Legislature(1999 - 2000)
03/03/1999 01:35 PM Senate HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
March 3, 1999
1:35 p.m.
MEMBERS PRESENT
Senator Pete Kelly, Vice-Chairman
Senator Gary Wilken
Senator Kim Elton
MEMBERS ABSENT
Senator Mike Miller, Chairman
Senator Drue Pearce
COMMITTEE CALENDAR
SENATE BILL NO. 56
"An Act allowing the disclosure of reports with regard to
inspection and investigations of certain health care facilities,
home health agencies, hospice programs, and assisted living homes;
authorizing the Department of Health and Social Services to license
home health agencies; and providing for an effective date."
-HEARD AND HELD
SENATE BILL NO. 57
"An Act relating to vulnerable adults; and providing for an
effective date."
-HEARD AND HELD
SENATE BILL NO. 58
"An Act establishing an in-home and community-based services
program for certain adults with long-term care needs; and providing
for an effective date."
-HEARD AND HELD
SENATE BILL NO. 59
"An Act relating to the certificate of need program for nursing
care facilities and other facilities; and providing for an
effective date."
-HEARD AND HELD
PREVIOUS SENATE COMMITTEE ACTION
SB 56 - No previous action to report
SB 57 - No previous action to report
SB 58 - No previous action to report
SB 59 - No previous action to report
WITNESS REGISTER
Mr. Elmer Lindstrom, Special Assistant
Department of Health & Social Services
PO Box 110601
Juneau, AK 99811-601
Ms. Alison Elgee, Deputy Commissioner
Department of Administration
PO Box 110200
Juneau, AK 99811-0200
Mr. Dwight Becker, Protective Services
Coordinator
Department of Administration
Division of Senior Services
3601 C St., Suite 310
Anchorage, AK 99503-5984
Mr. Jay Livey, Deputy Commissioner
Department of Health & Social Services
PO Box 110601
Juneau, AK 99811-0601
Ms. Jane Demmert, Executive Director
Alaska Commission on Aging
PO Box 110209
Juneau, AK 99811-0209
ACTION NARRATIVE
TAPE 99-08, SIDE A
Number 001
VICE-CHAIRMAN KELLY called the Senate Health, Education and Social
Services (HESS) Committee to order at 1:35 p.m. and announced that
after the introduction of guests by Senator Elton the committee
would take up SB 56, a bill resulting from the Long-Term Care Task
Force Final Report.
Senator Elton introduced members of local Cub Scout Den 15,
including Den Mother Kathleen Lyden, Max Boatwright, Ben
Bettisworth, Forrest Clough, John Holt, Trevor Lyden, Kelly Newman,
and Karen Perdue. VICE-CHAIRMAN KELLY invited them to sit at the
committee table.
SB 56-HOME HEALTH AGENCIES/HOSPITALS/HOSPICES
VICE-CHAIRMAN KELLY asked Elmer Lindstrom to address SB 56, and
announced that Senator Wilken will take the lead on most of the
discussion as he was co-chairman of the Long-Term Care Task Force
(LTCTF).
Number 065
MR. ELMER LINDSTROM, Special Assistant to the Department of
Health & Social Services, briefly stated SB 56 has two primary
purposes. First, it would allow the department to continue to
provide a licensing regime for home health agencies which it has
been doing under the general powers of the department for some
time. Recently the Department of Law recommended the department
acquire specific statutory authority to license this type of
agency. The bill is technical in nature, giving explicit
authority to the department to continue licensing these agencies.
More importantly, MR. LINDSTROM continued, the legislation also
gives the department the ability to disclose to the public
licensing reports on all of the types of facilities and agencies.
It is a good consumer protection measure, and useful information
for persons shopping for a type of facility. He said it's a
"clean little bill," endorsed by the LTCTF and the department.
MR. LINDSTROM brought up one suggested amendment. The home
health language is placed in AS 18.28 which relates to state
assistance for community health aide programs and has no relation
to the additional material being added to AS 18.28. Department
staff suggested that AS 18.18 would be a more appropriate place
to put the language. If the committee is interested in making
that change, MR. LINDSTROM requested that his staff be able to
work with Legal Services to quickly resolve it.
