Legislature(2021 - 2022)BUTROVICH 205

04/28/2022 01:30 PM Senate HEALTH & SOCIAL SERVICES

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01:36:32 PM Start
01:36:53 PM SB183
01:49:52 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= SB 183 HOME AND COMMUNITY-BASED SERVICES TELECONFERENCED
Heard & Held
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         April 28, 2022                                                                                         
                           1:36 p.m.                                                                                            
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator Shelley Hughes, Vice Chair                                                                                              
Senator Lora Reinbold                                                                                                           
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Senator Mia Costello                                                                                                            
Senator Tom Begich                                                                                                              
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE BILL NO. 183                                                                                                             
"An Act relating to home and community-based services; and                                                                      
providing for an effective date."                                                                                               
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 183                                                                                                                  
SHORT TITLE: HOME AND COMMUNITY-BASED SERVICES                                                                                  
SPONSOR(s): SENATOR(s) GRAY-JACKSON                                                                                             
                                                                                                                                
02/08/22       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/08/22       (S)       HSS, FIN                                                                                               
04/26/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
04/26/22       (S)       Heard & Held                                                                                           
04/26/22       (S)       MINUTE(HSS)                                                                                            
04/28/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
JASMIN MARTIN, Staff                                                                                                            
Senator David Wilson                                                                                                            
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Reviewed the explanation of changes from                                                                  
version B to version I of SB 183.                                                                                               
                                                                                                                                
JOHN LEE, Director                                                                                                              
Division of Senior and Disability Services                                                                                      
Department of Health and Social Services (DHSS)                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Responded to questions on SB 183.                                                                         
                                                                                                                                
SENATOR GRAY-JACKSON                                                                                                            
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Sponsor of SB 183.                                                                                        
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:36:32 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:36 p.m.  Present at the                                                               
call to order were Senators Reinbold, Hughes and Chair Wilson.                                                                  
                                                                                                                                
            SB 183-HOME AND COMMUNITY-BASED SERVICES                                                                        
                                                                                                                                
1:36:53 PM                                                                                                                    
CHAIR WILSON announced  the consideration of SENATE  BILL NO. 183                                                               
"An  Act  relating  to home  and  community-based  services;  and                                                               
providing for an effective date."                                                                                               
                                                                                                                                
CHAIR  WILSON  solicited  a  motion   to  adopt  the  work  draft                                                               
committee substitute (CS) for SB 183.                                                                                           
                                                                                                                                
1:37:09 PM                                                                                                                    
SENATOR HUGHES moved  to adopt the Health and  Social Services CS                                                               
for SB 183, work order 32-LS1346\I, as the working document.                                                                    
                                                                                                                                
1:37:20 PM                                                                                                                    
CHAIR WILSON objected for purposes of discussion.                                                                               
                                                                                                                                
1:37:30 PM                                                                                                                    
At ease.                                                                                                                        
                                                                                                                                
1:38:17 PM                                                                                                                    
CHAIR WILSON reconvened the meeting.                                                                                            
                                                                                                                                
1:38:36 PM                                                                                                                    
JASMIN  MARTIN,   Staff,  Senator  David  Wilson,   Alaska  State                                                               
Legislature,  Juneau,  Alaska, stated  that  the  CS mirrors  the                                                               
companion bill for this legislation,  HB 292. She paraphrased the                                                               
explanation of changes from version B to version I that read as                                                                 
follows:                                                                                                                        
                                                                                                                                
     Version   32-LS1346/I   (Senate   Health   and   Social                                                                
     Services)                                                                                                              
                                                                                                                              
     Throughout:                                                                                                            
                                                                                                                                
     Changes  references  from   Department  of  Health  and                                                                    
     Social Services to Department of Health.                                                                                   
                                                                                                                                
