the                                                                  
     section of statutes relating  to payment assistance, to                                                                    
     raise the amount of monthly  income a resident may keep                                                                    
     for  incidental  expenses  from   $200  to  $500.  This                                                                    
     section also  makes conforming  changes to  reflect new                                                                    
     language added in Section 5 of this bill.                                                                                  
                                                                                                                                
     Section  3. This  section  amends  AS 47.55.030(a)  the                                                                  
     section  relating  to  payment   by  a  resident,  with                                                                    
     conforming  language that  reflects Section  5 of  this                                                                    
     bill.                                                                                                                      
                                                                                                                                
     Section  4.  This  section   repeals  and  reenacts  AS                                                                  
     47.55.030(b),  which charges  the  Department to  adopt                                                                    
     regulations regarding  a monthly rate for  Pioneer Home                                                                    
     residents, to reflect changes made in Section 5.                                                                           
                                                                                                                                
     Section 5.  This section amends AS  47.55.030 by adding                                                                  
     a  new  section,  (f).  This  section  works  to  limit                                                                    
     Pioneer Home  Rate increases to  no more than  the rate                                                                    
     of inflation,  as measured by  Social Security  Cost of                                                                    
     Living  Adjustment,  using  current monthly  and  daily                                                                    
     rates  (adjusted   for  inflation  since  2004)   as  a                                                                    
     starting point.                                                                                                            
                                                                                                                                
     Section  6.  This  section  amends  AS  47.55.070,  the                                                                  
     statute regarding  indebtedness of  a home  resident to                                                                    
     the  State, with  conforming  language  to reflect  the                                                                    
     changes made in Section 5 of this bill.                                                                                    
                                                                                                                                
     Section 7.  This section  makes conforming  changes, by                                                                  
     repealing sections of  statutes requiring public notice                                                                    
     for proposed  rate changes, which could  be infrequent.                                                                    
     Section 5 of this bill sets this as an annual process.                                                                     
                                                                                                                                
10:01:47 AM                                                                                                                   
                                                                                                                                
Senator Wielechowski  was curious how  long a person  had to                                                                    
be  a resident  of the  state to  qualify for  a space  in a                                                                    
Pioneer Home.                                                                                                                   
                                                                                                                                
Representative Fields deferred to the department.                                                                               
                                                                                                                                
10:03:13 AM                                                                                                                   
                                                                                                                                
CLINTON  LASLEY, DEPUTY  COMMISSIONER, DEPARTMENT  OF HEALTH                                                                    
AND  SOCIAL SERVICES,  relayed that  in 2018,  because rates                                                                    
had not  increased commensurate with  the cost  of providing                                                                    
services for  many years, the  department had put  forward a                                                                    
rate  increase  of substantial  size  for  the Pioneer  Home                                                                    
systems. Rates  were increased  to cover  the cost  of care,                                                                    
and  a protective  mechanism had  been put  into place  that                                                                    
protected  elders who  could not  afford rates,  by allowing                                                                    
for  payment from  the assistance  program.  He shared  that                                                                    
under statute,  elders 65 years  of age, or older,  who have                                                                    
lived in the  state one year, are eligible to  move into the                                                                    
system  or  sign up  for  the  waitlist.  he said  that  the                                                                    
payment assistance program had  been established long ago to                                                                    
ensure that  any elder  who qualified to  move into  a home,                                                                    
could,  regardless   of  ability   to  pay.  He   offered  a                                                                    
hypothetical: if  an elder moving  in at $13,333,  could pay                                                                    
the rate, and  did not qualify for Medicaid,  they would pay                                                                    
out-of-pocket. If  they could not  pay the rate there  was a                                                                    
formula  in  place  that would  consider  their  assets  and                                                                    
marital status and could allow  them to apply to the payment                                                                    
assistance  program.  He  said  that the  portion  that  the                                                                    
patient could not  pay would be subsidized by  the state. He                                                                    
said that the  department did not generally  go after elders                                                                    
for the subsidized  amount and that the  state might receive                                                                    
the  occasional check  from an  estate after  a patient  had                                                                    
died.                                                                                                                           
                                                                                                                                