Number 115
VICE-CHAIRMAN KELLY stated it's a good idea, and he recommended
that the amendment be drafted before the series of bills is again
taken up by the committee.
SENATOR WILKEN commented that SB 56 relates to Recommendation #3
of the LTCTF, and he referred to the report backup. He said this
legislation has the wholehearted endorsement of the task force
and the committee.
VICE-CHAIRMAN KELLY mentioned that Mr. Dwight Becker is on
teleconference, and asked Mr. Becker if he is available to answer
questions on SB 56 or any of the other bills. MR. BECKER
responded he would address SB 57 and SB 58.
SENATOR WILKEN commented that SB 56 opens the record, and asked
if it is essentially a consumer information bill.
MR. LINDSTROM replied "absolutely," and the prohibition on being
able to disclose this information is a relic of an old federal
law. SENATOR WILKEN asked if the legislation protects identifi-
cation of specific clients or personal data. MR. LINDSTROM
responded he's very certain the licensing reports would always
protect the confidentiality of clients.
Number 157
SENATOR ELTON mentioned to the zero fiscal note on SB 56. He
asked if staff would go through the files to purge client names
when someone comes in to ask for disclosure of records.
MR. LINDSTROM replied he doesn't believe the license reports
would contain confidential information on individual patients.
SENATOR WILKEN asked Mr. Livey if he would like to add to the
discussion on SB 56. He declined to do so.
SB 57-CARE FOR VULNERABLE ADULTS
VICE-CHAIRMAN KELLY brought up SB 57 for a quick overview and
suggested that questions be directed to Mr. Becker who is waiting
on-line.
Number 178
MS. ALISON ELGEE, Deputy Commissioner, Department of Admini-
stration, explained the Division of Senior Services operates the
Adult Protective Services program for the state. There is an
apparent oversight in the existing statutory structure that
prevents the department in some circumstances to complete an
investigation on a Report of Harm. Right now the law allows the
vulnerable adult that is under investigation, or the surrogate
decision-maker for that vulnerable adult, to ask that the
department terminate an investigation. If, in fact, the
surrogate decision-maker is the subject of that investigation or
the vulnerable adult is thought to not be competent to make that
decision on their own behalf, the department has no ability to
continue the investigation under the current law. This proposal
will correct that so that a thorough investigation can be
completed, and it will also allow the department to share infor-
mation in certain circumstances as well. MS. ELGEE said that Mr.
Becker will answer specific questions.
Number 201
SENATOR ELTON asked about the role of the long-term care
Ombudsman, its investigative reports, and if this bill also
covers the Ombudsman.
MS. ELGEE answered that this bill is the result of a recommenda-
tion that the long-term care Ombudsman brought to the LTCTF
regarding a situation encountered in investigations conducted by
both that office and by Adult Protective Services. A set of
protocols determines which direction a complaint might go for an
investigation internal to the office. Frequently investigations
are conducted by the social workers in Adult Protective Services
with participation by the long-term care Ombudsman.
SENATOR ELTON asked if the Ombudsman is under the same protocols
as the department.
MR. DWIGHT BECKER, Protective Services Coordinator, replied that
different state statutes apply to the long-term care Ombudsman,
as well as a federal statute. That office investigates instances
of reported abuse against seniors aged 60 and older who are in
licensed facilities that also include nursing homes. The
Ombudsman also advocates for persons aged 60 and over and handles
complaints against agencies or facilities. The department has
developed protocols to coordinate investigations, with Protective
Services looking into licensing actions and the Ombudsman
following up on alleged abuse.
SENATOR WILKEN remarked for the record that SB 57 reflects the
LTCTF Recommendation #7. He asked if this legislation is
"preventative maintenance" resulting from an expectation that
this exploitation may become an issue in the future as the
elderly population increases.
MS. ELGEE replied the department was concerned in a couple of
circumstances that a surrogate decision-maker was at the heart of
a Report of Harm, but was unable to pursue it. It is not a
widespread issue now, but she said the Senator is correct in
saying this measure is preventative.
