02/12/2020 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Coronavirus: Alaska's Response and Preparedness | |
| HB96 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | HB 96 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 12, 2020
1:32 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Natasha von Imhof, Vice Chair
Senator Cathy Giessel
Senator Tom Begich
MEMBERS ABSENT
Senator Mike Shower
COMMITTEE CALENDAR
PRESENTATION: CORONAVIRUS: ALASKA'S RESPONSE AND PREPAREDNESS
- HEARD
COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 96(FIN)
"An Act relating to Alaska Pioneers' Home and Alaska Veterans'
Home payments, rates, and services."
- MOVED CSHB 96(FIN) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 96
SHORT TITLE: PIONEERS' HOME AND VETERANS' HOME RATES
SPONSOR(s): REPRESENTATIVE(s) FIELDS
03/15/19 (H) READ THE FIRST TIME - REFERRALS
03/15/19 (H) STA, HSS
03/26/19 (H) STA AT 3:00 PM GRUENBERG 120
03/26/19 (H) Heard & Held
03/26/19 (H) MINUTE(STA)
03/28/19 (H) STA AT 3:00 PM GRUENBERG 120
03/28/19 (H) Heard & Held
03/28/19 (H) MINUTE(STA)
04/02/19 (H) STA AT 4:00 PM GRUENBERG 120
04/02/19 (H) Moved CSHB 96(STA) Out of Committee
04/02/19 (H) MINUTE(STA)
04/03/19 (H) STA RPT CS(STA) 2DP 4NR
04/03/19 (H) DP: SHAW, FIELDS
04/03/19 (H) NR: LEDOUX, WOOL, STORY, KREISS-TOMKINS
04/09/19 (H) HSS AT 3:00 PM CAPITOL 106
04/09/19 (H) -- MEETING CANCELED --
04/11/19 (H) HSS AT 3:00 PM CAPITOL 106
04/11/19 (H) -- MEETING CANCELED --
04/18/19 (H) HSS AT 3:00 PM CAPITOL 106
04/18/19 (H) Heard & Held
04/18/19 (H) MINUTE(HSS)
04/23/19 (H) HSS AT 3:00 PM CAPITOL 106
04/23/19 (H) Moved CSHB 96(STA) Out of Committee
04/23/19 (H) MINUTE(HSS)
04/24/19 (H) HSS RPT CS(STA) 4DP 1NR 1AM
04/24/19 (H) DP: DRUMMOND, TARR, ZULKOSKY, SPOHNHOLZ
04/24/19 (H) NR: JACKSON
04/24/19 (H) AM: PRUITT
04/24/19 (H) FIN REFERRAL ADDED AFTER HSS
04/29/19 (H) FIN AT 1:30 PM ADAMS ROOM 519
04/29/19 (H) Heard & Held
04/29/19 (H) MINUTE(FIN)
05/02/19 (H) FIN AT 1:30 PM ADAMS ROOM 519
05/02/19 (H) Heard & Held
05/02/19 (H) MINUTE(FIN)
05/03/19 (H) FIN AT 1:30 PM ADAMS ROOM 519
05/03/19 (H) Moved CSHB 96(FIN) Out of Committee
05/03/19 (H) MINUTE(FIN)
05/06/19 (H) FIN RPT CS(FIN) NT 4DP 6NR
05/06/19 (H) DP: KNOPP, JOSEPHSON, ORTIZ, FOSTER
05/06/19 (H) NR: JOHNSTON, TILTON, LEBON, MERRICK,
SULLIVAN-LEONARD, WILSON
05/07/19 (H) CORRECTED FIN RPT CS(FIN) NT 4DP 6NR
05/07/19 (H) DP: ORTIZ, KNOPP, JOSEPHSON, FOSTER
05/07/19 (H) NR: JOHNSTON, LEBON, TILTON, MERRICK,
SULLIVAN-LEONARD, WILSON
05/10/19 (H) TRANSMITTED TO (S)
05/10/19 (H) VERSION: CSHB 96(FIN)
05/10/19 (S) READ THE FIRST TIME - REFERRALS
05/10/19 (S) HSS, FIN
01/27/20 (S) HSS AT 1:30 PM BUTROVICH 205
01/27/20 (S) Heard & Held
01/27/20 (S) MINUTE(HSS)
01/29/20 (S) HSS AT 1:30 PM BUTROVICH 205
01/29/20 (S) -- MEETING CANCELED --
02/12/20 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
ANNE ZINK, M.D., Chief Medical Officer
Division of Public Health
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Presented on Coronavirus: Alaska's Response
and Preparedness.
CLINTON LASLEY, Acting Deputy Commissioner
Family, Community, and Integrated Services; Director
Division of Alaska Pioneer Homes
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented an overview of rate increases at
the Pioneer Homes.
LAURA MARTINSON, representing self
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 96.
KARI SPENCER, representing self
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 96.
LYNN WILLIS, representing self
Eagle River, Alaska
POSITION STATEMENT: Testified in support of HB 96.
KAY ANDREW, President
Pioneers of Alaska Igloo 16 & 7
Ketchikan, Alaska
POSITION STATEMENT: Testified in support of HB 96.
ED ZASTROW, member
Pioneers of Alaska Igloo 16 & 7
Ketchikan, Alaska
POSITION STATEMENT: Testified in support of HB 96.
AVES THOMPSON, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 96.
MALAN PAQUETTE, representing self
Kenai, Alaska
POSITION STATEMENT: Did not testify on HB 96.
DEBBIE TILSWORTH, representing self
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 96.
NORMAN BEAN, representing self
Palmer, Alaska
POSITION STATEMENT: Testified in support of HB 96.
DOROTHY DITTMAN, representing self
Palmer, Alaska
POSITION STATEMENT: Testified in support of HB 96.
BILL BROKAW, representing self
Palmer, Alaska
POSITION STATEMENT: Testified in support of HB 96.