     Section 2:                                                                                                             
     Page 1, line 14                                                                                                          
     Removed  "reduce  payment  for services."  Payment  for                                                                    
     services is determined  through a rate-setting process,                                                                    
     if this  language remained in the  bill, the Department                                                                    
     of Health & Social Services  would have needed to do an                                                                    
     individual  assessment for  anyone on  a waiver  if the                                                                    
     rates  changed   in  a  given  year.   Assessments  for                                                                    
     reductions  in level  of services  will  still need  to                                                                    
     occur.                                                                                                                     
                                                                                                                                
     Page 2, line 22                                                                                                          
     Replaced  language   so  the  assessment   process  for                                                                    
     reduced   services  only   applied  to   personal  care                                                                    
     services  instead  of   all  home  and  community-based                                                                    
     waiver  services.  Personal   care  services  were  the                                                                    
     services  most  frequently  referred to  in  testimony.                                                                    
     This change narrows  the scope of the  bill and reduces                                                                    
     implementation   costs   while    still   helping   the                                                                    
     population in need.                                                                                                        
                                                                                                                                
     Page 2, line 29                                                                                                          
     Removes  "live  independently"  and goes  back  to  the                                                                    
     original  statutory language  of "materially  improved"                                                                    
     as the threshold for  reducing or terminating services.                                                                    
     This  means that  to reduce  or terminate  services, an                                                                    
     individual  needs to  have "materially  improved" since                                                                    
     their last assessment.                                                                                                     
                                                                                                                                
     Page 3, line 25                                                                                                          
     Removes  language   changing  the  definition   for  an                                                                    
     "independent qualified  health care  professional." The                                                                    
     definition is now what it originally was in statute.                                                                       
                                                                                                                                
     Section 5:                                                                                                             
     Page 4,  line 14  Inserts a  new section  requiring the                                                                  
     [Department  of  Health]  to   produce  a  report  that                                                                    
     includes:                                                                                                                  
     ?  An assessment  of  the payment  rates  for home  and                                                                    
     community-based services  that address the  adequacy of                                                                    
     those rates to meet relevant workforce needs                                                                               
     ?  The number  of individuals  receiving services,  the                                                                    
     number  of  individuals   eligible  for  services,  the                                                                    
     average amount  of time  spent on  a waitlist,  and the                                                                    
     average amount  of service  hours a  recipient receives                                                                    
     annually, monthly, weekly                                                                                                  
     ?  An assessments  and recommendations  to enhance  the                                                                    
     delivery of relevant services to eligible individuals                                                                      
     Additional sections were renumbered accordingly.                                                                           
                                                                                                                                
1:39:50 PM                                                                                                                    
SENATOR  HUGHES  asked  why  the phrase  in  Section  2,   reduce                                                               
payment for services was removed.                                                                                               
                                                                                                                                
1:40:01 PM                                                                                                                    
MS. MARTIN  said it matches  the House  version of the  bill. She                                                               
offered her belief  that this was one of the  many questions that                                                               
will require some follow up.                                                                                                    
                                                                                                                                
CHAIR WILSON  advised that once HB  292 comes to the  Senate, the                                                               
committee will hear  a presentation that will answer  many of the                                                               
questions.  He asked  Mr.  Lee if  he wished  to  comment on  the                                                               
reason for removing the phrase.                                                                                                 
                                                                                                                                
1:40:47 PM                                                                                                                    
JOHN LEE,  Director, Division of Senior  and Disability Services,                                                               
Department  of  Health  and Social  Services  (DHSS),  Anchorage,                                                               
Alaska, stated that  the change was made in  negotiation with the                                                               
sponsor of  the companion  bill, HB  292. As  originally drafted,                                                               
both  SB 182  and  HB  292 required  the  department  to put  the                                                               
approximately 8,000  individuals it serves through  an assessment                                                               
process  that envisions  a rate  reduction. These  bills are  not                                                               
about rate setting;  theyre  about services that  are provided to                                                               
individuals  and   the  phrase   was  deleted  to   reflect  that                                                               
difference.                                                                                                                     
                                                                                                                                
1:42:07 PM                                                                                                                    
SENATOR REINBOLD asked who requested  the changes and why, if the                                                               
changes affect the indeterminate fiscal  note, and if the sponsor                                                               
supports the changes.                                                                                                           
                                                                                                                                