10:06:48 AM                                                                                                                   
                                                                                                                                
Mr. Lasley thought  it might be beneficial  to the committee                                                                    
for the  department to  provide an  overview of  the Pioneer                                                                    
Home systems and  how the rating increases  had affected the                                                                    
systems. He  relayed that in  2019 the earned  revenue would                                                                    
be approximately $7 million more  than in previous years due                                                                    
to rate increases. He said that  any elder that lived in the                                                                    
homes under  the rate structure  that went through  in FY19,                                                                    
had been subsidized  by the state. He explained  that if the                                                                    
top level was $6795 (Level  III) the department knew that it                                                                    
cost  $13,333; every  elder was  being subsidized  $7,000 at                                                                    
Level  III.  He  said  that the  current  payer  source  mix                                                                    
reflected approximately  8 percent  less private pay  and an                                                                    
increase of 16 percent in payment assistance.                                                                                   
                                                                                                                                
10:09:02 AM                                                                                                                   
                                                                                                                                
Co-Chair von  Imhof recalled  an earlier  conversation about                                                                    
married couples and payment assistance.                                                                                         
                                                                                                                                
Mr.  Lasley stated  that  a single  individual  living in  a                                                                    
Pioneer  Home system  could have  only  $10,000 in  personal                                                                    
assets  to qualify  for  assistance.  Married couples  could                                                                    
have  $98,000 in  personal assets  and could  own a  primary                                                                    
residence;  the  primary  residence  would  not  be  counted                                                                    
against the $98,000.                                                                                                            
                                                                                                                                
Co-Chair von  Imhof wondered about the  choices people would                                                                    
have  once  they had  liquidated  all  their assets,  except                                                                    
their home,  and would  they be forced  to sell  their home.                                                                    
She queried what happened to  patients when their assets ran                                                                    
out and they were still living in a Pioneer Home.                                                                               
                                                                                                                                
Mr. Lasley  stated that  spouses who  had a  loved one  in a                                                                    
Pioneer Home could keep $3160 of their personal income.                                                                         
                                                                                                                                
Co-Chair von Imhof restated her question.                                                                                       
                                                                                                                                
Mr.  Lasley stated  that  such a  person  would qualify  for                                                                    
payment  assistance. He  added  that there  had  been a  few                                                                    
instances in which the department  had to evaluate whether a                                                                    
person  could  live off  $3,160  per  month. Prior  to  last                                                                    
years   rate increase,  the spousal  support was  $2,000. He                                                                    
added that  the monthly  amount was  adjusted to  align with                                                                    
Medicaid qualifications.                                                                                                        
                                                                                                                                
10:13:04 AM                                                                                                                   
                                                                                                                                
Co-Chair  von Imhof  asked what  happened  when the  Pioneer                                                                    
Homes  understood from  actuarial  data at  the  start of  a                                                                    
persons  care that their funds  would be depleted before the                                                                    
need for care ended.                                                                                                            
                                                                                                                                
Mr.  Lasley responded  that social  workers would  work with                                                                    
the  family. The  family  would be  private  pay until  they                                                                    
reached   the  resource   threshold,  at   which  time   the                                                                    
department  would  be  helping  the  family  apply  for  the                                                                    
Medicaid waiver program.  He said that at  the highest level                                                                    
of  care  most of  the  individuals  would qualify  for  the                                                                    
waiver but would  also have to meet  the financial threshold                                                                    
set by the federal government.                                                                                                  
                                                                                                                                
Co-Chair von  Imhof asked how  much Medicaid would  pay, per                                                                    
month,  to cover  the cost  of  the highest  level of  care,                                                                    
approximately $13,000 per month.                                                                                                
                                                                                                                                
Mr. Lasley stated that the state paid approximately $7,000.                                                                     
                                                                                                                                