DAVE BROWN, representing self
Palmer, Alaska
POSITION STATEMENT: Testified in support of HB 96.
CRIS EICHENLAUB, representing self
Eagle River, Alaska
POSITION STATEMENT: Testified that the state must find ways to
cut costs.
ACTION NARRATIVE
1:32:01 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 1:32 p.m. Present at the
call to order were Senators Giessel, von Imhof, Begich, and
Chair Wilson.
^Presentation: Coronavirus: Alaska's Response and Preparedness
Presentation: Coronavirus: Alaska's Response and Preparedness
1:32:22 PM
CHAIR WILSON announced the presentation "Coronavirus: Alaska's
Response and Preparedness" by Dr. Anne Zink. He called Dr. Zink
to the table.
1:32:44 PM
ANNE ZINK, M.D., Chief Medical Officer, Division of Public
Health, Department of Health and Social Services (DHSS),
Anchorage, Alaska, said that during her PowerPoint, she would
give the medical background of the coronavirus as well as
describe what the state is doing. In the last 24 hours the virus
name changed from 2019-nCoV to the WHO (World Health
Organization) title COVID-19.
DR. ZINK reviewed slide 2, Coronaviruses. She explained that the
coronavirus is smaller than bacteria. There are seven types that
infect people. It is zootic, living amongst animals. Four types
cause the common cold. Ten to 30 percent of common colds are
caused by coronaviruses. Occasionally a novel, new, coronavirus
emerges, likely from animal species. It is called corona because
the virus has spikes that look like a halo.
DR. ZINK reviewed slide 3, Coronaviruses (general). She said
coronaviruses last one to two hours on nonporous or hard
surfaces and eight to 12 hours on porous or soft surfaces.
DR. ZINK reviewed slide 4, New Coronaviruses. She said the novel
coronavirus is believed to have jumped from animals into the
human population around November. The two most famous
coronaviruses that moved from an animal to a human host are SARS
(Severe Acute Respiratory Syndrome) and MERS (Middle Eastern
Respiratory Syndrome). Now there is COVID-19.
DR. ZINK reviewed slide 5, 2019-nCoV. She said the COVID-19 was
first reported by Chinese health officials on December 31, 2019.
It is not clear whether someone without symptoms can spread it
to others (asymptomatic shedding). The incubation period is
between two to 14 days with an average of five days. The numbers
of confirmed cases continue to change. As of today, there are
45,171 cases worldwide. One U.S. citizen died in Wuhan city and
outside of China, 1,014 deaths have occurred as of today. There
are 13 confirmed cases in the United States in six states and no
deaths have occurred in the United States.
DR. ZINK reviewed slide 6, Graph of nCoV cases to date. She
displayed a Johns Hopkins graph of COVID-19 showing confirmed
cases in mainland China and the rest of the world. From an
epidemiology standpoint, these graphs are very useful to see the
trends.
DR. ZINK reviewed slide 7, case Fatality. She said SARS had a
case fatality rate of 10 percent, meaning 10 percent of people
who got SARS died. MERS had a fatality rate of 35%. The
influenza fatality rate is .1 percent. The 2019n-CoV is
currently estimated to be 2 percent.
1:37:44 PM
SENATOR VON IMHOF observed that the influenza mortality rate
average is less than 1 percent. She asked how many people in the
United States generally get the flu and how many die.
DR. ZINK replied that last year there were about seven million
cases of flu with 3.7 million doctor visits and 109,000
hospitalizations and 8,000 deaths. Alaska has had just over
4,000 cases of flu and one confirmed death so far this year
CHAIR WILSON clarified that Alaska's peak flu season is later
than in the lower 48 and February is usually the peak.
DR. ZINK answered that it changes every year. The lower 48 this
year has had a bimodal distribution. There was a peak of
influenza B and then later a peak of influenza A. Alaska had a
peak in influenza B about the same time as the lower 48 but has
not seen the second peak of influenza A. In general, Alaska
tends to be a bit later than the lower 48 with flu cases.
DR. ZINK reviewed slide 8, Transmission. She explained that
transmission is now clearly person-to-person through respiratory
droplets when an infected person coughs or sneezes, usually at
close contact. That is different from an airborne disease that
can persist in the environment for a long period of time. It not
clear if it is transmitted through touching a surface or object.
It is unclear how easily it is spread from person to person.
That is why more data is needed from China. The current estimate
is that this coronavirus has an R naught value of about 2.5.
That means that each infected person will transmit the virus to
about 2.5 other people. Measles has a 12 value. SARS is 3. The
1918 flu pandemic was 1.5. H1N1 was 1.5 and the seasonal flu is
1.2. Part of the Centers for Disease Control and Prevention
(CDC) concern is that this seems to be slightly more infective
than general flu. That is why a lot of attention is being placed
on this disease.
1:41:07 PM
CHAIR WILSON asked about the efficacy of masks that were not the
N95 respirator masks.
DR. ZINK answered she will address that in a later slide, but
the CDC does not recommend the average person wear a mask. A
person wearing a mask is breathing into a wet, moist environment
collecting viruses and bacteria, and it is in general not useful
for protection from other persons. It can be useful when people
walk into a clinic coughing and sneezing so people who are ill
do not cough or sneeze on other people or on surfaces. If
someone is walking into a clinic sick, putting a mask on and
calling in beforehand is recommended. The N95 mask has to be
fitted and tested. It is useful for health care workers with
extensive exposure to people with airborne or droplet-exposed
viruses. The recommendation is not for the average person to
wear a mask.
CHAIR WILSON shared that he saw many people wearing masks at
airports during recent travel and that he wanted a health care
professional to address that.
DR. ZINK reviewed slide 9, Map from February 11, 2020. The slide
depicted a map of current cases in the United States.