SENATOR ELTON asked if "vulnerable adult" is further defined by
the age of that adult. MS. ELGEE answered that is correct. The
Adult Protective Services and the statutes closely parallel the
Children's Protective Services statutes. The distinction is age.
SENATOR ELTON asked if a parent is also a guardian, and would the
parent be covered by this bill if that parent is making decisions
for a 25-year old.
MR. BECKER replied the parent of a 25-year old could be the
guardian if legally appointed by court order, or if the parent
had legal power of attorney with authority to make decisions.
Being the parent of an adult doesn't automatically convey the
right to be the guardian.
SB 58-SERVICES FOR ADULTS WITH LONG-TERM NEEDS
VICE-CHAIRMAN KELLY brought up SB 58 and invited Deputy
Commissioner Alison Elgee to provide an overview for the
committee.
MS. ELGEE stated SB 58 creates a new program for home and
community based care for people who, for two reasons, may not
meet the Medicaid eligibility requirements. People either do not
meet the financial criteria to make them eligible for Medicaid,
or they do not meet the level of need determination to be
eligible for the department's home and community based care
waivers. The level of need under the waiver programs requires an
individual to need nursing home level of care.
A number of older Alaskans who are struggling to retain their
independence and stay at home have some financial resources that
are not significant enough to cover the cost of their home care.
These individuals have not reached the nursing home level of
care, but they will end up in a nursing home without some inter-
vention and early supports. This legislation establishes a "new
pot of money" to be available to people in those circumstances.
MS. ELGEE continued, stating it is not intended to supplement or
supplant existing state programs. It would be available to those
people who have no other public financing mechanisms. It is not
an entitlement program and would only operate to the degree that
the department has money to provide assistance to people. The
department would look first at an individual's personal
resources, including insurance and other third-party payment
sources, before making available the monies in this fund.
Number 318
SENATOR WILKEN noted that this bill relates to Recommendation #13
in the LTCTF final report and it carries a $425.0 fiscal note. He
said that of the four bills, SB 58 will require the most caution
in financing so that it does not balloon out of proportion.
Nonetheless, the task force felt that the state should help
people to stay in their homes without financial burden. SENATOR
WILKEN stated this bill will require a lot of work.
VICE-CHAIRMAN KELLY asked for a clarification of the level of
services needed by people who would not qualify for Medicaid.
MS. ELGEE explained that participation in the Choice Waiver for
the Elderly and the Adult with Physical Disabilities Waiver
requires meeting two eligibility criteria including income and
level of need, e.g., nursing home level of care.
Number 362
VICE-CHAIRMAN KELLY asked how the state gets around the Medicaid
criteria to allow those who don't normally qualify to receive it.
MS. ELGEE repeated that this legislation proposes a new program
and new funding that would be available to people who don't
qualify for Medicaid.
SENATOR ELTON asked if this client base is being served in any
other way now, or will these be new clients.
MS. ELGEE replied that the senior population is rapidly expand-
ing. The department is presently serving those who meet the
Medicaid eligibility or who are in the Pioneer Homes. Beyond
that, the department has few public resources to provide to
seniors. Frequently those who need this kind of support and
can't make it work at home are leaving the state to seek afford-
able care elsewhere. This will allow the department to provide
some supports for people who want to remain in Alaska. DOA also
views it as cost avoidance because with early intervention, a
number of people will never reach the nursing home level of care.
Spending a little money early on will save a lot of money later.
VICE-CHAIRMAN KELLY asked if the task force looked at ways of
using private care givers to achieve this same end.
SENATOR WILKEN replied private care givers are providing some of
those services now to a group of people who are not Medicaid
eligible yet under a financial strain to afford the services.
MS. ELGEE explained the department would not directly provide
these services with state employees, nor does it directly provide
the waiver programs. DOA uses the services of nonprofits and
private care givers, and it is providing a financing mechanism in
this legislation.
SB 59-CERTIFICATES OF NEED FOR HEALTH FACILITY
VICE-CHAIRMAN KELLY brought up SB 59 and announced that Mr. Jay
Livey would provide an overview of the bill.