10:15:44 AM                                                                                                                   
                                                                                                                                
Co-Chair Stedman  offered his real-world perspective  on the                                                                    
Pioneer Home experience.  He said that even if  a person has                                                                    
the financial  resources to get  into a home, a  person must                                                                    
get on the waitlist, and must be  at the top of that list to                                                                    
secure a space.  He said some members of  his community have                                                                    
ben  on the  waitlist for  20  years. He  stressed that  the                                                                    
chances of  a person new  to the  state getting on  the list                                                                    
and securing a  spot was small. He shared  that residence in                                                                    
his region  who did not sign  up on the list  early on would                                                                    
find that  they were far down  on the list when  they needed                                                                    
the  space. He  related that  many Alaskans  understood that                                                                    
they needed to put family members  on the list many years in                                                                    
advance. There was no cost to  keep them on the list until a                                                                    
spot became  available. He  said that the  cost of  care was                                                                    
significant and  that once all  assets were  liquidated, the                                                                    
system  worked with  families on  running  a credit  balance                                                                    
while working out how homes could  be sold in order to cover                                                                    
costs. He  said he had  never known  of anyone to  be thrown                                                                    
out of a  home for inability to pay. He  reiterated that the                                                                    
home worked with families to work out payment.                                                                                  
                                                                                                                                
Co-Chair  Stedman asked  about  spaces  being vacated  under                                                                    
Level I care, and what the  plan was to supplant the revenue                                                                    
so that rooms were not empty.                                                                                                   
                                                                                                                                
Co-Chair  von  Imhof  asked about  patients  entering  under                                                                    
specific care levels.                                                                                                           
                                                                                                                                
Mr. Lasley  responded that there were  two waitlists: active                                                                    
and inactive.  Once a person  was 65  years of age,  and had                                                                    
lived in  the state for  a year, they  could sign up  on the                                                                    
inactive  waitlist. This  meant that  at some  point in  the                                                                    
future  it was  anticipated that  the person  would want  or                                                                    
need to move into a Pioneer Home.                                                                                               
                                                                                                                                
10:19:52 AM                                                                                                                   
                                                                                                                                
Mr. Lasley  continued that  once the  person needed  to move                                                                    
into  a home  they would  be moved  to the  active waitlist,                                                                    
which gave the department the  indicator that the person was                                                                    
ready to  move into a home  within 30 days of  signing up on                                                                    
the list.  Many individuals  had been  on the  inactive list                                                                    
for many years  and many in small communities  stayed on the                                                                    
active list  for extended periods. The  original application                                                                    
date was applied,  which was why signing up  on the inactive                                                                    
list  early   was  beneficial.  He  said   that  455  elders                                                                    
currently lived  in the  system; 18  had moved  out directly                                                                    
related to  the rate increases,  a percentage of  which were                                                                    
receiving  Level I  care.  He said  that  the primary  place                                                                    
where elders had moved out were in Anchorage and Palmer.                                                                        
                                                                                                                                
10:22:23 AM                                                                                                                   
                                                                                                                                
Senator  Wielechowski asked  about the  waitlist before  and                                                                    
after the  rate increase.  He wondered  how many  people had                                                                    
declined to accept an opening due to the increased rates.                                                                       
                                                                                                                                
Mr.  Lasley estimated  that there  was 5,523  people on  the                                                                    
inactive waitlist,  where there  had been 5,340.  There were                                                                    
139 people  on the active  waitlist, which had been  210. He                                                                    
noted that  part of the reason  for the drop in  numbers was                                                                    
that 125  to 130 elders  passed before their name  ever came                                                                    
up on the list.                                                                                                                 
                                                                                                                                
Co-Chair von  Imhof thought  there had  been some  new homes                                                                    
built that were a source of competition.                                                                                        
                                                                                                                                
10:24:04 AM                                                                                                                   
                                                                                                                                
Senator Wielechowski asked about  the average length of time                                                                    
a person resided in the Pioneer Homes.                                                                                          
                                                                                                                                