DR. ZINK reviewed slide 10, Signs and Symptoms. She explained
that the signs and symptoms of 2019-nCoV are similar to those of
the common cold. This coronavirus appears to disproportionally
affect the elderly or those with underlying medical conditions.
DR. ZINK reviewed slide 11, Testing and Treatment. She explained
that the CDC has developed a PCR (Polymerase Chain Reaction)
test that looks at a little bit of the virus. Currently all
testing is being done at the CDC in Atlanta, but the CDC is
working on getting tests to Alaska. Alaska did get its first
test kit, but one of the three components of the test wasn't
functioning properly. Numerous states had the same experience
and are waiting for the CDC to recalibrate the tests and send
them out. Once everything is working well, it will take Alaska
two weeks to have those tests up and running. Alaska has two
labs run by Public Health, one in Anchorage and one in
Fairbanks, and is working to get those set up. Currently, there
is no known treatment except good supportive care. The CDC says
not to expect a vaccine soon.
DR. ZINK displayed slide 12, CDC Evaluation Flowchart, for who
should be screened for the coronavirus.
1:45:39 PM
SENATOR VON IMHOF shared that she has received calls from school
districts and wondered how Dr. Zink is dealing with school
districts and organizations that deal with large populations.
DR. ZINK replied that DHSS has been working with the Department
of Education and Early Development (DEED) as well as with
individual school districts. DHSS wrote letters to state
employees and superintendents of school districts. DHSS stood up
its emergency operations system and joint information center on
January 24. There are regular calls with PIOs (public
information officers) from districts and hospitals schools.
Consistent information is incredibly important. Dr Jay Butler
has said four epidemics are being fought right now. One is the
novel coronavirus, and the others are the epidemics of fear,
stigma, and misinformation. Good, consistent information is
incredibly important.
DR. ZINK displayed slide 13, Persons Under Investigation. A PUI
is a person with a higher risk of having the novel coronavirus.
A PUI is person who has clinical features and the features of
epidemiologic risk, such as travel to Hubei Province in China or
close contact with a laboratory-confirmed case of 2019-nCoV.
Alaska has no PUIs.
DR. ZINK reviewed slide 14, Notes on travel. She said that on
January 1, 2020, Huanan Seafood Wholesale Market was closed. On
January 23, 2020, Wuhan City shut down public transportation. On
January 31, 2020, a Presidential Proclamation suspended entry
into the United States to foreign nationals who visited Mainland
China in the past 14 days. Exempted persons included immediate
family members of U.S. citizens, legal permanent residents, and
crew members of air travel.
CHAIR WILSON pointed out that the Anchorage airport is one of
the busiest international airports in the country. He asked
about the screening process for pilots.
1:49:00 PM
DR. ZINK replied that currently, Anchorage is not one of the
five main airports that passengers from Mainland China are
traveling through. Seattle is one. Those passengers fill out a
health questionnaire. Customs and Border Protection call the CDC
quarantine if necessary. If passengers look well and their
answers are negative, these passengers are allowed to continue
on with their travels. Alaska is notified if someone has gone
through the process and flies to Alaska. Crew members for cargo
flights are thought to be at lower risk than the crew members
for passenger flights. The Presidential Proclamation excluded
crew members from the passenger quarantine measures. Eighty to
90 percent of medical supplies come from China, so a complete
stop of all of the supply chain from China could have large
health impacts. The FAA (Federal Aviation Administration) has
issued guidelines for crew members, and Alaska has worked
closely with the FAA on what that looks like. Alaska does have a
quarantine station that would evaluate crew members who look
ill. U.S.-based crews are advised to practice social distancing
while in China. With so many cargo flights, it is a concern in
Alaska. DHSS has been meeting with the airline companies and
crews making sure staff have seen these guidelines and are
staying in close contact with them.
DR. ZINK reviewed slide 15, Isolation vs. Quarantine. She said
she wanted to review this concept because the federal government
issued a quarantine order for the first time since the 1960s,
when it was done because of smallpox. That is different from
previous flu pandemic planning. Isolation is when someone is
sick and is separated from the rest of the population. This can
be done at home. Quarantine is for asymptomatic people, people
who are not sick but are high risk. High risk individuals are
asked to stay away from other people. The CDC is asking people
who have traveled to Mainland China to self-quarantine for 14
days if the travelers arrived in the United States after 2 p.m.
on February 3. That is based on when the rapid growth in China
occurred.
DR. ZINK reviewed slide 16, Prevention:
• Avoid touching your eyes, nose, and mouth with
unwashed hands.
• Avoid close contact with people who are sick.
• Stay home when you are sick.
• Cover your cough or sneeze with a tissue, then throw
the tissue in the trash.
• Clean and disinfect frequently touched objects and
surfaces using a regular household cleaning spray or
wipe.
• Wash your hands often with soap and water for at least
20 seconds, especially after going to the bathroom;
before eating; and after blowing your nose, coughing,
or sneezing.
• If soap and water are not readily available, use an
alcohol-based hand sanitizer with at least 60%
alcohol. Always wash hands with soap and water if
hands are visibly dirty.
DR. ZINK added that getting a flu shot is a great way to keep
the number of respiratory symptoms presenting to the hospital
down and keep the health care system up and running.
1:54:12 PM
DR. ZINK displayed slide 17, An Outbreak. The slide consisted of
a graph. The DHSS is spending so much time in combination with
federal, state, tribal, and local partners on this effort
because it is hoping that with good pandemic outbreak response,
the numbers of cases will be decreased the peak numbers of cases
and the demand on hospitals. Because Alaska has few hospitals
with great distances between them, it is imperative that
everything be done to keep hospitals functioning and minimize
the blow if this coronavirus comes to Alaska.