1:42:30 PM                                                                                                                    
CHAIR WILSON said  the changes were to align SB  183 with HB 292.                                                               
As Mr. Lee  indicated, the other body  identified certain changes                                                               
that would improve  the bill. He asked the sponsor  if she wished                                                               
to speak to her support for these changes.                                                                                      
                                                                                                                                
1:43:09 PM                                                                                                                    
SENATOR GRAY-JACKSON,  Alaska State Legislature,  Juneau, Alaska,                                                               
sponsor of  SB 183, stated  support for  the changes to  align SB
183 with HB 292.                                                                                                                
                                                                                                                                
CHAIR WILSON  mentioned an  earlier conversation  from department                                                               
representatives about the  work being done to  clarify some items                                                               
in the  fiscal note. Nevertheless,  it was indeterminant  at this                                                               
time.                                                                                                                           
                                                                                                                                
SENATOR HUGHES  offered her understanding that  a primary request                                                               
was  to  narrow  the  scope  of services  provided  by  home  and                                                               
community  based  waivers to  just  personal  care services.  She                                                               
asked  for an  explanation  of what  services  this change  would                                                               
exclude.                                                                                                                        
                                                                                                                                
SENATOR GRAY-JACKSON deferred the question to Mr. Lee.                                                                          
                                                                                                                                
1:44:56 PM                                                                                                                    
MR.  LEE limited  his comments  to Medicaid  funded services.  He                                                               
related that  the Personal Care  Services Program  (PCS) provides                                                               
services  for such  things  as activities  of  daily living.  The                                                               
Community  First   Choice  Program   is  similar  PCS,   but  for                                                               
individuals who meet institutional level  of care needs. Home and                                                               
Community-Based Waiver  services are the third  group of services                                                               
the department  provides. He said  these are all a  bit different                                                               
but  they all  provide  what's called  home  and community  based                                                               
services.  He  clarified that  home  and  community based  waiver                                                               
services (1915(c) Medicaid  waiver) are a subset of  the home and                                                               
community based services.                                                                                                       
                                                                                                                                
1:46:19 PM                                                                                                                    
SENATOR HUGHES  commented on the  explanation and asked  for some                                                               
examples  of  home and  community  based  services that  are  not                                                               
personal care services.                                                                                                         
                                                                                                                                
1:47:13 PM                                                                                                                    
MR. LEE  explained that  the home  and community  waiver services                                                               
(1915(c)   Medicaid  waiver)   are  for   individuals  who   meet                                                               
institutional  level of  care needs.  Personal care  services are                                                               
for lower  level of needs.  Personal care services  are typically                                                               
in home services,  but its  not mandatory;  examples include help                                                               
with  bathing, eating,  toileting, and  chores. Examples  of home                                                               
and   community  based   waiver  services   include:  residential                                                               
services in a group home;  supportive employment services for on-                                                               
the-job  activities; and   day-hab   services such  as taking  an                                                               
individual to  a movie,  bookstore, or  other location  where the                                                               
individual is able to interact with the broader community.                                                                      
                                                                                                                                
SENATOR  REINBOLD urged  the chair  to schedule  a hearing  on SB
191.  [Chair Wilson  concluded the  business on  SB 183  and then                                                               
advised that the schedule for next week was being developed.]                                                                   
                                                                                                                                
1:49:26 PM                                                                                                                    
CHAIR  WILSON   removed  his  objection;  he   found  no  further                                                               
objection and the CS for SB 183, version I, was adopted.                                                                        
                                                                                                                                
[SB 183 was held in committee.]                                                                                                 
                                                                                                                                
1:49:52 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair  Wilson adjourned  the Senate  Health  and Social  Services                                                               
Standing Committee meeting at 1:49 p.m.                                                                                         

Document Name Date/Time Subjects
SB 183 Work Draft Version I.pdf SHSS 4/28/2022 1:30:00 PM
SB 183
SB 183 Explanation of Changes v.B - I.pdf SHSS 4/28/2022 1:30:00 PM
SB 183