Mr. Lasley  stated the  average length was  a little  over 3                                                                    
years.                                                                                                                          
                                                                                                                                
10:24:29 AM                                                                                                                   
                                                                                                                                
Senator Bishop asked whether there  was a penalty if someone                                                                    
declined an opening when it became available.                                                                                   
                                                                                                                                
Mr.  Lasley  stated that  if  an  elder  was on  the  active                                                                    
waitlist  and declined  an available  space,  they would  be                                                                    
moved to  the inactive  waitlist for  180 days,  after which                                                                    
they could be put back on the active waitlist.                                                                                  
                                                                                                                                
10:25:34 AM                                                                                                                   
                                                                                                                                
Co-Chair von  Imhof noted  the time  and announced  that the                                                                    
meeting was scheduled to end at 10:30 AM.                                                                                       
                                                                                                                                
10:25:52 AM                                                                                                                   
                                                                                                                                
Senator Wilson asked  about the number of  residents in each                                                                    
level of care.                                                                                                                  
Mr. Lasley offered to provide the information later.                                                                            
                                                                                                                                
10:27:03 AM                                                                                                                   
                                                                                                                                
AVE   THOMPSON,   SELF,  ANCHORAGE   (via   teleconference),                                                                    
testified in support  of the bill.  He shared  that his wife                                                                    
was  a resident  of the  Memory Care  Unit at  the Anchorage                                                                    
Pioneer Home until August 31,  2019. The monthly cost of her                                                                    
residence and assistance  at Level iii was  $6795 per month.                                                                    
On  September  1,  2019,  the   Division  of  Pioneer  homes                                                                    
increased her  rate to  $13,333, per  month: a  96.2 percent                                                                    
increase.  He  shared that  he  and  his wife  were  private                                                                    
payers and the  cost was funded by  retirement income, long-                                                                    
term  care   insurance,  and  personal  savings.   The  cost                                                                    
increase  drove  his  wife  out of  the  Pioneer  Home.  Her                                                                    
replacement  would more  than likely  need state  subsidy to                                                                    
pay their bill. He felt that,  at this rate, in the long run                                                                    
most of  the Pioneer Home  residence would be  subsidized by                                                                    
public dollars.  He lamented  that the  administration would                                                                    
raise the rates while legislation  to reduce rates was still                                                                    
working  its way  through  the  legislature. He  appreciated                                                                    
that  effort  to make  the  user  pay  for the  service  but                                                                    
believed  that the  increases should  be  moderate and  done                                                                    
incrementally.                                                                                                                  
                                                                                                                                
10:30:10 AM                                                                                                                   
                                                                                                                                
Co-Chair von  Imhof OPENED public testimony.  She encouraged                                                                    
the public to submit written testimony.                                                                                         
                                                                                                                                
10:30:49 AM                                                                                                                   
                                                                                                                                
LEW TOBIN,  PIONEERS OF  ALASKA, NOME  (via teleconference),                                                                    
spoke in favor of the  bill. He shared that the organization                                                                    
had supported  Pioneer Homes since their  inception. He said                                                                    
that  Pioneer Homes  allowed pioneers  to live  in-state. He                                                                    
felt that  the rate increases were  unsettling for residents                                                                    
and  for  those on  the  waitlists.  He stressed  that  most                                                                    
elders in the  state would prefer to  remain independent and                                                                    
would move into group living  only if forced by circumstance                                                                    
and  financial  and health  problems.  He  stated that  many                                                                    
elders  did   not  have  the  financial   resources  to  pay                                                                    
increased  rates.  He  stressed  that  modern  life  ate  up                                                                    
savings quickly.  He enjoyed living  in Alaska and  hoped he                                                                    
would be able to when he  needed assistance in older age. He                                                                    
hoped  that  the rates  could  be  maintained at  reasonable                                                                    
levels and increases made in in moderation.                                                                                     
10:36:13 AM                                                                                                                   
                                                                                                                                