DR. ZINK reviewed slide 18, Disaster Preparedness. The slide
depicted a disaster management workflow that includes
plan/prepare, respond, and recover. Plan/prepare also includes a
plan to mitigate. Since Alaska currently has no PUIs or cases,
it is planning, preparing, and mitigating. Alaska has a pandemic
flu plan that it has worked on for years. That is being brushed
off. Last year Alaska had its raging contagion exercise, which
informs the state plan. It is impressive to her how much work
has been put into Alaska's disaster management plan.
DR. ZINK reviewed this information on slide 19, Preparing for
the next steps:
• Preparedness is something that we do, practice and
prepare for
• Build on existing structures and lessons learned from
the 1918 flu, H1N1, SARS, MERS, and Ebola
• Have recently updated Pandemic Influenza Plan that can
be used as guidelines
• Exercised planning for a contagious pandemic in the
"Ragin' Contagion" exercise from April 8-13, 2019
• Have active Emergency Medical Countermeasures
Management Plan
• DHSS EOC (Emergency Operations Center) stood up Jan.
24, 2020
• Working closely with other departments, tribal,
federal and local partnerships to run through all of
the "what ifs"
DR. ZINK reviewed slide 20, A Special case. This case involved
the repatriation of up to 240 U.S. citizens and their families
from China. Alaska received a call from the U.S. government
asking if Alaska would be willing to allow the plane carrying
those passengers to refuel in Anchorage on its way back from
China. When the plane landed in Anchorage on Saturday, January
28, 2020, DHSS had already stood up its Emergency Operations
Center and worked carefully with its federal partners to
consider scenarios such as what if the whole plane was positive.
DHSS learned a lot from preparing and planning and set limits
about what the state could or could not care for. It was in a
secure part of the North Terminal that was not accessed by other
passengers. The experience reminded her of how much better off
everyone is by working together. The quarantine window was
closed yesterday at 9 a.m., which means all passengers were
cleared from having any risk of infection. The very few Alaskans
who were part of the repatriation effort are all completely in
the clear.
1:59:11 PM
DR. ZINK reviewed slide 21, Looking forward - Cruise Ships and
Cargo. She said the department receives numerous questions about
planes, cargo ships, and cruise ships. Anchorage is one of the
busiest cargo airports in the world. Cruise lines are limiting
who can board with preboarding screening. DHSS has been talking
to its partners about what it would like in Juneau if a cruise
ship had coronavirus cases. DHSS has time to plan and prepare
for that and the cruise industry is very involved in that.
CHAIR WILSON asked if DHSS is working with Canada since some
cruise ships come from Canada.
DR. ZINK replied that in general it has been a large,
international effort. The recommendations have been similar
across the board. Most recommendations are coming from cruise
lines. Regardless of what country the ships originate from or
visit, the guidelines are all the same.
DR. ZINK reviewed slide 22, Strengths and Weaknesses. She said
one strength of Alaska is a strong, centralized public health
system including labs, epidemiology, and emergency operations
center. In other states, many times counties run their public
health and there can be breakdowns in communications. The strong
state, federal, tribal, and local partnerships are huge. Alaska
does have limited health care capacity. Housing and quarantine
will be a challenge, so DHSS is working through different
scenarios. Supply chains can be a concern. The rapid spread of
fear, stigma, and misinformation can be as damaging sometimes as
the virus itself. DHSS is closely monitoring this and working
with others to make sure the population is safe. As soon as it
sees any changes, it will get that information out to people.
DR. ZINK reviewed slide 23, What Is Being Done. She said DHSS is
providing weekly health provider webinars. Emergency operations
meetings continue. DHSS has daily national calls with federal
partners including the CDC. Public messaging and media and
interdepartmental preparedness planning are impressive and
ongoing.
DR. ZINK reviewed slide 24, What You Can Do. She said people can
wash their hands, stay home when sick, stay calm, get your flu
shot, and stay involved.
2:02:50 PM
SENATOR GIESSEL said she heard that the coronavirus had some
similarities to HIV.
DR. ZINK responded that she had heard that in the context of
what sort of retroviral and antiviral medications would be
useful. The spread is very different, but some of the antivirals
could be useful, she said.
CHAIR WILSON clarified that when Dr. Zink said earlier that she
has been in the state since July, she meant that she became a
state employee in July.
DR. ZINK answered that she has been a resident of the state for
almost 12 years and she began working for the state in this
capacity in July 2019.
2:03:45 PM
At ease
HB 96-PIONEERS' HOME AND VETERANS' HOME RATES
2:05:33 PM
CHAIR WILSON reconvened the meeting announced the consideration
of COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 96(FIN), "An Act
relating to Alaska Pioneers' Home and Alaska Veterans' Home
payments, rates, and services."
He noted that the committee heard an overview of the bill on
January 27 and he planned to continue public testimony at
today's hearing.
2:06:24 PM
CLINTON LASLEY, Acting Deputy Commissioner, Family, Community,
and Integrated Services, Director, Division of Alaska Pioneer
Homes, Department of Health and Social Services (DHSS), Juneau,
Alaska, said he would give an overview of how the rate increases
enacted in September affected the Pioneer Home system and what
the revenue projection looks like.
MR. LASLEY said the graph on slide 2, FY2019-FY2020 Revenue,
shows revenues from 2019 compared to the projections for FY
2020. Because of the rate increases, the Department of Health
and Social Services (DHSS) is projecting $7 million in
additional general fund program receipt revenue for FY 2020.
Last year the projection for the rate increase was $5.5 million.
One increase of $350,000 on the chart is federal revenue coming
from the Veterans Affairs (VA) because 14 beds at the Palmer
Pioneer Home became eligible for the higher VA reimbursement
rate.
