Legislature(2019 - 2020)SENATE FINANCE 532
03/09/2020 09:00 AM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB123 | |
| HB96 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 96 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 123 | TELECONFERENCED | |
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 |