THELMA  KAY ANDREW,  PIONEER IGLOO  16 &  17, KETCHIKAN  LIO                                                                    
(via teleconference), testified in  support of the bill. She                                                                    
was a  lifelong Ketchikan  resident. She  discussed concerns                                                                    
with  the rate  increases. She  felt that  the increase  was                                                                    
unreasonable  for   those  in  care  and   those  who  would                                                                    
eventually be  seeking care. She  argued that  elders should                                                                    
not  have to  seek care  out-of-state because  of cost.  She                                                                    
stated that the  Pioneers of Alaska played  an integral part                                                                    
of starting  the Pioneer  Homes of  Alaska by  donating land                                                                    
for buildings.  She discussed the  history of  Pioneer Igloo                                                                    
and  Pioneer Home  development.  She urged  support for  the                                                                    
legislation.                                                                                                                    
                                                                                                                                
10:39:58 AM                                                                                                                   
                                                                                                                                
DAVID  KARP, CITIZEN,  NOME (via  teleconference), spoke  in                                                                    
favor  of  the  bill.  He  discussed  his  mother-in-law,  a                                                                    
lifetime Nome  resident who was  a six-year resident  of the                                                                    
Pioneer  Home. He  discussed the  recently implemented  rate                                                                    
increase.  He   shared  that   his  mother-in-law   had  the                                                                    
resources to stay in the Pioneer  Home   but for a truncated                                                                    
time due to the increase. He  said that his family had found                                                                    
a place to move her, for  an increased amount that was still                                                                    
less  than  the  rate  increase. He  lamented  that  medical                                                                    
professionals cautioned the  family that by moving  her to a                                                                    
private   facility,   her    cognitive   health   would   be                                                                    
jeopardized; the  family conferred  and decided to  keep her                                                                    
in the Pioneer  Home, even with the increased  cost, for the                                                                    
sake  of  her  health.  His  mother-in-law  was  a  Level  4                                                                    
resident   and   had   limited   cognitive   abilities.   He                                                                    
appreciated  the care  she received  but  worried about  the                                                                    
increased cost.                                                                                                                 
                                                                                                                                
10:43:09 AM                                                                                                                   
                                                                                                                                
KATHERINE  BISHOP, LOCAL  ORGANIZING MINISTRY  ST. MICHAELS,                                                                    
PALMER  (via teleconference),  testified in  support of  the                                                                    
bill. She  encouraged the  committee to  take action  on the                                                                    
bill  as soon  as possible.  She noted  that there  had been                                                                    
individuals that  moved out of  the Palmer Pioneer  Home and                                                                    
no  longer were  receiving  the care  that  was needed.  She                                                                    
thought the  bill would provide predictability  of cost, and                                                                    
sustainability of the Pioneer Home systems.                                                                                     
                                                                                                                                
10:46:16 AM                                                                                                                   
BRAD RIDER, SELF,  JUNEAU, spoke in support of  the bill. He                                                                    
thought  the state  spent a  great deal  of money  on people                                                                    
with self-inflicted issues. He  emphasized the importance of                                                                    
Pioneers  in  the state.  He  emphasized  the importance  of                                                                    
taking care  of the  elders in the  state. He  stressed that                                                                    
the elderly  could not  always stand  up for  themselves. He                                                                    
believed  that  the  state  should   care  for  its  elderly                                                                    
population.                                                                                                                     
                                                                                                                                