MR. LASLEY displayed slide 3, Long Term Care Cost Comparison--
2019 Genworth. He noted that he used the [Pacific] Northwest for
cost comparisons. Genworth surveys providers to find out what
providers are charging in different markets. A website allows
users to select regions for doing comparisons. The chart looks
at prices for assisted living and nursing homes in Seattle,
Portland, Anchorage, Alaska, and the Pioneer Homes. Many have
asked him why he looks at nursing homes when the Pioneer Homes
are assisted living facilities, but the Pioneer Homes have
played a unique role in Alaska as there have not been enough
nursing home facilities in the state. The Pioneer Homes do not
provide every level of care but pride themselves in having
elders move in and age in place in their final home. The average
rate for nursing homes in Anchorage and Alaska is about the same
at $30,000 per month. The average rate for assisted living is
$6,000 per month. Some facilities in Anchorage have a base rate
with add-ons for additional services, such as nursing services.
The Pioneer Home system has 24-hour nurses unlike many assisted
living homes, especially the smaller ones. For this chart, he
averaged the rates for Levels I, II, and III to create the
average rate of $7,126 for assisted living in the Pioneer Homes.
He used the rate for Level IV, the highest level of care for
Pioneer Homes, for the nursing home rate of $14,167. The Pioneer
Homes have implemented Level V in regulation but are not
utilizing that level yet. DHSS has received capital funding to
build out a complex behavior neighborhood in the Anchorage
Pioneer Home. That project went out to bid a week ago.
Hopefully, DHSS will be able to stand up that complex in the
next few months.
2:12:22 PM
MR. LASLEY described slide 4, Pioneer Home Rates with Medical
CPI Urban, as the most important slide in the presentation. He
said he used the 2005 Pioneer Home rates to look at what the
rate increases should have been to stay up with what it truly
cost to provide services. The rates that went into effect
September 2019 are what it truly cost to provide services. In
2005, the Level I rate was $2,240 and Level III, which was the
highest level of care at that time, was $5,880. He applied
medical CPI to the 2005 rates. The table shows that today's
Pioneer Home rates are very close to what the 2005 rates would
be today with medical CPI. The cost of providing services at the
Pioneer Homes has been increasing at a rate close to medical
CPI. Part of the problem is that the Pioneer Home rate increases
have been sporadic. A methodology is needed to avoid this huge
gap between the rates and the cost of services.
MR. LASLEY noted that last year some people asked for the
justification for using medical CPI when the Pioneer Homes are
not hospitals, but the previous slides show that the cost of
doing business is much closer to medical CPI.
He said slide 5, Additional Cost in FY2020, shows just one
example of an additional cost to the system of $2,850,400 in FY
2020. This slide shows only non-UGF [unrestricted general fund]
and only some personnel services. This increase of $2.8 million
for FY 2020 is for furlough reversals and increased pay for
nurses to be equal to the private market. The Pioneer Home
system had to absorb that $2.8 million, which is an almost 5
percent increase (including $900,000 in general funds added to
the Pioneer Homes budget) for the Pioneer Home budget of $60
million.
MR. LASLEY said slide 6, Alaska Pioneer Homes Admissions,
Discharge, and Death Statistics, provides discharge data since
the rate increase went into effect. Since August 1 from January
13, there were 57 admissions, 46 deaths, and 21 discharges. From
their surveys, the Pioneer Homes know that 16 discharges were
for individuals who moved because of the rate increases.
MR. LASLEY presented slide 7, Occupancy-Waitlist Data, which
shows 176 people are on the active waitlist as of December 31
and 5,448 people are on the inactive waitlist. Slide 8, Levels
of Care, shows the number of residents in each level of care.
He said slide 9, Payer Source, shows the number of people for
different payer sources--Medicaid waiver, payment assistance,
and private pay--between 2018 and 2019.
2:19:07 PM
CHAIR WILSON opened public testimony on HB 96.
2:19:26 PM
LAURA MARTINSON, representing self, Juneau, Alaska, said she is
in favor of keeping Pioneer Homes as affordable as possible to
allow families like hers to stay more connected. Her grandfather
is a Korean War veteran. He was completely independent until
about a year ago when he broke his hip snow blowing his
neighbor's driveway at age 86. Moving him to a care facility was
one of the hardest decisions her family has had to make.
Ultimately, he chose to stay in Alaska to be close to his
family, most of whom are in Juneau. There are many more
affordable options outside of Alaska that allow more
independence but he wanted to be close to his family. Shortly
after he moved to the Sitka Pioneer Home, the cost of his care
increased by more than $20,000 for the year and he had a 30-day
warning for that. The size of the increase would be massive to
anyone, but for someone who has worked his entire life to be
self-sufficient in his older years is insurmountable. He is so
proud that he has saved enough to take care of himself and that
is crumbling out from beneath him. The fiscal priorities of the
state reflect who Alaskans are as a people. She knows
legislators are facing challenges, but a priority should be to
take care of the state's elders and keep them close.
2:22:07 PM
KARI SPENCER, representing self, Juneau, Alaska, said her 87-
year-old father is in the Sitka Pioneer Home. He is trying to
move to Juneau but he is on the waiting list. He has lived in
Juneau many years, volunteered at the St. Vincent de Paul store,
and picked up trash while he walked two miles every day.
Everyone called him the can man. He was given less than 30-days'
notice about the rate increase from $4,692 to $6,596, which is
an increase of 40 percent. He saved his whole life for this, and
he can self-pay at the Level II rate. She just saw him yesterday
in Sitka and told him that she would testify today. He wanted
everyone to know that he is very sad. If he runs out of money,
the state will liquidate his assets, including his life
insurance policies at the cash out rate instead of the full
rate. That would include his U.S. Navy military life insurance
that he bought at age 19. He is a Korean War veteran. He wanted
his voice to be heard supporting this bill because it represents
a moderate amount between the two rates.