Number 376
MR. JAY LIVEY, Deputy Commissioner, Department of Health & Social
Services, explained that SB 59 would change the criteria for
review of Certificate of Need applications for long-term care.
Currently, if a facility is going to cost more than $1 million,
it has to ask for a Certificate of Need from the department.
Under the current criteria of review, the standards are
availability, accessibility and quality. If a need can be
demonstrated for the nursing bed, the DHSS is hard-pressed not to
say yes.
This bill adds several other criteria for the department to
consider in its decision, including whether or not the nursing
home expansion fits into the plans of the community for long-term
care; whether or not the service provided will be efficient; and
most importantly, the cost-effectiveness of the nursing home
expansion. MR. LIVEY said 90% of the nursing home costs in
Alaska are paid by Medicaid. The department operating budget in
particular has an interest in the expansion of nursing home beds.
If other ways to provide that long-term care were less expensive
or more cost-effective to the state, the department could
consider those in its decision-making process.
Number 401
SENATOR WILKEN commented that SB 59 relates to Recommendation #21
of the LTCTF final report. He asked Mr. Livey to discuss the
skepticism surrounding this kind of legislation.
MR. LIVEY replied the skepticism probably arises from the degree
to which people want the state to regulate this kind of business.
The nursing home industry is largely run by private, nonprofit
organizations, but it's all state money. Ninety percent of the
$43 - $44 million the department spends on nursing homes out of
the Medicaid program is state money. The department needs tools
to regulate the growth and expenditure of the nursing home
business.
He continued, saying the department needs to look at other
alternatives for providing that same level of care through
assisted living, or through home and community-based waivers.
DHSS runs the waiver program in conjunction with the DOA. Home
and community-based care can be provided for significantly less
expenditure than nursing home care.
Number 426
SENATOR WILKEN asked Mr. Livey to explain the effect of the two-
year moratorium on the Certificate of Need.
MR. LIVEY said that two years ago the Legislature placed a two-
year moratorium on the development of nursing home beds. The
intent was to stop the growth of nursing home beds to let the
more efficient and less expensive community based care system
develop, including the building of more assisted living homes and
expansion of the home and community-based waiver. It was fairly
successful over the 2-year period. In 1998, about 143,000
patient days were provided through the home and community- based
care system. These patient days included the provision of
nutritional meals or a nurse visiting the home. Now, around
160,000 patient days are provided through the nursing homes,
about equalizing the two different services. However, the 143,000
patient days cost the Medicaid program about $6.5 million,
whereas the 160,000 patient days in institutions cost the
Medicaid program about $44 million.
The moratorium is now off. Where families have a choice, some
feel the nursing home is the best care provider, while others
like the community options.
SENATOR ELTON asked if the department might never issue a
Certificate of Need, if a criteria is cost-effectiveness. MR.
LIVEY replied it is just one of the criteria that include
accessibility and need. If there is consistently a waiting list
for nursing home care, that would still be a criteria considered
in the decision.
SENATOR ELTON assumed there might be a demand, due to the two-
year moratorium. MR. LIVEY stated that since it ended last
September, the department has had one certificate pending.
Facilities expanding the number of beds but falling below the $1
million threshold don't come to the department for review.
Regarding the pending certificate, the department would review
whether community-based services are available and the family
still prefers the nursing home option; if so, the Medicaid
program has an obligation to make it available and pay for that
service.
SENATOR WILKEN invited Ms. Jane Demmert to comment on the four
bills.
MS. JANE DEMMERT, Executive Director of the Commission on Aging,
expressed the commission's support for the four bills which
consider basic infrastructure to help aging residents stay in the
state. The commission is now drafting resolutions of support for
the bills that will be forwarded to the committee.
VICE-CHAIRMAN KELLY announced that the committee will consider a
new draft of SB 56 at its next hearing. He noted that CHAIRMAN
MILLER intends to take up these bills again on Monday, March 8
and Wednesday, March 10. There being no further business, the
meeting adjourned at 2:20 p.m.
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