10:47:46 AM                                                                                                                   
                                                                                                                                
JANET HENDERSON,  SELF, JUNEAU, testified in  support of the                                                                    
bill.  Her family  had moved  to  Alaska in  the 1960s.  She                                                                    
discussed  her family  history and  work in  the state.  She                                                                    
said  that her  parents had  saved in  order to  be able  to                                                                    
self-pay for  their stay  in a  Pioneer Home.  She discussed                                                                    
the  drawbacks  for  state residents  should  Pioneer  Homes                                                                    
become unavailable.  She thought  the governor had  tried to                                                                    
change   the  purpose   of   the   Pioneer  Homes,   without                                                                    
consideration  of  state  history.   She  thought  the  bill                                                                    
reaffirmed  that Alaska  was  geographically different  than                                                                    
the rest of  the country. Private long-term  care homes were                                                                    
not economically  viable in parts  of the  state; therefore,                                                                    
the state had a vested  interest in supporting Pioneer Homes                                                                    
as  the only  option  that existed  for  many families.  She                                                                    
furthered that the  bill would put payment  rates in statute                                                                    
so they would not be subject to political whims.                                                                                
                                                                                                                                
10:50:33 AM                                                                                                                   
                                                                                                                                
LYNN WILLIS, SELF, MATSU LIO  (via teleconference), spoke in                                                                    
support of  the bill.  He cited an  article from  the Senior                                                                    
Voice,   which  discussed   a  lawsuit   relating  to   rate                                                                    
increases. He  said that the  article showed that  16 people                                                                    
had left  the Pioneer Home  systems because of  an inability                                                                    
to pay,  not a refusal  to pay.  He mentioned his  friend in                                                                    
the Pioneer  Veterans' Home, who  had concerns  about having                                                                    
to move.                                                                                                                        
                                                                                                                                
10:52:02 AM                                                                                                                   
                                                                                                                                
CRIS  EICHENLAUB, SELF,  EAGLE  RIVER (via  teleconference),                                                                    
spoke in  support of  the bills   intent. He  thought elders                                                                    
were  the state's  most important  resource.  He wished  the                                                                    
bill addressed cost  drivers. He did not  believe that rates                                                                    
should be increased.                                                                                                            
                                                                                                                                
10:53:55 AM                                                                                                                   
                                                                                                                                
Co-Chair von Imhof CLOSED public testimony.                                                                                     
                                                                                                                                
Co-Chair von Imhof relayed that fiscal notes would be                                                                           
discussed at a future meeting.                                                                                                  
                                                                                                                                
HB 96 was HEARD and HELD in committee for further                                                                               
consideration.                                                                                                                  
                                                                                                                                
Co-Chair von Imhof discussed housekeeping.                                                                                      
                                                                                                                                
ADJOURNMENT                                                                                                                   
10:55:13 AM                                                                                                                   
                                                                                                                                
The meeting was adjourned at 10:55 a.m.                                                                                         
                                                                                                                                
                                                                                                                                

Document Name Date/Time Subjects
HB096 Sponsor Statement 3.25.19.pdf HHSS 4/9/2019 3:00:00 PM
HHSS 4/23/2019 3:00:00 PM
HSTA 3/26/2019 3:00:00 PM
SFIN 3/9/2020 9:00:00 AM
SHSS 2/12/2020 1:30:00 PM
HB 96
6 CSHB 96 Summary of Changes Version M to Version S 5.12.19.pdf SFIN 3/9/2020 9:00:00 AM
SHSS 1/27/2020 1:30:00 PM
SHSS 2/12/2020 1:30:00 PM
HB 96
3 CSHB 96 Supporting Document Sectional Analysis Version S 5.12.19.pdf SFIN 3/9/2020 9:00:00 AM
SHSS 1/27/2020 1:30:00 PM
SHSS 2/12/2020 1:30:00 PM
HB 96
HB 96 Agnew Beck Study 5.12.2019 - TOC and Executive Summary.pdf SFIN 3/9/2020 9:00:00 AM
HB 96
HB 96 Presentation to SFIN 3.9.2020.pdf SFIN 3/9/2020 9:00:00 AM
HB 96
SB 123 Public Testimony CIRI 3.2.20.pdf HRES 3/11/2020 1:00:00 PM
SFIN 3/9/2020 9:00:00 AM
SB 123
HB 96 Public Testimony.pdf SFIN 3/9/2020 9:00:00 AM
HB 96