2:24:33 PM
LYNN WILLIS, representing self, Eagle River, Alaska, said he was
representing himself and his friend of 45 years who lives in the
Palmer VA/Pioneer Home. Mr. Willis said he heard the state
representative say there was a methodology to the rate increase
and if ever there was a methodology that needed careful state
legislative oversight, it was this. The only word for this is
cruel. It scared his friend. He thought he would be evicted, and
Mr. Willis told him apparently that is not going to happen. His
friend has Parkinson's and can't talk or write well. He is at
the Level III of care and probably will advance to Level IV. The
state made him sign a care contract for Level IV, truly a
Hobson's choice. His friend doesn't want to become a ward of the
state. Mr. Willis was not encouraged to read the bill has a
50/50 chance. Every day that the legislature delays taking
action to bring justice to these people, these fees move them
closer to financial ruin. He urged the committee to bring a fair
solution to these most vulnerable of Alaskans.
2:26:51 PM
KAY ANDREW, President, Pioneers of Alaska Igloo 16 & 7,
Ketchikan, Alaska, said she is a lifelong resident of Ketchikan.
Her 200 local members of the Pioneers of Alaska are concerned
about the new price structure for the Pioneer Homes. The prices
are completely out of reason and not affordable to the residents
and future residents who need the security and care of the
homes. This could cost the state more in the end when residents
run out of money. These residents choose to stay in the state,
raise their families here, and support their communities and
state. These residents also hope to remain in Alaska in their
old age and to be able to afford to go to the Pioneer Home to
live out their lives and not have to go out of state because of
cost. The Pioneers of Alaska played an integral role in the
establishment of the Pioneer Homes. The original Pioneer Home in
Ketchikan was a four-unit apartment building built on land
donated by a member of Igloo 7. Igloo 16 and 7 continue to
support the Ketchikan Pioneer Home and hold several events a
year there, plus bring birthday cakes every month. She urged the
committee to pass the bill to continue to give a secure and safe
place for the state's elders.
2:29:10 PM
ED ZASTROW, member, Pioneers of Alaska Igloo 16 & 7, Ketchikan,
Alaska, said he is a 65-year resident of Alaska. He was the
chair of the Pioneer Homes Advisory Board for many years. He
signed up for admission to the Pioneer Homes many years ago
hoping to live out his remaining years in Ketchikan with the
assistance of the Pioneer Home system. Today with these price
increases he has concerns. A more reasonable cost should be
considered. Much of the testimony has been about people
concerned about running out of money. He reminded elected
officials in Juneau that the Pioneer Homes were committed to the
senior population in the state of Alaska.
2:30:43 PM
AVES THOMPSON, representing self, Anchorage, Alaska, said his
wife was in the memory care unit at the Anchorage Pioneer Home
until August 31, 2019. Her monthly cost for Level III care was
$6,795 a month. On September 1, 2019, the Division of Pioneer
increased the rate to $13,333 per month, an annual increase of
over $78,000 a year, a 96.2 percent increase. These residents
were private payers funded by their retirement income, long-term
care insurance, and personal savings. This increase drove his
wife out of the pioneer home. Her replacement, more than likely,
will be receiving a state or federal subsidy to pay the bill as
those are the only ones who can afford the pioneer home. In the
long run this means that all, if not most, of the residents will
be subsidized. Alaskans have often talked about a glide path to
a soft landing to minimize the effect of revenue reductions and
budget cuts. Late last summer HB 96 passed the House with a
substantial bipartisan majority. The Senate did not have time to
deal with this important bill and disappointingly, the
administration still enacted the rate increase. While he can
appreciate the effort to make the user pay for the service, this
action is not consistent with the discussions and negotiations
of other state agencies that received the benefit of
restorations or portions thereof of their budgets. The residents
of the Pioneer Homes can live with a more moderate increase and
further increases can be done incrementally, not in one fell
swoop.
2:33:30 PM
MALAN PAQUETTE, representing self, Kenai, Alaska, did not
testify on HB 96.
2:35:47 PM
DEBBIE TILSWORTH, representing self, Fairbanks, Alaska, said her
94-year-old mother has been a resident at the Fairbanks Pioneer
Home for two-and-a-half years. She said she listened to Mr.
Lasley's presentation last year about the 40 to 140 percent rate
increase. The residents opposed those rates and described the
hardships those rates would cause. At every legislative hearing
she participated in, there was overwhelming testimony from
people all over the state opposing such dramatic increases. She
sent a letter to Mr. Lasley May 15, 2019, signed by 103
residents of the Pioneer Homes and their families, opposing the
new rates. After HB 96 passed the House, about 20
representatives wrote to the administration asking the governor
to postpone the increases because this legislation was pending.
The administration ignored all the public testimony and the
request of the representatives and imposed increases anyway on
September 1, 2019.
MS. TILSWORTH said she is at the Pioneer Home six days a week,
and she sees the culture has changed. "I've heard residents tell
each other, 'If you need help, don't let the nurses or CNAs
know. Come to me. I'll stand outside your bathroom while you're
showering and make sure you don't fall. If they know you need
help, they'll bump you up to the next level and charge you
outrageous rates.'" She has heard residents talk about how they
are going to run out of money in months instead of years and
have to go on state assistance. She has heard them saying they
are paying more and getting less. There are three vacant rooms
in what she calls the high-rent neighborhood where the rate is
currently $13,333 a month. Not surprisingly, these rooms have
been vacant ever since the new rates went into effect. A friend
who was going to move her mother to the Pioneer Home canceled
the admission when she learned the rate would be $13,333 a
month. She moved her mother to the Washington area where she
found a beautiful home with assisted living for $4,500 a month.
Ms. Tilsworth asked the committee to support the more reasonable
rates of HB 96. The current rates need to be repealed and
refunds made. An apology is also in order from the
administration who caused such grief, hardship, and stress for
residents and their families.
2:38:53 PM
NORMAN BEAN, representing self, Palmer, Alaska, said he sold
everything to move into the Palmer Veterans Home. At some point
the Pioneer Home was going to close and the community supported
the home. Residents thought it would quiet down. Then increases
created stress. He is 91. He can't take too much stress. He
signed a contract with the Pioneer Home that he was to pay so
much. He figured that if he were careful, he might have enough
money. He doesn't understand the people in Juneau. He
understands Trump saying it's nothing but a swamp. That's what
is in Juneau now. He is a strong Republican. When he signed a
contract to buy a house, a car, property, the contract did not
change until it was paid for. This should not change until the
rites are read and he is under the ground.
2:42:01 PM
SENATOR GIESSEL said the members of this committee support this
bill and are eager to move it on to the next committee, so it
will hopefully cross the finish line this year. She thanked him
for his testimony.
2:42:26 PM
DOROTHY DITTMAN, representing self, Palmer, Alaska, said she was
born in Fairbanks and joined the military while in Alaska and
then came back home. She moved to the Palmer Veterans and
Pioneer Home on June 10, 2015, when she could afford the rate.
This September rates went up and she was allotted the courtesy
by the state to go on the assistance payment program. She cannot
afford to live there even though she loves it, but she has been
told that she has been grandfathered in. She asked where she
could go if anything unforeseen were to happen. She cannot
afford to live anywhere else. All the seniors she talked to
greatly feel this monetary crunch. HB 96 will be a godsend.
2:45:09 PM
BILL BROKAW, representing self, Palmer, Alaska, said he is a 60-
year-resident of Alaska. He has been in the Palmer Pioneer Home
for a year-and-a-half. His 81-year-old wife has Alzheimer's. He
is 84 himself and it became impossible to handle the 24/7 care
that she needed. As veterans, Mr. Brokaw, and his wife both
qualified for the Palmer Veterans home. The couple moved in in
June 2018. His wife has a room in the Alzheimer's section while
he is in the independent living area. Through his insistence, he
qualified his wife for the Medicaid waiver, VA help, and long-
term care help. The financial help of these agencies paid all
but $600. Last September the home made huge increases in rent.
Because of agency help and the Medicaid waiver, his wife did not
have increased charges, but his monthly charge increased over
$1,000 a month. He was not informed of this increase when making
the decision to move into the pioneer home. Their living
expenses exceed their income and there is no money for some of
the fun things associated with senior living. He was hoping the
Senate would pass HB 96 to rescind the huge increases from
September of 2019. The extravagant September increase would be
replaced by a much smaller increase based on the Consumer Price
Index for the urban wage earners and clerical workers in
Anchorage. He would hope for a refund for himself and other
residents who have suffered financially because of this
unwarranted increase. Financial help to financially strapped old
folks is desperately needed.
2:48:05 PM
DAVE BROWN, representing self, Palmer, Alaska, said he retired
after 23 years of service in the U.S. Army. He retired out of
Fort Richardson in 1976 and has lived in Alaska ever since. He
was able to enter the Palmer Veterans and Pioneer Home two years
ago because of veteran preference. His wife could not come at
the time. While waiting for his wife to join, she developed
Alzheimer's and went into assisted living, which cost him $4,000
a month. He sold his house and car and everything that he had.
He made a special fund to take care of her. The VA helps to
subsidize him at the Palmer home. His wife never got to join
him. She passed away a year ago this month. She was never able
to join him under the same roof. When he brought her ashes to
the Pioneer Home after she was cremated, that was the first time
in two-and-a-half years that the couple were under the same
roof. The spouse of a service member should be allowed in
automatically. It is too late for him, but the Palmer Pioneer
Home is a wonderful home. He doesn't want anything to happen to
disturb that. He strongly encouraged the passing of HB 96.
2:50:46 PM
CRIS EICHENLAUB, representing self, Eagle River, Alaska, said he
wanted to see real solutions, not Band-Aids, for the state's
challenges affecting things like ferry service, Pioneer Homes,
and education. People are trying to hit the easy button by going
for money, money, money and want to subsidize everything. There
are ways to be more efficient, such as using interns and church
organizations. The state must reorganize. There is a pot of
money with not enough in it. The legislature does not have to go
after people's permanent fund dividends. The state needs to see
how it can be cheaper. These people do not feel that their
expenses are being subsidized. There must be ways to make $4,000
a month work for someone.
2:53:03 PM
CHAIR WILSON closed public testimony on HB 96 and solicited a
motion.
2:53:42 PM
SENATOR VON IMHOF moved to report the committee substitute (CS)
for HB 96, version 31-LS0646\S, from committee with individual
recommendations and updated fiscal notes.
2:53:54 PM
There being no objection, CSHB 96(FIN) was reported from the
Senate Health and Social Services Standing Committee.
2:54:08 PM
At ease
2:54:13 PM
CHAIR WILSON reconvened the meeting. There being no further
business to come before the committee, Chair Wilson adjourned
the Senate Health and Social Services Standing Committee at 2:54
p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB096 Bill Version A 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 SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| 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 |
| HB096 Sectional Analysis 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 SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Fiscal Note DHSS-APHPA 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 SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Supporting Document Alaska Pioneer Homes Advisory Board Report 2018 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 SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Supporting Document Consumer Price Index in AK Statutes 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 SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Supporting Document-PPT Presentation 3.5.19 HSS Finance Subcommittee, 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 SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Letters of Support 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 SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Supporting Document AK Dept of Labor Consumer Price Index 2018 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 SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Fiscal Note DHSS-PH 3.26.19.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 SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Supporting Document DHSS Budget Subcommittee Amendment No. 1 PASSED 3.26.19.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 SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Letter of Support #11 3.27.19.pdf |
HHSS 4/23/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Letter of Support #12 3.27.19.pdf |
HHSS 4/23/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Letters of Support Redacted 3.27.19.pdf |
HHSS 4/23/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 ver U Sectional Analysis 3.28.19.pdf |
HHSS 4/23/2019 3:00:00 PM HSTA 3/28/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Summary of Changes Version M to Version U 3.28.19.pdf |
HHSS 4/9/2019 3:00:00 PM HSTA 3/28/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 CS ver U 3.28.19.pdf |
HSTA 3/28/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Fiscal Note ver U PHPA-HSTA 4.3.19.pdf |
HHSS 4/23/2019 3:00:00 PM HSTA 4/2/2019 4:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Fiscal Note ver U PH-HSTA 4.3.19.pdf |
HHSS 4/9/2019 3:00:00 PM HSTA 4/2/2019 4:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Supporting Document - AKARA Letter of Support 3.28.19.pdf |
HHSS 4/9/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Opposing Document - Letter of Opposition 3.28.19.pdf |
HHSS 4/9/2019 3:00:00 PM HHSS 4/23/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Supporting Document - Letter of Support 3.28.19.pdf |
HHSS 4/23/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Supporting Document - Letter of Support 3.29.19.pdf |
SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Supporting Document - Letter of Support 3.27.19.pdf |
SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Opposing Document - Letter of Opposition 3.28.19 #2.pdf |
SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB096 Supporting Document - Letter of Support 3.28.19 #2.pdf |
SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Sponsor Statement 4.3.19.pdf |
HHSS 4/9/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Summary of Changes Version M to Version U 4.3.19.pdf |
HHSS 4/9/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Sectional Analysis Version U 4.3.19.pdf |
HHSS 4/9/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Fiscal Note Payment Assistance Allocation 4.3.19.pdf |
HHSS 4/9/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Fiscal Note Pioneer Home Allocation 4.3.19.pdf |
HHSS 4/9/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Sectional Analysis Version M 4.3.19.pdf |
HHSS 4/9/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Supporting Document Combined Letters of Support 4.8.19.pdf |
HHSS 4/9/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Sponsor Statement 4.3.19.pdf |
HHSS 4/23/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Sectional Analysis Version U 4.3.19.pdf |
SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Summary of Changes Version M to Version U 4.3.19.pdf |
HHSS 4/23/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Supporting Document Combined Letters of Support 4.8.19.pdf |
HHSS 4/23/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Version U 4.3.19.pdf |
HHSS 4/23/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB0096 Bill Version M 4.3.19.PDF |
HHSS 4/23/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Fiscal Note Payment Assistance Allocation 4.3.19.pdf |
HHSS 4/23/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Fiscal Note Pioneer Home Allocation 4.3.19.pdf |
HHSS 4/23/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Sectional Analysis Version M 4.3.19.pdf |
HHSS 4/23/2019 3:00:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Supporting Document PPT Presentation 4.24.19.pptx |
SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Sectional Analysis Version M 4.24.19.pdf |
HFIN 4/29/2019 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Sponsor Statement 4.24.19.pdf |
HFIN 4/29/2019 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Summary of Changes Version M to Version U 4.24.19.pdf |
HFIN 4/29/2019 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Supporting Document Combined Letters of Support 4.24.19.pdf |
HFIN 4/29/2019 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB 96 Supporting Doc. Support .pdf |
HFIN 4/29/2019 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB 96 NEW FN DHSS PH 5.2.19.pdf |
HFIN 5/2/2019 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB 96 Supporting Doc Testimony.pdf |
HFIN 5/2/2019 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB 96 Supporting Doc DHSS PH costs.pdf |
HFIN 5/2/2019 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB 96 Amendment 2 Wilson .pdf |
HFIN 5/3/2019 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB 96 Amendment 1 Josephson.pdf |
HFIN 5/3/2019 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB 96 Amendment 3 Knopp.pdf |
HFIN 5/3/2019 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB 96 Supporting Doc Petition of Support.pdf |
HFIN 4/29/2019 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| 1 CSHB 96 Sponsor Statement 5.12.19.pdf |
SHSS 1/27/2020 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| 2 CSHB 96 House Finance Committee Substitute Version S 5.12.19.PDF |
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 |
| 4 CSHB96 Version S Payment Assistance Allocation Fiscal Note 5.12.19.pdf |
SHSS 1/27/2020 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| 5 CSHB96 Version S Pioneer Homes Allocation Fiscal Note 5.12.19.pdf |
SHSS 1/27/2020 1:30:00 PM 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 |
| 7 HB 96 Supporting Document Combined Letters of Support 4.18.19.pdf |
SHSS 1/27/2020 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| 8 CSHB 96 Supporting Doc Petition of Support 5.12.19.pdf |
SHSS 1/27/2020 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| 9 CSHB 96 Supporting Document-Agnew Beck Study 5.12.19.pdf |
SHSS 1/27/2020 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| 10 CSHB 96 Supporting Document-Pioneer Home Advisory Board Report 5.12.19.pdf |
SHSS 1/27/2020 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| 11 CSHB 96 Supporting Document PPT Presentation 5.12.19.pdf |
SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| 12 HB 96 Supporting Doc DHSS PH costs 5.12.19.pdf |
SHSS 1/27/2020 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB 96 Supporting Document PPT Presentation 1.22.2020.pdf |
SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| CSHB96 Supporting Document-2019 AFN Resolution 1.23.2020.pdf |
SHSS 1/27/2020 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB 96 FN DHSS AK Pioneer Home.pdf |
SHSS 1/27/2020 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| HB96 FN DHSS APH Payment Assistance.pdf |
SHSS 1/27/2020 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
CSHB96 HB 96 |
| CSHB 96 Supporting Document PPT Presentation 1.27.2020.pdf |
SHSS 1/27/2020 1:30:00 PM SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| AKPH update SHSS 02-12-20.pdf |
SHSS 2/12/2020 1:30:00 PM |
HB 96 |
| novel Coronavirus (nCoV) Feb 12 2020.pdf |
SHSS 2/12/2020 1:30:00 PM |
DHSS Update on the Coronavirus by Dr. Anne Zink, Chief Medical Officer |